Download INCORPORATING NUTRITION INTO AGRICULTURAL

Technical
Module
assessment in
for
emergency
needs
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Food and nutrition
Purpose of the module
How to use the module
GENERAL



OPERATIONAL
The importance of

integrating nutrition in
emergency food and
agriculture assessments and 
interventions

Understanding why people
are at risk of malnutrition 


What is nutrition information
and why collect it?
TECHNICAL

Food and nutrients

Types of malnutrition and
assessment methods

Integrating food and nutrition in
project design, implementation and
evaluation
What do you want to know?
What nutrition information
should you collect?
How can you collect nutrition
information?
How can you interpret
nutrition information?
 Tools:
Examples of food sources
Seasonal calendar of nutritional
vulnerability
 Key references
This Technical Module aims to
Promote the integration of nutrition and household food security in Search
emergency
assessments
and Contact : Florence Egal (ESNP),
interventions……………………………………
Charlotte DUfour (consultant)
……………………………………
Prepared by: ESNP
Charlotte Dufour (ESNP Consultant)
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TABLE OF CONTENTS*
Purpose of the module ....................................................................................................... 3
How to use the module ...................................................................................................... 3
GENERAL ............................................................................................................................ 4
The importance of integrating nutrition in emergency food and agriculture operations ....... 4
Understanding why people are at risk of malnutrition ......................................................... 5
Food consumption .......................................................................................................... 5
Disease .......................................................................................................................... 5
Household food security ................................................................................................. 6
Health services and environment .................................................................................... 6
Caring and feeding practices .......................................................................................... 7
OPERATIONAL: ................................................................................................................... 8
What is nutrition information and why collect it? ................................................................. 8
What do you want to know? ............................................................................................... 8
What nutrition information should you collect? ................................................................... 9
Symptoms of malnutrition ............................................................................................... 9
Disease prevalence and mortality patterns ..................................................................... 9
Food consumption and diet diversity............................................................................... 9
Food security ................................................................................................................ 10
Health and sanitation .................................................................................................... 10
Care practices .............................................................................................................. 11
How can you collect nutrition information? ....................................................................... 12
Sources of information .................................................................................................. 12
Critically assessing the quality of nutrition information .................................................. 13
How can you interpret nutrition information? .................................................................... 14
Establishing links between the different variables ......................................................... 14
Identifying areas requiring interventions ....................................................................... 14
TECHNICAL ....................................................................................................................... 15
Food and nutrients ........................................................................................................... 15
Types of nutrients ......................................................................................................... 15
Nutrient requirements ................................................................................................... 15
Which foods to eat in the diet?...................................................................................... 16
Types of malnutrition and assessment methods .............................................................. 17
Protein-energy malnutrition (macronutrient malnutrition) ............................................... 17
Micronutrient deficiencies: ............................................................................................ 20
Who is at risk of malnutrition? ....................................................................................... 21
Integrating nutrition in project profile design ..................................................................... 22
Formulation of specific objectives and indicators .......................................................... 22
Targeting: ..................................................................................................................... 23
Selection of most appropriate type of assistance and activities ..................................... 23
Seeking synergies with partners ................................................................................... 24
Tools ................................................................................................................................ 25
Examples of food sources of energy, protein, iron, vitamin A and vitaminc C ............... 25
Seasonal calendar of nutritional vulnerability ................................................................ 27
Key references................................................................................................................. 28
* Note: This document is to be put in CD or web version, organised as presented in the introduction
table, p.1 (the table of contents will not be valid then)
The text highlighted in yellow and underlined, is meant to indicate links that could be established on
the web or CD version.
Charlotte Dufour (ESNP Consultant)
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Purpose of the module
The purpose of this module is to provide simple and practical guidelines to professional staff
for the incorporation of nutrition and household food security into emergency needs
assessment and project profile design.
The specific objectives of the module are:
 To explain why nutrition and household food security are essential for emergency
agricultural assistance in situations of natural disasters and complex emergencies.
 To provide practical tools for the gathering and interpretation of relevant information,
and for the formulation of emergency food and agriculture operations.
 To provide definitions of basic nutrition terms and techniques, and key references.
The guide will not provide detailed information on methods of data collection, indicators and
data analyses. However, the guide shall mention the type of information to be gathered,
where it can be found, how to interpret the results and to use them in emergency food and
agriculture operations.
How to use the module
This module is organised in three sections:
The GENERAL section introduces the importance of integrating nutrition in emergency food
and agriculture interventions. It provides a framework for understanding why people affected
by crises are at risk of malnutrition. This framework will serve as a basis for assessing the
impacts of a crisis on households’ nutrition situation.
The OPERATIONAL section is the core part of the nutrition module for Emergency Needs
Assessment. It provides guidance on how to collect important information on malnutrition
patterns and causes (in particular household food security, caring and feeding practices and
health and sanitation), with a view to understand how nutrition-related problems can be
addressed through emergency assistance.
The TECHNICAL section provides simple definitions and information on food and nutrients,
on the various types of malnutrition and on how these can be diagnosed or assessed. It also
presents examples of how nutrition can be incorporated in emergency food and agriculture
interventions, to maximise their impact on affected population’s welfare. Finally, it proposes
tools and references that can be useful for collecting and analysing nutrition information.
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GENERAL
The importance of integrating nutrition in emergency food and
agriculture operations
In all emergencies, whether natural disasters or human-made crises, the immediate attention
of the general public, donors, and mass-media, is called by the loss of life of affected people
and by the ensuing risks for the lives and livelihoods of those who have outlived the event.
Improvement of the nutritional situation of beneficiaries becomes therefore the main goal of
emergency assistance, for malnutrition and vulnerability to malnutrition entail risks to life on
the short and medium-term.
Furthermore, one often observes a vicious cycle of malnutrition, disease, and destitution: an
inappropriate diet leads to reduced resistance to disease and greater vulnerability to
malnutrition. Disease and malnutrition reduce individuals’ physical and intellectual faculties
and labour capacity, thereby affecting household food security and caring capacity, and
increasing vulnerability to malnutrition. It should be the purpose of assistance to reverse this
cycle.
Graph 1: Nutrition as a key component of food and agriculture programmes
Food production
programmes
Increased food
availability and access
to food
Greater working capacity
(physical and intellectual)
Nutrition :
Improved food use, to
meet nutritional
requirements
Improved nutritional
status and physical and
mental well-being
By improving access to food and restoring some self-sustaining capacity, emergency
agricultural interventions contribute to achieve the goal of improving and protecting the
nutritional situation of crisis-affected households.
But in order to achieve good nutrition, it is important to take into account the whole food
chain, including how food is produced, collected, bought, processed, sold, prepared, shared
and eaten, as well as how food is digested, absorbed and used by the body, and how it
finally influences well-being. This entails having an understanding of the various factors that
affect nutritional status.
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Understanding why people are at risk of malnutrition
Malnutrition is ‘multi-factorial’, i.e. several interacting factors determine nutritional
vulnerability and contribute to poor nutrition. This is why addressing malnutrition requires
having a holistic approach. The various causes of malnutrition are presented in the
conceptual framework (Figure 1) and key factors are described in greater detail below.
Figure 1. Why are people at risk of malnutrition?
MALNUTRITION
DISEASE
FOOD CONSUMPTION
Affects how food is used by
the body
Energy intake,
Nutrient intake (diet diversity)
FOOD SECURITY
= Access to adequate food
throughout the year.

through food
production

through food
purchase
Food availability
CARING AND
FEEDING PRACTICES
Child care
Infant and child feeding
Eating habits
Food preparation
Intra-household food
distribution
Capacity to care for
dependent individuals
HEALTH &
SANITATION
Water quality & quantity
Hygiene and sanitation
Food safety and quality
Access and use of health
services
SOCIO-ECONOMIC AND POLITICAL ENVIRONMENT
Food consumption
The qualityDemography,
and quantityEducation,
of foods consumed
is a key
determinant
of nutritional
status. While
Macro-economy,
Policy
environment,
natural resource
the intake
of
energy
is
important
in
the
diet,
other
nutrients,
such
as
vitamins,
proteins and
endowment, market conditions, livelihood systems, social institutions, cultural attitudes.
minerals are also required. Hence, the amount of food consumed, the frequency of
consumption, and the diversity of the diets in terms of nutrient composition are essential to
nutritional well-being.
Disease
But adequate food consumption is not sufficient to ensure nutritional well-being. It depends
on how food is utilised by the body. Disease strongly affects nutritional status through its
effect on food utilisation. Illness often leads to increased dietary requirements for body repair
of tissues damaged by the disease and to cater for increased loss of nutrients, due to
malabsorption of nutrients, altered metabolism and loss of appetite.
Diseases such as measles, diarrhoea, tuberculosis (TB), respiratory infections and HIV/AIDS
have a major influence on an individual’s nutritional status.
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Household food security
Food security is defined as a situation when all people, at all times have physical, social and
economic access to sufficient, safe and nutritious foods that meets their dietary needs and
preferences for an active and healthy life.
Households can access foods by:
 Producing their own food, which depends on having the means to produce foods (fields,
seeds, tools, animals, pasture).

Purchasing food. The ability to purchase sufficient food is determined by:
- purchasing power to buy food and essential products (this depends on income
sources and on the price of essential foods)
- Access to markets (which can be restricted by logistical / geographical obstacles or
insecurity)
Access to food is largely determined by food availability, which is a factor of production
capacity, amount of imports and amount of storage. Food availability is also influenced by
the availability of seeds, pest infestation/attack, weather conditions, availability of pasture,
land acreage under cultivation, labour availability and insecurity issues. The amount of food
used by households, traded or stored all influence food availability at household level.
An important aspect of food security is adequate access to food at all times, though many
populations experience variations in food access. For example, in agricultural communities,
crop harvesting patterns determine food availability; in pastoral population which rely heavily
on milk, milk production varies with rainfall and availability of grazing lands. Access to food
can also be affected by variations in employment opportunities.
Health services and environment
Sanitary conditions and access and use of health services and are important determinants of the
prevalence of diseases that increase the risk of malnutrition and affect food security (through
decreased productivity and cost of treatment). The issues to take into consideration include:

Environmental conditions and sanitation: availability and access to clean water in
sufficient quantities (for drinking, cooking and cleaning); means of disposing of faecal
waste; housing conditions (crowding, availability of heating and clothing in cold settings,
presence of animals…).

Health services: availability (structures, trained personnel, essential drugs), access
(distance and transportation means), affordability (cost), acceptability (treatment and
attention received) and use (affected by local heath beliefs and practices).
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Caring and feeding practices
Good care at household level ensures that the food and healthcare resources provided to
individual members result in optimal survival, growth and development. Caring and feeding
practices vary with age and culture.
Caring practices involve:
 Psychosocial care: responsiveness to the needs of individual household members

Caring capacity: the capacity of household members to care for dependent individuals
(babies, orphans, elderly, the physically and mentally disabled...)

Hygiene (bathing, hand-washing, washing of cooking utensils, food hygiene, hygiene of
clothing, bedding, etc.)

Home health practices (promotion of good health, home remedies and management of
common ailments, recognising ill health, deciding to seek assistance)

Specific care during periods of vulnerability (childhood, pregnancy, illness).
Feeding practices involve:
 Infant and child feeding practices (exclusive breastfeeding, type of weaning foods and
preparation, and age of introduction of complementary foods)

Food preparation (cooking, presentation, hygienic storage)

Intra-household food distribution (Is there preferential feeding? Is each household
member able to eat sufficiently to meet their nutritional requirements?)

Eating habits (the type of food and frequency of eating). Eating habits can be influenced
by customs and beliefs (e.g. cold and hot food classifications), that may restrict the
types of foods eaten at certain periods (e.g. illness) or by certain individuals (e.g.
pregnant and lactating women).
Caring and feeding practices depend on:
 The caregiver’s knowledge, beliefs, education and the ability to put knowledge into
practice
 Resources (money and time) required for the provision of adequate care
 Support within the family or community.
Crisis situations can have a negative impact on nutritional status by affecting any one or
several of the factors described above. Food and agricultural operations aiming to improve
food security are therefore likely to have a limited impact on nutritional status if they are
implemented in isolation from humanitarian interventions addressing other causes of
malnutrition, notably the health and environmental situation, and caring practices.
The incorporation of nutrition into food and agriculture emergency operations shall give the
means to deliver assistance that will have a true impact on the overall welfare of crisisaffected populations, going beyond the impact on food production.
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OPERATIONAL:
What is nutrition information and why collect it?
Nutrition is about people. Collecting nutrition information ensures that populations’ and
individuals’ overall welfare is placed at the heart of emergency assessments and responses.
Nutrition information covers both:
- information on nutritional status (presence and prevalence of protein-energy
malnutrition and micronutrient deficiencies)
- information on factors of nutritional vulnerability (food consumption, disease
prevalence, food security, health and sanitation, caring and feeding practices)
Nutrition information fulfils various roles. It can serve as:
 a vital indicator of the overall welfare of populations
 a means to identify the most vulnerable or affected individuals or groups
 a screening tool to identify malnourished individuals needing special assistance
 an indicator to monitor the effects of emergency interventions among vulnerable groups
 an early-warning indicator.
What do you want to know?
The nutrition component of an Emergency Needs Assessment should aim to answer the
following questions:

How has the crisis impacted on a population’s nutritional status and food consumption,
as compared to the situation prior to the crisis?

Who is most affected by the crisis or faces the greatest nutritional risk?

What are factors of nutritional vulnerability and how are these likely to evolve in coming
weeks and months? Is the nutritional situation likely to improve or deteriorate? Why?

How can factors of nutritional vulnerability be addressed in the emergency response?
To answer these questions, you should collect information on nutritional status and factors of
nutritional vulnerability (see What nutrition information should you collect?).
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What nutrition information should you collect?
Understanding a population’s nutritional situation requires to collect information on
manifestations of malnutrition as well as factors of nutritional vulnerability (see
Understanding why people are at risk of malnutrition).
It is important to collect this information for different livelihoods groups, as there can be
strong variations between different group’s vulnerability to malnutrition. It is also important to
analyse nutrition information in relation to household characteristics, including
geographical location, household composition and social and economic status (displaced,
refugee, origin, orphan, disabled, widow, single mother, professional activity, etc.).
Usual seasonal patterns must be taken into account to identify changes from pre-crisis to
post-crisis in order to detect deteriorations in the nutrition situation as well as coping
mechanisms put in place in response to the crisis. (See Seasonal calendar of nutritional
vulnerability)
The checklist below is proposed as a guide to the most important information to obtain, but
should not be taken as a rigid and closed questionnaire. Most of the answers should lead to
further questions such as why, how, who, where and when. In addition, the checklist should
be adapted to each crisis and agro-ecological area, since some of the questions may be
irrelevant in a given context.
Symptoms of malnutrition

Are there any indications of high rates of acute malnutrition (weight-for-height, MUAC,
marasmus and kwashiorkor) in affected areas?


Which population groups / geographical areas seem most affected?
Are there indications of micronutrient deficiencies, notably iron, vitamin A, and iodine
deficiencies or other relevant micronutrient deficiencies in the crisis-affected area?
See Types of malnutrition and Assessment methods
Disease prevalence and mortality patterns



What are the main diseases in the area and can they have an effect on the nutritional
situation? (e.g. measles, respiratory infections, and diarrhoea in children in particular, as
well as tuberculosis, malaria, HIV/AIDS in all age groups)
Are there indications that mortality rates are unusually high? See Types of malnutrition and
Assessment methods
Are certain groups more exposed to disease than others?
Food consumption and diet diversity
Food consumption is an effective and simple entry point to evaluate the food security
situation in order to estimate the extent of food intake shortfall compared to individual needs.
As it is difficult to measure and quantify in emergency situations, semi-quantitative and
qualitative indicators are generally used:

How many meals are eaten per day in “normal” times (e.g. the same time last year)?
How many meals are eaten per day presently?
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
What main foods are eaten and how frequently? Have the foods eaten changed as a
result of the crisis (e.g. consumption of "famine" food and wild foods)? Is the diet
providing enough essential nutrients? (see Examples of food sources of energy and key
nutrients).
Food security
Food access
 How do households access food? (own production, collection, barter, purchase, gifts, food






aid, wild foods…)? What is the relative importance and reliability of each source?
What foods does the household produce (crops, home gardens, animals, fishing) and
with which constraints (climate, water supplies, storage facilities, etc)?
Does the household have sufficient purchasing power to buy food and essential items
(income vs. cost of foods and items)?
What are the household’s income sources (employment, sale of own production,
remittances, loans, income-generating programmes…) and how reliable are they?
Do households have safe access to food and crop markets (distance, transportation
means, cost)?
Are there food stocks? For which foods? And how long can they last?
Are there times of food scarcity, for which foods, when, and for how long?
Coping strategies
 What coping strategies are households or individuals implementing to maintain their
food security? (e.g. sale of assets, migration in search of jobs, indebtedness, etc.)?
 What are the costs or risks associated with these coping strategies over the short,
medium and long-term?
 How could coping strategies be supported so as to maximise their positive impact and
reduce the associated costs and risks?
 Are there differences in how different population groups are coping?
Health and sanitation
Food safety
 Are there signs of food contamination (rotting, bad smell...)?
 Are there hygiene problems in food storage and preparation (e.g. exposure to
contamination, insufficient cooking time)?
Water and sanitation
 Do households have access to clean water? What is the main source of water, and how
far is it?
 How are excreta disposed of? Does this protect people from contamination? (e.g.
isolated area, no link to water sources, etc.)
 How are housing conditions? Is there overcrowding? Do shelters protect correctly
against cold, rain, disease vectors (e.g. mosquitoes)? Are they well ventilated?
Access to health services
 Is there a hospital, clinic or basic health post nearby which can be reached easily?
 Does it provide adequate care? (sufficient health staff, medicines, etc.)
 Do people use these health services? If not, why? (lack of trust, too far, poor service…)
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Care practices
Caring capacity
 Who is taking care of dependent individuals in the household, and at community level
(community structures and kinship networks)?
 Has the crisis affected carers’ ability to look after dependent household members?
 Which households face caring problems? (E.g. households having a high number of
dependent members compared to the number of working-able individuals, large families,
disabled and sick individuals, socially marginalised, etc.)?
Feeding practices and habits
 Are children exclusively breastfed? What are the main weaning foods and at what age
are they introduced?
 Has the crisis affected infant feeding practices and how? (E.g. are some mothers facing
difficulty to breastfeed? Are weaning foods available?)
 Are there any beliefs and habits that restrict the consumption of certain foods?
 How is food distributed within the household? Are all household members able to eat
enough?
Hygiene and health practices
 Are there hygiene problems in the household (dirty home, infrequent body and hand
washing, dirty clothing…)
 Where do household members seek health care? (traditional healer? Local clinic?)
N.B. Gender is an important dimension in the caring capacity, as women are generally the
main care-givers. Women head-of-households typically face the largest burden in terms of
caring responsibility.
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How can you collect nutrition information?
Sources of information
In general, nutrition information can be collected at field level through:

Feeding centres: Data from therapeutic and supplementary feeding centres provide
information on seasonal trends in malnutrition (through admission rates), immediate
causes of malnutrition (e.g. types of disease), location of pockets of malnutrition (e.g.
origin of patients). In-depth interviews with patients can also provide information on
factors of nutritional vulnerability.

Rapid assessments: these are mainly carried out on an ad-hoc basis and are useful
when nutrition information is urgently needed. A combination of methods is used,
including MUAC to obtain a gross estimate of malnutrition prevalence. Though the
information collected is less reliable than nutritional survey data, it is useful to rapidly
identify pockets of vulnerability where further investigation would be needed and/or
urgent action.

Nutrition surveys: collection of weigh-for-height data among children below 5 years
and occasionally among adults using BMI and/or MUAC (in particular women of
reproductive age), according to standard survey methodologies. In some cases,
complementary information is collected (e.g. mortality, morbidity, signs of micronutrient
deficiencies, feeding practices, food security). If well conducted, these surveys provide
reliable and detailed information for specific regions.

Qualitative surveys: qualitative surveys are very useful to gather information on food
consumption, caring and feeding practices. Household food security, access to health
services, etc. The methods used include focus groups, in-depth interviews, direct
observation, case studies on individuals or groups, etc.

National health and demographic surveys: In most countries, surveys on basic
demographic, health, and nutrition information is collected at a national level. Though
these may not give precise data, notably at the local level, and may not provide data for
all areas due to data collection difficulties, they can give an indication of the general
situation and of regional patterns.
(c.f. Demographic and Health Surveys
www.measuredhs.com and Multiple Indicator Cluster Surveys -UNICEF).

Health facilities: in some countries, health and nutrition data is routinely collected
through health facilities. Health facility data is useful in monitoring trends in malnutrition
and disease prevalence rates over time. Health facility data is not representative of the
entire population since not all children are brought to the health centre. Caution should
therefore be exercised when interpreting this data. Furthermore, when data collection
methods are not standardised across the country it is difficult to make regional
comparisons.
Professionals responsible for emergency agricultural operations are not expected to collect
all this information themselves, but to gather it through the following means :

Programme and survey reports on the pre-crisis situation and current situation from:
- Country institutions (e.g. Ministries of Agriculture, Health, Social Affairs…)
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UN agencies (WFP, UNICEF, WHO, UNHCR), ICRC and NGOs involved in
nutritional programmes (feeding centres, kitchens), food aid distributions, health and
sanitation, and shelter services, agriculture programmes.
Meetings with nutritionists and/or representatives of relevant institutions and aid
organisations, both at headquarter level and in the field.


Field visits to crisis affected areas: these are opportunities to observe any clear signs of
malnutrition and to have direct discussions with crisis-affected households and key
informants (particularly women and malnutrition-affected households) on their food and
nutritional problems. Though this is not sufficient to obtain a comprehensive assessment
of the nutrition situation, it is useful to triangulate information collected through other
means and to explore specific issues that may have been overlooked in other surveys.
Critically assessing the quality of nutrition information
Appraising the reliability of the collected information is absolutely essential, and can be done
by considering the following issues:

Target population and/or area: in which area was the assessment conducted? Among
which population groups?
 Be careful not to extrapolate findings for one area or population group to other
populations, unless you have strong foundations for such comparisons (e.g. similar
livelihoods, similar crisis impact)

Sampling: How were households or individuals selected for inclusion in the survey?
Were they randomly or purposively selected? Is the sample representative of the wider
population?
 Surveys –in particular anthropometric surveys- that do not follow accepted sampling
methodologies (e.g. exhaustive sampling, 2-stage cluster sampling, systematic sampling,
stratified sampling) can be subject to bias.
 Random sampling and the calculation of average malnutrition rates, that do not take into
account variations within the surveyed population (in terms of livelihoods, food habits,
access to health care, etc.), can mask strong differences within the surveyed population and
miss pockets of vulnerability.

Data collection method: How was data collected and by whom? Did surveyors receive
proper training?
 Anthropometric data is subject to measurement error if surveyors are not properly trained.
Qualitative data collection methods also require strong skills to avoid certain biases (e.g.
response bias) and superficial data collection
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How can you interpret nutrition information?
The objective of analysing the nutrition information you have collated is answer the
questions raised in “What you want to know” above. This entails establishing links between
the various types of information that were collated and, on the basis of this analysis,
identifying potential areas for intervention.
Establishing links between the different variables
Understanding the nutritional situation requires to have a comprehensive understanding of
how factors of nutritional vulnerability interact and determine the population’s nutritional
status. (see Understanding why are people at risk of malnutrition)
For example, though malnutrition rates may be low in some areas, a strong reduction in food
consumption can indicate imminent deterioration of individuals’ nutritional status. But this
reduction in food consumption must be put in context of patterns of food access: is it they
likely to improve or deteriorate? Does the presence of crops in the fields, for instance,
suggest an improvement in the food supply?
On the other hand, high malnutrition rates can occur when there is no apparent food
shortage, but when diseases, such as diarrhoea or AIDS, are highly prevalent. Issues of
hygiene, feeding practices, and/or access to health care can be called into questions.
Placing information on a seasonal calendar of nutritional vulnerability can support analysis.
Identifying areas requiring interventions
Interventions that contribute positively to improving nutritional status are extremely diverse,
ranging from support to food production (distribution of agricultural inputs, animal health
projects, etc.) to health facilities, water and sanitation, education, etc.
This entails that nutrition interventions should not be stand-alone operations, but integrated
in other interventions that address the different factors of nutritional vulnerability. Specific
nutrition activities include nutrition education and monitoring of nutrition indicators for
targeting and project monitoring and evaluation. (see Integrating Nutrition in Emergency
Food and Agriculture Interventions).
Nutrition information should therefore be interpreted together with information collected
in other technical areas, to identify the more relevant interventions. Issues to take into
consideration include:




Relevance and effectiveness: the intervention’s capacity to have a positive impact on
nutritional status.
Feasibility, in light of the constraints (access, security, operational capacity)
Integration / cohesion with existing projects and strategies, in particular with the
population’s strategies (e.g. risk of undermining local coping capacity or duplicating
existing strategies)
Relative importance / priority: what are the areas requiring priority action? Note:
population members’ priorities may differ from aid agencies’ perception of priorities!
In view of these concerns, it is essential to discuss potential interventions with population
members or those who work directly with them, since they may have insights on the situation
and potential interventions that may not have been picked up through the needs
assessment.
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TECHNICAL
Food and nutrients
Nutrition covers the whole spectrum of the food chain, from production, collection, purchase,
processing, trade, preparation, distribution among household members, consumption, and
body digestion and use.
Types of nutrients
Food is made up of nutrients such as carbohydrates, proteins, fats, vitamins and minerals.
Vitamins and minerals are called micronutrients.
Each type of nutrients serves particular functions in the body:
 Carbohydrates and fats in the body are "burned", or broken down, to produce the
energy the body needs to perform different physical activities. The rest is used by the
body for growth and general maintenance, and in the renewal of its tissues.

Fat is a particularly concentrated source of energy and contains twice as many
kilocalories (1) as carbohydrates and proteins. In addition they are also needed for the
absorption and use of some vitamins, especially vitamin A.

Proteins are needed to build and maintain muscle, blood, skin, bones and other tissues:
they are the primary building blocks of the body. They are especially important for
children, and pregnant and lactating women.

Vitamins and minerals help the body to work properly. They contribute to tissue repair,
and ensure for children in particular, healthy growth, mental development and protection
from infection.
Nutrient requirements
The amount of energy (kilocalories) and nutrients people require from their diets in order to
stay healthy and active varies with age, sex, pregnancy and lactation, level of activity and
state of health.
The most critical stage of human development is from conception to about 3 years of age, a
period when physical growth occurs most rapidly. It is crucial, therefore, that small children
and pregnant and lactating women receive the right amount of nutritious food in order to
ensure proper growth, brain development and resistance to infection of the foetus and young
child.
An example of energy, protein, and fat requirements for different sex and age groups is
given in Table 1 below.
1
1 g. of fat brings 9 kcal; 1 g. of protein and 1 g. of carbohydrate bring 4 kcal each.
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Table 1: Example of daily requirement of energy, protein and fat for different sex and
age groups
Individual
Man (active)
Woman
Child
Age / status
18 - 60 years
Childbearing
age
Pregnant
Lactating
Under 1 year
5 years
12 years (boy)
14 years (boy)
Energy (kcal)
2940
2140
2240
2640
Protein (g.)
57
48
55
68
Fat (g.)
83
59
65
73
800
1510
2170
2620
12
26
50
64
Breast milk
42
60
73
Which foods to eat in the diet?
All foods from plants and animals contain a mixture of nutrients, but each one has a different
amount of each nutrient.
To achieve a balanced diet and stay healthy, people must eat a variety of foods each day.
For example:
 Cereals (e.g. rice, maize, sorghum, millet, wheat) are rich in carbohydrates and also
contain significant amounts of protein and B vitamins.
 Roots and tubers (e.g. cassava, yams, taro, sweet potatoes, plantains, etc.) are good
sources of carbohydrates but contain relatively little protein relatively poor sources of
vitamins A and C.
 Pulses (legumes) such as peas, beans, and groundnuts are rich sources of protein and
iron, while soybeans and groundnuts are also good sources of fat.
 fruits and vegetables, including leaves (cassava, cowpea, bean, sweet potato leaves)
contain significant amounts of vitamins and minerals.
 Dark green leafy vegetables, yellow/orange fruits and vegetables (e.g. mangoes,
papayas and pumpkin), liver, dairy products, and eggs, are very rich in vitamin A
 Animal products (meat, dairy products, fish, eggs) are good sources of protein and iron.
Liver in particular is very rich in minerals and vitamins.
 Oil (from palm, coconut, sesame, olive, sunflower, etc.) and butter brings fat principally.
 seafood, sea fish, and iodised salt, are good sources of iodine.
See Examples of food sources of energy, protein, vitamins A and C, and iron.
The nutrient content of food changes with the degree of freshness of the food and the
methods of processing, preserving and preparing it. For instance, if the outer skin of cereal
grains is removed during milling, most of the cereal's minerals and vitamins are lost. The
vitamin C content of vegetables diminishes if the vegetables are overcooked.
Depending on the usual meal frequency, food providing the daily requirements can be
spread out over 2 or 3 meals per day for adults. Because of their small stomach size,
children under 5 years of age need more meals and should be given snacks between the
main family meals. These snacks can be in the form of leftovers from the main meals.
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Types of malnutrition and assessment methods
Malnutrition occurs when there is an imbalance between the nutritional intake (consumed
and absorbed nutrients) and nutritional requirements.
Malnutrition increases the risk of mortality, by decreasing exposure to disease, and –in the
case of severe acute malnutrition- by preventing essential body functions to perform properly
(notably the heart and brain). Other consequences of malnutrition include:
 Impaired learning capacity (children).
 Decreased physical capacity and work performance.
 Low birth weight and nutritional deficiencies among babies from malnourished mothers.
There are two main types of malnutrition, described below.
Protein-energy malnutrition (macronutrient malnutrition)
Protein-energy malnutrition (PEM) occurs when individuals lack sufficient quantity of food to
meet energy and nutrient needs.
There are two main manifestations of PEM:
 chronic malnutrition, also known as stunting, which is characterised by low height-forage (i.e. shorter and smaller than well-fed children of the same age). Chronic
malnutrition sets in after some months or years of inadequate diet, leading to failed
growth.

acute malnutrition, also know as wasting or emaciation, which is characterised by low
weight-for-height (i.e. they are thinner than well-fed children of the same height). Acute
malnutrition occurs when there is an acute shock (lack of food and/or illness) and greatly
increases mortality risk.
Both chronic and acute malnutrition can be severe or moderate, depending on the severity of
malnutrition. However, the term “severe malnutrition” is generally used to refer to severe
acute malnutrition. The clinical manifestations of severe malnutrition include:
 Marasmus: marasmus patients are extremely thin, with a weight-for-height under 70% of
the median (see box 1)
 Kwashiorkor: kwashiorkor patients present bilateral oedema, which first develops at the
feet and legs, and can affect the whole body if the nutritional status is not restored. Their
skin is pale and may be peeling, and their hair becomes pale and looses curl.
 Marasmus-kwashiorkor: patients are both extremely thin (weight-for-height under 70%
of the median) and present oedema on the feet, legs, and sometimes on the arms and
face.
Unless they receive therapeutic feeding and medical treatment, children with severe proteinenergy malnutrition are likely to die
INSERT PHOTOGRAPHS OR DRAWINGS OF CHILDREN WITH MARASMUS AND
KWASHIORKOR.
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Assessing individual nutritional status with anthropometric indicators
Chronic and acute malnutrition can be diagnosed using anthropometric indicators (based on
body measurements) that are presented in Box 1.
N.B. While reliable indicators have been developed for assessing child nutritional status, it is
much more difficult to objectively assess adolescent and adult malnutrition.
BOX 1: MOST COMMON ANTHROPOMETRIC INDICATORS USED IN EMERGENCY
SITUATIONS
(a) Evaluation of the nutritional status in children under 5 years of age
The most common indices used in nutritional surveys of children under 5 years old in
emergencies are:
-
Weight-for-height: reflects failure to gain weight, or a loss of weight, and therefore recent
adverse conditions leading to "wasting" or "acute malnutrition".
-
Height-for-age: "stunting" or "chronic malnutrition", reflects a failure to gain height, and so
represents more of an integrated record of all past experiences.
Weight-for-age: cannot distinguish between tall thin children from those who are short with
adequate weight
Mid-upper arm circumference (MUAC): is an alternative measurement quick to undertake and
which can reflect recent weight loss and has found to be a good predictor of mortality risk..
-
Measurements of body size in the population are compared to measurements made in a "reference",
non-malnourished population of the same age and sex, in order to identify wasting, stunting, and
underweight.
Severity
Indicator
Wasting
(acute
malnutrition)
Stunting
(chronic
malnutrition)
Undernutrition
(combination
wasting and
stunting)
Moderately malnourished
Severely malnourished
Weight-for-height between -3 and -2 standard
deviations from the reference value or
MUAC between 11cm and 12 or 12,5 cm
Weight-for-height < -3 standard
deviations from the reference value
&/or MUAC under 11cm
&/or oedema (kwashiorkor)
Height-for-age between -3 and -2 standard
deviations from the reference value
Height-for-age < -3 standard
deviations from the reference value
Weight-for-age between -3 and -2 standard
deviations from the reference value
Weight-for-age < -3 standard
deviations from the reference value
The choice of index to use is related to the purpose of the measurements, and practical constraints.
Weight-for-height is the most appropriate index for assessing short-term changes in weight. In
situations where age cannot be reported accurately (most emergency situations) weight-for-height
and MUAC are the only options.
MUAC is an easy measurement that can be done by literate persons of the community with simple
training and minimum equipment (a tape, textbook and pen are sufficient). The measurement should
nonetheless be accurately done as small errors in measurement technique can make a big difference
to survey findings. For this reason, it is recommended to use MUAC only for quick screening and
rapid assessments of the situation, in order to determine the need for a survey which would use
weight-for-height.
(b) Evaluation of the nutritional status of adults above 18 years of age
In many situations of food insecurity, parents try to protect young children from becoming
malnourished, at a cost to their own health. In famine situations in particular, adult malnutrition may
prove to provide an early guide to households and communities at risk.
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For adults above 18 years of age, the equivalent indicator to weight-for-height in children is the Body
Mass Index (BMI) calculated as weight/height 2. Mid-upper arm circumference (MUAC) can also be
used as an alternative, quicker method of screening individuals.
Indicator/
Severity
Undernutrition
Moderately malnourished
Severely malnourished
Body Mass Index between 16 and 18.5
Body Mass Index < 16
Men's MUAC between 20 and 22.9 cm
Women's MUAC between19 and 21.9 cm
Men's MUAC < 19.9 cm
Women's MUAC <18.9 cm
Population assessments
Malnutrition rates are calculated for a population (e.g. % of population members that are
wasted and/or stunted) to assess the level of nutritional risk through nutritional surveys.
Malnutrition rates are generally calculated among children 6-59 months old, because it is
assumed they are the most vulnerable age group to malnutrition, and deteriorations in their
nutritional status can provide an early warning of deterioration in the wider population’s
nutritional situation. Furthermore, reliable anthropometric or clinical indicators for malnutrition
in other age groups are still lacking. However, in some cases, data on adult malnutrition (in
particular women of reproductive age) is collected.
Thresholds of acute malnutrition prevalence have been defined to indicate the significance of
the malnutrition problem at the population level. However, levels under non-emergency
conditions vary greatly across populations. Furthermore, there may be pockets of high
malnutrition or extreme vulnerability that may not be visible through aggregate data. The
thresholds below are given for guidance, and should be used with caution.
Table 1: Classification of global acute malnutrition using Z-scores (established by WHO)
Global Acute Malnutrition Rates
(Weight-for-height Z-score)
< 5%
5-9.9%
10-14.9 %
>15%
Interpretation
Acceptable level
Poor
Serious
Critical
Mortality data is sometimes collected to complement nutrition data in estimating the severity
of the situation. The following thresholds have been defined to describe the gravity of a
situation. But like the thresholds for malnutrition rates, they must be used with caution.
Table 2: Classification of mortality data
Indicator
Crude Mortality Rate
(CMR)
Under 5 Mortality Rate
(U5MR)
Definition
An estimate of the rate at which
population members die during a
specified period.
The number of deaths among children
between birth and their fifth birthday
expressed per 10,000 live births.
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Interpretation
≥1 / 10,000/ day : situation of
alert
≥2 / 10,000 / day : emergency
≥2 / 10,000 / day: situation of
alert
≥4 / 10,000 / day : emergency
Draft, Nov 20th 2004
Micronutrient deficiencies:
Mineral and vitamin deficiencies often accompany malnutrition from energy and protein
deficiency because micronutrients are contained in various foods bringing also calories and
protein.
However, micronutrient deficiencies can also occur in isolation if:
 Specific micronutrient-rich foods in the diet are insufficiently consumed compared to
needs
 Absorption of the micronutrient is impaired due to interaction with other foods or drinks
in the diet.
 Increased losses occur due to infections, parasitism, or physiological status (such as
iron during menstrual and birth delivery blood losses in women of fertile age).
 Needs are increased due to growth and building of new tissues: e.g. iron in young
children and in pregnant women.
Iron, vitamin A and iodine deficiencies are the three micronutrient deficiencies most
widespread world-wide.



Iron deficiency results in anaemia (drop of blood haemoglobin levels), decreased
resistance to infections, impaired learning ability, decreased physical capacity, low birth
weight, and increased risk of death associated with pregnancy and childbirth.
Vitamin A deficiency causes night blindness and ocular lesions (xerophtalmia) leading to
blindness, decreased resistance to infections, and increased child mortality.
Iodine deficiency results in a variety of disorders including goitre (thyroid enlargement),
impaired learning ability and reduced mental function (cretinism) and reproductive
complications (still births, abortions and infant deaths).
Other micronutrient deficiencies often encountered in crisis situations include deficiencies in
folate, vitamin PP (niacine), vitamin C, vitamin B1 (riboflavine) and zinc. Some MDDs are
very rare but can occur in crisis-affected and food aid dependant populations due to
extremely poor diet quality (e.g. scurvy –vitamin C deficiency- in drought-affected areas of
Afghanistan).





Folate deficiency provokes anaemia, increased susceptibility to infections, low birth
weight, foetal malformations, delayed growth in early childhood and adolescence,
delayed sexual development, and increased risk of heart disease.
Vitamin PP (niacine) deficiency results in skin problems (pellagra) and impaired
metabolism of energy by the body.
Vitamin C deficiency causes scurvy, decreased resistance to infections, and poor
healing.
Vitamin B1 (riboflavine) deficiency results in neuro-muscular disorders (beri-beri).
Zinc deficiency results in delayed growth and decreased resistance to infections.
Evaluating micronutrient status is often more difficult than estimating protein-energy
malnutrition, especially when micro-nutrient deficiencies are sub-clinical (there are no visible
signs of deficiency) and obtaining an accurate diagnosis requires biological measurements
(in the blood, urine, etc.), which are difficult to collect and analyse in emergency situations.
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BOX 2: EVALUATING MICRONUTRIENT STATUS
Micronutrient status can be evaluated:
Directly:

Biological measurements of blood, urinary, or tissue levels of the micronutrient. Results are
then compared to levels expected in non-deficient individuals. Examples of biological indicators
are blood haemoglobin for iron deficiency; serum retinol for vitamin A deficiency; urinary iodine
for iodine deficiency.

Clinical signs are easily collected indicators, but less reliable because of their subjectivity. For
example: pale eyelids are usual in iron deficiency anaemia; cornea damage occurs in vitamin A
deficiency; goitre (thyroid enlargement) appears in iodine deficiency.
Indirectly:

Biological functions that depend on the presence of a micronutrient can be evaluated. For
example: the respiratory capacity in iron-deficient individuals; eye sight adaptation to dark in
vitamin A-deficient individuals.

The quantity and type of food consumed provide information on the amount of micronutrient
ingested. However, in general non-quantitative estimates are made because weighing food
consumed is often not feasible, and food composition tables are not always detailed enough.
Semi-quantitative and qualitative indicators include the frequency of consumption of
micronutrient-rich food, and consumption of enhancers and inhibitors of absorption.
The target population groups among which the information is collected depend on the type of
micronutrient involved, since vulnerability to micronutrient deficiencies can vary largely according to
age, sex and physiological status.
Who is at risk of malnutrition?
Malnutrition affects predominantly individuals who present one or several of the following
characteristics:
 They have increased nutritional needs for growth (young children, adolescents), for
foetal development (pregnant women), lactation (lactating women), or physical activity.
 They suffer from impaired absorption and assimilation of foods and loss of appetite
linked to disease (e.g. patients affected by HIV/AIDS; measles; tuberculosis) and to age
(elderly)
 They depend on care and attention provided by other individuals for their feeding,
hygiene, health and other essential practices (young children, orphans, the sick, the
elderly, the disabled
 They are marginalised for social, political, religious reasons, or for their belonging to a
given group of the population (e.g. displaced persons, single mothers, political
opponents, etc).
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Integrating nutrition in project profile design
FAO emergency interventions are very diverse, from distribution of agricultural inputs,
support to animal production, irrigation projects, support to fishing activities, pest
management, etc. (see Appendix 2 of the ENA Guidelines Core Module). FAO also carries
out specific nutrition interventions (e.g. in particular nutrition education and training), but food
and nutrition issues are most effectively addressed when integrated in other interventions.
FAO interventions essentially address food insecurity, one of the main underlying causes of
malnutrition. But this is not sufficient to ensure that crisis-affected populations’ nutritional
status improves. Health and sanitation, and caring and feeding practices should also be
addressed to ensure that food security interventions have the greatest possible impact on
crisis-affected households’ well-being.
Integrating food and nutrition in emergency programmes can help provide a comprehensive
approach to supporting households’ livelihoods.
Nutrition can be integrated in project design at four levels:
 in the formulation of project objectives and indicators
 in the targeting of households
 in the selection of interventions
 in creating synergies with other organisations and stakeholders
Formulation of specific objectives and indicators
Formulating objectives in terms of improving nutritional status ensures that emergency
interventions are geared towards improving the health and well-being of crisis-affected
households and individuals.
Nutritional indicators provide objective measurements of whether the population’s food
security and health situation has improved. Nutrition indicators can include:
- indicators of nutritional status (e.g. anthropometric data, micronutrient status),
- indicators of food consumption (e.g. are household members eating more, and is their
diet composed of various foods providing essential nutrients).
While it is important to gear interventions towards improving nutritional status, improvements
or deterioration in nutritional status cannot be directly or solely attributed to the success or
failure of a project, given the diversity of factors that affect malnutrition. Food consumption
data may provide a more direct measurement of impact for interventions aiming to improve
household food security.
Measuring the achievement of programme objectives with nutritional indicators requires to:
 Identifying the most suitable nutrition indicators (e.g. that are relevant to the intervention
and not too complicated to collect and analyse)
 Establishing a baseline for the chosen indicators
 Establishing, or supporting, a nutrition surveillance system
A very important function of nutritional surveillance systems, in addition to programme
monitoring and evaluation, is to monitor changes in the food and nutritional situation, and
identify priority needs and interventions.
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N.B.: Measuring nutritional indicators is not an easy enterprise which generally requires
close collaboration with other agencies, government institutions (notably the Ministry of
Health) and NGOs who have the expertise to conduct reliable nutritional surveillance.
Targeting:
Including malnutrition or risk of malnutrition among the targeting criteria can contribute to
ensuring that emergency assistance goes to those that most need it.
The presence of malnourished individuals is a clear indicator of difficulties faced by
households in terms of either of the three factors (i) food security, (ii) access to health
services, water and sanitation, proper shelter, and (iii) capacity for caring dependent
household members and individuals vulnerable to malnutrition.
N.B.: Some households or individuals maybe particularly vulnerable to malnutrition for
various reasons (age, pregnancy, lactation, socially marginalised, AIDS-affected, etc.), even
if signs of malnutrition are not (yet) apparent.
Professionals responsible of the project should collaborate in particular with UN agencies
and NGOs providing food aid and nutritional support in the area in order to identify
households with malnourished members and members at risk of malnutrition (location,
demographic and socio-economic characteristics).
N.B. When targeting vulnerable households, notably those affected by malnutrition of food
insecurity, there is a risk that they may not be able to participate to emergency agricultural
assistance projects because of lack of manpower (e.g. women-headed households,
households with a high number of dependent members including those HIV-infected and
disabled, etc.), lack of access to land, and/or lack of animals.
Project design should therefore ensure that
 Project benefits are re-distributed to them, or physical assistance is provided for the
implementation of project activities
 Non-labour intensive crops, agricultural practices, and food processing techniques are
encouraged, as well as activities such as home gardening that can be performed close to
the household
 Nutritional support is given to severely malnourished household members from
programmes implemented by other UN agencies and NGOs. This is necessary because
agricultural support alone will take too long before it has positive effects on the nutritional
status of severely malnourished individuals.
Selection of most appropriate type of assistance and activities
By taking into account the prevailing nutritional problems in the project area, and by
elucidating the main causes of malnutrition, FAO emergency interventions can be selected
and designed to have the greatest possible on nutritional status, by taking into account all
underlying causes of malnutrition.
FAO emergency interventions are generally expected to improve household food security,
either by improving food production, by generating income, and facilitating access to
markets. But interventions can be designed in a way that maximises the impact on nutritional
status, by:

Addressing specific nutritional deficiencies: Food and agriculture interventions can
support the production of crops and produce that provide nutrients that are lacking in
the diet. (see Examples of food sources of energy, protein, vitamins A and C, and iron)
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
Improving access to food year round: through the planting of various crops harvested at
different times; access to animal products along the year; improved storage capacities;
introduction of food conservation techniques.

Incorporating nutrition education: improving access to food is one thing. Making sure
foods are consumed so as to improve nutritional status is another. Nutrition education is
essential to:
- promote the consumption of a diverse range of foods and inform households on the
nutritional value of key local foods
- promote adequate food preparations techniques (to preserve the nutrient content of
foods) and food hygiene
- provide training on food processing and preservation
In addition to its impact on food security and food consumption, emergency food and
agriculture interventions can also have indirect positive impacts on health-related causes
of malnutrition. For example, they can:
 facilitate the economic access to health services and shelter thanks to income obtained
from the trade of agricultural produce
 contribute to improve access to water thanks to the building and repair of pumps and
wells that can be used both for agricultural and domestic needs
 decrease the incidence of some diseases such as malaria, by repairing drainage
systems and removing stagnant water where mosquitoes and parasites breed
 decrease the incidence of food-borne diseases through a better access to water and
fuel wood for cooking, as well as training in food handling and processing.
On the other hand, emergency agricultural operations can create environmental hazards
linked to the misuse of fertiliser and plant treatment chemicals, hence the need to adhere to
a strict code of conduct for the use of these inputs, and to eventually include training and
communication on these hazards among project activities. (See module on pesticides)
Finally, it is important to take into consideration the caring capacity of households when
designing food and agriculture interventions. These may have implications in terms of time
allocation, leading to potential problems with the caring capacity of beneficiary households.
Difficulties can happen if care-givers are directing most of their time for the implementation
of agricultural activities and have no sufficient time left for caring for dependent individuals.
On the other hand, emergency agricultural projects may have positive effects on the society
caring capacity by encouraging solidarity mechanisms such as the share of projects benefits
with households unable to participate to the project for physical, social, or time reasons.
Seeking synergies with partners
Malnutrition is multi-factorial and should thus be addressed through comprehensive
programmes. Focusing on the improvement of populations’ nutritional situation provides a
framework for coordinating emergency food and agriculture interventions with agencies
working in other sectors.
Professionals should thus discuss with partners involved in health and sanitation, and shelter
programmes to identify opportunities for pooling efforts to provide a comprehensive
assistance to selected households. Relevant contacts are country institutions (in particular the
Ministries of Agriculture, Health, Social Affairs, Rural Development), UN agencies (WFP, WHO,
UNICEF, UNHCR), ICRC and NGOs.
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Tools
Examples of food sources of energy, protein, iron, vitamin A and
vitaminc C
References:
- Improving nutrition through home gardening. A training package for preparing field workers in
Southeast Asia. FAO, 1995.
- Improving nutrition through home gardening. A training package for preparing field workers in
Africa. FAO, 2001.
In the tables below, "X" refers to a reasonable or good source; "-" refers to a poor or nil source.
Table 1: Cereals, pulses (legumes), roots and tubers sources of energy, protein, iron and vitamin C,
on the basis of 100 g. edible food
Cereals, pulses,
Energy
Protein
Iron (*)
Vitamin A
Vitamin C
roots, tubers
Barley
X
X
Canna root
X
Cashew fruit
X
Cashew nut
X
X
X
Cassava roots
X
X
Cassava leaves
X
X
X
Cocoyams
X
Cowpea
X
X
Enset
X
X
Groundnut
X
X
X
Hyacinth bean
X
X
Long bean
X
X
X (leaves)
Maize
X
X
X (yellow)
Millet
X
X
Mung bean
X
X
Oyster nut
X
X
Pigeon Pea
X
X
Rice (polished)
X
X
X
Shea butter nut
X
X
Sorghum
X
X
Soybean
X
X
X
String bean
X
Sweet potato
X
X (yellow/orange)
X (yellow/orange)
Taro root
X
X
Teff
X
X
Wheat
X
X
Wing bean
X
X
Yam
X
(*): Iron is of poor bio-availability (intestinal absorption) in plant products. Foods rich in vitamin C and
animal products are strong enhancers of iron absorption (see Annex 2).
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Table 2: Fruits and vegetables sources of energy, protein, iron, vitamin A and vitamin C, on the basis
of 100 g. edible food
Fruits
and
Energy
Protein
Iron (*)
Vitamin A
Vitamin C
Vegetables
Amaranth
or
X
X
African spinach
Avocado
X
Banana
X
X
Baobab seed
X
Baobab fruit
X
Bitter leaf
X
Breadfruit
X
Carrots
X
Chillies
X
Citrus
X
Coconut flesh
X
Coconut milk
X
X
Coconut oil
X
Cucumber
X
Custard apple
X
Drumstick tree
X
Guava
X
X
Jackfruit
X
X
Kapok seed
X
Leaves
X
X
X
Litchi
X
Longan
X
Mango (ripe)
X
X (also unripe)
Okra
X
Okra pods
X
X
Papaya (ripe)
X
X
X
Passion fruit
X
Pineapple
X
Pumpkin
X
X
Pumpkin leaves
X
X
X
X
Rambutan
X
Rape
X
Red palm oil
X
X (unrefined)
Rosella
X
Soursop
X
Sugar cane
X
Sweet pepper
X
Tomato
X
Water spinach
X
X
X
(*): Iron is of poor bio-availability (intestinal absorption) in plant products. Foods rich in vitamin C and
animal products are strong enhancers of iron absorption (see Annex 2).
Table 3: Animal products sources of energy, protein, iron and vitamin A, on the basis of 100 g. edible
food
Animal products (*)
Energy
Eggs
Fish
X (fatty)
Meat
X
Milk and dairy products
X (not skimmed)
(*): Animal products are not a source of vitamin C
Charlotte Dufour (ESNP Consultant)
Protein
X
X
X
X
26
Iron
X
X
X
-
Vitamin A
X
X (fatty)
X (liver)
X (not skimmed)
Draft, Nov 20th 2004
Seasonal calendar of nutritional vulnerability
Seasonal calendars are very useful to describe seasonal patterns concerning a variety of
nutrition-related issues, such as:
- cropping patterns
- food availability
- income sources
- price of foods
- disease prevalence
- labour demand
This helps understand patterns of vulnerability, as well as the impact of the crisis, as
illustrated below.
Example 1: Nutritional stress calendar for small-scale fish-smokers in Chokomey and
Oshiyie, Ghana (from Guidelines for Participatory Nutrition Projects, FAO)
Nutritional stress
Rains
Fish catch low
Income from fish low
- big smokers
- small smokers
Maize price = high
Cassava price = high
“Meal” price high
Heavy labour
Fish processing
Heavy labour
Agriculture
Diarrhoea
Malaria
Measles
Coughing/colds
Sept
x
Oct
Nov
x
x
x
x
x
x
x
x
Dec
x
Jan
Feb
Mar
x
Apr
x
x
May
X
X
Jun
x
x
Jul
x
x
x
x
x
x
x
x
x
x
X
x
x
x
X
X
x
x
x
x
x
x
x
x
x
Aug
x
x
x
x
x
x
x
X
X
X
x
x
x
x
x
x
x
x
x
x
x
x
x
x
X= period when this occurs, undermining nutritional status
These calendars can also help understand how the timing of the crisis has impacted on the
nutritional situation.
Example 2: Timing of disaster in relation to the agricultural cycle in Somalia, the April
1992 war in Baidoa and the Central Sorghum Belt (From: PractitionerHandbook on
Participation of Crisis-Affected Populations in Humanitarian Action, ALNAP/Groupe URD)
Months
Feb
Seasons
Sorghum
crop calendar
Mar
Apr
May Jun
Gu season
Sowing
Weeding
Disaster
Impact
War
No
plantation.
Food
and
seed stocks
destroyed or
consumed.
Charlotte Dufour (ESNP Consultant)
Insecurity
The
few
seeds
that
were
sown
could not be
weeded
or
taken care of.
27
Jul
Aug
Harvest
Sept
Oct Nov Dec
Dehr season
Storing & Sowi Weeding
consumin ng
g
Yield
Availability
of
limited or seed extremely
nonlimited
existent
Draft, Nov 20th 2004
Jan
Harvest
This calendar shows how the impact of the war on the nutritional situation was increased by
the fact it occurred before the sowing season, rather than after the harvest.
It can be useful to do two calendars: one describing a “normal year”, and one describing the
present (crisis) year.
These calendars can be elaborated with population members during rapid assessments, or
used to put together and analyse the information collected on the various factors of
nutritional vulnerability. When working with population members, remember to use the local
calendars.
Key references
FAO Food and Nutrition Division (Nutrition Programme Services), 2004, Protecting and Promoting
Good Nutrition in Crisis and Recovery: A Resource Guide, Rome.
FSAU (Food Security Analysis Unit for Somalia), 2003. Nutrition: a guide to data collection, analysis,
interpretation and use. Funded by USAID/OFDA
Complete?
Charlotte Dufour (ESNP Consultant)
28
Draft, Nov 20th 2004