| Summary: | This study aimed to identify methods to improve: 1) the assessment of the need for humanitarian nutritional intervention in adults in complex emergencies; and 2) the collection and quality of routine adult malnutrition data. A systematic literature review of methods for nutritional assessment of adults that could be used in complex emergencies was conducted. Hair pluckability was identified as a potential method, and empirical studies were conducted to investigate its reliability in healthy volunteers. A questionnaire was sent to NGOs to determine the most important context factors when considering adult nutritional status. Data were collected from three NGOs on the nutritional status of 13,599 adults from 33 feeding programmes in five different countries. As context data relevant to each feeding programme were unavailable, country-specific data were often used. Hair pluckability was significantly different between- and within-observers (p<0.001). In the feeding programmes, context factors were more significantly associated with Mid Upper Arm Circumference (MUAC) than Body Mass Index (BMI). Poor security and food security were also significantly associated with poorer nutritional status, but here was evidence that some of the associations were explained by differences in the type of feeding programme. Hair pluckability was found to be an unreliable indicator of nutritional status. MUAC may be a more useful method of assessing nutritional status in complex emergencies than BMI. The usefulness of the NGO data was limited due to bias and possible confounding, and the low number and spread of data points being compared. This highlights the need for standardised data collection methods, to enable comparison of nutritional needs between populations. Education and training of field workers in data collections methods is recommended.
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