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JANUARY 2018 Persistent Global Acute Malnutrition A discussion paper on the scope of the problem, its drivers, and strategies for moving forward for policy, practice, and research A FEINSTEIN INTERNATIONAL CENTER PUBLICATION Helen Young and Anastasia Marshak FRIEDMAN SCHOOL OF NUTRITION SCIENCE AND POLICY Persistent Global Acute Malnutrition fic.tufts.edu 1 Feinstein International Center Cover photo: Anastasia Marshak Citation: Young, H., Marshak, A. Persistent Global Acute Malnutrition. Boston: Feinstein International Center, Tufts University, 2017. Corresponding author: Helen Young Corresponding author email: helen.young@tufts.edu Photo credits: Anastasia Marshak This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents do not necessarily reflect the views of USAID or the United States Government. Copyright 2017 Tufts University, all rights reserved. “Tufts University” is a registered trademark and may not be reproduced apart from its inclusion in this work without permission from its owner. Feinstein International Center, Friedman School of Nutrition Science and Policy Tufts University 114 Curtis Street Somerville, MA 02144 USA Tel: +1 617.627.3423 Twitter: @FeinsteinIntCen fic.tufts.edu Persistent Global Acute Malnutrition fic.tufts.edu 2 Acknowledgements We gratefully acknowledge the support of USAID’s Center for Resilience in support of this work through grant number AID-OAA-G-17-0003. This report would not have been possible without the input of key stakeholders in academia and the INGO community, and of donors and independent professionals. We would like to specifically thank the following people for their incredible contribution to this report: Silke Pietzsch, Julien Chalimbaud, Chris Hillbruner, Josselin Gauny, Elizabeth Bontrager, Josephine Ippe, Kate Golden, Susanne Jaspers, Patrick Webb, Le Minh Tram, Andi Kendle, Abigail Perry, Tanya Khara, Hélène Pasquier, Olivia Freire, Mark Myatt, Grainne Mairead Moloney, Erin McCloskey Rebelo, Esther Busquet, and Alessandro Iellamo. In addition, we would like to thank André Briend, Erin Boyd, Gwenaëlle Luc, Marion Junca, and Peter Hailey for their contribution as reviewers as well as interviewees. We would also like to thank Sabina Carlson Robillard for her work on the literature review and case studies. Persistent Global Acute Malnutrition fic.tufts.edu 3 Contents Acknowledgments 3 Acronyms 6 Executive summary 7 Introduction 9 Methodology 11 1. Defining the problem: Scale and scope of persistent GAM 12 2. What are the perceived drivers of GAM in these contexts? 17 Perceptions of the drivers of persistent GAM 18 Cross-cutting themes 21 3. Methodological challenges in identifying trends in and drivers of GAM 25 Challenges in identifying trends in GAM 25 Methodological challenges in understanding drivers of GAM in contexts where 26 GAM is persistent 4. What are the implications for current practice and policy? 30 Why are current programs having a limited impact on persistent GAM? 30 Limited experience of successful exit or transition in the context of persistent GAM 30 What is the answer? 32 5. What are the implications for future research? 33 Why is the existing evidence base on persistent GAM insufficient? 33 What is the answer? 36 Conclusion 37 References 38 Annex 1. Additional Tables and Figures 44 Annex 2. Case Studies 50 Grand Kanem Region of Chad 50 Cox’s Bazar, Chittagong, Bangladesh 51 Northern Bahr-el-Ghazal, South Sudan 51 Maradi and Zinder, Niger 52 Persistent Global Acute Malnutrition fic.tufts.edu 4
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