Understanding malnutrition in emergencies

1The forms of malnutrition

Malnutrition covers several realities. Acute malnutrition (wasting) reflects rapid weight loss, often linked to illness or a sudden lack of food: it is what kills fastest in emergencies. Chronic malnutrition (stunting) reflects long-term deprivation: the child is too short for their age. Micronutrient deficiencies (iron, vitamin A, iodine, zinc) weaken immunity and development.

Acute malnutrition is divided into moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). A child with SAM has a risk of death about nine times higher than a well-nourished child. Global acute malnutrition (GAM) adds MAM and SAM together in a population.

2Causes: the UNICEF conceptual framework

The UNICEF framework distinguishes three levels of causes:

• Immediate causes: inadequate dietary intake and disease (diarrhoea, measles, malaria, respiratory infections), which reinforce each other.
• Underlying causes: household food insecurity, child care and feeding practices, access to water, sanitation and health services.
• Basic causes: poverty, conflict, displacement, gender inequality, governance.

Practical consequence: an effective nutrition response is multisectoral. Treating without acting on water, health and access to food means seeing the children come back.

3Measuring nutritional status

Three measurements are used for screening and diagnosis in children aged 6 to 59 months:

• Mid-upper arm circumference (MUAC), measured at the midpoint of the left upper arm with a colour-coded tape: below 115 mm = SAM; 115 to below 125 mm = MAM.
• Weight-for-height expressed as a z-score against WHO standards: below -3 = SAM; -3 to below -2 = MAM.
• Bilateral pitting oedema: press for three seconds on the top of both feet; if a dent remains, it is SAM, whatever the MUAC.

MUAC is simple, quick and can be used by community health workers and even by trained mothers (the “Family MUAC” approach). In pregnant or breastfeeding women, a low MUAC (often below 230 mm, depending on the national protocol) signals a risk.

4Thresholds and classification of the situation

Anthropometric surveys give the prevalence of GAM among children aged 6-59 months. Commonly used benchmarks (WHO): below 5% = acceptable; 5 to 9.9% = alert; 10 to 14.9% = serious; 15% or more = critical. The IPC Acute Malnutrition classification (IPC AMN) places each area from Phase 1 to Phase 5 and guides priorities.

Other indicators complete the analysis: crude mortality rate and under-five mortality, measles vaccination coverage, ongoing epidemics, breastfeeding practices. Always apply the country's national protocol: it takes precedence over general benchmarks.