Research: Nutrition

Context-Specific Causes of and Solutions to Malnutrition

Our research on context-specific causes of malnutrition generates new knowledge on what works to prevent malnutrition in all its forms. For example, our study on including adolescent girls in care groups in Northern Nigeria revealed that the International Medical Corps’ care group program contributed to increased knowledge and improved practices among adolescent girls, helping to prevent malnutrition, prevent illness in their households and prompting them to seek health services where necessary.

As part of efforts to strengthen our multi-sectoral nutrition programming in the Amalima Loko program in Matabeleland North province of Zimbabwe, we conducted a nutrition causal analysis (NCA) study to examine the underlying causes of undernutrition. The study found context-specific factors of undernutrition among women of reproductive age and children under 5 (CU5), including risk factors such as socio-cultural norms, beliefs and behaviors that drive poor dietary intake, especially poor animal-source food (ASF) consumption. Our findings informed a series of health and nutrition community sessions where we discussed some of the myths and misconceptions about ASF consumption for pregnant women and CU5.

In Chad, we implemented a Link NCA study over five months to determine the causes and risk factors for undernutrition in the Abdi district. The study found eight major risk factors: inadequate infant feeding practices; high prevalence of infantile illnesses; poor access to medical centers/care; inadequate therapeutic practices; poor access to potable water sources; inadequate hygiene practices; insufficient agricultural production; and high maternal workload. Results from the Link NCA study were used to adapt International Medical Corps’ existing interventions for IYCF and to develop a larger multisectoral intervention strategy on nutrition security to reduce undernutrition beyond traditional community-based management of acute malnutrition (CMAM) approaches.

Wasting (Acute Malnutrition)

Wasting (or acute malnutrition) is a life-threatening condition, increasing the risk of death and serious illness. A major public health issue in low-income countries, it is characterized by extreme weight loss that results in low weight for height, and/or low mid-upper arm circumference (MUAC) readings with or without the presence of bilateral oedema. The State of Food Security and Nutrition in the World 2023 found that approximately 45 million CU5 globally continue to suffer from wasting, particularly in humanitarian settings.

Using existing primary data from International Medical Corps’ country offices, we conducted a study to assess the impact of the family MUAC approach on CMAM outcomes among CU5 in CMAM sites that we support in eight countries: Central African Republic (CAR), DRC, Ethiopia, Mali, Nigeria, Somalia, South Sudan and Yemen. In Sudan, International Medical Corps and the University of Khartoum conducted a case-control study to identify risk factors associated with relapse of severe wasting—also known as severe acute malnutrition (SAM)—among children aged 6–59 months who were discharged after recovering from SAM and receiving treatment in an International Medical Corps-supported outpatient therapeutic program. The study showed that odds of relapse were lower among children who were breastfed and whose caregivers had received IYCF counseling, and that hygiene promotion and prevention of unprescribed use of medicine for the treatment of malnutrition helped reduce the odds of relapse.

COVID-19 and Nutrition

In the early stages of the COVID-19 pandemic, many studies focused on the risk factors of COVID- 19 for the elderly or people with pre-existing conditions, such as diabetes, lung disease or obesity. Little attention was paid to risk factors associated with malnutrition, particularly in the context of humanitarian and low-resource settings. To address this gap, International Medical Corps partnered with the Johns Hopkins Bloomberg School of Public Health on two studies to examine risk factors for hospitalization and death associated with COVID-19 in South Sudan and the DRC.

One study, which was the first of its kind, assessed malnutrition as a COVID-19 risk factor. The results from this study showed that being underweight and anemic is related to hospitalization but not to mortality. The second study found respiratory symptoms and chronic disease co-morbidities to be the main risk factors for severe outcomes (hospitalization or death)—similar to findings from many studies globally—and enabled International Medical Corps to successfully implement guidelines for triaging patients at risk for severe outcomes.

Intersection of Nutrition and Technology

Our research studies on the intersection of nutrition and technology assess the suitability, relevance and effectiveness of mobile applications or mobile health technology to improve nutrition outcomes in low-resource settings. In South Sudan, we conducted a study with Johns Hopkins University to evaluate the accuracy of child stature and MUAC measurements produced by the third-generation AutoAnthro 3D imaging system, developed by Body Surface Translations Inc. Between 2013 and 2016, International Medical Corps collaborated with World Vision and Save the Children to develop and pilot a mobile health app to improve CMAM treatment, reporting, monitoring and supply management in Afghanistan, Chad, Kenya, Mali and Niger.