The IPC Acute Malnutrition Analysis Worksheet supports methodical, transparent and consistent evidence-based analysis by taking the analysis through the IPC Acute Malnutrition Analytical Framework and linking evidence to the IPC Acute Malnutrition Reference Table. The Worksheet is a major advantage to analysis and, although not mandatory, is highly recommended.
The IPC Acute Malnutrition Analysis Worksheet consists in 11 steps (Box 87). While Steps 1 and 2 are applied to both current as well as Projection classifications, Steps 3 to 8 are only applicable for Current classifications, and Steps 9 to 11 are applicable only for Projections. If multiple projection classifications are carried out, Steps 9 to 11 should be repeated.
Procedures for completing the Worksheet are briefly described below. It is highly advisable that parts of the Worksheet, especially Steps 1 and 2 and optimally also Steps 3 and 5, are prepared before the analysis workshops.
Purpose: To introduce the characteristics of the area and population to allow for contextualization of evidence.
Approach overview:
Purpose: To help organize wide-ranging data from multiple sources for ease of access and reference, and provide a tool for supporting documentation of the evaluation of reliability of evidence.
Approach overview:
Purpose: To analyse evidence following the IPC Acute Malnutrition Analytical Framework and Reference Table, considering the local context and reliability score, including reference to historical trends.
Approach overview:
Purpose: To analyse evidence on contributing factors to Acute Malnutrition as well as other issues of concern so as to identify major contributing factors to Acute Malnutrition in the analysis area.
Approach overview:
Provide evidence and critical reasoning for all contributing factors for which evidence is available and relevant to Acute Malnutrition, considering the following guidance:
Other issues: Other important issues (e.g. mortality, anaemia, vitamin A deficiency) that are not necessarily directly/strongly related to Acute Malnutrition but are important considerations should be taken into account and highlighted in the IPC Acute Malnutrition products as necessary.
Purpose: To conclude on phase classification and provide the critical reasoning based on supporting and contradictory evidence used to arrive at phase conclusion (Box 88).
Approach overview:
Purpose: To highlight the key drivers so that decision-makers are aware of the key factors triggering the crisis and action can be more strategically planned.
Approach overview:
List the key drivers of Acute Malnutrition, not only the immediate and underlying causes, but also include acute shocks, such as drought and conflict.
Convergence of evidence, taking into account contributing factors and historical data on Acute Malnutrition, is required when estimates of historical Acute MalnutritionGAM based on WHZ, or GAM based on WHZ from similar areas, or evidence collected within the six months preceding the time of analysis (but not from the same season) are used to classify areas. Additionally, historical data on the relationship between GAM based on WHZ, and GAM based on MUAC in the area of analysis are required when classification is performed on GAM based on MUAC.
During the convergence of evidence, analysts first need to gather information on the following indicators:
Both current and historical/trend data should be gathered; the historical data should come from the same season of analysis. At least two of the above indicators must be available to carry out the convergence of evidence, although more would strengthen the analysis. Ideally, information on these indicators should come from representative surveys. However, other source such as the Health Management Information System (for diseases) can also be used. In terms of the community management of Acute Malnutrition coverage data, coverage surveys using acceptable methods should ideally be used. However, other methods of estimating coverage can also be used as proxy. Analysts would then look at the current as well as the historical/trend data on the contributing factors and determine if these factors have been stable, deteriorating or improving.
Example 1: Consider an area with 11 percent GAM based on WHZ from re-analysed survey data (from a high administrative unit). According to the IPC Acute Malnutrition Reference Table, this level of prevalence indicates IPC Acute Malnutrition Phase 3. As per a health assessment, about 35 percent of children in the area are affected by diarrhoea during the current season of analysis. The historical data on diarrhoea for the same area show that diarrhoea prevalence has always been around 30 percent for the area in the past three years. The IPC Acute Food Insecurity analysis has always placed the area into Phase 3 in the past two years, and the current IPC Acute Food Insecurity analysis indicates the same situation. There has been no major change in the health or the community management of Acute Malnutritioncoverage for the area. In this case, it is reasonable to assume that all main contributing factors remained stable during the current season of analysis.
Analysts would then look at the available historical data on Acute Malnutrition (i.e. GAM based on WHZ) for the area. Assume that according to the historical data, other than being in Phase 2 once two years ago, the area has always remained in Phase 3 in the same season in the past five years. Considering both current as well as historical data on both contributing factors and outcome indicators, in this case it is reasonable to classify the area as Phase 3.
Example 2: Consider that the same area has only GAM based on MUAC data from an exhaustive screening (8.3 percent) and assume that the contributing factors are described as above. In this case, analysts would look at the historical data on the relationship between GAM based on WHZ and GAM based on MUAC. Assume that the relationship shows the following:
WHZ | 17.3 | 18.1 | 20 | 13.8 | 11.1 |
MUAC | 13.2 | 11.5 | 11.9 | 12.4 | 7.1 |
It is evident from the above that the WHZ-based prevalence is always higher than MUAC prevalence in this area; additionally, the upper bound of the phase (according to the GAM based on MUAC) has always corresponded with the GAM based on the WHZ phase - i.e. when the area was in Phase 4 based on WHZ, it corresponded with the upper Phase of MUAC; the same applied when the area was in Phase 3 based on WHZ). Therefore, given that there are no changes in the contributing factors, it is reasonable to assume that with the GAM prevalence of 8.3 percent, the area is likely to be in Phase 3.
Purpose: To help provide information on the limitations faced by analysts during the analysis.
Approach overview:
Document all limitations (not only data, but also analytical limitations) faced during the analysis.
Purpose: To highlight to decision-makers and partners the key response objectives needed to address the situation at hand.
Approach overview:
Purpose: To determine the potential (most likely) changes in the contributing factors in order to identify their possible impact on outcome indicators so that potential changes in the classification can be determined. In the projection analysis, the IPC Acute Malnutrition tries to determine the most likely evolution ofGAMAcute Malnutrition. Since Acute Malnutrition is an outcome of various contributing factors, the potential changes in contributing factors are first looked at in this Step 9; that is, based on the historical trends and seasonality, etc., the most likely changes in each of the contributing factors to Acute Malnutrition are first determined. Based on the changes in the contributing factors, the changes in outcome (i.e. the GAMAcute Malnutrition) are then determined (in Step 10).
Approach overview:
Purpose: To provide early warning information for decision-makers by highlighting the potential changes in the Acute Malnutrition situation.
Approach overview:
Purpose: To identify triggers for analysis updates and validity of projections.
Approach overview:
Identify risk factors to monitor: Consider risk factors that could raise Acute Malnutrition during the projection period and thus need to be monitored against assumed evolution included in Step 8