It is, however, critical to recognise that nutritionally vulnerable individuals live in households and communities that will also be vulnerable and that targeting assistance only to individuals in these circumstances is likely to jeopardise impacts of any intervention. In addition, there are other groups, such as adolescent girls, the elderly and the disabled, that are known to be disproportionately affected by crisis. As such, this tool includes important actions for prevention of undernutrition among older children and adolescent girls, as well as for the households and communities of PBWGs and children under five (described below as nutritionally vulnerable households). It is the early stages of response design that will support understanding of the main causes of undernutrition and define who is in need of assistance and the levels at which this should be targeted.
The nutritional vulnerability of PBWGs and children
PBWG and children under the age of five years are often considered to be particularly nutritionally vulnerable in humanitarian settings due to a combination of physiological needs, developmental requirements and the heightened risks for these groups associated with crisis conditions. Reasons for their increased vulnerability include:
- Increased nutritional needs: Pregnancy and breastfeeding increase nutritional requirements considerably due to the needs of foetal growth and development and the production of breastmilk. Children under 5 are growing rapidly, which increases nutrient requirements and, at the same time, have relatively small stomach capacities, which makes the nutrient density of their diet particularly important.
- Immune system vulnerability: Pregnancy naturally suppresses some aspects of the immune system to protect the foetus, increasing susceptibility to infections, which can worsen nutritional deficiencies. Young children’s immune systems are immature and are less able to fight infections, leading to a vicious cycle where malnutrition and illness exacerbate each other.
- Long–term consequences: Poor nutrition for PBWGs can lead to complications for their own health such as obstructed labour, postpartum haemorrhage and long– term health issues. Malnourished mothers are more likely to give birth to malnourished infants, perpetuating a cycle of poor health and poverty. In children, malnutrition in the first 1,000 days (from conception to 2 years-of-age) can result in irreversible damage to physical growth and cognitive development, reducing educational and economic potential later in life.
- People with disabilities and older people are important to consider in undernutrition prevention planning for several key reasons:
- Physiological vulnerability: These groups often have reduced ability to obtain, prepare and consume food due to physical limitations, mobility issues, or chronic health conditions. In addition, they may have reduced social networks or caregiving support, increasing their vulnerability to food and nutrition insecurity.
- Economic constraints: Many older people and people with disabilities live on low incomes, that can make access to a good quality diet financially challenging.
- Specific nutritional needs: Older people and people with disabilities frequently require specialised diets, increased nutrient intake, or specific dietary accommodations to maintain health.
- Increased health risks: Undernutrition in these groups can rapidly accelerate health decline, leading to weakened immune systems, increased hospitalisation rates, higher mortality risks and reduced quality of life.
Addressing their specific nutritional needs can require targeted interventions that consider their unique physiological, economic and social circumstances. The Humanitarian inclusion standards for older people and people with disabilities were developed by the Age and Disability Capacity Programme (ADCAP).
The document outlines three nutrition inclusion standards:
- Collection of information: Older people and people with disabilities have their nutritional needs identified and monitored.
- Addressing barriers: Older people and people with disabilities have access to nutrition services and facilities.
- Participation and resilience: Older people and people with disabilities participate in nutrition programmes and their capacities are strengthened.
The nutrition inclusion standards complement existing standards and guidance on nutrition. They should be read in conjunction with the key inclusion standards and Sphere Minimum Standards in Food Security and Nutrition.