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Nutrition Cluster Coordination (NCC)
Meeting Minutes
10 th June, 2012 - Sanaa - WFP office
Participants:
Name Agency Email Address
Mr.Nagib Abdulbaqi UNICEF nabdulbaqi@unicef.org
Mr.Abdulkarim Al-Hubaishi WFP abdulkarim.al-hubaishi@wfp.org
Ms.Latifa Beltaifa WFP latifa.beltaaiefa@wfp.org
Dr. Isam –AlDeenAwad CSSW info@csswyemen.org,
Dr Hisham Musleh IOM artols2002@yahoo.com
halqubati2@gmail.com
Dr Wafa AlSaedi MDM-F sanaa.mdm.assisstant@gmail.com
Dr Wisam Al Timimi UNICEF waltimimi@unicef.org
Mr.Jean Pierce ICRC jnezeyalagabo@icrc.org
Mr.Mubarak Ahmad ICRC muahmad@icrc.org
Ms.Lenna Abdullah MOPH eryan_7@yahoo.com
Mr. Farouk Al Salihi IFAD f.al-salihi@ifad.org
Ms. Marie Thomes Vision-Hope Marie.thomas@vision-hpoe.org
Mr.Rene.de Vnies ECHO Rene.de-vnies@echofield.eu
Mr.Beka Teshome RI bekates@yahoo.com
Dr AbdulKarim Nasser YRC Nasr.196.@hotmail.com
Mohammed Nayef Intersos Harad.yemen@intersos.com
Dr. Agostinno Munyiri UNICEF amunyiri@unicef.org
Dr. Mohammed Al-Emad WHO alemadm@yem.emro.who.int
Dr. Fekri Dureab WHO fekridureab@yahoo.com
Ms. Nashwa Hazaa WFP Nashwa.Hazaa@wfp.org
Mr. Ahmed Al Garbani MSFE Msfe.sanaa-med@@barcelona.msf.org
Michiko Kyokan MSFE Msfe.sanaa-med-dep@@barcelona.msf.org
Dr Lodesani Cuodia MSFF Msff-sanaa-medco@paris.msff.org
Dr. Nader Makki IMC nadermakki@yahoo.com

Purpose of the meeting: This is an extra ordinary cluster meeting to present the results of
Hajjah SMART survey and discuss with partners the recommendations and the way forward:
The meeting chaired by Dr. Agostino Munyiri :
Mr Nagib Abd Al Baqi presented the finding as per the attached , it was updated that Hajja
governorate nutrition surveys have been conducted through the collaboration of Nutrition
Cluster, MoPH , UNICEF and local authorities across the low land, mountains areas and IDP
camps of the governorate. The main purposes of the surveys are to assess the Nutrition
Situation of the Low Land, Mountains areas and IDP camps of the Hajja Population and
assessment of Infant and Young Child Feeding practices, Morbidity,Mortality and Water,
Sanitation and Hygiene practices to make recommendations for interventions.
A brief outline was presented on the methodology, geographical location where the surveys
were conducted and samples size used for the survey. It was also indicated that the quality
control measures were taken during the survey implementation to ensure appropriate
sampling procedures, anthropometric measurements, representativeness and reliability of
findings. The overall quality of each survey was presented and all the key characteristics of
the WHZ curve were found within the plausible range for all surveys and were in line with
the quality standards.
It was noted that the Hajja governorate Nutrition Survey results revealed a critical nutrition
situation in the IDP camps and in Lowland Ecological Zone, exceeding the emergency
threshold of >15% GAM rate while the rate in the Mountainous zone indicate that the
nutrition situation is poor. Global Acute Malnutrition rate of 15.7 % and Severe Acute
Malnutrition rates of 3.0 % are recorded in the IDP camps. GAM rate of 21.6% and
SAM rate of 3.7% are recorded in Lowland Ecological Zone. GAM and SAM rates in
the Mountainous Ecological Zone were 9.3% and 0.9%, respectively. These results
indicate a very worrying and critical situation with high risk of malnutrition related death if
emergency response is not delivered or if it’s interrupted. The prevailing aggravating factors
like high morbidity, inadequate sanitation conditions and poor feeding practice are just likely
to depress this critical nutritional condition.
Discussion around recommendations:
As a result, continuation/expansion of the existing nutrition interventions including the
CMAM programme and district level humanitarian needs micro planning were
recommended. Improving access to safe water and sanitation, promoting key child feeding
and hygiene practices and health education at the community level were also found a concern
to the surveyed areas. The recommendations were provided to participants for their feedback,
but later it was agreed that (Action point) :the whole survey reports to be circulated in an e-
mail for participants feedback and inputs within one week , Mr Nagib will be the focal point
for compilation .
Next step, the chairman opened the floor for discussion and invited the participants to ask
questions and provide feedbacks.
MSFE reported implementing rapid nutrition assessments in their operational areas and found
low prevalence of malnutrition by MUAC and it was requested for explanation why there is a
difference in the prevalence of malnutrition between the MSF survey and the current SMART
survey. It was pointed out that the results of the rapid assessments using MUAC screening
and standard nutrition survey by SMART are not comparable because of completely different
methodological approach. It was also further elaborated that SMART methodology is an
international golden standard method to provide the necessary information on nutrition and

elated factors, to help inform decision makers and stakeholders of the nature and scale of the
nutrition situation and for the purposes of guiding the design and implementation of an
appropriate response. On its part, MSFE acknowledged that their rapid assessment results
using MUAC screening and the standard nutrition assessment result using SMART
methodology are not comparable and requested UNICEF to share the MUAC results in the
SMART assessment. Nagib Abdulbaqi revealed that in the Hajja governorate survey, the
team have also taken MUAC measurements from the study subjects and will share the finding
to the interested partners.
Recommendation: The head of Nutrition in the Ministry of Public Health emphasized that
future nutrition assessments/Surveys should be planned in consultation with the MOPH so
that the government is aware of what was going on and ensure that all assessments in the
country are conducted according to agreed standard SMART methodology.
Explanation why there was low death rate reported despite the prevalence of acute
malnutrition is above the emergency threshold. It was explained that the relationship between
mortality and acute malnutrition as measured by Weight-for-Height (W/H) is a complicated
scenario and still the global debate. However, mortality is usually estimated as an average
over the previous several months and GAM with W/H is a cross-sectional snapshot.
Secondly, the analysis is ecological (i.e. we are not looking at the risk of death in wasted
individuals but the correlation between a previous mortality rate and a current GAM
prevalence in a population). Thirdly, W/H may only be weakly associated with mortality so
GAM by W/H may be weakly correlated with mortality. Finally, an important thing to
consider is that the relationship between malnutrition and mortality is not a fixed relationship.
Most deaths among malnourished children are attributable to disease/infection rather than
simply a lack of nutrients. A major factor in the association is the amount of exposure to
infection the malnourished children face. Malnutrition makes people vulnerable to infection
(and therefore to death), so the higher their exposure, the more likely they will be to contract
some infection their bodies would have difficulty in fending off because of their poor
nutritional status. The high GAM rate but low mortality in Yemen could be due to a number
of factors like; a very recent, rapid rise in malnutrition; or low exposure to infection or even
the timely intervention and health services to treat infections as they arise. The fact that the
prevalence of oedema was ‘zero’ could also give some explanation to this complicated
scenario. It’s also worth arguing that the situation of high GAM by W/H with low mortality
could be as simple as "lots of death coming quite soon" if lifesaving intervention are not in
place to salvage the situation.
In conclusion, interpreting mortality and GAM assessed at the same time needs to be treated
with caution since the mortality estimate is (usually) for the period before the GAM estimate.
The SMART method cannot distinguish between rising and falling mortality and it must be
noted that a typical mortality survey reports on what has happened on average in the past not
what is happening now.
Recommendation: A stand-alone prospective study is required to fully understand this
scenario.
Participants also asked about the source of mortality data as well as the recall period. It was
explained that the mortality data was gathered from mother’s recall and the recall period was
90 days. It was also described that in Yemen, there was poor record in birth registration as
well as death certificate.
MSF also raised a question why there were less deaths in the therapeutic feeding centers of
their operational areas. The chairman recommended a bilateral discussion between MSF and
UNICEF experts to further discussion on this topic, and get clarity on the MUAC versus

anthropometric measurements, to have only one clear message going out on the prevalence of
malnutrition in the surveyed areas. See Addendum.
Comparison with the previous survey in July 2011: The overall nutrition situation after the
survey in July 2011 was discussed. Although the results of the July 2011 and the current
survey are not directly comparable due to seasonality, it was noted that there was a decrease
(not an improvement as the current magnitude also showed the level is still above WHO
emergency threshold) in the prevalence of acute malnutrition .The change in the level of
acute malnutrition in the IDP population over the past 10 months could be attributed to the
various interventions going on. These includes expansion of the service coverage to 12 OTP
as well as 6 SFP, health and hygiene promotion activities, water supply and sanitation
interventions and extensive capacity building of the service providers.
A comment was raised, why Hayran district was not included in the assessment? It was
explained that the Hayran district was included in the sampling frame together with Khayran,
Harad, Abs and Mustaba districts.
A participant also asked if it’s possible to see the correlation between the feeding practice
indicators and acute malnutrition. It was explained that the proportion of 6-24 months in the
sample is not adequate to conduct the causal relationship analysis and separate study are
required to fully understand such relationship.
It was also commented why the sanitation practice among the IDP population was low while
there was a hygiene promotion campaign undergoing since 2009 in the camps . It was
explained that outside the camp the sanitation condition is poor as indicated by lack of latrine
(as an example).
It was also suggested that information sharing on the capacity building activities should be
available for partners.
AOB
UNICEF informed partners that the Rayma survey was also completed and the results of the
mentioned survey will be shared with partners during the next Cluster meeting.
UNICEF also updated partners on the upcoming planned nutrition surveys that will be
commenced in the various governorates in the coming weeks. As per the CFSS, it was
mentioned that Lahj, Ibb, Sanna rural and Aden are the priorities in the next round of
SMART surveys.
Action point: (1) UNICEF bilaterally discuss with MSF after the meeting
(2) NCC to circulate the Hajja SMART survey report to cluster members to
submit their comments/feedback with in 1 week (late by Monday, 18 th July
2012).
The meeting was adjourned at 10:30 AM.

Addendum -1-
Side meeting UNICEF, MSF, WHO:
The bilateral discussion between UNICEF and MSF was conducted immediately after the
meeting. The WHO representative was also presented during the discussion. As per MSF
request, the IDP MUAC results of the Hajja governorate was shared with them. Accordingly,
the MUAC results for proxy SAM was 1.4% and the proxy GAM was 7.9%. During the
discussion, it was mentioned that the interpretation of the MUAC should be made with
caution in the Yemeni context. As an example, the Somalia scenario was raised where the
proxy SAM >1.0% is considered as a reference indicator for critical and very critical nutrition
situation. During the bilateral discussion, MSF also raised a question as to why there was low
death in the TFC where they are implementing the therapeutic programme. It was described
that it could be due to sub-optimal progarmme coverage, where poor families in rural villages
couldn’t access the TFC service (for e.g., could be because unable to afford the transport cost,
or the awareness within the community regarding the programme). It was pointed out that
well designed and intensive community mobilization and outreach service complimented by
effective mobile team is useful to increase the service coverage. It was also described that the
low death in the TFC where MSF is working cannot fully described in the meeting as there
are different factors contributed to that. Finally, MSF assured not to provide press release in
regards of the nutrition situation based on the MUAC findings to ensure that similar message
send out among cluster partners, donors and the global community at large.