Protocol 2.1: Use analytical framework to guide convergence of evidence

The purpose of the IPC Acute Malnutrition Analytical Framework (Figure 10) is to help guide the analysis through a logical outline of the drivers of acute malnutrition. By following the Framework, analysts are able to converge evidence for classifying the severity and identification of key drivers. The Framework is divided into contributing factors and outcomes (Box 79). The contributing factors include basic, immediate and underlying causes of acute malnutrition, and the outcomes are acute malnutrition and mortality. It should be noted that mortality is a higher outcome than acute malnutrition – i.e. being acutely malnourished is a risk factor for mortality. In the IPC Acute Malnutrition analysis, however, the outcome of interest is acute malnutrition.

The IPC Acute Malnutrition Analytical Framework is an adapted version of the UNICEF Conceptual Framework on Malnutrition.

Contributing factors

a. Vulnerability, Resources and Control: This is the first component of the basic causes. The five livelihood assets (financial, physical, human, social and natural), policies, institutions and processes, gender, and mitigating factors, all of which in relation to their potential impact on acute malnutrition, are analysed.

• Livelihood assets – This term relates to an analysis of the five assets and their impact on Acute Malnutrition.
• Policies, institutions and processes  – These involve an analysis of key policies, institutional actors and socio-economic and political issues related to Acute Malnutrition.
• Gender – This causal factor takes into account gender roles at the societal, community and household levels, with attention to aspects of livelihoods pertaining to food access, utilization and nutrition, including access to water, education and health services, and their relationship to Acute Malnutrition.
• Mitigating factors – These include factors that may have mitigating effects on Acute Malnutrition.

b. Acute events or ongoing conditions: This second component of basic causal factors can include natural disasters (e.g. drought, flood, tsunami), socio-economic instability (e.g. volatility in staple food prices, energy or food shortages), conflict (e.g. war, civil unrest), disease (e.g. HIV/AIDS, cholera, malaria) and other events/conditions that can have an impact on Acute Malnutrition.

• Caring and feeding practices: Recognizing the importance of the care environment for mothers and children, and taking into consideration  women’s status in the family and the community,  and protection issues, IPC Acute Malnutrition analysis considers issues that affect infant and young child feeding practices, intra-household allocation of resources, and cultural beliefs and practices (including food restrictions, care habits and taboos).
• Health services and environmental health: This refers to health and environmental factors affecting households and individuals. The analysis of health services and environmental health focuses on vaccination coverage (both routine as well as campaign), Water, Sanitation and Hygiene (WASH), health-seeking behaviour, and coverage of Acute Malnutrition treatment programmes.
• Food security dimensions: This refers to the four dimensions that form the basis of the food security conceptual framework: availability, access, utilization and stability. Within these four broad categories, a general description of the food security context at the national, sub-national, community and household levels can be generated as applicable to the analytical framework. These dimensions determine the extent to which food is available in the area of analysis, if/how it can be accessed, how it is then utilized, and the overall consistency of these factors over time (stability).

• Health status: The analysis of health status considers the main childhood illnesses according to the Integrated Management of Childhood Illnesses, such as malaria, diarrhoea, pneumonia, measles, and HIV/AIDS, because they directly contribute to Acute Malnutrition (Box 82). Other context-specific diseases (e.g. dengue) that affect Acute Malnutrition as well as disease outbreaks are also taken into account in the analysis
• Food consumption: Both the quality and quantity of food consumed by children are considered under food consumption. Additionally, breastfeeding is considered because breast milk continues to be a main source of food for children of 6–23 months. It is recognized that having adequate food security at the household level may not always guarantee adequate food consumption by children – i.e. behavioural and cultural norms and taboos all come into play with regard to child feeding

The result of the interaction of between dietary intake and health status will directly affect the nutritional status of a child; if there is inadequate consumption and/or health status, the child is likely to become acutely malnourished (Box 83). Furthermore, it is recognized that Acute Malnutrition may also lead to mortality, which is a higher-level outcome.