Use of coping strategies to detect households at risk for malnutrition during humanitarian emergencies

Background: Both the number of food emergencies occurring annually and the proportion due to conflict have increased steadily over the past 20 years. Rapid identification of food emergencies and the targeting of food aid to food insecure households can prevent both malnutrition and disease, potentially saving thousands of lives each year, especially young children. The measurement of household coping strategies as a rapid and simple proxy for food security has become popular in the humanitarian community; however no studies have adequately validated household coping strategies against benchmark measures of food consumption or caloric intake. Methods: Using a two-stage study design, we randomly sampled 2,497 households in the Palestinian Territories during the Al Aqsa intifada, an internationally recognized humanitarian emergency. Basic anthropometric scores, including weight for height and height for age, were determined for all children age 6-59 months in the household. Standard cut points of a Z score less than -2 for both weight for height and height for age were used to identify the presence of acute malnutrition and chronic malnutrition, respectively. Caloric intake was measured for the youngest child in each household age 12-59 months using a previously validated 24-hour food recall questionnaire. Heads of households were surveyed on 16 household coping strategies, which were used to construct a coping strategies index (CSI) similar to those used by most humanitarian organizations. Results: 4.0% of children in our sample were found to be acutely malnourished and 11.1% were chronically malnourished. 65.1% fell below 80% of USDA recommended daily caloric intake. Our CSI correlated weakly but significantly with acute malnutrition (r=.04, p<.05), chronic malnutrition (r=.06, p<.01), and reduced caloric intake (r=.07, p<.002). The CSI had a sensitivity of 73% and a specificity of 38% for predicting acute malnutrition and a sensitivity of 66% and a specificity of 38% for predicting chronic malnutrition in children age 6-59 months. The CSI had a sensitivity of 64% and a specificity of 40% for detecting reduced caloric intake in children age 12-59 months. Conclusion: Though an index of household coping strategies correlated statistically with both malnutrition and reduced caloric intake, it had poor sensitivity and specificity compared to benchmark indicators.