Research Snapshots

Unravelling community
clustering in Chad
This is a summary of the following report: Luc G, Keita
M, Houssoube F et al (2023) Community Clusteringof Food Insecurity and Malnutrition Associated with
Systemic Drivers in Chad. Food and Nutrition Bulletin,
44, 2, S69–S82. https://journals.sagepub.com/
doi/10.1177/03795721231189970

T

his study focuses on agropastoral communities in
Chad's Sahelian belt experiencing prolonged hunger, high food insecurity, and wasting.

The researchers conducted this mixed method study to understand the spatial distribution of child wasting and household food insecurity and systemic drivers (including conflict,livelihoods, vegetation, and cultural norms), as well as to better
understand the relationship between child wasting and household food insecurity, with the goal of improving linkages in programming and targeting. A cross-sectional randomised cluster
survey was conducted in August and September 2021 in Kanem and Bahr-el-Ghazal regions across 86 villages, reaching
7,002 households and 6,136 children to collect data on childanthropometry, household food security, and livelihoods. These
primary data were then triangulated with secondary geospatial data on the local vegetation index and conflicts, as wellas with qualitative interviews with local actors. Analysis wasconducted using comparison tests and linear and logistic crude
and adjusted models, as well as looking at the design effect asa measure of clustering of outcomes at the community level.
Results at regional level showed that malnutrition wasworse in Bahr-el-Ghazal, while food insecurity was worse inKanem. The authors also found weak associations between
food security and malnutrition indicators in both regions.
Geospatial analysis showed the distribution of both childwasting and food insecurity were highly clustered, and that
communities with a high prevalence of child wasting were
not the same as those with the highest levels of food insecurity. Except for conflict and natural resources, whichwere associated with both outcomes, the origins of malnutrition and food security had generally different pathways.
The drivers of food insecurity were linked with poverty andshocks (surface cultivated, sources of income, multidimensional poverty, conflict, and rainfall). The drivers of malnutrition were linked with greater livestock ownership at thecommunity level and proximity to seasonal rivers, with norelationship to food insecurity. This could potentially indicate greater household use of non-potable water (givencommunity preference and use of seasonal rivers) as well as
increased sharing between animals and humans.
The authors note that, despite the clear clustering of theoutcomes at the community level, few studies – particularly
few quantitative studies – analyse food insecurity or malnutrition at the community level. Both study design and datacollection tend to be focused on individual and household
characteristics, potentially missing key community drivers
but also more basic causes of these outcomes. The reportargues that participatory processes that involve communities all along the project cycle are critical to making sure activities are context sensitive. Funding mechanisms should
support sustainable and sequenced investments to respondto protracted crises. The authors conclude that community-level and systemic drivers require greater considerationfrom the start in research design and data collection. Thereis a need for better integrated humanitarian, development,and peace-building interventions to address the persistenthigh prevalence of food insecurity and child wasting.

“I go to sleep on an empty stomach”:

Older people in humanitarian
nutrition
This is a summary of the following
report: “I go to sleep on an emptystomach” (2024) HelpAge International.
https://www.helpage.org/resource/
i-sleep-on-an-empty-stomach/Older people are often overlooked in humanitarian responses, where the focus
remains predominantly on
infants, children, and maternal health.
Due to factors such as disease susceptibility and changes in metabolism, older people are particularly vulnerable tomalnutrition. This report consolidates
a comprehensive review of 42 documents. Additional insight was thenprovided through interviews with 28
humanitarian actors and 10 older people from Ethiopia.

“Food remains thebiggest challenge. It’s aconstant reminder of how
vulnerable we are in theface of circumstances
beyond our control.”– Jirmo Toke, 81, Ethiopia

Although guidance on older people’s inclusion exists, it is rarely applied.
A lack of consensus on diagnostic criteria for malnutrition in older age remains
a barrier. Despite heterogeneity, current evidence suggests that 23% of older people experience malnutrition globally – with this figure heavily influenced
by independent living status and carepractices. There is a paucity of evidence
on malnutrition, in terms of both prevalence and risk, for this group in humanitarian settings.

“We share not only thepain of hunger but also
the worry about where thenext meal will come from.”– Elema Boru, 75, Ethiopia

Older people have a variety of different needs, and treating them as a single
group fails to account for the intersection of age, disability, ethnicity, sexualorientation, gender identity, economic activity, and health status. The evidence suggests that older women havepoorer outcomes than men in disasterand conflict settings, with data from
Ukraine highlighting that older women face greater barriers to accessing assistance than men. Lack of meaningful
consultation with older people regarding their diverse needs during times ofhumanitarian crisis planning and response is particularly problematic. A
compounding difficulty is the limited
understanding of the diverse nutritional needs over the life course, particularly in later life, among humanitarian andnutrition partners.
Another barrier to including older people in humanitarian nutrition is alack of funding. This is true of the nutrition sector in general, but organisations report particular challenges whenobtaining funding for this age group inemergency settings. This may be partially attributed to negative perceptions surrounding older people in humanitarian crises, where they are often labelled
as dependent or economically inactive.
Reframing these perceptions remains
critical. In crises, older people can provide support and wisdom to their communities. Many are actively involved indisaster response and recovery, family care, and income generation – withmany having experienced previous crises themselves.

“Life at this age is too
difficult. No one helps
me and my wife. I’m apastoralist and I rearedanimals for a living. Those
animals were my sourceof income, but due to thedrought I lost all of mylivestock.”– Male, 98, Qabana’a Kebele

The full findings of the report are beyond the scope of this summary. We encourage readers to explore the 10 key
recommendations found in the executive summary, with more detailed recommendations for nutrition cluster
coordinators and members, nationalgovernments, and donors found in the
body of the report. These point to thepractical next steps to ensure the inclusion of older people in humanitarian nutrition responses.

FIELD EXCHANGE ISSUE 72, April 2024 www.ennonline.net/fex

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