From the editor

An aerial view of Darfur, Sudan
The role of data and analytical tools in guiding and evaluating emergency programming figures strongly in this issue of Field Exchange. There are two field articles which shine light on the causes of malnutrition in very different contexts. ACF-USA carried out a baseline survey in an area of the Democratic republic of Congo (DRC) where high levels of Konzo are reported. The survey identified key causes of Konzo which included not using enough water during cassava preparation underpinned by lack of access to water. Programme recommendations were framed accordingly. The second article, written by FSANU, examined trends in rates of malnutrition amongst pastoralists in Somalia and showed how these are strongly correlated with milk availability and seasonal factors. This finding is in line with other work reported in Field Exchange1.
A further two field articles report on the impact of cash-based interventions on a variety of outcomes. The first is a cash for work programme in Guinea where impact on food consumption, income and coping strategies are measured. The second is an income generating activity programme involving cash grants and training in southern Sudan where impact on coping strategies, hunger levels and MUAC are measured.
The importance of monitoring is a key issue in the WFP evaluation of their 2009 EMOP (Emergency Operation) in Darfur. Here, the evaluation describes how the Darfur Food Security Monitoring System (DFSMS), which WFP established in 2009, showed not so much the impact of the General Food Distribution (GFD) but the lack of impact of a reduction in the GFD. For a variety of reasons, WFP had to reduce the ration during 2009, first to 70% and then 60% of a full ration. Taking account of milling and transport costs, as well as taxes to sheiks, there were times in the year when beneficiaries were making do with less than a half a full ration. However, the DFSMS showed no change in prevalence of malnutrition, mortality or coping strategies/ livelihood activities. The evaluation concluded that this reflected the disconnect between numbers registered and actual numbers, i.e. there was significant over-registration, as well as the reasonable harvest in many parts of Darfur and alternative livelihood options amongst the internally displaced population (IDP).
The research section of this issue of Field Exchange also has a strong focus on assessment and evaluation. An article by World Vision analyses the causes of malnutrition amongst the Dinka in southern Sudan. These are found to be largely embedded in social and cultural practices. There are two research pieces relating to food security measurements in Zimbabwe. The first looks at food security differences between adults and children in the same household and concludes that children tend to have worse food security. The implication being that household level targeting of interventions is not always appropriate. The second article describes the use of different measures of food security, i.e. Household Dietary Diversity Score (HDDS), months of food shortages, and the Household Food Insecurity Access Scale (HFIAS). It found that used separately, these different measures provide unique insights into the level and type of food security. The authors conclude that it may be best to combine different measures of food security to obtain a fuller picture of the situation and therefore enable the design of more appropriate responses.
Another study examined data from Indonesia during 1998 when prices of foods went 'through the roof' - the consumer food price index went up 188% at a time when various subsidies on food were removed. The authors conducted the analysis at two levels in an attempt to assess impact on food access. First, using the Starchy Staple Ratio (SSR) as the summary measure of household nutritional welfare, they assessed the impact of the dramatic change in food prices on household dietary composition. Secondly, the authors examined how the income elasticity of the SSR differs in the two survey rounds characterised by very different relative prices between cereals and other major food groups. The results suggest that cash transfer programmes may be even more effective during crises to protect the consumption of many essential micronutrients compared with non-crisis periods. However, in order to ensure that all micronutrients are consumed, specific nutritional supplementation programmes are also likely to be required, especially for nutrients like Vitamin C.
A study based on nutrition and mortality data from the Horn of Africa set out to assess criteria for emergency intervention decision-making based on associations between child wasting and mortality from 2000 to 2005. The analysis found that higher rates of global acute malnutrition (GAM) were associated with increased mortality of children under 5 years of age and that the association was stronger among populations with pastoral livelihoods than with agricultural livelihoods. Although GAM is therefore more effective in identifying groups with higher mortality risk for those practicing some pastoralism, there is still a useful predictive power for agricultural populations, with lower GAM cutoff points. In all groups, spikes of GAM and under five morality rate (U5MR) corresponded with drought (and floods). The authors conclude that different GAM cutoff points are needed for different populations. For example, to identify 75% of U5MR above 2/10,000/day, the GAM cut-off point ranged from 20% GAM in the Rift Valley (Kenya) to 8% in Oromia or SNNPR (Ethiopia) or from 15% for pastoralists to 10% for agropastoralists.
Another article questions the appropriateness of current Sphere standards for protracted (IDP) situations. The summary focuses on the current nutrition standards. The authors argue that there is no framework that analyses particular risk factors for nutritional deficiencies in protracted displacement and thus no appropriate standardised recommendations exist. They suggest a collaborative effort - modelled on the Sphere process - is needed to address this.
Finally, there are two summaries of studies on the cost-effectiveness of community managed programmes for the treatment of severe acute malnutrition - in Ethiopia and Malawi. The Ethiopia study compares community based therapeutic care (CTC) cost-effectiveness with centre based therapeutic feeding programmes costeffectiveness, whereas the Malawi study determines cost-effectiveness of community based management of acute malnutrition (CMAM) in terms of disability-adjusted life years (DALYS). In both cases, the community-managed interventions are found to be highly cost-effective.
A number of cross-cutting issues and conclusions emerge from all these articles and studies. First, there appears to be an unstoppable process whereby measurement and analytical tools are continuously being refined or developed anew. In one sense this is encouraging, as these analytical advances provide greater insight into problems and how best to address these.

Second, and admittedly based only upon the snap-shot of experiences and research in this issue of Field Exchange, those agencies with an interest in impact measurement of food and nutrition programmes appear to be placing less emphasis on anthropometric indicators and more on a range of nutrition-related indicators or tools. These indicators or tools are able to help explain cause of malnutrition or how an intervention may be impacting nutrition, i.e. they provide plausible models of impact. Again, this is encouraging as nutrition and/or mortality data on their own may tell us little about processes that either lead to malnutrition or positively impact malnutrition.
Finally, and perhaps on a more discouraging note, this expansion of indicators and tools may lead to less standardisation of approaches used in assessment, monitoring and evaluation, and therefore greater difficulty in making comparisons between programmes and their impact. In this issue of Field Exchange this is seen most obviously in two sets of articles (cost effectiveness of CMAM/CTC and impact of cash transfer programmes). While it may be argued that a 'free market' for the development of different analytical tools will lead to more creativity, innovation and ultimately better practice, the down-side is that decision-makers are less able to make comparisons and learn from the myriad of field experiences out there. Donors in particular are affected by the plethora of approaches used by agencies to justify interventions and then measure their impact and are increasingly calling out for greater standardisation of assessment and monitoring tools amongst agencies. There is clearly a balance to be struck here and it is perhaps difficult to say where the line should be drawn. However, the current free-for-all and resulting lack of standardisation may well undermine achievements and should alert us once again to the need for stronger leadership in our sector to guide how we make assessments and then evaluate our response.
Jeremy Shoham, Editor
1Analysis of the 1996 Konzo outbreak in Democratic Republic of Congo. Field Exchange, Issue No 17, November 2002. p7. http://fex.ennonline.net/17/analysis.aspx
More like this
FEX: WFP evaluation of emergency operation in Sudan
Fasher-Kabkabiya and Kutum-Fasher, Dafur Summary of evaluation1 The World Food Programme (WFP) recently published an evaluation of their general food distribution programme...
FEX: Livelihoods analysis and identifying appropriate interventions (Special Supplement 3)
3.1 Livelihoods assessment and analysis in emergencies The livelihoods framework provides a tool for analysing people's livelihoods and the impact of specific threats or shocks...
FEX: Impact of cross-sectoral approach to addressing konzo in DRC
By Marie-Morgane Delhoume, Julie Mayans, Muriel Calo and Camille Guyot-Bender Marie-Morgane Delhoume is an agricultural engineer specialising in agro-development of tropical...
FEX: A cross-sectoral approach to addressing Konzo in DRC
By Dr. Emery Kasongo and Muriel Calo Emery Kasongo is the ACFUSA Project Manager who led the study described. Previously he has worked as national consultant on several food...
FEX: Blanket BP5 distribution to under fives in North Darfur
By Hanna Mattinen, ACF Since 2005, Hanna Mattinen has been Food Aid Advisor at the Action contre la Faim (ACF) headquarters, focusing on policy and operational issues around...
FEX: Practical pointers for prevention of konzo in tropical Africa
By J.H Bradbury, J.P.Banea, C. Mandombi, D, Nahimana, I.C. Denton and N. Kuwa Dr J Howard Bradbury, Emeritus Fellow, Australian National University, developed the cassava...
en-net: Relationship between Mortality and Acute Malnutrition
In most surveys I have seen, there is a positive linear relationship between CMR/U5MR and acute malnutrition. Also, the report...
FEX: From the editor
Group of women participating in a focus group discussion This is another bumper issue of Field Exchange, with eight field articles and just under 20 research summaries. On the...
FEX: Suspected toxic ingestion outbreak in central Afghanistan
By Gerald Martone, International Rescue Committee (IRC) Gerald Martone is the Director of Emergency Response at the International Rescue Committee's Headquarters in New York....
FEX: Study of causes of persistent acute malnutrition in north Darfur
Summary of study1 Children and their caregivers enrolled in the BSFP In spite of national and international efforts to manage the devastating impact of the conflict in Darfur...
FEX: Contextual data collection in nutrition surveys in Ethiopia
Women carrying grass grown in the Awassa region of Ethiopia, which they sell in the market to get a small income. Summary of analysis1 The study described in this article was...
FEX: Issue 30 Editorial
Many pieces in this issue of Field Exchange strengthen our understanding of best practice in nutritional emergencies. We highlight four in this editorial. Victoria Sibson from...
FEX: Distribution of WFP food aid in West Darfur
Summary of research1 Receiving WFP food aid in West Darfur In order to investigate the evolution of the humanitarian situation in Darfur, trends in nutritional status and...
FEX: Support for primary production (Special Supplement 3)
7.1 Introduction This section focuses on supporting agricultural production, in particular farming and livestock production, as livelihood strategies. Production support can...
FEX: Constraints to achieving Sphere minimum standards for SFPs in West Darfur: a comparative analysis
A view of Mornei camp The current conflict in Sudan's westernmost state of Darfur began in early 2003, although most humanitarian agencies only gained access to the area and...
FEX: Gender impact analysis of unconditional cash transfers in south central Somalia
Summary of published research1 A woman tiedyes clothing Location: Somalia What we know already: Cash transfer programming can positively impact on nutrition and food...
FEX: Grounding Food Security Monitoring in an Understanding of the Local Economy: Understanding differences – and making a difference
This article was written by Philippa Coutts of The Food Economy Group, using an illustration from Darfur and work of Yousif Abubaker, Abdel Rahmin Nor Hussein and Mohamed Salih...
FEX: Multi-sector, nutrition-sensitive response to drought emergency in Pakistan
By Ali Dino Kunbher, Shafqat Ullah and Dr Mazhar Alam View this article as a pdf Click here to listen to an interview with the authors on the ENN podcast channel Ali Dino...
FEX: Piloting LQAS in Somaliland
By Tom Oguta, Grainne Moloney and Louise Masese Tom Oguta has been working with FAO/FSAU in the Nutrition Surveillance Project in Somalia as a Nutrition Project Officer for...
FEX: Milling vouchers in Dafur to optomise food aid
By Hanna Mattinen and Loreto Palmaera Hanna Mattinen has been Food Aid Advisor at the ACF headquarters since 2005, with a focus on food assistance and cash-based...
Reference this page
Jeremy Shoham (). From the editor. Field Exchange 41, August 2011. p2. www.ennonline.net/fex/41/fromtheeditor
(ENN_4192)