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Managing Konzo in DRC • Cash for Work in Urban Guinea

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August 2011 Issue 41 ISSN 1743-5080 (print) • Managing Konzo in DRC • Cash for work in urban Guinea • Income generation in Southern Sudan • National NGOs treat SAM in Niger • IYCF across sectors in Haiti • Pastoral malnutrition trends in Somalia Contents Field Articles News 2 A cross-sectoral approach to addressing Konzo in DRC 28 Announcing Field Exchange ‘Digest’ 26 Cash-for-work in urban setting in Guinea 28 UNICEF e-learning on nutrition in emergencies now available 52 Cash supported income generation activities in Southern Sudan 28 En-net update 58 The new role of Nigerien medical NGOs in treating SAM 29 New initiative to create a CMAM Forum 62 Seasonal Trends in Pastoral Malnutrition in Somalia 29 Update on SQUEAC/SLEAC method 64 Save the Children’s IYCF programme and linkages to Protection, 29 Nutrition books available from TALC Food Security and Livelihoods in Haiti 2010 30 Planned study on feasibility and efficacy of IYCF in CMAM Research integration in Ethiopia 31 WHO consultation on management of moderate malnutrition in 6 Childhood Malnutrition and the Dinka of Southern Sudan U5s 8 Fluctuations in wasting in vulnerable child populations in the 36 2011 Edition of the Sphere Handbook Humanitarian Charter and Greater Horn of Africa Minimum Standards in Humanitarian Response 9 Knowledge, Attitudes and Practices Study on Offal Consumption 41 Summary of Global Nutrition Cluster meeting among the Somali Population 42 Harmonised Training Package: Version 2 nears completion 10 Global CMAM mapping in UNICEF supported countries 42 FANTA2 produces CMAM Costing tool (2011) 13 Lipid-Based Nutrient Supplement Research Network Meeting 43 UNHCR Operational Guidance for use of special nutritional 15 Feasibility of private micro flood insurance provision in Bangladesh products 16 The Psychology of Food Riots: Why do price hikes lead to unrest? 44 Peoples-uni: public health capacity building through online 17 Revisiting Sphere: new standards of service delivery for new education trends in protracted displacement 45 Update on Scaling up Nutrition (SUN) and the ‘1000 Day’ 17 Household threat of escalating food prices and recovery movements policies 47 New sachet/carton sizes for F75 and F100 therapeutic milks 18 Cash transfers protecting dietary diversity during food crisis Views 19 Differences in food insecurity between adults and children in Zimbabwe 56 Draft Guidelines for the Marketing of Ready to Use 20 Review of evidence of role of nutrition in HIV infection Supplemental Foods for Children 21 Cost effectiveness of community-based and inpatient Evaluation therapeutic feeding programmes to treat SAM in Ethiopia 53 WFP evaluation of emergency operation in Sudan 23 Cost effectiveness of CMAM in Malawi 25 Food security indicators after humanitarian interventions in Agency Profile Zimbabwe 61 Nairobi Nuts Group (NNG) 25 Emergency intervention priorities from child wasting and mortality in the Horn of Africa An aerial view of Darfur, Sudan Diego Fernandez/WFP, Sudan, 2007 Diego Fernandez/WFP, 1 From the Editor he role of data and analytical tools in guid- Another study examined data from Indonesia ing and evaluating emergency during 1998 when prices of foods went ‘through programming figures strongly in this issue the roof’ – the consumer food price index went up Tof Field Exchange. There are two field arti- 188% at a time when various subsidies on food cles which shine light on the causes of were removed. The authors conducted the analy- malnutrition in very different contexts. ACF-USA sis at two levels in an attempt to assess impact on carried out a baseline survey in an area of the food access. First, using the Starchy Staple Ratio Democratic republic of Congo (DRC) where high (SSR) as the summary measure of household nutri- levels of Konzo are reported. The survey identified tional welfare, they assessed the impact of the key causes of Konzo which included not using dramatic change in food prices on household Curt Carnemark/World Bank, Nigeria, 2008 Curt Carnemark/World enough water during cassava preparation under- dietary composition. Secondly, the authors exam- pinned by lack of access to water. Programme ined how the income elasticity of the SSR differs in recommendations were framed accordingly. The the two survey rounds characterised by very second article, written by FSANU, examined different relative prices between cereals and other trends in rates of malnutrition amongst pastoral- major food groups. The results suggest that cash ists in Somalia and showed how these are strongly transfer programmes may be even more effective continuously being refined or developed anew. In correlated with milk availability and seasonal during crises to protect the consumption of many one sense this is encouraging, as these analytical factors. This finding is in line with other work essential micronutrients compared with non-crisis advances provide greater insight into problems reported in Field Exchange1. periods. However, in order to ensure that all micro- and how best to address these. nutrients are consumed, specific nutritional A further two field articles report on the impact supplementation programmes are also likely to be Second, and admittedly based only upon the of cash-based interventions on a variety of required, especially for nutrients like Vitamin C. snap-shot of experiences and research in this issue outcomes. The first is a cash for work programme of Field Exchange, those agencies with an interest in Guinea where impact on food consumption, A study based on nutrition and mortality data in impact measurement of food and nutrition income and coping strategies are measured. The from the Horn of Africa set out to assess criteria for programmes appear to be placing less emphasis second is an income generating activity emergency intervention decision-making based on anthropometric indicators and more on a programme involving cash grants and training in on associations between child wasting and range of nutrition-related indicators or tools. southern Sudan where impact on coping strate- mortality from 2000 to 2005. The analysis found These indicators or tools are able to help explain gies, hunger levels and MUAC are measured. that higher rates of global acute malnutrition cause of malnutrition or how an intervention may (GAM) were associated with increased mortality of be impacting nutrition, i.e. they provide plausible The importance of monitoring is a key issue in children under 5 years of age and that the associ- models of impact. Again, this is encouraging as the WFP evaluation of their 2009 EMOP ation was stronger among populations with nutrition and/or mortality data on their own may (Emergency Operation) in Darfur. Here, the evalu- pastoral livelihoods than with agricultural liveli- tell us little about processes that either lead to ation describes how the Darfur Food Security hoods. Although GAM is therefore more effective malnutrition or positively impact malnutrition. Monitoring System (DFSMS), which WFP estab- in identifying groups with higher mortality risk for lished in 2009, showed not so much the impact of those practicing some pastoralism, there is still a Finally, and perhaps on a more discouraging the General Food Distribution (GFD) but the lack useful predictive power for agricultural popula- note, this expansion of indicators and tools may of impact of a reduction in the GFD. For a variety tions, with lower GAM cutoff points. In all groups, lead to less standardisation of approaches used in of reasons, WFP had to reduce the ration during spikes of GAM and under five morality rate (U5MR) assessment, monitoring and evaluation, and 2009, first to 70% and then 60% of a full ration. corresponded with drought (and floods). The therefore greater difficulty in making comparisons Taking account of milling and transport costs, as authors conclude that different GAM cutoff points between programmes and their impact. In this well as taxes to sheiks, there were times in the year are needed for different populations. For example, issue of Field Exchange this is seen most obviously when beneficiaries were making do with less than to identify 75% of U5MR above 2/10,000/day, the in two sets of articles (cost effectiveness of a half a full ration. However, the DFSMS showed no GAM cut-off point ranged from 20% GAM in the CMAM/CTC and impact of cash transfer change in prevalence of malnutrition, mortality or Rift Valley (Kenya) to 8% in Oromia or SNNPR programmes). While it may be argued that a ‘free coping strategies/ livelihood activities. The evalu- (Ethiopia) or from 15% for pastoralists to 10% for market’ for the development of different analytical ation concluded that this reflected the disconnect agropastoralists. tools will lead to more creativity, innovation and between numbers registered and actual numbers, ultimately better practice, the down-side is that i.e. there was significant over-registration, as well Another article questions the appropriateness decision-makers are less able to make compar- as the reasonable harvest in many parts of Darfur of current Sphere standards for protracted (IDP) isons and learn from the myriad of field and alternative livelihood options amongst the situations. The summary focuses on the current experiences out there. Donors in particular are internally displaced population (IDP). nutrition standards. The authors argue that there affected by the plethora of approaches used by is no framework that analyses particular risk agencies to justify interventions and then meas- The research section of this issue of Field factors for nutritional deficiencies in protracted ure their impact and are increasingly calling out Exchange also has a strong focus on assessment displacement and thus no appropriate standard- for greater standardisation of assessment and and evaluation. An article by World Vision analyses ised recommendations exist. They suggest a monitoring tools amongst agencies. There is the causes of malnutrition amongst the Dinka in collaborative effort – modelled on the Sphere clearly a balance to be struck here and it is perhaps southern Sudan.
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