1 For the purpose of this tool the term undernutrition includes wasting, stunting and micronutrient deficiencies all of which frequently occur at high levels in the same populations affected by food insecurity and crisis and which commonly share the same risk factors. A multisectoral response that aims to address all these forms of undernutrition simultaneously where they occur, makes optimal use of resources and can improve the cost effectiveness of programming. (Thurstans, S., Sessions, N., Dolan, C., et al. (2021). The relationship between wasting and stunting in young children: A systematic review. Maternal & Child Nutrition, 18:e13246. https://doi.org/10.1111/mcn.13246 and Emergency Nutrition Network. The need to consider Wasting and Stunting together Talking Points for a Donor Audience. Sept, 2024)
2 WHO (2023) WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under five years. Geneva: World Health Organization. Available at: https://app.magicapp.org/#/guideline/ noPQkE
3 UNICEF, 1990 and 1992, A UNICEF policy review: Strategy for improved nutrition of children and women in developing countries. UNICEF, New York
4 Black, R. E. , Alderman, H. , Bhutta, Z. A. , Gillespie, S. , Haddad, L. , Horton, S. , Lartey, A. , Mannar, V. , Ruel, M. , Victora, C. G. , Walker, S. P. , & Webb, P. (2013). Maternal and child nutrition: Building momentum for impact. The Lancet, 382(9890), 372–375. 10.1016/S0140-6736(13)60988-5
5 Black, R. E. , Allen, L. H. , Bhutta, Z. A. , Caulfield, L. E. , de Onis, M. , Ezzati, M. , Mathers, C. , Rivera, J. , & Maternal and Child Undernutrition Study Group . (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet, 371(9608), 243–260. 10.1016/S0140-6736(07)61690-0
6 Shekar, M. , Kakietek, J. , Dayton Eberwein, J. , & Walters, D. (2017). An investment framework for nutrition: Reaching the global targets for stunting, anemia, breastfeeding, and wasting. The World Bank.
7 Victora, C. G. , Christian, P. , Vidaletti, L. P. , Gatica‐Dominguez, G. , Menon, P. , & Black, R. E. (2021). Revisiting maternal and child undernutrition in low‐income and middle‐income countries: variable progress towards an unfinished agenda. The Lancet, 397, 1388–1399. 10.1016/S0140-6736(21)00394-9
8 Keats, E.C. et al. (2021) ‘Effective interventions to address maternal and child malnutrition: an update of the evidence’, The Lancet. Child & Adolescent Health, 5(5), pp. 367–384. Available at: https://doi.org/10.1016/S2352-4642(20)30274-1
9 Black, R.E. et al. (2013) ‘Maternal and child undernutrition and overweight in low-income and middle-income countries’, The Lancet, 382(9890), pp. 427–451. Available at: https://doi.org/10.1016/S0140-6736(13)60937-X
10 Specific intervention areas that were removed include biofortification and agronomic fortification; Policies to reduce prices or increase access to nutritious foods and diverse diets.
11 Sadler K, Walters T, Brown R, Cherotich L, Abi Akar R. (2024) ‘Multisectoral prevention of undernutrition for food insecure contexts: An evidence synthesis’. Elrha: London. Elrha_Prevention-of-Undernutrition_Evidence-Synthesis_Final-082025.pdf
13 ibid
14 IPC Overview and Classification System | IPC - Integrated Food Security Phase Classification (no date) (Accessed: 27 February 2024).
15 Guidelines for Analysis and Identification of Areas of Concern (Hot Spots), Addis Ababa 2019
16 Global Nutrition Cluster (2023). Coordination Toolkit. Coordination Toolkit | Global Nutrition Cluster
17 Levinson, F.James and Yarlini Balarajan (2013).. Addressing Malnutrition Multisectorally: What have we learned from recent international experience? Unicef Nutrition Working Paper, UNICEF and MDG Achievement Fund, New York, August 2013.
18 Emergency Nutrition Network. Multi-sectoral Nutrition Programming – A review of current literature and evidence. ENN, Oxford.
19 UNDP. Area-based Programing in contemporary crisis and development response Fit for Purpose? Area-Based Programming in Contemporary Crisis and Development Response - World | ReliefWeb
20 ENN ibid
21 CARE. Nutrition at the Centre: National Scale Up for Impact: Strengthening the Multi-Sectoral Approach to Nutrition
22 Kim et al. Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study. BMC Public Health.
23 Menon P et al. Rethinking effective Nutrition Convergence. Economic and Political Weekly, India.
25 Sadler K, Walters T, Brown R, Cherotich L, Abi Akar R. (2024) ‘Multisectoral prevention of undernutrition for food insecure contexts: An evidence synthesis’. Elrha: London. Elrha_Prevention-of-Undernutrition_Evidence-Synthesis_Final-082025.pdf
26 ie, redefining indicators to reflect the current realities and focussing on relative changes rather than absolute measures
28 What is “Inter-Cluster / Sector Collaboration (ICSC)”? V2, Sept 2023. What is inter-cluster / sector collaboration? | Global Nutrition Cluster
29 JIAF - HPC Collective Learning - OCHA Knowledge Base
30 Linknca nutrition causal analysis
31 “If a programme does not lead to a reduction in direct nutrition outcomes such as stunting and wasting, this does not mean it has been a failure and “should not be interpreted as a lack of benefits or a reason to discourage investment in nutrition”. Monitoring nutrition outcomes that fall outside the timeframe of your programme may reflect negatively on that programme, even though it actually may have been (or may yet be) successful.” (Monitoring and Evaluation of Nutrition-Relevant Programmes A guidance note, TASC Project, May 2022
32 https://www.who.int/data/gho/indicator-metadata-registry/imr-details/7047
33 Biannual administration is recommended where the baseline prevalence is more than 50%. (Preventive chemotherapy to control soil-transmitted helminth infections in at–risk population groups, WHO 2017)
34 A half–dose of albendazole (ie, 200 mg) is recommended for children younger than 24 months-of-age.
35 https://docs.wfp.org/api/documents/WFP-0000158062/download/
36 https://www.fao.org/nutrition/assessment/tools/household-dietary-diversity/en/
37 https://docs.wfp.org/api/documents/WFP-0000147801/download/
38 https://inddex.nutrition.tufts.edu/data4diets/indicator/minimum-dietary-diversity-mdd-iycf
39 https://www.fao.org/nutrition/assessment/tools/minimum-dietary-diversity-women/en/
40 The Humanitarian, Development And Peace Nexus Approach Practical Guidance with Recommended Steps & Examples from Country Food Security Clusters. Global Food Security Cluster, January 2023
41 https://www.nutritioncluster.net/sites/nutritioncluster.com/files/2021-03/GNC_HDN_GlobalReport.pdf
42 MQSUN+/Emergency Nutrition Network (ENN). 2020. Strengthening the Humanitarian Development Nexus for Nutrition in Protracted Crises.
44 Gillespie S, Menon P, Heidkamp R, Piwoz E, Rawat R, Munos M, Black R, Hayashi C, Kumar Saha K, Requejo J. Measuring the coverage of nutrition interventions along the continuum of care: time to act at scale. BMJ Glob Health. 2019 Jun 24;4(Suppl 4):e001290. doi: 10.1136/bmjgh-2018-001290. PMID: 31297250; PMCID: PMC6590959.
45 Alive & Thrive. (2021) Ethiopia Adolescent Nutrition: A Review of the Evidence and Recommendations. (Accessed: 1 October 2024).
46 Lopez-Ejeda, N. and Guerrero, S., Effectiveness, cost–effectiveness, and coverage of severe acute malnutrition (SAM) treatment delivered by Community Health Workers (CHWs) in Mali and Niger: To investigate a modified protocol for treatment of severe acute malnutrition delivered by Community Health Workers (CHWs) and compare it to the current Community Management of Acute malnutrition (CMAM) protocol.
47 Guevarra, E., Norris, A., Guerrero, S. and Myatt, M., 2014. Assessment of Coverage of Community–based Management of Acute Malnutrition. Version 2. CMAM Forum Technical Brief, July 2012, Valid International, Action Against Hunger–UK, Brixton Health
48 eg, Nguyen, P.H., Frongillo, E.A., Sanghvi, T., Kim, S.S., Alayon, S., Tran, L.M., Mahmud, Z., Aktar, B. and Menon, P. (2018) 'Importance of coverage and quality for impact of nutrition interventions delivered through an existing health programme in Bangladesh', Maternal & Child Nutrition, 14(4), p. e12613. doi:10.1111/mcn.12613.
49 Technical note on convergent programming.
51 Garrett J, Natalicchio M. (2011). Working Multisectorally in Nutrition: Principles, Practices, and Case Studies. Washington, D.C.; 2011.
53 Dash, Antaryami, Shahab Ali Siddiqui, Debashmita Bhaumik, and Antara Dhargupta. (2022). “Assessing the Multi-Sectoral Convergence of Interventions Impacting Nutrition at the Household Level: Lessons from Sundarbans, West Bengal, India
55 Smith, L. C., & Haddad, L. J. (2015). Reducing child undernutrition: Past drivers and priorities for the post–MDG era. World Development, 68, 180–204. DOI: 10.1016/j.worlddev.2014.11.013.
57 The World Bank. (2013). Building Resilience: Integrating Climate and Disaster Risk into Development.
58 Pellaud, J., & Weiss, C. (2021). Social Networks and Community Resilience: A Practical Approach for Disaster Risk Reduction. International Journal of Disaster Risk Reduction, 60, 102326.
59 Grellety, E., & Golden, M. H. N. (2018). The importance of multiple interventions in the prevention and treatment of malnutrition. The Lancet Global Health, 6(3), e294-e295. DOI: 10.1016/S2214-109X(18)30045-7.
63 Ibid.
64 FHI Solutions (2023). Closing the Gender Nutrition Gap: An action agenda for women and girls. July 2023
65 Hillenbrand E, Karim N, Mohanraj P and Wu D. (2015). Measuring gender– transformative change: A review of literature and promising practices. CARE USA. Working Paper.
69 This case study is based on the learning brief: REAP for Nutrition. Impact and Learning Report: Lishe Bora authored by BOMA in Kenya, Oct 2023.
70 The Graduation Approach used by USAID Nawiri consists of a sequenced, time-bound package of interventions intended to “graduate” poor households to sustainable livelihoods and to reduce risk of malnutrition.
71 Graduation criteria included: household food security (no child going to bed without an evening meal and participants eat at least two meals a day), sustainable livelihoods (businesses with 25% higher productive asset/value than original cash transfer and participants with multiple income sources), shock preparedness (participants reported increased access to credit and participants meet savings target of a minimum of KES 8,000) & human capital investment (households with school-aged girl child attending primary school and female participants with an increased role in household decision-making).
72 This case study is based on the experience and programming of Save the Children International and partners in Kenya and was authored by Save the Children in Kenya, 2024
73 This case study is drawn from: Becquey, E. et al. (2022) Integrated Research on Acute Malnutrition (IRAM) Impact evaluation of a package of integrated and multisectoral services (PASIM) to reduce child wasting in Chad. Washington DC: IFPRI
74 This case study was provided by Scaling–Up Nutrition Secretariat (SUN–YEMEN), Ministry of Planning & International Cooperation, Yemen
75 Sadler K, Walters T, Brown R, Cherotich L, Abi Akar R. (2024) ‘Multisectoral prevention of undernutrition for food insecure contexts: An evidence synthesis’. Elrha: London. Elrha_Prevention-of-Undernutrition_Evidence-Synthesis_Final-082025.pdf
77 A single dose of a vitamin A supplement greater than 25 000 IU is not recommended as its safety is uncertain.
78 United Nations Children’s Fund (UNICEF). Key Issues Brief: Age prioritization of nutrition interventions for child survival, growth and development in resource-constrained contexts. UNICEF, 2024. UNICEF, New York. World Health Organization (WHO. Risk-differentiated care: a paradigm shift to improve child mortality. Webinar. Sept 2024. First results (childhealthtaskforce.org)
79 It is important to note that the extrapolation of this to individual treatment for wasting is not currently justified given that mortality risk in children who are malnourished is not concentrated in those under 2. The risk is equal in under and over 2 years in these children (Thurstans, S., et al., Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis. Matern Child Nutr, 2023. 19(1): p. e13431. doi: 10.1111/mcn.13431. https://pubmed.ncbi. nlm.nih.gov/36164997/).
80 United Nations Children’s Fund (UNICEF). Key Issues Brief: Age prioritization of nutrition interventions for child survival, growth and development in resource-constrained contexts. UNICEF, 2024. UNICEF, New York. World Health Organization (WHO. Risk-differentiated care: a paradigm shift to improve child mortality. Webinar. Sept 2024. First results (childhealthtaskforce.org)
81 It is important to note that the extrapolation of this to individual treatment for wasting is not currently justified given that mortality risk in children who are already malnourished is not concentrated in those under 2. The risk is equal in under and over 2 years in these children (Thurstans, S., et al., Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis. Matern Child Nutr, 2023. 19(1): p. e13431. doi: 10.1111/mcn.13431. https://pubmed.ncbi.nlm.nih.gov/36164997/).