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Humanitarian Charter and Minimum Standards in Humanitarian Response

Appendix 3

Nutrition assessment checklist

Below are sample questions for assessments examining the underlying causes of undernutrition, the level of nutrition risk and possibilities for response. The questions are based on the conceptual framework of the causes of undernutrition. The information is likely to be available from a variety of sources and gathering it will require various assessment tools, including key informant interviews, observation and review of secondary data (see also Core Standard 1Core Standard 3 and Core Standard 4).

Pre-emergency situation

  1. What information already exists on the nature, scale and causes of undernutrition among the affected population (see Food security and nutrition assessment standard 2)?

The current risk of undernutrition

  1. The risk of undernutrition related to reduced food access –see Appendix 1: Food security and livelihoods assessment checklists.
  2. The risk of undernutrition related to infant and young child feeding and care practices
    • Is there a change in work and social patterns (e.g. due to migration, displacement or armed conflict) which means that roles and responsibilities in the household have changed?
    • Is there a change in the normal composition of households? Are there large numbers of separated children?
    • Has the normal care environment been disrupted (e.g. through displacement), affecting access to secondary caregivers, access to foods for children, access to water, etc.?
    • Are any infants not breastfed? Are there infants who are artificially fed?
    • Has there been any evidence or suspicion of a decline in infant feeding practices in the emergency, especially any fall in breastfeeding initiation or exclusive breastfeeding rates, any increase in artificial feeding rate and/or any increase in proportion of infants not breastfed?
    • Are age-appropriate, nutritionally adequate, safe complementary foods and the means to prepare them hygienically accessible?
    • Is there any evidence or suspicion of general distribution of breastmilk substitutes such as infant formula, other milk products, bottles and teats, either donated or purchased?
    • In pastoral communities, have the herds been away from young children for long? Has access to milk changed from normal?
    • Has HIV and AIDS affected caring practices at household level?
  3. The risk of undernutrition related to poor public health (see Health chapter)
    • Are there any reports of disease outbreaks which may affect nutritional status, such as measles or acute diarrhoeal disease? Is there risk that these outbreaks will occur? (See Essential health services - control of communicable diseases standard1standard 2 and standard 3.)
    • What is the estimated measles vaccination coverage of the affected population? (See Essential health services - child health standard 1.)
    • Is Vitamin A routinely given with measles vaccination? What is the estimated Vitamin A supplementation coverage?
    • Are there any estimates of mortality rates (either crude or under-5)? What are they and what method has been used? (See Essential health services standard 1)
    • Is there, or will there be, a significant decline in ambient temperature which is likely to affect the prevalence of acute respiratory infection or the energy requirements of the affected population?
    • Is there a high prevalence of HIV?
    • Are people already vulnerable to undernutrition due to poverty or ill health?
    • Is there overcrowding or a risk of or high prevalence of TB?
    • Is there a high incidence of malaria?
    • Have people been in water or wet clothes or exposed to other harsh environmental conditions for long periods of time?
  4. What formal and informal local structures are currently in place through which potential interventions could be channelled?
    • What is the capacity of the Ministry of Health, religious organisations, community support groups, breastfeeding support groups or NGOs with a long- or short-term presence in the area?
    • What nutrition interventions or community-based support were already in place and organised by local communities, individuals, NGOs, government organisations, UN agencies, religious organisations, etc.? What are the nutrition policies (past, ongoing and lapsed), the planned long-term nutrition responses and programmes that are being implemented or planned in response to the current situation?