Chapter 1. Introduction

This field guide is intended for all those who are faced with the need to make rapid but reliable estimates of nutritional status in emergencies as a basis for subsequent action.

In an emergency, time is often limited and there is a need for immediate information on the severity and extent of nutritional problems.

As a result, data are often hastily collected and are later found to be of little use.

A group of experts from WHO, UNICEF, UNHCR, Centers for Disease Control (CDC) Atlanta, FAO, Save the Children Fund (SCF) UK, and representatives from countries of the Eastern Mediterranean Region met in Alexandria, Egypt, in January 1992, to review the minimum of information on nutritional status needed in an emergency for first decisions on nutritional relief and for its planning, and to develop a field guide for obtaining such information. The resulting set of standardized procedures is presented here. It has been written for use by the various agencies and to allow comparison of results from different surveys.

To facilitate the task of those in charge of obtaining information on nutritional status, the group made a number of decisions on issues such as minimum sample size, survey participants, and the level of analysis needed, striking a balance between the methodically appropriate and the logistically feasible. Decisions were based on scientifically sound methodologies and were meant to assist individuals with little statistical or epidemiological knowledge to carry out a survey that will yield reliable data for first assessment and for planning.

Those wishing to obtain more information on sample size selection, alternative methods of analysis, etc., should refer to the handbook on survey methodology published by the CDC, Atlanta, the UNHCR/MSF manual, or the WHO publication The Management of Nutritional Emergencies in Large Populations (revised edition). A list of material for further reading is given in Annex 8.

THE POSSIBLE OBJECTIVES OF A SURVEY OF NUTRITIONAL STATUS IN EMERGENCIES

· to diagnose the problem and determine its extent;

· to identify groups at highest risk, e.g. nomads, displaced groups, specific age groups;

· to estimate the numbers of people needing assistance;

· to act as a baseline to monitor the impact of interventions or the response to an improving or worsening situation.

The objective or purpose of a survey should be clearly determined before the start.

Those surveyed are usually preschool children.

In a rapid assessment of nutritional status in emergencies, the only indicator to be used is weight-for-height.

In addition, the presence or absence of oedema should be noted as oedema adds to a child’s weight and so might confound the results.