Management of severe acute malnutrition in children.

Severe acute malnutrition (SAM) is defined as a weight-for-height measurement of 70% or less below the median, or three SD or more below the mean National Centre for Health Statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a mid-upper-arm circumference of less than 110 mm in children age 1-5 years. 13 million children under age 5 years have SAM, and the disorder is associated with 1 million to 2 million preventable child deaths each year. Despite this global importance, child-survival programmes have ignored SAM, and WHO does not recognise the term "acute malnutrition". Inpatient treatment is resource intensive and requires many skilled and motivated staff. Where SAM is common, the number of cases exceeds available inpatient capacity, which limits the effect of treatment; case-fatality rates are 20-30% and coverage is commonly under 10%. Programmes of community-based therapeutic care substantially reduce case-fatality rates and increase coverage rates. These programmes use new, ready-to-use, therapeutic foods and are designed to increase access to services, reduce opportunity costs, encourage early presentation and compliance, and thereby increase coverage and recovery rates. In community-based therapeutic care, all patients with SAM without complications are treated as outpatients. This approach promises to be a successful and cost-effective treatment strategy.

Evaluating humanitarian assistance programmes in complex emergencies

Evaluation is a key tool in efforts to improve accountability and performance in the operation of the international humanitarian aid system. However, humanitarian aid has been subjected to less rigorous monitoring and evaluation procedures than those applied to development aid. As the share of averseas development assistance allocated to humanitarin aid has raisen, and awareness of the complexity of humanitarian assistance has increased, so the need to develop appropriate methodologies for the evaluation of relief aid has become more apparent. This good practice review is the written output of an OECD/DAC project iniciated to identify and disseminate best practice in the evaluation of humanitarian assistance programmes. The study seeks to improve the consistency and quality evaluation methodologies, and enhance the accountability function of evaluation, contribute to institutionalising the lessons learned, and identify better methods for monitoring performance of humanitarian aid operations (AU)