NUTRITION IN COMPLEX EMERGENCIES;
POLICIES, PRACTICE AND DECISION-MAKING
NUTR 308
Spring 2010 Syllabus
Lead Instructor: Kate Sadler PhD
Co-Instructor: Helen Young PhD
Feinstein International Center,
200 Boston Avenue, Suite 4800
Medford, MA 02155
Tel: 617 – 627 - 4163
Guest Instructors:
Jennifer Martin: Emergency Nutrition Programme Manager, Concern Worldwide, Ireland
Caroline Tanner: Nutritionist and independent consultant, Washington DC
Mark Myatt: Epidemiologist and Nutrition Assessment Specialist, Brixton Health UK
Public Health Specialist: To be announced
Place and Time Every Wednesday 9am – 12 noon
Room 156, Jaharis Building
150 Harrison Ave. Boston
Purpose of the course:
The course will examine the central role and importance of food and nutrition in complex emergencies
and introduce students to the concept of Public Nutrition1. The implications of this approach for
assessment and analysis, policy development, program design and implementation will be examined.
This will provide an understanding of; the nutritional outcomes of humanitarian crises and complex
emergencies (malnutrition, mortality and morbidity); and also the causes of malnutrition and mortality in
emergencies. The course has a field oriented focus based on a wide range of recent and past nutritional
crises. The course reviews international response strategies, nutrition programmes and relevant
policies, and at the same time incorporates relevant applied research drawn from a wide-ranging
literature including research by Tufts/FIC. The course provides the opportunity for active class
participation drawing upon the actual work experience of the students and applying a range of up-to-date
case-study materials based on current humanitarian crises.
Overview:
Part I of the course provides an overview of the role of food and nutrition in the process, dynamics and
outcomes of complex emergencies, and introduces a conceptual framework for analyzing causes of
malnutrition and mortality in emergencies. Relevant nutrition theory and concepts are also reviewed,
with a view to ensuring non-nutritionists have a basic understanding of core concepts. This section also
covers assessment and analysis of nutritional problems in emergencies, specifically in defining the extent
and severity of the problem of malnutrition and nutritional risk, with a view to humanitarian response.
Part II reviews the main types of nutrition and food security interventions (design, implementation,
monitoring, practical challenges and constraints) that are designed to address nutritional risks and
outcomes, as identified throughout the course.
Course Grading and Assessments:
(see separate documents under ‘Classroom’ - ‘Assignments’ on the Angel course site for
assessment questions)
Grading will be based on a combination of:
a) Participation in class & web-based discussions 10%
b) 2 short written mid-term assignments 40% (20% each)
Each of these is due before the class to which they refer (see mid-term assessment questions
on Angel)
c) Mid-term review (multiple choice) test 10%
This electronic quiz will be available on Blackboard from 17th March and will be due by COB
31st March (the first class after Spring Break).
d) Final take-home assignment 40%
This will take the form of a project to be completed in groups of 2-4 people (no more than 4),
with project tasks split between you. A choice of project questions will be made available
during the second week of class for your consideration. You will need to have decided on your
group and your question and put some initial thought into your project by the 7th April. During
the week following the 7th April Mark Myatt (consultant epidemiologist and nutrition
assessment specialist) will be available to meet each group to discuss your initial thoughts.
Arranging a meeting with Mark is compulsory. The final grade for this assignment will be split
25% for the written report and 10% for a 10-15 minute presentation to be delivered during the last class (28th April). Your final report must be submitted to me by 1st May 2010.
Class learning objectives
Please see separate document entitled ‘Learning Objectives’ on the Angel course site
Course reading:
Essential readings are listed for each lecture. All students are expected to do at least the essential
reading, these are key for our discussions in class – please take note of page numbers or chapters in
bold, as these indicate the specific sections you should read. The further reading list provides
opportunity to explore specific issues in more depth; it is up to you what you take from this list. All
readings are available electronically on the Angel course website or can be downloaded via the links
given.
Please also see ‘mid-term assessment’ questions to help guide your reading.
General readings and tools applicable to most classes:
Young, H., A. Borrel, et al. (2004). "Public nutrition in complex emergencies." The Lancet 365(1909):
1899.
WHO. 2000. The Management of Nutrition in Major Emergencies. Geneva: World Health Organization .
The Sphere Project. Minimum Standards in Food Security, Nutrition and Food Aid. Chapter 3 in:
Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Chapter 3 The SPHERE
Project, 2003.
http://www.sphereproject.org/component/option,com_docman/task,cat_view/gid,70/Itemid,203
IASC. 2008 A Toolkit for Addressing Nutrition in Emergency Situations
http://www.humanitarianreform.org/humanitarianreform/Portals/1/cluster%20approach%20page/clusters%20
pages/Nutrition/Global_Nutrition_Cluster_Nutrition_Emergencies_Toolkit_June_2008.pdf
and just for fun …(some bedtime reading perhaps!)
Eggers, D. 2007. ‘What is the What’. Vintage Books. New York
This is a great account of one of the lost boys’ (Valentino Achak Deng) journey across S. Sudan into Kenya -
many good references and thought-generating issues for nutrition in emergency affected populations
PART I: INTRODUCTION AND ASSESSMENT
Date: Jan 27th
Class 1: Malnutrition in emergencies; what, who, why?
An overview of the different types of malnutrition and their public health significance in emergencies.
Physiological vulnerability in relation to the inter-generational cycle of malnutrition will be covered. An
overview of classification of nutrients in the diet, including the concept of Type I and Type II nutrients.
The roles and responsibilities of different international agencies for addressing malnutrition will be
introduced.
An essential class for non-nutritionists.
Essential Reading:
i. Latest issue of: Nutrition Information in Crisis Situations (formerly RNIS) (Highlights, Risk Factors
affecting Nutrition in Selected Situations, Greater Horn of Africa):
http://www.unscn.org/Publications/html/rnis.html
ii. Young, H., A. Borrel, et al. (2004). "Public nutrition in complex emergencies." The Lancet
365(1909): 1899.
iii. Seal A, Prudhon C. 2007 Assessing micronutrient deficiencies in emergencies: current practice
and future direction. 2007. Geneva, Switzerland, UN Standing Committee on Nutrition. Nutrition
Information in Crisis Situations. Page 1
iv. WHO. 2000. Chapter 2, Major nutritional deficiency diseases in emergencies. In: The
Management of Nutrition in Major Emergencies. Geneva: World Health Organization
Policies
i. WFP. 2004.
Further reading:
United Nations Standing Committee on Nutrition (SCN). (2002). Nutrition in the context of conflict and
crisis. SCN News, 24, 3-94. Available at:
http://www.unsystem.org/scn/Publications/html/scnnews.html .
Toole, M. J. 1990. Prevention of excess mortality in refugee and displaced populations in developing
countries. Journal of the American Medical Association 263, no. 24: 3296-320
WFP. Food For Nutrition: Mainstreaming Nutrition in WFP. Rome: WFP; 2004 Rome, 24–26 May 2004.
M. H. N. 1995. Specific deficiencies versus growth failure: type I and type ll nutrients. SCN
News 12: 10-14 .
Prinzo ZW, de Benoist B., 2002, Meeting the challenges of micronutrient deficiencies in emergency-
affected populations. Proceedings of The Nutrition Society 61(2):251-257.
Seaman, J. 1999. Malnutrition in emergencies: How can we do better and where do the
responsibilities lie? Disasters 23, no. 4: 306-25 Nutrition in Emergencies: May 2004.
Date: Feb 3rd
Class 2: Malnutrition in emergencies; food crises, health crises or political crises?
The role of nutrition in the process, dynamics and outcomes of complex emergencies will be addressed. A
brief overview of Sen’s entitlement theory of famine and some subsequent modifications will be discussed.
An introduction to the concept of Public Nutrition, focusing on the project cycle and role of the conceptual
framework of the causes of malnutrition and its relevance in complex emergencies will also be reviewed.
Essential Reading:
i. Keen, D. 2009. Famine. Pages 100-115 in Complex Emergencies. Polity Press, Cambridge, UK New
This book chapter is a good summary of the processes driving famine and the different theories, put
forward by authors like Sen and De Waal, underpinning causal analysis and response to famine.
However, if you have never read any Sen or De Waal – as students of international FPAN you really
should!; please see further reading list below.
ii. Macrae, J., and A. Zwi. 1992. Food as an instrument of war in contemporary famines: a review of the
evidence. Disasters 16, no. 4: 299-321
iii. Maxwell, D., Sadler, K. et al. 2008 Understanding ‘Emergency Food Security’. Chapter 2 in
Emergency food security interventions. Humanitarian Practice Network. Good Practice Review No.
10 pp 7-16 iv. Levitt, E. J., Pelletier, D. L., and Pell, A. N. 2009. Revisiting the UNICEF malnutrition framework to
foster agriculture and health sector collaboration to reduce malnutrition: A comparison of stakeholder
priorities for action in Afghanistan. Food Policy 34: 156-165 New
Further reading:
Sen, A. 1981. Poverty and Famines: An Essay on Entitlement and Deprivation. Oxford: Clarendon
Press. p1-8
de Waal, A. 1990. A re-assessment of entitlement theory in the light of recent famines in Africa.
Development and Change 21: 469-90
The PLOS Medicine Editors. (2008). Scaling up international food aid: food delivery alone cannot
solve the malnutrition crises. PLOS Medicine. 5(11): 1525-1527
Hampshire K, Casiday R, Kilpatrick K and Panter-Brick C. (2008). The social context of childcare
practices and child malnutrition in Niger’s recent food crisis. Disasters.
de Waal, A., 1989, Death [sub-heading: Causes of Death]. Chapter 7 in: Famine that Kills. Darfur,
Sudan, 1984 - 1985. London: Clarendon Paperbacks; pp. 186-194
Salama, P., P. Spiegel, et al. (2004). "Lessons learned from complex emergencies over the past
decade." Lancet 364: 1801-13.
Edkins, J. (1996). "Legality with a vengeance: Famines and humanitarian relief in 'Complex
Emergencies'." Journal of International Studies 25(3): 547-575
de Waal, A. 2000. Democratic Political Process and the Fight Against Famine. Who Fights? Who
Cares? War and Humanitarian Action in Africa. Trenton, New Jersey. Asmara, Eritrea.: Africa World
Press, Inc.; pp. 129-157.
de Waal A, Whiteside A., 2003. New variant famine: AIDS and food crisis in southern Africa. The
Lancet 362:1234-1238.
Lautze, S. and Maxwell, D. (2007) Why do famines persist in the Horn of Africa? Chapter 10 in The
New Famines. Why famines persist in an ear of globalization. Devereux, S. 2007 Oxon: Routledge
pp222-245
This is a good discussion of the role of ‘basic’ causes (cf UNICEF framework) can play in malnutrition
and famine
Date: Feb 10th
Class 3: Meaning and measurement of malnutrition (Part l); Individual anthropometric status and
associated risks.
An overview of measurement of individual nutritional status (children) will be briefly discussed. The
calculation of nutritional indices and reference values and the classification of malnutrition will be
addressed. The operational implications of the new WHO growth standards will be reviewed, as well as the
recent work on MUAC. The relationship between severity of malnutrition and risk of mortality in
emergencies will be briefly reviewed.
Please print the following ‘bookmarks’ and bring to class with you:
1. FANTA (2004) Anthropometry Basics: FANTA bookmark. Washington: FANTA.
2. FANTA (2006) Assessing Nutrition Situations in Emergencies: FANTA bookmark. Washington: FANTA.
Essential Reading:
i. Young, H. and S. Jaspars (2006). The Meaning and Measurement of Acute Malnutrition: A Primer
for Decision-makers. Humanitarian Practice Network Paper No 56. London, Humanitarian
Practice Network, Overseas Development Institute. Pages 1 to 14
ii. Seal. (2007). Operational implications of using 2006 World Health Organization growth standards
in nutrition programmes: secondary data analysis. BMJ. 334 (7596): 733-738.
iii. Young, H. and Jaspars, S. Review of Nutrition and Mortality Indicators for the IPC: Reference
Levels and Decision-making. 2009. Rome, UN SCN; IPC Global Partners. Pages 50-63 New
iv. Myatt M et al. (2008). Effect of body shape on weight-for-height and MUAC in Ethiopia. Field
Exchange, Emergency Nutrition Network, 34: 11.
v. IASC Global Nutrition Cluster and SCN Task Force on Assessment Monitoring & Evaluation. Fact
sheet on the implementation of 2006 WHO Child Growth Standards for emergency nutrition
programs for children aged 6-59 month. 2009. New
Further reading:
Collins S, Duffield, A., Myatt, M. 2000. Adults. Assessment of nutritional status in emergency-affected
populations: Administrative Committee on Coordination/ Sub-Committee on Nutrition,
Myatt M, Khara T, Collins S. (2006) A review of methods to detect cases of severely malnourished
children in the community for their admission into community-based therapeutic care programs. Food
and Nutrition Bulletin Supplement SCN Nutrition Policy Paper No 21. 27(3):S7-S24
Pelletier D. (2006). Theoretical considerations related to cutoff points. Food and Nutrition Bulletin. 27
(4, supplement 2): S224.
de Onis, M., A. W. Onyango, et al. (2006). "Comparison of the World Health Organization (WHO)
Child Growth Standards and the National Center for Health Statistics/WHO international growth
reference: implications for child health programmes." Public Health Nutrition: 9(7): 942–947.
ENN. (2008). Impact of WHO growth standards on programme admissions in Niger. Field Exchange,
Emergency Nutrition Network, 34: 6.
Briend A, Golden MH, Grellety Y, Prudhon C, Hailey P. 1995. Use of mid-upper-arm circumference
for nutritional screening of refugees. Lancet 345(8957):1119-20.Class 4:
Gorstein, J., K. Sullivan, R. Yip, M. de Onis, F. Trowbridge, P. Fajans, and G. Clugston. 1994. Issues
in the assessment of nutritional status using anthropometry. Bulletin of the World Health Organization
72, no. 2: 273-83.
Young, H., and S. Jaspars. 1995. Nutrition, disease and death in times of famine. Disasters 19, no. 2:
94-109.
Toole, M. J.; Nieburg, P., and Waldman, R. J. 1988. The association between inadequate rations,
undernutrition prevalence, and mortality in refugee camps: case studies of refugee populations in
eastern Thailand, 1979-1980, and eastern Sudan, 1984-1985. J Trop Pediatr. Oct; 34(5):218-24
Manuals:
FANTA (2003) Anthropometric Indicators Measurement Guide. Washington: FANTA. Contact:
www.fantaproject.org
WFP and CDC (2005). A Manual: Measuring and Interpreting Malnutrition and Mortality. Rome,
Nutrition Service, Policy, Strategy & Programme Support DivisionWorld Food Programme
Date: Feb 17th
Class 4: Meaning and measurement of malnutrition (Part ll); Anthropometric surveys including
analysis, interpretation and use for decision-making.
The session will provide an introduction to sampling and survey design, statistical analysis and
interpretation, with an emphasis on reviewing survey validity and reliability rather than being able to
undertake surveys. The meaning and interpretation of survey findings for complex emergencies will be
discussed. Nutritional risk and vulnerability will be addressed in relation to findings and broader factors. .
Essential reading:
i. Young, H. and S. Jaspars (2006). The Meaning and Measurement of Acute Malnutrition: A Primer for
Decision-makers. Humanitarian Practice Network Paper No 56. London, Humanitarian Practice
Network, Overseas Development Institute. pages 15 – 46
ii. Bilukha OO. (2008). Old and new cluster designs in emergency field surveys: in search of a one-fits-
all solution. Emerging Themes in Epidemiology. 5(7): 1-7
iii. Grais, R. F., Luquero, F. J., Grellety, E., Pham, H., Coghlan, B., and Salignon, P. 2009. Learning
lessons from field surveys in humanitarian contexts: a case study of field surveys conducted in North
Kivu, DRC 2006-2008. Confl.Health 3: 8 New
iv. Salama P, Assefa F, Talley L, Spiegel P, van der Veen A, Gotway C., 2001, Malnutrition, measles,
mortality, and the humanitarian response during a famine in Ethiopia. American Medical Association
2001;286(5):563-571
Further reading:
Deitchler M et al. (2007). A field test of three LQAS designs to assess the prevalence of acute
malnutrition. Int J. Epidemiology 36 (4): 858-864.
Spiegel PB. (2007). Who should be undertaking population-based surveys in humanitarian
emergencies? Commentary, Emerging Themes in Epidemiology. 4(12): 1-5.
6
Grandesso, F., F. Sanderson, et al. (2005). "Mortality and Malnutrition Among Populations Living in
South Darfur, Sudan: Results of 3 Surveys, September 2004." Journal of the American Medical
Association 293: 1490-1494.
Aldoori, W.; Armijo-Hussein, N.; Fawzi, W. W., and Guillermo Herrara, M. 1994. Child nutrition and
armed conflicts in Iraq. Journal of Tropical Pediatrics. 40:32-36.
Yip, R., and T. W. Sharp. 1993. Acute malnutrition and high mortality related to diarrhea. Lessons
from the 1991 Kundish refugee crisis. Journal of the American Medical Association 279: 587-90.
Kaiser, R., B. A. Woodruff, et al. (2006). "Using Design Effects From Previous Cluster Surveys to
Guide Sample Size Calculation in Emergency Settings." Disasters 30(2): 199.
Davis, A. 1996. Targeting the vulnerable in emergency situations. Who are the vulnerable? The
Lancet, no. 348: 868-71.
Kelly, M. 1992. Entitlements, coping mechanisms and indicators of access to food: Wollo Region,
Ethiopia, 1987-88. Disasters 16, no. 4: 322-38.
! Degomme O and Guha-Sapir D. (2007). Mortality and nutrition surveys by Non-Governmental
organisations. Perspectives from the CE-DAT database. Commentary, Emerging Themes in
Epidemiology. 4(11): 1-5.
Manuals
Save the Children (2004). Emergency Nutrition Assessment Guidelines for field workers. London,
Save the Children. (not available on Blackboard)
FSAU and FAO (2005) Nutrition, a Guide to Data Collection, Analysis, Interpretation and Use Nairobi:
FSAU. (not available on Blackboard): downloadable pdf format in English: www.fsausomali.org
MANUAL aimed at mid-level managers in all sectors who would like to better understand nutrition
information and its use. The MANUAL sets out all the steps involved in nutrition data collection and
analysis including practical guidance for use by survey enumerators, health facility workers and other
field workers. Additional materials have also been prepared to support the use of the manual during
training.
PART II- INTERVENTION STRATEGIES, MONITORING AND EVALUATION
Date: Feb 24th
Class 5: EMERGENCY FOOD AID; mechanisms, modalities and planning rations
Review of the importance and evolution of emergency food aid programming and summary of current key
UN and donor policies. Overview of food distribution modalities (GFD, SFPs, FFW, School Feeding,
VGFs), their objectives & target groups. Policies and procedures for planning general rations, including
an overview of key food groups in the diet and related food commodities in the food basket. The
calculation of a populations minimum average nutritional requirement, making adjustments, planning an
appropriate food basket (acceptable, palatable, hygienic, fuel efficient). Introduce recommended daily
requirements and calculation of nutritional composition of foods.
Essential Reading:
i. Maxwell, D., Sadler, K. et al. 2008 ‘Food aid and in-kind assistance. Part of Chapter 7 in Emergency
food security interventions. Humanitarian Practice Network. Good Practice Review No. 10 pp 61-70
ii. Bush, J. 1995. The role of food aid in drought and recovery: Oxfam's North Turkana (Kenya) Drought
Relief Programme, 1992 - 94. Disasters Journal 19, no. 3: 247-59.
iii. WFP. (2008). Vouchers and cash transfers as food assistance instruments: opportunities and challenges.
The World Food Programme, Rome, 25 September 2008. Pages 1-10
iv. UNHCR, UNICEF, WFP, WHO. 2002. Food and Nutrition Needs in Emergencies. Geneva: United
Nations High Commissioner for Refugees, United Nations Children's Fund, World Food Programme,
World Health Organization. (pages 1 to 29)
v. Jackson, R. 2009. Swaziland cash and food transfer program. Field Exchange 36 pages 2-4 New
vi. Zerbe, N. (2004). "Feeding the famine? American food aid and the GMO debate in Southern Africa."
Food Policy 29: 593-608.
Further Reading:
Rowe, J., Brodegard, W., Pike, O., Steele, M. F., and Dunn, A. M. 2008. Storage, preparation, and
usage of fortified food aid among Guatemalan, Ugandan, and Malawian beneficiaries: A field study
report. Fd.Nutr.Bull. 29: 213-220. New
UNHCR, WFP. 2002. Memorandum of Understanding between the Office of the United Nations High
Commissioner for Refugees (UNHCR) and the World Food Programme (WFP): UNHCR, WFP, 2002.
World Food Program. WFP Strategic Plan 2008-2011. 2008. Rome, WFP. New
Reed, B. and Habicht, J-P. 1998. Sales of food as sign of distress, not excess. The Lancet. 351:128-
130.
World Food Programme (2007). Consolidated Framework Of WFP Policies. Rome, World Food
Programme.
Kadiyala, S. and S. Gillespie (2004). "Rethinking food aid to fight AIDS." Food and Nutrition Bulletin
25(3): 271-282.
Jaspars, S., and H. Young. 1995. General Food Distribution in Emergencies: from Nutritional Needs
to Political Priorities. Good Practice Review 3. London: Relief and Rehabilitation Network, Overseas
Development Institute. P. 81-123
Anonymous. 2002. How safe is GM food? Editorial. Lancet 360(9342):1261.
Sklaver B. 2003. Humanitarian Daily Rations: The Need for Evaluation and Guidelines. Disasters
27(3):259-271. )
Finch, L. (2004). "Fighting for food aid—the struggle to assist groups affected by HIV/AIDS." Lancet
364: 1650-51.
! Schofield, C., and J. Mason. 1996. Setting and evaluating the energy content of emergency rations.
Disasters 20, no. 3: 248-60
! WFP. (2008). Food assistance in the context of HIV: ration design guide. The World Food
Programme, Rome, July 2008.
Date: Mar 3rd
Class 6: Addressing micronutrient deficiencies
The risks for micronutrient deficiencies in emergencies and the challenges for their assessment will be
addressed. Strategies for prevention and control of micronutrient deficiency diseases will be discussed.
These will include; Vitamin A supplementation, fortification of foods locally, regionally and internationally
(salt, cereals, blended food, oil) and improving the quality of the general ration programme and promoting
access to sources of micronutrient rich food.
Essential Reading:
i. Seal A, Prudhon C. 2007 Assessing micronutrient deficiencies in emergencies: current practice and
future direction. 2007. Geneva, Switzerland, UN Standing Committee on Nutrition. Nutrition
Information in Crisis Situations.
Cheung, E., Mutahar, R., Assefa, F., Ververs, M.-T., Nasiri, S. M., Borrel, A. and Salama, P. (2003) An
epidemic of scurvy in Afghanistan: assessment and response. Food and Nutrition Bulletin, 24, 247-255.
iii. Dye TD. (2007). Contemporary Prevalence and Prevention of Micronutrient Deficiencies in Refugee
Settings Worldwide. Journal of Refugee Studies, 20(1): 108-119.
iv. Seal A, Kafwembe E, Kassim IAR, Hong M, Wesley A, Wood J, Abdalla F and van den Briel T.
(2008). Maize meal fortification is associated with improved vitamin A and iron status in adolescents
and reduced childhood anemia in food aid-dependent refugee population. Public Health Nutrition.
11(7): 720-728.
v. WHO, WFP, UNICEF. Preventing and controlling micronutrient deficiencies in populations affected by
an emergency: joint statement by the World Health Organization, the World Food Programme and
the United Nations Children's Fund. 2007. Geneva, WHO.
Further Reading:
WFP, May 2004. Micronutrient Fortification; WFP experiences and ways forward. Policy Issues.
World Food Programme, Rome.
Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A et al. Effects of routine
prophylactic supplementation with iron and folic acid on admission to hospital and mortality in
preschool children in a high malaria transmission setting: community-based, randomised, placebo-
controlled trial. Lancet 2006; 367(9505):133-143.
Tansey E, Bani I. Household-based food fortification for anaemia control in Sudan. Field Exchange
31, 23-26. 2007. Oxford, UK, Emergency Nutrition Network.
De Pee S, Moench-Pfanner R, Mrtini E, Zlotkin SH, Dartin-Hill I, Bloem M. Home fortification in
emergency response and transition programming: Experiences in Aceh and Nias, Indonesia. Food
and Nutrition Bulletin 2007; 24:247-255.
Henry, C. J. K., and J. Seaman. 1992. The micronutrient fortification of refugee rations to prevent
nutritional deficiencies in refugee diets. Journal of Refugee Studies 5, no. 3/4: 359-67.
Seal, A. J., P. I. Creeke, et al. (2005). "Iron and Vitamin A Deficiency in Long-Term African
Refugees." Journal of Nutrition 135: 808-813.
Seal, A. J. (2006). "Excess dietary iodine in long-term African refugees." Public Health Nutrition 9(1):
35-39.
Depoortere, E. (2004). "Potential of Using QBmix to Prevent Micronutrient Deficiencies in
Emergencies." Field Exchange, Emergency Nutrition Network 22: 12-14.
West CE. 2000. Vitamin A and measles. Nutrition Reviews;58 (2):S46-S54.
Date: Mar 10th
Class 7: General Food Distribution and Targeting; principles, procedures and protection
Professor Helen Young will lead this class
Review of the general approaches to food distribution and targeting, including practical constraints and
challenges and how they are addressed. Review of standard practices for monitoring food distribution
and targeting, with case-examples. A consideration of how distribution and targeting practice either
upholds humanitarian principles and protection, or alternatively undermines them and implications for
nutrition.
Essential Reading:
i. Jaspars, S., 2000. Solidarity and soup kitchens: A review of Principles and Practice for Food
Distribution in Conflict, HPG Report 7. Humanitarian Policy Group, Overseas Development Institute &
Nutrition Works, Public Nutrition Resource Group.
9
ii. Maxwell, D., Sadler, K. et al. 2008 ‘Food aid and in-kind assistance. Part of Chapter 7 in Emergency
food security interventions. Humanitarian Practice Network. Good Practice Review No. 10 pp 70-82
New
iii. Jaspars, S., and J. Shoham. 1999. Targeting the vulnerable: A review of the necessity and feasibility
of targeting vulnerable households. Disasters 23, no. 4.
iv. Young, H., A. Taylor, et al. (2004). "Linking Rights and Standards: The Process of Developing
'Rights-based' Minimum Standards on Food Security, Nutrition and Food Aid." Disasters 28(2): 142-
159.
Clay DC, Molla D, Habtewold D. 1999. Food aid targeting in Ethiopia. A study of who needs it and who
gets it. Food Policy 24: 391-409.
Further reading:
Taylor, A. and J. Seaman (2004). Targeting Food Aid in Emergencies. ENN Special Supplement
Series No 1, Emergency Nutrition Network.
Maxwell D and Burns J. (2008). Targeting in complex emergencies: southern Sudan case study.
Feinstein International Centre, May 2008. New
Frize J. (2008). Targeting in complex emergencies: Colombia country case study. Feinstein
International Centre, July 2008. New
Jaspars S and Maxwell D. (2008). Targeting in complex emergencies Somalia country case study.
Feinstein International Centre, July 2008. New
Date: Mar 17th
Class 8: Nutrition and food security: Early warning, nutritional surveillance and assessments
Professor Helen Young will lead this class
Early warning systems, food security assessments, and nutritional surveillance systems will be reviewed in
order to examine the nutritional dimensions of vulnerability, and the implications for direct and indirect
nutrition actions (advocacy, policies, programming).
Essential reading:
i. Maxwell, Daniel, Kate Sadler, Amanda Sim, Mercy Mutonyi, Rebecca Egan, and Mackinnon Webster.
2008. Emergency Food Security Interventions. Good Practice Review No 10. London: Humanitarian
Practice Network. Overseas Development Institute. London (December 2008) (p7 – 52, chapters 2 to 5) New
HPG (2008). Links between needs assessment and decisions in food crisis response. Field
Exchange, Emergency Nutrition Network, 33: 9. New
iii. Rivero E, Salse N and Zapatero E. (2008). Integrated nutrition and food security surveillance in Malawi.
Field Exchange, Emergency Nutrition Network, 33: 21-23. New
iv. Maxwell D, Watkins B. 2003. Humanitarian information systems and emergencies in the Greater Horn of
Africa: Logical components and logical linkages. Disasters 2003;27(1):72-90.
v. Hemrich, G. (2005). "Matching food security analysis to context: the experience of the Somalia Food
Security Assessment Unit." Disasters 29(SI): S61-S91.
vi. Watson, F., C. Dolan, et al. (2006). A review of Save the Children-UK's Nutritional surveillance
programme in Ethiopia. Final draft. . London, Nutrition Works.
10
See also general readings:
The Sphere Project. 2003. Minimum Standards in Food Security, Nutrition and Food Aid. Chapter 3 in:
Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Chapter 3. The SPHERE
Project.
Further reading:
Johnecheck W & Holland DE. (2007). Nutritional status in postconflict Afghanistan: Evidence from the
National Surveillance System Pilot and National Risk and Vulnerability Assessment. Food and Nutrition
Bulletin. 28 (1): 3.
Devereux, S. (2006). Identification of methods and tools for emergency assessments to distinguish
between chronic and transitory food insecurity, and to evaluate the effects of various types and
combinations of shocks on these different livelihood groups. Rome, World Food Programme,
Emergency Needs Assessment Branch (ODAN).
FSAU (2006). Integrated Food Security and Humanitarian Phase Classification; Technical Manual.
Version 1. . Nairobi, Food Security Analysis Unit for Somalia. .
Jaspars S, Shoham J. 2003. A critical review of approaches to assessing and monitoring livelihoods in
situations of chronic conflict and political instability. Working Paper 191. 2003, Annex 1. A description of
different assessment approaches. London: Overseas Development Institute, 2002: 47 - 60.
Duffield, A. and M. Myatt (2004). An analysis of Save the Children UK's and the Disaster
Preparedness and Prevention Commission's Nutritional Surveillance Programme dataset in some of
the most drought prone areas of Ethiopia, 1995-2001. London, Save the Children UK.
Swift, J. 1989. Why are rural people vulnerable to famine? IDS Bulletin 20, no. 2: 8-15.
Famine/ Food security
Additional readings may be recommended
Websites:
http://www.fsausomali.org/index.php@id=41.html
Date: Mar 31st
Class 9: Public Health in Emergencies
A guest lecturer in public health will lead this class (TBC)
Health assessments and surveillance with a focus on basic epidemiological approaches will be reviewed.
Prevention, treatment and control of communicable diseases including measles, water and sanitation,
diarrhea, reproductive health will be discussed, particularly in relation to their impact on preventing and
controlling deterioration in nutritional status.
Essential Reading:
i. Checchi F and Roberts L. (2008). Documenting mortality in crises: what keeps us from doing
better? PLoS Medicine, 5(7): 1025-1032. New
ii. Connolly, M. A., M. Gayer, et al. (2004). "Communicable diseases in complex emergencies: impact
and challenges." Lancet 364: 1974-83.
iii. Waldman, R. (2006). Health in Fragile States, Country Case Study: Democratic Republic of the
Congo. Arlington, Virginia, USA, Basic Support for Institutionalizing Child Survival (BASICS) for
the United States Agency for International Development (USAID) New pg 1-26
WHO. 2000. Chapter 6, Prevention, treatment and control of communicable diseases In: The
Management of Nutrition in Major Emergencies. Geneva: World Health Organization.
See also from Class on Micronutrients:
West CE. Vitamin A and measles. Nutrition Reviews 2000;58 (2):S46-S54.
Further Reading:
Checchi, F. and L. Roberts (2005). Interpreting and using mortality data in humanitarian
emergencies A primer for non-epidemiologists. London, Humanitarian Practice Network Paper No
52, Overseas Development Institute.
Waldman, R.J. Prioritizing health care in complex emergencies. Lancet. 2001; 357:1427-29.
Goma Epidemiology Group. 1994. Public health impact of the Rwandan Refugee crisis: what
happened in Goma, Zaire, in July 1994? The Lancet, no. 345: 339-.
Lautze, S., J. Leaning, et al. (2004). "Assistance, protection, and governance networks in complex
emergencies." Lancet 364(9451): 2134-41.
Moss, W. J., M. Ramakrishnan, et al. (2006). "Child health in complex emergencies." Bull World
Health Organ 84(1): 58-64.
Salama, P., P. Spiegel, et al. (2004). "Lessons learned from complex emergencies over past
decade." Lancet 364(9447): 1801-13.
Toole, M. J.; Waldman, R. J. 1997, The public health aspects of complex emergencies and refugee
situations. Annual Review of Public Health, Vol.18, pp.283-312
Black RE, Morris SS, Bryce J. 2003, Where and why are 10 million children dying every year? The
Lancet 361:2226-2234.
Harvey, P. April 2004. HIV/AIDS and humanitarian action. HPG Research Report #16. ODI,
London.
Date: Apr 7th
Class 10: Selective Feeding Programmes (Part I); Supplementary Feeding
An overview of the different types of selective feeding programmes will be provided. The objectives, design,
organisation and monitoring of supplementary feeding programmes will be reviewed. Problematic issues
around supplementary feeding will be explored (targeting, acceptability, programme quality, efficiency and
effectiveness).
Essential Reading:
i. Effect of Preventive Supplementation With Ready-to-Use Therapeutic Food on the Nutritional Status,
Mortality, and Morbidity of Children Aged 6 to 60 Months in Niger: A Cluster Randomized Trial. Isanaka,
S.2, Nohelly, N., Ali, D. et al. JAMA. 2009;301(3):277-285. New
ii. Navarro-Colorado C, Mason F and Shoham J. (2008). Measuring the effectiveness of Supplementary
Feeding Programmes in emergencies. Humanitarian Practice Network Paper No 63. London,
Humanitarian Practice Network, Overseas Development Institute: 1-26. New
iii. WFP. (2008). WFP Targeted Supplementary Feeding in Ethiopia. Field Exchange, Emergency
Nutrition Network, 32: 23-24. New
iv. Defourny I et al. (2007). " Management of moderate acute malnutrition with RUTF in Niger Field
Exchange, Emergency Nutrition Network (31): 2-4.
2
Sheila Isanaka took Nutr 308 just last year!
12
v. MSF. Food is not enough. Without essential nutrients millions of children will die: Medecins Sans
Frontieres; 2007
vi. Norton R, Golden M, Ashworth A. 17 Letters. Field Exchange 31, 17-18. 2007. Oxford, UK,
Emergency Nutrition Network.
v. Myatt M. (2008). SQUEAC: Low resource method to evaluate access and coverage of programmes.
Field Exchange, Emergency Nutrition Network, 33: 2-5. New
See also from General readings
The Sphere Project. Minimum Standards in Food Security, Nutrition and Food Aid. Chapter 3 in:
Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Chapter 3 The SPHERE
Project, 2003.
Further reading:
Maxwell, D., Sadler, K. et al. 2008 ‘Food aid and in-kind assistance. Part of Chapter 10 in Emergency
food security interventions. Humanitarian Practice Network. Good Practice Review No. 10 pp 111-116
new
Vautier, F., K. Hildebrand, M. Dedeurwaeder, and M. Herp. 1999. Dry supplementary feeding
programmes: an effective short-term strategy in food crisis situations. Trop Med Int Health 4, no. 12:
875-9.
UNHCR/WFP. 1999. UNHCR/WFP Guidelines for selective feeding in emergency situations, United
Nations High Commissioner for Refugees, World Food Programme. WHO. 2000. The Management of
Nutrition in Major Emergencies. P 74 – 83. Geneva: World Health Organization
Enserink M. (2008). Lancet and MSF split over malnutrithe Advancement of Science. 319: 555. New
Ruel, M. T., P. Menon, et al. (2004). "Donated fortified cereal blends improve the nutrient density of
traditional complementary foods in Haiti, but iron and zinc gaps remain for infants." Food and Nutrition
Bulletin 25(4): 361-376.
Curdy, A. 1995. The relevance of supplementary feeding programmes for refugees, displaced or
otherwise affected populations. In Report of a workshop on the improvement of the nutrition of refugees
and displaced people in Africa., ACC/SCN, Geneva.
Nielsen, J., P. Valentiner-Branth, et al. (2004). "Malnourished children and supplementary feeding
during the war emergency in Guinea-Bissau in 1998–1999." American Journal of Clinical Nutrition 80:
1036-42.
Golden M and Grellety Y. (2008). Failure to respond to treatment in supplementary feeding
programmes. Field Exchange, Emergency Nutrition Network, 34: 23- 24. New
Date: Apr 14th
Class 11: Selective Feeding Programmes II; Therapeutic Feeding Programmes & Community-
based Management of Acute Malnutrition (CMAM)
Guest lecturer: Jennifer Martin, Emergency Nutrition Programme Manager, Concern Worldwide,
Ireland
An overview of the management of severe acute malnutrition, phases of treatment, management of
associated medical complications and nutritional and medical protocols will be discussed. Guidelines will
be reviewed. The design and organisation of programmes including centralized versus community-based
treatment approaches will be described. Monitoring at individual and programme will be discussed.
13
Essential Reading:
i. WHO. WHO child growth standards and the identification of severe acute malnutrition in infants and
children: A Joint Statement by the World Health Organization and the United Nations Children's Fund.
2009. Geneva, World Health Organization. New
ii. Collins, S. 2004, Community -based therapeutic care: A new paradigm for selective feeding in
emergencies. HPN Paper Number 28, November 2004 pp 1-11
iii. Sadler K, Myatt M, Feleke T, Collins S. A comparison of the programme coverage of two therapeutic
feeding interventions implemented in neighbouring districts of Malawi. Public Health Nutr 2007;1-7.
iv. Golden M et al. (2007). Discussion about controversial topics in CTC (including MUAC measurements
and commercial versus local RUTF). Letters. ENN, Field Exchange: 31: 17-20.
v. Community-based management of severe acute malnutrition: A Joint Statement by the World Health
Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition
and the United Nations Children’s Fund. (2007). World Health Organization/World Food
Programme/United Nations System Standing Committee on Nutrition/The United Nations Children’s
Fund.
vi. Collins S, Myatt M, Golden BE. Dietary treatment of severe malnutrition in adults. Am J Clin Nutr 1998;
68:193-199.
See also from General readings
! The Sphere Project. Minimum Standards in Food Security, Nutrition and Food Aid. Chapter 3 in:
Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Chapter 3 The
SPHERE Project, 2003.
And from previous classes
! FANTA (2004) Anthropometry Basics: FANTA bookmark. Washington: FANTA.
! Myatt M, Khara T, Collins S. (2006) A review of methods to detect cases of severely malnourished
children in the community for their admission into community-based therapeutic care programs.
Food and Nutrition Bulletin Supplement SCN Nutrition Policy Paper No 21. 27(3):S7-S24
Further Reading:
Maxwell, D., Sadler, K. et al. 2008 ‘Food aid and in-kind assistance. Part of Chapter 10 in Emergency
food security interventions. Humanitarian Practice Network. Good Practice Review No. 10 pp 117-
122 New
Golden, M. H. N. 1996. Severe Malnutrition. In: Oxford Textbook of Medicine., 1278-96 Oxford
University Press. If you want more background on the physiology of severe acute malnutrition
read this
C. Prudhon et al. (2006). Proceedings of the WHO, UNICEF, and SCN Informal Consultation on
Community-based Management of Severe Malnutrition in Children. SCN Nutrition Policy Paper No.
21. Food and Nutrition Bulletin. 27 (3, supplement): S99.
Bahwere P, Piwoz E, Joshua MC, Sadler K, Grobler-Tanner CH, Guerrero S et al. Uptake of HIV
testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat Severe
Acute Malnutrition in Malawi: a descriptive study. BMC Infect Dis 2008; 8:106. New
Collins, S., N. Dent, et al. (2006). "Management of severe acute malnutrition in children." The
Lancet(06): 69443-9.
Gaboulaud V, Dan-Bouzoua N, Brasher C, Fedida G, Gergonne B, Brown V. Could nutritional
rehabilitation at home complement or replace centre-based therapeutic feeding programmes for
severe malnutrition? J Trop Pediatr 2007; 53(1):49-51.
Heikens GT. How can we improve the care of severely malnourished children in Africa? PLoS Med
2007; 4(2):e45
Collins, S. and Yates, R. 2003. The need to update the classification of acute malnutrition. The
Lancet 362:249
Salama P, Collins S. 1999. An ongoing ommission; adolescent and adult malnutrition in famine
situations. ENN: Issue 6: February 1999. http://ennonline.net/fex/06/fa19.html
Schofield, C., and A. Ashworth. 1996. Why have mortality rates for severe malnutrition remained so
high? Bulletin of the World Health Organization 74, no. 2: 223-29.
Date: Apr 21st
Class 12: Infant feeding and HIV in emergencies
Caroline Tanner, Nutritionist and independent consultant, will co-teach this class with Kate
The importance of breast feeding and appropriate complementary feeding in refugee and other emergency
situations will be given. Appropriate strategies for protecting, supporting and promoting breast-feeding
among emergency affected populations, including policy development and co-ordination will be discussed.
An overview of the key factors for consideration in providing nutritional support for people living with
HIV/AIDS will also be discussed.
Essential Reading:
i. Jacobsen. M et al. 2003. Breastfeeding status as a predictor of mortality among refugee children in
an emergency situation in Guinea-Bissau. Tropical Medicine and International Health. Vol 8: No.
11:992-6.
ii. Kelly, M. 1994. Infant feeding in emergencies. Disasters 18, no. 2: 110-121.
iii. IFE Core Group. (2007). Infant and young child feeding in emergencies. Operational guidance for
emergency relief staff and programme managers. Version 2.1, Infant Feeding in Emergencies Core
Group. New
iv. Assefa F, Sukotjo S, Winoto A and Hipgrave D. (2008). Increased diarrhea following infant formula
distribution in 2006 earthquake response in Indonesia: evidence and actions. Field Exchange,
Emergency Nutrition Network, 34: 30-35. New
v. Kadiyala, S. and S. Gillespie (2004). "Rethinking food aid to fight AIDS." Food and Nutrition Bulletin
25(3): 271-282.
Policies
vi. WHO (2004). Guiding principles for feeding infants and young children during emergencies. 2004,
World Health Organization. (pages 8 – 10)
vii. UNHCR (2006). UNHCR Policy Related to the Acceptance, Distribution and use of Milk Products in
Refugee Settings. Geneva, UN Refugee Agency.
Further Reading:
UNHCR. (2008). Guidance on infant feeding and HIV in the context of refugees and displaced
populations. Geneva. April 2008. New
WFP. (2008). Food assistance in the context of HIV: ration design guide. The World Food
Programme, Rome, July 2008. New
15
Borrel, A.; Taylor, A.; McGrath, M.; Seal, A.; Hormann, E.; Phelps, L., and Mason, F. 2001. From
policy to practice: challenges in infant feeding in emergencies during the Balkan crisis. Disasters.
Jun; 25(2):149-63.
UNICEF Nutrition Section NYHQ (2005). Information on Infant and young feeding in emergencies for
UNICEF offices and partners. New York, UNICEF.
Seal, A.; Taylor, A., and Gostelow, L. 2001. Review of policies and guidelines on Infant Feeding in
Emergencies: Common ground and Gaps. Disasters. Vol 25(2).
Almedom, A. M., and A. de Waal. 1990. Constraints on weaning: evidence from Ethiopia and Sudan.
J.Biosoc.Sci, no. 22: 489-500.
Coetzee, D., K. Hilderbrand, et al. (2005). "Effectiveness of the first district-wide programme for the
prevention of mother-to-child transmission of HIV in South Africa." Bulletin of the World Health
Organization 83(7): 489-494.
WHO. Infant and young child nutrition. Global strategy on infant and young child feeding. Fifty-fifth
World Health Assembly A55/15 16 April 2002. Geneva: World Health Organization, 2002.
Leyenaar, J. (2004). "Human Immuno-deficiency virus and infant feeding in complex humanitarian
emergencies: priorities and policy considerations." Disasters 28(1): 1-15.
UNICEF, UNHCR, WFP, and WHO. – Joint Statement. 1999. Policy on infant feeding in the Balkan
Region.
Websites
http://www.iycn.org/ New
The Infant and Young Child Nutrition (IYCN) Project is the flagship project on infant and young child
nutrition of the US Agency for International Development (USAID). Begun in 2006, the five-year project
aims to improve nutrition for mothers, infants, and young children and prevent the transmission of HIV to
infants and children. IYCN builds on 25 years of USAID leadership in maternal, infant, and young child
nutrition. Our focus is on proven interventions that are effective during pregnancy through the first two
years of life.
Date: Apr 28th
Class 13: Presentation of group projects
Guest Commentator: Epidemiologist and Nutrition Assessment Specialist, Brixton Health UK
Each small group will present a summary of their final assessment project back to class. Grades for this
project will be awarded based on content of a written report, stated contribution of each group member and
quality of presentation in class.
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