Levels of Nutrition

Nutrition Level Assessment in a Population

Good nutrition in a population complements the prevention and mitigation of morbidity and mortality in emergency situations, as well as supports the return to favorable conditions for recovery and development. The degree of malnutrition experienced by populations afflicted by disaster is related to pre-disaster nutrition levels, food security, time to recovery, degree of displacement, scale of environmental insult, and adequacy of relief efforts.

Rapid assessment of malnutrition within a population afflicted by disaster is among the first responses to an emergency, particularly where there may be significant food insecurity, such as during drought, flooding, and displacement. The initial emergency food security assessment (EFSA) is begun days following a sudden crisis, report of an abrupt deterioration of a continuing crisis, or the opening of access to areas that were previously unreachable. The EFSA is designed to answer two major questions: Is there a food security or nutrition crisis that poses an immediate risk to human life? And, if so, where and to whom should a relief intervention target? The initial EFSA also assesses a population's sociodemographic characteristics, community food resources, household food security, food resource accessibility, food availability and affordability, and community food production resources. Information on the seasonal effect of the disaster, evidence of malnutrition or excess mortality, and indications of water insecurity or lack of sanitation is also collected. EFSAs give only approximate results, however, and are the basis for the prompt launch of emergency relief operations prior to assessing and managing malnutrition at an individual level.

Nutrition Level Assessment in Individuals

Malnutrition, in the context of disaster relief, is a result of insufficient energy and/or nutrient consumption, and may be divided into three general categories: protein-energy malnutrition (kwashiorkor), total-energy malnutrition (marasmus) and micronutrient deficiency (such as iron, selenium, zinc, or vitamins). However, significant overlap is common, and treatment for each does not greatly differ in the acute management of disasters. In addition, the duration and severity of malnutrition, regardless of type, are important distinctions when classifying nutritional status among individual refugees. The techniques for determining nutritional status differ across age groups and duration of malnutrition. To highlight these differences, the anthropometric and clinical techniques for determining acute and chronic malnutrition among infants and children and adults are discussed separately.

In children, three standardized indicators of malnutrition exist: weight-for-height (W/H), mid-upper arm circumference for age (MUAC), and clinically evident bilateral lower extremity edema. Weight-for-height is [Page 388]determined by measuring the child's height in centimeters and weight in kilograms; then, using the standardized table developed by the World Health Organization (WHO), the corresponding number of standard deviations (SD) from the median W/H is found. The WHO and United Nations Children's Fund (UNICEF) recommend a cutoff for W/H below −3 SD to identify infants and children as having severe acute malnutrition (SAM). The MUAC is determined by measuring the midpoint arm circumference of a child's relaxed, hanging left arm.

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