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Contents<br />
<strong>Field</strong> Articles<br />
3 MUAC versus weight-for-height debate in the Philippines<br />
30 Examining the integration <strong>of</strong> Food by Prescription into HIV care and<br />
treatment in Zambia<br />
46 Increasing Access to Ready-to-use Therapeutic Foods (RUTF)<br />
59 Improving blanket supplementary feeding programme (BSFP) efficiency<br />
in Sudan<br />
63 Multi-pronged approach to the management <strong>of</strong> moderate acute<br />
malnutrition in Guinea<br />
Focus on coverage assessment<br />
33 Foreword<br />
34 Remote monitoring <strong>of</strong> CMAM programmes coverage: SQUEAC lessons in<br />
Mali and Mauritania<br />
37 Causal analysis and the SQUEAC toolbox<br />
39 Using SLEAC as a wide-area survey method<br />
45 News<br />
• Register now for coverage assessment workshop in Oxford<br />
• Coverage assessment forum launched on en-net<br />
• Technical Reference for SQUEAC and SLEAC Methods, 2012<br />
Research<br />
6 Qualitative review <strong>of</strong> an alternative treatment <strong>of</strong> SAM in Myanmar<br />
9 Dangerous delay in responding to Horn <strong>of</strong> Africa early warnings <strong>of</strong> drought<br />
11 Community case management <strong>of</strong> severe acute malnutrition in southern<br />
Bangladesh<br />
12 Mortality risk factors in severely-malnourished children hospitalised with<br />
diarrhoea<br />
13 Voices from the field: Optimising performance for humanitarian workers<br />
15 Exclusive breastfeeding promotion by peer counsellors in sub-Saharan<br />
Africa<br />
15 Effects <strong>of</strong> a conditional cash transfer programme on child nutrition in Brazil<br />
16 MUAC and weight-for-height in identifying high risk children<br />
17 Civil-military coordination during humanitarian health action<br />
18 Operational research in low-income countries: what, why, and how?<br />
20 Effects <strong>of</strong> agricultural and nutrition education projects on child health in<br />
Malawi<br />
21 Study <strong>of</strong> causes <strong>of</strong> persistent acute malnutrition in north Darfur<br />
22 Effects <strong>of</strong> performance payments to health workers in Rwanda<br />
23 ‘Zap’ it to me: short-term impacts <strong>of</strong> a mobile cash transfer programme<br />
24 Revisiting the concept <strong>of</strong> growth monitoring and its possible role in<br />
community-based programmes<br />
26 Political economy <strong>of</strong> adaptation through crop diversification in Malawi<br />
27 Practical challenges <strong>of</strong> evaluating BSFP in northern Kenya<br />
News<br />
48 UNHCR Technical Workshop on the Operational Guidance on the use <strong>of</strong><br />
Special Nutritional Products<br />
49 infoasaid: communication in emergencies<br />
50 Experiences <strong>of</strong> the Nutrition in Emergencies Regional Training Initiative<br />
53 Minimum Reporting Package (MRP) on Supplementary Feeding Programmes<br />
54 Improving patient assessment: The ‘MOYO’ Weight-for-Height Chart<br />
54 E-learning course on Social Safety Nets<br />
55 En-net update<br />
55 Attractive scholarship for EDAMUS Masters programme<br />
55 Government <strong>of</strong> Sudan CMAM Training Course on Inpatient Management <strong>of</strong><br />
Severe Acute Malnutrition: Training Materials (2011)<br />
56 UNHCR standardised nutrition survey guidelines and training<br />
57 Putting nutrition products in their place: ACF position paper<br />
58 Conference on government experiences <strong>of</strong> CMAM scale up, Ethiopia, 2011<br />
Evaluation<br />
61 Evaluation <strong>of</strong> Concern’s response to the Haiti Earthquake<br />
63 Review <strong>of</strong> Integrated Food Security Programme in Malawi<br />
Agency Pr<strong>of</strong>ile<br />
32 Centres for Disease Control and Prevention (CDC), International<br />
<strong>Emergency</strong> and Refugee Health Branch (IEHRB)<br />
68 Obituaries<br />
From the Editor<br />
This <strong>issue</strong> <strong>of</strong> <strong>Field</strong> <strong>Exchange</strong> gives extended coverage to a<br />
briefing paper just released by Oxfam and SC UK on the<br />
2011 response to the Horn <strong>of</strong> Africa crisis. This paper argues<br />
that the response was late and led to the unnecessary<br />
deaths <strong>of</strong> between 50,000 to 100,000 people, at least half <strong>of</strong> whom<br />
were children under 5 years. According to the authors, there was<br />
sufficient early warning to trigger a response as early as November<br />
2010 but the main response only unravelled in July 2011, following<br />
declaration <strong>of</strong> famine and concerted media coverage. The paper<br />
identifies the usual litany <strong>of</strong> reasons for <strong>this</strong> failure <strong>of</strong> response, i.e.<br />
only responding when media attention is overwhelming, politically<br />
influenced decision-making, time-lags between early warning and<br />
appeals, making appeals on the basis <strong>of</strong> capacity to deliver and<br />
access rather than need, inability to act on risk and forecasts and the<br />
divide between development and emergency programming and<br />
funding. These reasons are familiar to most <strong>of</strong> us and were largely<br />
applied to analyses <strong>of</strong> previous failures <strong>of</strong> response going back as<br />
far as the Sahelian famine <strong>of</strong> 1984. However there is a coherence<br />
and clarity in <strong>this</strong> paper, particularly in the way it trains its focus on<br />
the need for future response to be based more upon risk reduction<br />
and the institutional structural change needed to support such an<br />
approach.<br />
The ENN fully supports the recommendations in <strong>this</strong> briefing<br />
paper and believes that <strong>this</strong> important document can provide a<br />
powerful advocacy tool for change. Some <strong>of</strong> the <strong>issue</strong>s around the<br />
emergency/development divide raise uncomfortable questions for<br />
the ENN itself, which we will reflect upon in due course. There is<br />
however one important element <strong>of</strong> the analysis which we feel is not<br />
adequately addressed in the report. This relates to the relationship<br />
between early warning and donor response and the recommendation<br />
for use <strong>of</strong> earlier triggers and risk analysis. These<br />
recommendations are hardly new and have been made repeatedly<br />
over the past 25 years. The piece <strong>of</strong> the jigsaw that is still missing is<br />
the lack understanding and transparency about ‘how donors make<br />
decisions whether to respond’. The failure <strong>of</strong> donor response over<br />
many years in certain high pr<strong>of</strong>ile emergencies suggests that there<br />
are complex political and institutional processes that hinder timely<br />
and effective response, including the type <strong>of</strong> risk taking advocated<br />
in the Oxfam/SC UK briefing paper. The nutrition community,<br />
perhaps not unsurprisingly, continues to focus on ‘technical’ solutions,<br />
yet until we have a better understanding <strong>of</strong> the constraints<br />
faced by donors and their ‘room for manoeuvre’ to effect change,<br />
our technical solutions will have little impact on response. We therefore<br />
strongly support any advocacy efforts that encourage donors<br />
to systematically analyse their decision-making processes during<br />
emerging crises and to make such findings publically available.<br />
And now to the rest <strong>of</strong> <strong>this</strong> <strong>Field</strong> <strong>Exchange</strong> edition. <strong>Field</strong> articles<br />
in <strong>this</strong> <strong>issue</strong> <strong>of</strong> <strong>Field</strong> <strong>Exchange</strong> (no 42) can largely be divided into<br />
those related to the treatment <strong>of</strong> severe acute malnutrition (SAM)<br />
and those related to treatment and prevention <strong>of</strong> moderate acute<br />
malnutrition (MAM). Three <strong>of</strong> the SAM related articles describe the<br />
experience <strong>of</strong> conducting different types <strong>of</strong> coverage surveys for<br />
community based management <strong>of</strong> acute malnutrition (CMAM)<br />
programmes and feature in a special section <strong>of</strong> <strong>this</strong> <strong>issue</strong> on coverage<br />
assessment. An article by Ernest Guevarra, Saul Guerrero, and<br />
Mark Myatt describes the use <strong>of</strong> the SLEAC method to assess<br />
national level coverage <strong>of</strong> CMAM in Sierra Leone. The advantage <strong>of</strong><br />
the approach is that relatively small sample sizes are required to<br />
make accurate and reliable classifications <strong>of</strong> coverage and to identify<br />
barriers to programme access. Assessments can therefore be<br />
completed relatively quickly. The authors conclude that the SLEAC<br />
method should be the method <strong>of</strong> choice when evaluating coverage<br />
<strong>of</strong> CMAM programmes at regional or national level. An article by<br />
Jose Luis Alvarez Moran, Brian Mac Domhnaill and Saul Guerrero at<br />
Action Contre la Faim (ACF) describes the experience <strong>of</strong> conducting<br />
remote SQUEAC investigations in Mali and Mauritania where certain<br />
areas are difficult to reach by external investigators. The approach<br />
does require greater reliance on field teams, as well as strengthening<br />
or modifying certain SQUEAC processes, e.g. separating the data<br />
collection and analysis processes, using new technologies and<br />
addressing supervision and motivation <strong>issue</strong>s proactively. A third<br />
article on coverage assessment describes the use <strong>of</strong> the SQUEAC<br />
method to undertake a causal analysis <strong>of</strong> SAM in rural areas <strong>of</strong> eastern<br />
Sudan. The data collected were sufficient to identify risk factors<br />
and risk markers (i.e. diarrhoea, fever, early introduction <strong>of</strong> fluids<br />
other than breastmilk) that were associated with SAM. The authors<br />
suggest that it is possible to use the SQUEAC toolbox to collect<br />
causal data using staff trained as SQUEAC supervisors and trainers,<br />
although data analysis may require staff with a stronger background<br />
in data-analysis.<br />
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