1. Autier, P. Nutrition assessment through the use of a nutritional scoring system. Disasters. 1998; 12(1): 70-80.
Abstract: In 1984 and 1985, Chad was affected by a large-scale drought. In order to ensure rapid decision making for the allocation of food and because of the practical problems encountered when using the classical nutritional survey methods, a Nutritional Score System (N.S.S.) was developed. This method was based on the use of social, economic and nutritional indicators and allowed comparison of nutritional status between communities. This paper discusses how the N.S.S. was developed and applied, and how it compared with the classical survey methods.

2. Benini, A. A. Armed conflict, access to markets and food crisis warning: a note form Mali. Disasters. 1992; 16(3): 240-248.
Notes: Abstract written by Tulane University.
Abstract: Prediction of famines has historically been based on the interpretation of a set of market indicators adopted for use in early famine warning systems. More recent work on famine prediction has advocated the importance also of socio-economic (agricultural and community health) indicators to warn against situations of famine. While the value of these indicators are established for populations living in a stable political situation, a different set of indicators may be necessary to predict a situation of impending food crisis in an area affected by war. In an attempt to address such a need, this article discusses the problems associated with the use of traditional market and socio-economic indicators for famine prediction in conflict situations and recommends a different approach be adopted for early famine warning in situations of armed conflict.

3. Bern, C. and Nathanail, L. Is mid-upper-arm circumference a useful tool for screening in emergency settings? Lancet. 1995 Mar 11; 345(8950): 631-3.
Keywords: Anthropometry: methods/ Arm: *anatomy & histology/ Body Height/ Body Weight/ Child Nutrition Disorders: *diagnosis: epidemiology/ Child, Preschool/ Emergency Medical Services/ Human/ Infant/ Infant, Newborn/ *Nutrition Assessment/ Nutritional Status/ Refugees/ Rwanda: epidemiology/ War
Notes: COMMENTS: Comment in: Lancet 1995 Apr 29; 345(8957): 1119-20
COMMENTS: Comment in: Lancet 1995 Apr 29; 345(8957): 1120
Abstract: In refugee emergencies, rapid collection of nutritional data provides important information for public-health planning. In Rwandan refugee camps in eastern Zaire in August, 1994, a two-step procedure of screening for referral to supplementary feeding programmes was used-- mid-upper-arm circumference (MUAC) followed by weight-for-height for children with MUAC of less than 12 cm. To assess the usefulness of this procedure, we analysed data from complete screening of 3681 children in three camps. The performance of MUAC varied with the cut-off chosen; a high cut-off of 14 cm allowed detection of 88% of children with low weight-for-height but at the cost of measuring more than 40% of children in the second step. MUAC preferentially selects younger children as malnourished, and misses older children with low weight-for- height. The groups of children chosen by low MUAC and by low weight-for- height have poor overlap, varying from 20% to 39% overlap depending on age. Thus two-step screening does not save as much time as might be expected and low MUAC cannot be used as a substitute for low weight-for- height. For decision-making in refugee settings, weight-for-height surveys or screening are probably more efficient strategies for data collection.

4. Binkin, N.; Sullivan, K.; Staehling, N., and Nieburg, P. Rapid nutrition surveys: how many clusters are enough? Disasters. 1992; 16(2).
Abstract: On the basis of theoretical considerations, population-based nutrition surveys of 30 clusters of 30 children should provide reasonably valid estimates of the prevalence of malnutrition with at least 95 percent confidence that the estimated prevalence differs from the true value by no more than 5 per cent. In areas of famine in Africa, where an urgent need often exists for rapid nutritional assessment to determine the extent and severity of the problem, visiting 30 sites is often logistically difficult. To determine the effects of using fewer than 30 clusters on the validity and precision of the estimated level of undernutrition, we used data from the 1983 Swaziland National Nutrition Survey and from rapid nutrition surveys performed in 1984 and 1985 in Burkina Faso, Guinea, and Niger. Fewer than 30 clusters may result in point prevalence estimates that differ dramatically from the true prevalence and, in most instances, are less precise. In contrast, little is gained by collecting more than 30 clusters. In summary, around 30 clusters provide relatively valid and precise estimates of the prevalence of undernutrition, and every effort should be made to obtain the logistic support required to study this number of clusters.

5. Briend, A.; Golden, M. H.; Grellety, Y.; Prudhon, C., and Hailey, P. Use of mid-upper-arm circumference for nutritional screening of refugees. Lancet. 1995 Apr 29; 345(8957): 1119-20.
Keywords: Anthropometry: methods/ Arm: *anatomy & histology/ Body Height/ Body Weight/ Child Nutrition Disorders: *diagnosis: therapy/ Child, Preschool/ Human/ *Nutrition Assessment/ Refugees
Notes: COMMENTS: Comment on: Lancet 1995 Mar 11; 345(8950): 631-3.
Note: Abstract written by Tulane University.
Abstract: This letter to the editor advocates the use of mid-upper arm circumference rather than weight-for-height for nutritional screening in refugee camps because of its superior ability to predict mortality and its greater simplicity of measurement and interpretation.

6. Clay, E. and Everitt, E. Food aid and emergencies: A report on the Third IDS Food Aid Seminar, DP 206. 1985 Jul.
Abstract: The Ethiopian famine and the crisis threatening sub-Saharan Africa were the backdrop to the Seminar, which was attended by key officials from national and international agencies and NGOs that allocate and handle emergency aid. Much of the discussion was pegged to three case studies: Ethiopia, then in the full glare of publicity; Somalia, epitomizing the continuing emergency; and South Asia, providing an example of food security systems that work. The wider debate focused on weaknesses in the emergency aid system and how these could be overcome. Could present early warning indicators, and response to them, be improved? Would greater flexibility by donors in sanctioning funds, and a two-phase programme ensuring swift dispatch of at least some assistance, speed response to sudden disasters? Could components of the South Asian food security and distribution systems have applicability in Africa? The importance of moving rapidly from relief to development aid after a disaster was stressed as an obvious but difficult objective. Further research was called for on the adequacy and composition of emergency rations and on methods of assessing immediate needs.

9. Demaeyer, E. M. Nutritional indicators in times of emergency. Ann Soc Belg Med Trop. 1976; 56(4-5): 263-70.
Keywords: Anthropometry/ Child/ Child Nutrition/ Child, Preschool/ *Disasters/ Female/ Human/ Infant/ Infant, Newborn/ Male/ Nutrition Disorders: *diagnosis/ *Nutrition Surveys/ Pregnancy/ Protein-Energy Malnutrition: diagnosis
Notes: Abstract written by Tulane University.
Abstract: The set of indicators most appropriate to measure the nutritional status of populations in emergency situations often requires consideration of a different set of factors than those considered in a situation of non-emergency. Factors of cost and ease of measurement as well as consideration of the equipment required for assessment, the degree to which the data is continuously available, and the facility by which data can be processed all must be considered when determining the most appropriate screening tool for use in emergency situations. This article recommends indicators related to health and dietary intake for assessment of nutritional status in times of disaster and provides a summary of four groups of indicators (clinical, biochemical, anthropometric, and vital signs) in the field of health, noting the appropriateness of their use in emergencies.

10. Dusauchoit, T. MSF-CIS (Celula Inter-Seccoes), Mozambique: A data collecting system focused on food security and population movements. Relief and rehabilitation network paper 1. London: Overseas Development Institute; 1994. Note: Abstract available at the Overseas Development Institute’s web site: www.oneworld.org/odi/rrn/pubs/neabl.html. Abstract: Medecins Sans Frontieres (MSF) has been in Mozambique since 1985, and in 1992, they started to collect accurate and timely information about the region themselves. The Inter-MSF drought unit (CIS) project began, with remunerated local people gathering information on food and nutrition., They related this information to six topics: population movement, market condition, food stocks, nutritional outlook, food and health. Dusauchoit hits on many important programme topics and problems in this report: how to get up-to-date information; how to get it to the right people and places; how to get people in very different NGOs to communicate and cooperate; how to move a programme along in a constantly changing context; and how to distinguish the proper end of a programme from a change of direction. In the case of CIS, concerns thus changed to monitoring food security and health at the district level in the context of population changes. The resulting reports were circulated to 600 organizations and individuals. The CIS’s experience and its success have made many think more broadly and strategically about nutritional health and food security.

11. Eldridge, C. Thought for food: suggestions for a systematised approach to emergency food distribution operations. Disasters. 1989; 13(2): 134-152.
Abstract: The following paper is a synopsis of a longer report, under the same name, aimed at the people responsible for implementing relief food operations. The report attempts to fill a perceived need for a manual covering the organisation of relief operations from planning to evaluation stages. Following the initial planning phase, the distribution of relief food can be viewed as a logistics operation sandwiched between two phases of data acquisition - one before the distribution of relief to targeted destinations, and the other after the distribution, to assess its efficacy and to identify problems.

12. Ferro-Luzzi, A. and James, W. P. Adult malnutrition: simple assessment techniques for use in emergencies. Br J Nutr. 1996 Jan; 75(1): 3-10.
Keywords: Adult/ Anthropometry/ Arm: anatomy & histology/ Body Mass Index/ Developing Countries/ Emergencies/ Female/ Human/ Male/ Mass Screening/ Nutrition Disorders: *diagnosis: epidemiology/ Prevalence/ Sex Factors/ Support, Non-U.S. Gov't
Abstract: The recent recognition of the problem of adult malnutrition requires methods for specifying the severity of undernutrition. The measurement of mid upper arm circumference (MUAC) can now be used as a screening method for underweight (normally assessed from the BMI) or as an additional criterion with the BMI to identify the preferential loss of peripheral tissue stores of fat and protein. By analysing and extrapolating anthropometric data from nine detailed adult surveys from Asia, Africa and the Pacific a series of MUAC cut-off points have now been identified to allow the screening of individual adults under extreme conditions, e.g. during famine. Grade 4 malnutrition is now specified for those with a MUAC < 200 mm for men and < 190 mm for women since these MUAC values correspond to the loss of fat stores at BMI of < 13. Food supplementation is clearly needed in these individuals. Extreme wasting (grade 5 malnutrition) corresponds to MUAC values of < 170 and < 160 mm for men and women respectively. These adults have extremely low BMI, i.e. about 10, have lost most, if not all, of their protein stores and are at a high risk of imminent death. These individuals will need immediate special feeding regimens to ensure their survival. The sex-specific MUAC values corresponding to BMI of 16, 13 and 10 can now therefore be used for rapid screening and the choice of remedial action.

13. Green, R. H. and Mavie, M. From survival to livelihood in Mozambique. IDS Bull. 1994; 25(4): 77-84.
Notes: Abstract written by Tulane University.
Abstract: In this article, the approach of rehabilitation construction is presented in a sub-Saharan Africa context and then traced in a more detailed way through a case study of Mozambique. The author addresses rehabilitation needs based on situation circumstances and provides a listing of information necessary for baseline assessment of the extent of a disaster. A programme checklist is also included and obstacles to effective rehabilitation intervention are outlined. The need for programmatic flexibility for achievement of rehabilitation in the context of disaster recovery and poverty situations is emphasized.

14. Hamid, G. M. Livelihood patterns of displaced households in Greater Khartoum. Disasters. 1992; 16(3): 230-239.
Abstract: Members of impoverished households in Greater Khartoum, who have been displaced from their homelands by famine and civil war, gain a livelihood by utilising a wide variety of subsistence activities and sources. These include moonlighting, income diversification and pooling, exchange relations, scavenging, relief supplies from aid agencies and remittances for relatives working in other areas. This finding challenges the widely held view of the displaced as dependent and parasitic on the wider urban community. Several public policies are identified which have a detrimental effect on the livelihood of the displaced.

15. Henderson, P L. and Biellik, R J. Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981. International Journal of Health Services. 1983; 13(2): 289-306. Abstract: The civil chaos created by a combination of drought and hostilities in the Ogaden region of Southern Ethiopia during the past five years has caused the majority of the indigenous, principally nomadic population to flee the area and seek refuge either in Somali refugee camps or in Ethiopian shelters for displaced persons. This paper compares the provision of basic food rations, selective feeding programs, primary health care, and preventative health measures between the two groups. During 1980-1981, Somalia received more international assistance per capita than Ethiopia. Large numbers of Western personnel provided health and nutrition services in Somali refugee camps, whereas no foreigners were involved in Ethiopian shelters. These disparities were largely due to inadequate publicity concerning the problems Ethiopia faces, partly resulting from real and perceived political limitations related to the Soviet presence in that country. Refugee needs in Somalia have been publicized far more adequately, partly due to that country’s alignment with the West. The Ethiopians, nevertheless, demonstrated greater efficiency in assisting their disaster victims; camp services comparable to those in Somalia were available despite greater logistic difficulties and fewer donated resources. The effectiveness of relief operations in Somalia was reduced by political constraints on governmental agencies.

16. Jaspars, S. The Rwandan refugee crisis in Tanzania: initial successes and failures in food assistance. Relief and rehabilitation network paper 6. London: Overseas Development Institute; 1994.
Notes: Abstract is quoted from introduction to paper.
Abstract: "The objective of this paper is to provide RRN members with an account of the food assistance operations in Benaco camp during the two months following the initial influx, giving a preliminary assessment of the factors contributing to the comparative success of the initial operation and also to examine the issues from the Benaco experience which are pertinent to other situations. Inevitably substantial difficulties were encountered during the operation and the paper discusses two of the principal difficulties, notably those resulting from a lack of accurate information on the camp population and the relationship between the accurate information on the camp population and the relationship between the two key UN agencies; WFP (responsible for the supply of the general ration to the camp) and UNHCR (responsible for coordinating the distribution of the food within the camp). The writer’s perspective is of a food coordinator employed by UNHCR during the first few weeks of the operation. This paper offers only a preliminary review but it is hoped will share experiences and possible lessons from this very recent, and ongoing, operation."

17. Kelly, M. Operational value of anthropometric surveillance in famine early warning and relief: Wollo Region, Ethiopia, 1987-88. Disasters. 1993; 17(1): 48-55.
Abstract: In this article I examine the operational implication of the findings reported in ‘Entitlements, Coping Mechanisms and Indicators of Access to Food: Wollo Region, Ethiopia, 1987-1988’ (Kelly, 1992). The usefulness of anthropometric and other indicators for early warning and relief planning in Wollo is assessed by comparing the findings of Save the Children Fund’s nutritional surveillance programme with those of the Early Warning and Planning Service of the Ethiopian government’s Relief and Rehabilitation Commission. Case studies are used to illustrate the value of anthropometric and other indicators for targeting relief food and monitoring its effects. The costs of monitoring various indicators are then considered, and the cost of the Save the Children Fund programme is compared with that of other programmes. It is argued that in Wollo, anthropometric surveillance is a cost-effective means of improving early warning, planning, targeting and monitoring.

18. MacFarlane, S. B. J.; McConnell, C. R., and Russell, W. B. A computer assisted exercise in classifying nutritional status: a new tool for learning. Disasters. 1993; 17(1): 70-79.
Notes: Abstract written by Tulane University.
Abstract: The use of nutritional surveys and analysis of nutritional data is important in assessing the nutritional and health needs of a community. To assist in training individuals for dealing with nutritional assessment and analysis, a computer simulation model is suggested. The computer simulation software has been established by the Liverpool Epidemiology Programme at the Liverpool School of Tropical Medicine and has been made possible by funding from the Overseas Development Administration. This article provides a description of the software’s capabilities and describes a case study to exemplify how the software can be used for individual and group learning.

19. Manley, M.; Steinhoff, M. C.; Srilatha, V.; Abel, R., and Mukarji, D. The wasting-stunting classifying scale: a new device for the rapid assessment of nutritional status of young children. J Trop Pediatr. 1983 Feb; 29(1): 35-9.
Keywords: *Body Height/ *Body Weight/ Child/ *Child Nutrition/ Child, Preschool/ Female/ Growth/ Human/ Infant/ Infant Nutrition Disorders: *classification: diagnosis/ Male
Notes: Abstract is quoted from summary of article.
Abstract: "A new wasting-stunting classifying scale has been developed to allow the rapid assessment of the nutritional status of young children. Three hundred and five children were classified by this device and the results compared to classification using the NCHS-WHO tables of weight-for-height and height-for-age. The field classification with the WSC scale showed a sensitivity of 94 percent, and a specificity of 93 percent in weight-for-height classification, and 99 percent sensitivity and 90 percent specificity in height-for-age. Ninety-three percent of the examined children were correctly classified by the WSC scale in this preliminary evaluation."

20. Nieburg, P.; Berry, A.; Steketee, R.; Binkin, N.; Dondero, T., and Azil, N. Limitations of anthropometry during acute food shortages: High mortality can mask refugees' deteriorating nutritional status. Disasters. 1988; 12(3): 253--258.
Abstract: Longitudinal comparison of anthropometric data from cross-sectional surveys is commonly used to assess nutritional status in relief operations. In a refugee camp in Sudan, assessment indicated a high level of childhood malnutrition, but nutritional status appeared relatively unchanged between cluster sample surveys in January (26.3% below 80% of median weight-for-height) and March 1985 (28.4% below 80% of median weight-for-height). However, in this interval, which was marked by irregular food supplies and relatively low energy (calorie) intake as well as by a high incidence of diarrhoeal disease and measles, nearly 13% of all children in the camp died. This deceptive appearance of stability in nutritional status in the face of high mortality may be explained by ongoing nutritional deterioration ("replacement malnutrition") among surviving children. These findings demonstrate that collection and analysis of mortality data are essential for the correct interpretation of anthropometric results during periods of uncertain food supply.

21. Schaefer, K. C. An analytic model for emergency food provision. Disasters. 1995; 20(4): 315-321.
Abstract: Donor agencies employ a range of food provision and cost-sharing policies, including food linked to cash distribution grants, food sales ("monetization"), and distribution of food through a local agency. This paper develops a systematic methodology for choosing the proper blend of policies. The model requires estimates of several simple economic indicators in the recipient country. Two numerical applications of the model are developed, and extensions of the model for peculiarities of specific fields are suggested.

22. Sharp, K. Between relief and development: targeting food aid for disaster prevention in Ethiopia. Relief and rehabilitation network paper 27. London: Overseas Development Institute; 1998.
Abstract: The paper focuses on the question of how food aid can best be targeted to the neediest households in food-insecure areas, particularly in the context of the 1993 National Policy on Disaster Prevention and Management (NPDPM) and its central strategy of channeling relief food through employment generation schemes (EGS) in place of general free distributions. The debate on household-level targeting of such schemes has centered on the choice between self-targeting and administrative/community targeting.
As a framework for the discussion, a typology of targeting methods is briefly set out, suggesting that three dimensions of classification are needed for each targeting system: the institutional channel or mechanism; the level; and selection criteria. Community targeting, which has received little attention in the international literature, is discussed.
A review of previous Ethiopian experience with targeting shows little evidence that it successfully self-selects the poorest and excludes the relatively better-off, even at low payment rates. A summary of views expressed by beneficiaries and implementing staff in chronic food-aid recipient areas sheds further doubt on the potential of pure self-targeting to meet the targeting objectives of the NPDPM. However, it also suggests that the community targeting option is not an easy or cheap one, and that a strong preference for sharing aid as widely as possible within communities applies equally to employment entitlements.
The paper concludes that a combination of self-targeting elements with community prioritization of the neediest households is the best available targeting option for EGS. At the same time, attention is needed to improving the administrative targeting at area levels.

23. Shoham, J. Emergency feeding programmes. BMJ. 1992 Sep 12; 305(6854): 596-7.
Keywords: Africa/ *Food Supply/ Human/ *International Cooperation/ Starvation
Notes: see comments
COMMENTS: Comment in: BMJ 1992 Oct 3; 305(6857): 829
Abstract: The article states that emergency interventions may offer an inadequate balance of foods and poorly designed feeding programs. Both the general feeding programs and supplementary feeding programs often fail to improve the nutritional status of refugees and prevent further deterioration and death from starvation. Some of the reasons for this include: (1) micronutrient deficiencies in the general rations, (2) the tendency of some donor governments "to provide only sufficient cereals for the general rations while supplying oil and legumes on a seemingly ad hoc basis" (597) which is unpalatable for young children, (3) instituting supplementary feeding programs in lieu of an adequate general ration, (4) implementing wet feeding programs and, (5) automatically implementing supplementary feeding programs in food emergencies induced by drought.

24. Shoham, J. Emergency supplementary feeding programmes. Relief and rehabilitation network good practice review 2. London: Overseas Development Institute; 1994.
Notes: Abstract quoted from introduction to the review.
Abstract: The review provides " a short, accessible overview of what may be considered ‘good practice’ in designing and implementing emergency supplementary feeding programmes (SFPs). It is aimed primarily at NGO, UN, and donor staff who are not specialists in nutrition and emergency feeding but who may, in the context of some future emergency, be involved in decisions about feeding programmes. The review may also prove useful to those nutritionists who do not have widespread experience of different emergency situations and the complex array of issues which must frequently be considered in determining whether to implement an emergency SFP and how such a programme might be designed."

25. Taylor, W. R. An evaluation of supplementary feeding in Somali refugee camps. Int J Epidemiol. 1983 Dec; 12(4): 433-6.
Keywords: Body Height/ Body Weight/ Child, Preschool/ Disease/ Evaluation Studies/ Female/ Human/ Infant/ Infant, Newborn/ Male/ Nutrition Disorders: *diet therapy/ Pregnancy/ *Refugees/ Somalia/ Tuberculosis: physiopathology
Abstract: Supplementary feeding programmes (SFP) that were functioning in Somali refugee camps were evaluated in March 1981 in order to describe their process of operation and to measure their effect on the refugees' nutritional status. While those children enrolled in SFPs gained weight, many malnourished children in camp had not been identified so that the programme's overall effectiveness was reduced. Even among children who attended SFPs regularly, the rate of weight gain diminished rapidly each succeeding month of attendance. This underlines that supplementary feeding is a short-term, remedial measure in disaster relief and should be quickly incorporated into a broader plan for relief assistance so that resources can be used most efficiently.

26. United States Agency for International Development (USAID). Southern Sudan: monitoring a complex emergency. FEWS special report 97-6. USAID; 1997 Sep 26.
Notes: Abstract written by Tulane University.
Abstract: Many of the challenges to institute and evaluate a program of food aid are exemplified by the circumstances in southern Sudan. This report discusses the wide variety of food sources that different groups rely upon, as well as the way conflict not only directly endangers people but also indirectly harms agricultural and herding practices and trade activities. The extent of aid needed in different types of refugee situations is addressed. The report describes four elements essential to monitoring food security conditions in complex emergencies: 1) understanding of the major elements of food security and livelihoods, 2) ability to monitor during times of stress, 3) coordinating body, and 4) adequate funding. Also included are some data and basic information about food sources and consumption patterns in the various regions of southern Sudan and how traditional patterns have changed in response to the ongoing conflict.