|Assessment of Nutritional Status in Emergency-Affected Populations - Adults (UNSSCN, 2000, 24 p.)|
Low weight-for-height, usually defined as less than - 2SDs of the NCHS/WHO reference median value, or sometimes 80% of the NCHS/WHO reference median of weight-for-height. At present, no clear definition of wasting in adults is available.
Low height-for-age, usually defined as less than - 2SDs of the NCHS/WHO reference median value, or sometimes 80% of the NCHS/WHO reference median of height-for-age.
Body mass index (weight/height2). An index of protein and fat stores.
Bilateral dependant pitting oedema resulting from undernutrition. In both adults and children this is an important sign of severe undernutrition, carrying a high mortality risk.
The mid upper arm circumference, measured on a straight left arm (in right handed people) mid way between the tip of the shoulder (acromium) and the tip of the elbow (olecranon). An index of peripheral protein and fat stores. This is an accepted measure of acute undernutrition.
The accumulation of serous fluid in the peritoneal cavity.
The ratio of leg-length to trunk-length, sometimes called the sitting height to standing height ratio (SH/S).
The number of new cases of undernutrition in a defined population within a specified period of time95.
The total number of undernourished individuals in a given population at any one time95.
An indicator is a variable taking one of two possible values, one indicating the presence of a condition, the other indicating absence of the condition 95. In the context of assessing nutritional status this will usually mean whether or not an individual is above or below a pre-defined value of a particular body measurement or combination of measurements (e.g. MUAC, weight, BMI). A clear idea of the purpose of the assessment being undertaken should inform the choice of body measurement used and the cut-off points that are applied to it.
Sensitivity is the number of people correctly identified by an indicator as being undernourished divided by the total number of undernourished people measured. A sensitive indicator will identify a large proportion of the undernourished people measured.
Specificity is the number of people correctly identified by an indicator as non-undernourished divided by the total number of non-undernourished people measured. A specific indicator will correctly identify a large proportion of the non-undernourished people measured.
Ongoing scrutiny, generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy. Its main purpose is to detect changes in trend or distribution in order to initiate investigative or control measures 95. The appropriateness of a nutritional indicator for surveillance lies in its ability to reflect the true incidence of undernutrition in a population. The principal objective of a surveillance system is to provide information in order to aid decision making at a community level and there may be no immediate benefits for the individuals surveyed 96. Surveillance normally estimates incidence rather than prevalence.
A survey which examines the presence or absence of undernutrition in each member of a representative sample of a population at one particular time. A survey estimates prevalence rather than incidence 95.
In the context of nutrition, the purpose of screening is to select individuals at increased risk of morbidity and mortality who are likely to respond to treatment and to treat them. The numbers selected by the indicator used are those that need treatment 96. In emergency relief programmes, the appropriate indicator cut-off point (screening level) is that which selects the number of individuals that can be treated with the resources at hand 94. Such cut-off point values cannot therefore be determined universally but must be tailored to suit the resources available in each particular situation 94. The choice of underlying body measurement will often be determined by available equipment (e.g. scales may not be available to measure weight).
The performance and analysis of routine measurement aimed at detecting changes in the nutritional status of an individual.
UNITED NATIONS Administrative Committee on Coordination
SUB-COMMITTEE ON NUTRITION
THE UN SYSTEM'S FORUM FOR NUTRITION
VISION AND MANDATE
Our long-run vision is of a world in which malnutrition is no longer a human development constraint. This is possible, but to achieve it will require decisive action at country level, supported by a coherent and co-ordinated international strategy, founded on human rights and providing a framework for action throughout the UN and international development finance system, implemented in close partnership with NGOs, bilaterals and governments. Nutrition needs to be made a key development priority, recognized as vital to the achievement of other social and economic goals. Good nutrition under normal conditions contributes to the prevention and mitigation of death and malnutrition in emergency situations. Good nutrition facilitates the prompt return to conditions favouring development following disasters.
The mandate of the ACC/SCN is to raise awareness of nutrition problems and mobilize commitment to solve them - at global, regional and national levels; to refine the direction, increase the scale and strengthen the coherence and impact of actions against malnutrition world wide; and to promote cooperation amongst UN agencies and partner organizations in support of national efforts to end malnutrition in this generation.
Three main areas for action have been identified: (i) Promote of harmonized approaches among the UN agencies, and between the UN agencies and governmental and non-governmental partners, for greater overall impact on malnutrition. (ii) Review the UN system response to malnutrition overall, monitor resource allocation and collate information on trends and achievements reported to specific UN bodies. (iii) Advocate and mobilize to raise awareness of nutrition issues at global, regional and country levels and mobilize accelerated action against malnutrition. These three functions are all vital and of equal importance and can be seen as a triangle, one dependent on the other.
The UN members of the ACC/SCN are the FAO, IAEA, IFAD, ILO, UN, UNAIDS, UNDP, UNEP, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNRISD, UNU, WFP, WHO and the World Bank. The ADB and IFPRI are also part of this group. From the outset, representatives of bilateral donor agencies and NGOs have participated actively in SCN activities. The Secretariat is hosted by WHO in Geneva.
The SCN undertakes a range of activities to meet its mandate. Annual meetings have representation from those mentioned above as well as academia - a one-day Symposium is held during the annual meeting, focussing on a subject of current importance for policy. The SCN convenes working groups on specialized areas of nutrition; currently there are nine working groups in areas ranging from foetal and infant malnutrition, nutrition of the school aged child, and household food security to capacity building.
The SCN's reports on the world nutrition situation, published every two to three years, are authoritative sources of information to guide the international community in its nutrition work. Nutrition Policy Papers and the SCN News summarise current knowledge on selected topics. Quarterly bulletins on the nutritional status of refugees and displaced persons are also published in collaboration with a large network of NGOs.
GENERAL SUMMARY - SUGGESTED INDICATORS
ASSESSING ADULT UNDERNUTRITION IN THE FIELD
SURVEYS AND POPULATION LEVEL ASSESSMENTS OF CHRONIC UNDERNUTRITION
If the survey results are used to compare BMI between populations then BMI must be standardised for the average population Cormic Index (sitting height/standing height)
SCREENING SEVERELY UNDERNOURISHED ADULTS
THERAPEUTIC FEEDING CENTRES
1. MUAC < 160 mm alone
3. Famine oedema (Beattie grade 3 or worse) alone as assessed by a clinician to exclude other causes
Additional social factors can be included in the model. The relative weighting of these, for example whether you need one, two or three additional social factors to tip the balance in favour of therapeutic rather than supplementary care must be determined locally. Relevant social factors could include the following:
- Access to food (quality and quantity)
SUPPLEMENTARY FEEDING CENTRES
MUAC < 161-185mm and no relevant clinic signs or few relevant social criteria
In any particular situation, workers should take these suggested standards as the starting point and adapt them according to situation-specific factors.