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Taking forward research on adult malnutrition

Summary of ongoing research By Laura Wyness, Researcher, University of Aberdeen, UK

Adult malnutrition was initially put on the agenda of the United Nations Standing Committee on Nutrition (UNSCN) Working Group on Nutrition in Emergencies meeting in April 1999. The current position of research in this area is that there is no consensus on standards or indices to assess malnutrition in adults in complex emergencies. At the UNSCN meeting in 2001, research priorities, identifying steps to improve the assessment of adult malnutrition, were agreed. Since then, the thematic group on adult malnutrition within the working group has becoming increasingly active. Work is now being taken forward through a unique academic - NGO (non-governmental organisation) partnership, inter-linked by PREN (Partners for Research in Emergency Nutrition), a recently established collaborative research group at the University of Aberdeen, (figure 1).

Working in partnership with NGOs, bilateral and global organisations, PREN aims to carry out much needed epidemiological and evidence-based practice research, driven by questions from the field, within the area of malnutrition in complex emergencies. A Memorandum of Understanding (MoU) has been developed to provide assurance to all members involved in the project on issues such as data ownership, publication, confidentiality and management of the arrangement.

This exciting partnership work has enabled research on severe adult malnutrition to be actively taken forward. Completion of this project is planned around the end of 2005. The project group will ensure regular dissemination between field and academic areas.

Aims

The aims and objectives of the project were defined over several months through discussions between PREN and the HSAG. The main aims of the project are first, to carry out a robust, standardised Systematic Critical Literature Review (SCLR), to explore the indicators of nutritional status available to assess severe adult malnutrition. Secondly, to develop techniques for assessing routine, retrospective field data on severe adult malnutrition that has been collected by different NGOs. This form of data is being used, as it will include a broad range of contexts and populations. This work will help achieve the third aim to develop a model to aid the assessment of severe malnutrition in adults during complex emergencies.

Literature

The SCLR will search for, quality assess and summarise the evidence identified in the published and unpublished literature on methods currently used, and methods that could be used, to assess the nutritional status of adults during a complex emergency. The methods of nutritional assessment may include anthropometric and functional indications, clinical signs, and contextual or situation indicators.

Initial Survey

In the initial stages of this project, a survey was conducted to investigate the type of data collected by NGOs, the problems experienced when collecting this data and the format of the data. A total of 27 NGOs were contacted and asked to complete a questionnaire (response rate 60%). The findings from this survey were used to inform the planning of the project.

The current stage of the project is to request routine retrospective field data on severe adult malnutrition from NGOs. To facilitate the preparation of the data for analysis, data from a few NGOs will be initially requested, with other NGOs being contacted as required. The data initially requested will consist of databases of Therapeutic Feeding Programmes (TFPs) and nutritional surveys (on database and hardcopy, if available). Context variables will be sought from Food Security Reports and Head of Mission Reports.

Table 1 Project Research Questions
Questions at Population Survey Level Why do you find significant numbers of severely malnourished adults in some crises and not in other crises?
Do context factors give a direction of risk of severe malnutrition in an adult population, taking different levels of anthropometric measures as the dependent variable?

Can context factors inform/help interpret and generalise findings from specific surveys done in specific contexts?

On a descriptive basis, analysis will be carried out on two levels, i) Acute and ii) Acute-onchronic emergency situations. Each level will aim to take into account the prevalence of co-morbidities (e.g. HIV/TB).

Questions at Feeding Centre Population Level Are the associations found at the population survey level also seen at the TFP population level, (i.e. what context factors characterise the situation in a TFP with significant numbers of severely malnourished adults)?
How are context factors associated with different levels of anthropometric measures?

Data Analysis

Descriptive statistics of each NGO's dataset will be carried out and findings reported back to that particular NGO. Analysis of the data will be carried out at two levels. The specific questions that the data will be used to address are shown in table 1.

For further information contact: Laura Wyness, PREN Researcher (l.wyness@abdn.ac.uk) and Dr Jane Knight, PREN Project Leader, (PREN@abdn.ac.uk) University of Aberdeen, Department of Public Health, Medical School, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland UK.
Tel: +44 (0)1224 551883 Fax: +44(0)1224 550925

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Reference this page

Laura Wyness (2004). Taking forward research on adult malnutrition. Field Exchange 22, July 2004. p10. www.ennonline.net/fex/22/taking