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
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                  Somerville, MA 02144 USA
                  Tel: +1 617.627.3423
                  Twitter: @FeinsteinIntCen
                  fic.tufts.edu
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                  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.
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            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                                                                                                           
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