Menu ENN Search

Letter on Field Exchange quality control, by André Renzaho

Dear Field Exchange

A need for quality control, consistency and diligence for articles published in Field Exchange.

As an experienced practitioner and trainer in refugee public health nutrition, I have enjoyed reading the various nutritionrelated articles published in this newsletter. There is no doubt that "Field Exchange" has become a reference for both expatriate and field staff with and without a background in nutrition in terms of planning, implementing and evaluating emergency food and nutrition programs. However, over the last four years I have realized that the quality of published articles is highly variable. I therefore took a content analysis of articles and pictures published in this newsletter from issue 13 through to issue 21. The following are my findings:

Inconsistent and inaccurate definition of "global acute malnutrtion": The article by Regine Kopplow, Field Exchange 2003, Issue 20 page 22-26 is an appropriate example.

Ambiguity: In the article "community-based approach to managing severe malnutrition", published in March 2004, Issues 21: p16, figure 1 suggest a new classification of severe malnutrition. It classifies acute malnutrition into three categories: 1) complicated malnutrition, 2) severe uncomplicated malnutrition and 3) moderate uncomplicated malnutrition. Criteria for complicated malnutrition are W/H <80% or bilateral pitting oedema or MUAC<110mm and one of the following: anorexia, LRTI, high fever, severe dehydration, severe anemia and not alert. Criteria for sever uncomplicated malnutrition are W/H <70 or bilateral pitting oedema or MUAC <110mm plus appetite, clinically well and alert. The confusion is over what they have termed complicated malnutrition. It is not clear why W/H <80% was taken to be equivalent of MUAC<110mm (and not MUAC 125mm). In other words, if this new classification is to be accepted, in which malnutrition category do children with MUAC 110-125mm and who are either anorexic or have LRTI, high fever, severe dehydration, severe anemia belong to?

Lack of mutual respect, violation of intellectual property rights and egocentricity. The majority of the published articles (except those appearing in the newsletter as summary of published paper) are mainly published by western expatriate staff based either at headquarters or in the field 1) describing their representative NGOs experiences in implementing food and nutrition related programs or 2) presenting evaluation findings in terms of successes and lesson learned. In most of the cases, the authors are publishing the articles as sole authors without any mention of the contribution of the hard working local staff. It would be preferable if articles published in "Field Exchange" either acknowledges input of local staff involved in the project or invites some the staff to co-author the papers. Otherwise, the "exploitative nature" and "neo-colonial attitude" ingrained in humanitarian assistance programs will not be eradicated. The gallery of pictures accompanying the various articles and those presented at the end of each issue is testimony to "neo-colonialism". The majority of pictures imply a situation with westerners as the "master" while portraying "indigenous" as the "starved", "powerless" or "helpless". In addition, can I also point to the fact that indigenous people depicted in the various pictures/ photographs need to be consulted before their photographs are published. They need to understand from the onset how their photographs will be used. As a matter of transparency and respect, photographs/pictures that accompany the various articles published in the newsletter need to indicate whether the depicted indigenous people (including patients) granted the permission for their photographs to be published.

Recommendations: 1.The ENN editorial team needs to ensure that there is a proper process in place to scrutinize submitted articles to ensure that data presented are not misleading. There is a need to standardize malnutritionrelated concepts and ensure that, no matter how humble the project might be, presented data meet some standards of academic rigour such that the results can be internationally comprehended and compared. 2. I suggest the publication of an erratum in relation to the article by Regine Kopplow, Field Exchange 2003, Issue 20 page 22-26. 3. There is a need to reflect equality and to display non-exploitative behaviours in the gallery of pictures featuring in the newsletter as well as the articles published. Local staff may not have the infrastructure or external exposure to display their talents, but their contribution should, at least, be acknowledged.

André M.N. Renzaho

André Renzaho (B. Nutr & Diet, MPH) is currently employed at World Vision Australia as Program Quality Advisor and has just completed his PhD in Public Health Nutrition at Deakin University, Australia.

Email: renzaho@optusnet.com.au, renzah@deakin.edu.au or andre.renzaho@worldvision.com.au

 

The ENN would like to respond to the letter above. We appreciate the effort that Mr Renzaho has made in collating evidence for the 'variable quality of published articles'. Indeed on one level we would agree that quality is variable. However, rather than take this as a criticism we would argue that this reflects the very ethos underpinning Field Exchange. The publication (which we would like to insist is not a newsletter) was set up to facilitate the documentation of field level experiences in order that these should not be lost. Many field staff lack the time, professional support or confidence to produce articles for peer reviewed journals. Thus, many vital experiences are lost. Field Exchange therefore purposively encourages and publishes articles which may not meet the more rigorous standard of peer reviewed journals in the belief that such articles may provide invaluable lessons which would otherwise not be recorded or shared with other practitioners. While the Field Exchange editors try as hard as they can to ensure technical rigour, there is a risk that too many questions back to authors may 'scare off' potential contributors. It is therefore editorial policy to publish pieces that reflect the diverse technical capacity of a wide variety of humanitarian actors. We wonder whether Mr Renzaho has fully understood this fundamental aspect of our publication.

We were somewhat surprised at many of the specific technical criticisms posted by Mr Renzaho. Most of these are clearly typographical errors (probably occuring at the print setting stage). For example, '<185mm<220' is meaningless while defining malnutrition on the basis of wt/ht or ht/age <2 Z score is evidently an unintended mistake rather than a technical error. Similarly, using '£' signs as opposed to < or > is clearly a nonsense and could only be explained by typological error. The fact that Mr Renzaho chooses to highlight these insinuating poor technical quality is in our view unfair. Scrutiny of any publication (newspaper or journal) will throw up a large number of 'typos' and corrections in subsequent issues.

Some of Mr Renzaho's criticisms are more substantial. He identifies a number of articles where reported nutrition surveys have not included oedema with the significant risk that prevalence of malnutrition is under-estimated. While it may be that Field Exchange could have made an editorial comment in these cases highlighting the departure from best practice it just as well to be aware that a number of agency staff do not include oedema measurements in surveys - either due to lack of capacity to accurately assess oedema or because of lack of professional support in the field.

Mr Renzaho asks why weight for height <80% was taken to be equivalent to MUAC <110 mm in a new classification of malnutrition used in CTC involving 'complicated malnutrition' In this case it appears that he has misunderstood the classification. W/H <80% is not taken to be equivalent to a MUAC <110mm but an alternative criteria in conjunction with other criteria, ie.anorexia, severe anaemia, etc. While such a distinction is subtle it is not incomprehensible.

Finally, Field Exchange is squarely criticised for not obtaining more articles from local staff or at least acknowledging the contribution of local staff and for using photographic images which accentuate 'Eurocentrism'. Mr Renzaho also questions whether we obtain permission from each person whose photograph is used. In our defence we would like to say that we encourage authorship from local staff as much as possible and that our partner agency nutritionists attempt to support local staff in writing articles. There have been many notable successes. However, where this is not possible it seems prudent to still record the experience through international agency staff authorship rather than lose the experience entirely. If local staff have not been involved in writing a piece then attribution cannot take place. However, it is in our view a little unfair to jump from this to an accusation that international agency staff are perpetuating the "exploitative nature" and "neo-colonial attitude ingrained in humanitarian assistance programmes". The ENN are in fact attempting to increase the participation of southern based individuals/agencies. We have recently submitted two proposals for funding specifically to strengthen our capacity to target southern based agencies (ministries, local NGOs and church groups), with information about the ENN and Field Exchange, Finally, a criticism is levelled at Field Exchange regarding photographs. Most photographs are provided by agency libraries. Clearly, we cannot ask permission to publish these photos from the subject. Where Field Exchange staff take photos (this only happens occasionally) we of course as a matter of policy ask the subject for their permission to publish the photograph. We are well aware of issues of representation and the need to avoid representing subjects as passive victims. We are also only too aware that agencies (including World Vision) struggle with the very real conflict of representing reality while not wishing to perpetuate ingrained Eurocentrist views. We do our best to steer a middle ground.

We would like to thank Mr Renzaho for his vigilance in scrutinising our publication in order that typographical errors or misleading statements (where these exist) can be highlighed.

Editor

More like this

FEX: Finding the right MUAC cut-off to improve screening efficiency

Author Koert Ritmeijer, MSF Holland In Hlaing Thayer township, Yangon, Burma, ORWs were spending a considerable amount of time doing weight and height measurements on all...

en-net: MUAC only programming

Hi, I would like to ask about any experience or operational document to refer to regarding MUAC only programming in relation to therapeutic feeding programs and supplementary...

FEX: Can height-adjusted cut-offs improve MUAC’s utility as an assessment tool?

By Michel Van Herp, An Verwulgen, Bérengère Leurquin, and Pascale Delchevalerie Michael Ven Herp, Bérengère Leurquin, An Verwulgen & Pascale Delchevalerie Michael Ven Herp is...

FEX: Issue 26 Editorial

Over the years, Field Exchange has had its fair share of criticism to which the editorial team have always tried to respond positively. More often than not, we publish critical...

en-net: Borderline MUAC and Z-score measurements

What is the most appropriete practical decision should one make when confronted with cases of borderline MUACs and Z-scores of 11.5cm and <2 SD respectively in nutrition...

en-net: MUAC cutoff to screen SAM

Looking at the WHO growth standard for MUAC, one can understand the change of MUAC with age. So my concern is, is it feasible to use the same MUAC cutoff (<11.5CM) for...

en-net: Coping strategy for use of RUTF

Dear Experts,

We have RUTF stocks available through September 2019, and likely to have a national stockout of RUTF from October to December.

To mitigate the...

en-net: MUAC and Age

It has been noted that a number of 6 month old children are actually less than 65 cm.... indicates stunting. In some cases mothers are not sure of age, but from observation,...

en-net: WFH versus MUAC

I would like experts input in this regard. I wish Mark Myatt to be one of the respondent of my question. Much has been said about the discrepancy of MUAC and WFH in some...

en-net: MUAC cut off point

What things should be mentioned in deciding MUAC cut off point ? what data are need? I want to know the admission criteria and discharge criteria for severe and moderate acute...

en-net: Comparison of MUAC and W/H Prevalence?

Mark and ENN, hi all, According to the WHO/UNICEF Joint Statement on WHO child growth standards and the identification of severe malnutrition in infants and children (2009),...

FEX: Neo-Colonialism and ‘Otherness’: Representational Issues in Field Exchange

By Dorrie Chetty Dorrie Chetty is a senior lecturer at the University of Westminster UK. Her current research interests include gender, development, globalisation and media...

en-net: When will SMART / ENA support MUAC?

Just a quick question ... We now use MUAC for admission into TFP. Some use it for admission into SFP. A recent meeting in Geneva proposed that SFP admission criteria be based...

en-net: discharge criteria

I have two scenarios, which is some discharge criteria of SAM cases, and it is as follows:
1. Oedema cases: if a child has oedema (++) plus W/H <-3 Z-score, How many...

en-net: Reporting of MUAC data from nutrition and mortality surveys

I am just wondering if, in view of recently published research looking at the association between weight-for-height and body shape, and MUAC and body shape (Myatt et al Jan...

en-net: Steps to measure MUAC

Countries like Ethiopia is already introduced new method of MUAC measurement for extension health workers. it is just Estimating the midpoint of the left upper arm. the the old...

en-net: Is it valid to use similar cut-off points for prevalence of wasting using z scores for different countries and contexts?

Hi there, II faced this situation and want to to hear your ideas. We have a programme running for long, but the GAM rates during the hunger gap based on WHO standards 2006 is...

en-net: What's the spontaneous recovery rate for SAM?

If there are 20 million SAM children globally and 1 million die of SAM each year, this makes it seem that many SAM children recover without treatment (given that we know global...

FEX: MUAC versus weight-for-height debate in the Philippines

By Bernardette Cichon Bernardette is a Public Health Nutritionist who at the time of the work described in this article, worked with Action Contre la Faim (ACF). She is...

FEX: Letter on using MUAC v weight-for-height in assessment, by Mark Myatt

Recently, ENN was party to an exchange of questions and discussion between field staff and 'experts' relating to decisions on the use of readymade therapeutic products versus...

Close

Reference this page

André M.N. Renzaho (2004). Letter on Field Exchange quality control, by André Renzaho. Field Exchange 23, November 2004. p15. www.ennonline.net/fex/23/lettersandre

(ENN_2463)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.