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Revising the nutrition component of the Sphere Handbook

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Susan Thurstans

Sphere revision nutrition focal point SCUK

Normal user

17 Sep 2009, 17:00

The below topic is raised by Susan Thurstans, Save the Children UK, emergency response personnel for nutrition and nutrition Focal Point for the revision of the Sphere Handbook - Humanitarian Charter and Minimum Standards in Disaster Response-

The Sphere Handbook has been one of the most widely recognised tools for improving humanitarian response, not only by NGOs but also, and increasingly, by United Nations agencies, host governments, donor governments and other actors involved in humanitarian response. For the Sphere Handbook to remain relevant, Sphere needs to keep in touch with changing practices in the context of humanitarian work, as well as technical innovations. To this end, and acknowledging the significant changes that have taken place since the 2004 edition, the Sphere Board has decided to revise the Sphere Project Handbook.

Dear EN-net forum colleagues,

The revision process is to be coordinated by a group of Focal Points and the Sphere project team over the next year, with publication scheduled in the last quarter of 2010. Each focal point is guided by a Core Working Group. Specifically for nutrition, this is formed of representatives from NGOs, UN agencies, academic institutions and independent consultants each of whom specialise in core areas of the nutrition component of Sphere. As the nutrition focal point I will be working very closely with this group as well as other technical and cross cutting focal points to ensure that new approaches, new ideas, appropriate tools and methodologies are included.

The main nutrition components are comprised of six minimum standards within chapter 3. I would like to invite FSN members to give feedback to the following questions in relation to these minimum standards.

1. What are the indicators/guidance notes that need to be adjusted? Please be specific, suggest actual changes and provide evidence based background knowledge or references to your suggestion
2. What are the new standards which should be added, if any? Please be specific, suggest ideas for the standards and accompanying indicators and guidance notes and provide evidence based background knowledge or references to your suggestion
3. What information is missing that needs to be considered and reflected in the indicators/guidance notes or annexes.

The full text can be found
In English:,com_docman/task,cat_view/gid,17/Itemid,26/lang,english/
In French:,com_docman/task,cat_view/gid,44/Itemid,26/lang,english/
In Spanish:,com_docman/task,cat_view/gid,46/Itemid,26/lang,english/

I thank you in advance for your contributions to this upcoming handbook revision and I look forward to hearing from you!

Best wishes

Mark Myatt

Consultant Epideomiologist

Frequent user

18 Sep 2009, 17:24

Some brief comments ...

The case-defintions for feeding programs (children) are antiquated.

The "NCHS/CDC" references have been superseded by the WGS reference.

MUAC is preferable to W/H when surveying patoralist populations and other populations with a long-legged / short-trunked body-shape.

MUAC is now the primary admission criteria in CTC / CMAM programs.

Anthropometry surveys should collect MUAC data in order to estimate program needs.

The use of two-stage screening (MUAC followed by W/H) for admission into CTC / CMAM is no longer considered good practise as it tends to undermine program coverage in CTC / CMAM.

Indirect estimation (i.e. from an anthropometric survey) of program coverage is no longer considered good practise. Alternative methods such as CSAS and SQUEAC / SLEAC are preferred.

I hope these help.

Tarig Abdulgadir

CMAM Specialist / UNICEF

Normal user

18 Sep 2009, 21:13


One essential indicator in CMAM projects now is failure to respond to treatment that can be attributed to quality of services or beneficiary dependant factors or psychosocial factors, it has been considered as a third catogry of discharge beside cured,defaulter and yet is defined as concept but no certain value to define what is acceptable within the program , we have seen that a lot in TFC,CTC programs in Darfur, is a quick note and i will come back to you again with other comments


Susan Thurstans

Sphere revision nutrition focal point SCUK

Normal user

15 Oct 2009, 15:31

Mark and Tarig, thank you both for your valuable contributions. I look forward to discussing them alongside feedback from the consultation process with the core working group for the revision process.
Best wishes

Michael Golden

Normal user

16 Oct 2009, 14:55

Failure to respond to treatment is very important. it is not acceptable to leave these children languishing in a program and then to discharge them as failures! The algorithm that Yvonne Grellety and myself published in ENN gives an algorithm for failure to respond in supplementary programs that is equally applicable to OTP programs.

Talal Faroug Mahgoub

Nutrition Specialist- UNICEF

Normal user

20 Oct 2009, 09:12

I have posted this same comment in other post and am sorry to repeat it again here particularely that the revision for the sphere standerds will eb inlight of having new approaches on ground;

Given the fact that the two approaches (CMAM or CTC and the traditional TFC) are programs for management of severe acute malnutrition, these standards were set for TFCs which has the two phases (phase one, transition and phase two in one compound) and the management is taking place as one unit and reporting as well in one monthly reporting format (the reports here are the tool which is capturing the monthly trends of the performance indicators), in the CMAM/CTC approach the two phases are separated and sometimes being run by different partners which in turn makes the reports comes for the same child at two treatment stages from two centers.
What I'm trying to say is that applying the same standards to be met by the SC and the OTP does not look making sense due to the changes in the conditions for the same child, the issue need to be revisited from that angle instead of looking at it from emergency and non emergency situations, as the severely malnourished with complication child remain severely malnourished with complications in both situations and the difference will be in the numbers of admissions which does not require to amend the standers accordingly , so am suggesting to amend the standards of the OTP indicators to set somewhere in the middle between the SFC and the SC/TFC for the cure , defaulters and death rates.

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