Acute malnutrition in the Sahel affects an estimated six million children under five years, of whom about 1.4 million require treatment for severe acute malnutrition. While there is considerable evidence of the effectiveness of interventions to treat moderate acute malnutrition under optimal conditions, there is insufficient and equivocal understanding of the relationship between malnutrition treatment and prevention work. In addition to examining the impacts of various components of World Food Programme (WFP) programming on core outcomes, the series of impact evaluations on moderate acute malnutrition programming synthesised in this report contribute evidence on the value of the interrelationship between programmes for preventing and programmes for treating moderate acute malnutrition in emergency and post-emergency contexts. The impact evaluations are part of the Humanitarian Assistance Thematic Window of the International Initiative for Impact Evaluation (3ie), which launched in 2014 with the overall objective of generating high-quality evidence for improving the quality of life of those in humanitarian crises.
This report is a synthesis of the main findings and lessons from four WFP-funded impact evaluations of nutrition and food security interventions in four countries of the Sahel region of Sub-Saharan Africa: Chad, Mali, Niger and Sudan. The evaluations examined aspects of WFP’s programmes for food security and the treatment and prevention of moderate acute malnutrition and their impact on nutrition and food security outcomes, and identified lessons for improving programme effectiveness to achieve core WFP objectives in food security and nutrition. The synthesis provides cross-cutting evidence to inform strategic choices on future programming to address moderate and severe acute malnutrition as a tool for improving overall nutrition and food security outcomes. The impact evaluations consider the following main questions:
Chad: What is the impact of interventions for preventing moderate acute malnutrition on the incidence and prevalence of moderate acute malnutrition in children under two years with varying levels of access to moderate acute malnutrition treatment? (Saboya et al. forthcoming)
Mali: What are the impacts of conflict and food assistance on child malnutrition and other development outcomes? (Gelli et al. forthcoming)
Niger: What are the impacts on nutrition outcomes of various combinations of programme components in WFP’s protracted relief and recovery operation? (Brück et al. forthcoming)
Sudan: What are the impacts of various interventions for treating and preventing moderate acute malnutrition on the incidence and prevalence of moderate and severe acute malnutrition in children under five years and pregnant and lactating women? (Guevarra et al. forthcoming)
The impact evaluations identify lessons relevant to WFP programmes and provide insights into how different components of WFP programming interact with one another. The evaluation results are situated, however, within the particular context of each study area. WFP implemented food security and nutrition-related protracted relief and recovery operations in the Sahel region because of high rates of poverty coupled with fast population growth, climate change, recurrent food security and nutrition crises, and violence due to armed conflicts. iii The impact evaluations also contribute to the literature on what works to improve nutrition and food security outcomes in humanitarian contexts. Although acute malnutrition has been identified as a major driver of child mortality in the developing world, large evidence gaps remain (Black et al. 2008; Bhutta et al. 2008; Victora et al. 2008; Bryce et al. 2008; Morris et al. 2008). 3ie carried out an assessment of existing synthesis-type studies of the evidence base for humanitarian interventions (Appendix A) and identified significant knowledge and evidence gaps regarding the prevention and treatment of acute malnutrition.
The impact evaluations covered in this synthesis reported various effects, depending on the context and the combination of programmes implemented. The impact evaluation for Chad found that the prevention programme – blanket supplementary feeding – had a positive effect on the incidence of moderate acute malnutrition during the lean season, particularly for households supported by seasonal work. When looking at the interaction between the prevention programme (blanket supplementary feeding) and the treatment programme (targeted supplementary feeding), the prevention programme had a larger (positive) impact on moderate acute malnutrition incidence amongst households with poorer than average access to the treatment programme.
The evaluation for Sudan found a significant reduction in the prevalence of children at risk of malnutrition where food-based interventions for preventing moderate acute malnutrition were added to the treatment programme (targeted supplementary feeding). The Niger evaluation concluded that continued provision of food assistance for assets in combination with treatment and/or prevention programmes significantly reduced the incidence of moderate acute malnutrition, serving as a nutrition-sensitive form of assistance.
The impact evaluation in Mali found that access to general food distribution led to increases in households’ non-food and food expenditures and in micronutrient availability. The evaluation examined the delivery of a package of multisector nutrition interventions and found that households living close to conflict and receiving at least two forms of assistance – particularly general food distribution and school feeding – showed statistically positive effects on nutrition outcomes, whereas the effects were not significant for households that received only one form of food assistance. Disaggregating by degree of exposure to conflict, the evaluation also uncovered that the effects on children’s nutrition outcomes were concentrated mostly in areas that were not in the immediate vicinity of conflict and that this might, in part, be because these households had greater access to aid.
This synthesis report is based on a systematic analysis of the four impact evaluations and identifies several operational and policy-related lessons. Based on these lessons, the recommendations identified in the synthesis relate to improving operational efficiency and coverage, tailoring programme components according to context, increasing interagency cooperation and improving monitoring and cost data.