Transcript Mat og ernæring i sultkatastrofe situasjon

Food and nutrition in
emergency
(Mat og ernæring i sultkatastrofer)
Lecture
ERN 2110- UiO og SERN 2200
April 2012
Ingrid Barikmo
Oslo and Akershus University College
Høgskolen i Oslo og Akershus
http://www.fao.org/docrep/013/i2050e/i2050e.pdf
Public nutrition in complex emergencies, Lancet 2004; 364: 1899–909
The prevalence of acute malnutrition should be interpreted in the context of:
•mortality
•coping strategies
•disease
•seasonality
•other factors.
Efforts continue to improve analysis of underlying causes of malnutrition and
consideration of a wider range of non-food aid interventions, which should help
to avoid the food-first bias in programming.
IASC
Inter-Agency
Standing Committee

Humanitarian reform
(the cluster approach)
seeks to improve the
effectiveness of
humanitarian response
by ensuring greater
predictability,
accountability and
partnership. It is an
ambitious effort by the
international
humanitarian
community to reach
more beneficiaries,
with more
comprehensive needsbased relief and
protection, in a more
effective and timely
manner
UNHCR, UNICEF, WFP and WHO have
jointly developed these guidelines as a
practical tool for assessing, estimating
and monitoring the food and nutrition
needs of populations in emergencies
BASIC PRINCIPLES
A coordinated approach
 Context-specific assistance
 A general food basket based on
providing 2,100 kcal per person per
day
 Timely distribution of an adequate,
basic ration

BASIC PRINCIPLES (cont)

A standard food ration

Community participation

Monitoring, adjusting and targeting
Why 2100 kcal?

The need for energy in emergencies is
estimated to be at average 1900 – 2500
kcal/person/day (Energibehov i krisesituasjoner er beregnet til
gjennomsnittlig 1900 - 2500 per person)

It is to use for initial planning and 2100
kcal is recommended (WHO) (Til bruk for
planlegging er derfor 2100 kcal anbefalt (WHO))
ANNEX 1: Energy requirements for emergency-affected populations
Developing country profile (demography and anthropometry); Kilocalories per day
Malea
Age/sex group
(years)
Femalea
Male & Femalea
% of total
population
Energy
requirement
per caput
% of total
population
Energy
requirement
per caput
% of total
population
Energy
requirement
per caput
0
1.31
850
1.27
780
2.59
820
1b
1.26
1,250
1.20
1,190
2.46
1,220
2b
1.25
1,430
1.20
1,330
2.45
1,380
3b
1.25
1,560
1.19
1,440
2.44
1,500
4b
1.24
1,690
1.18
1,540
2.43
1,620
0–4
6.32
1,320
6.05
1250
12.37
1,290
5–9
6.00
1,980
5.69
1730
11.69
1,860
10–14
5.39
2,370
5.13
2040
10.53
2,210
15–19
4.89
2,700
4.64
2120
9.54
2,420
20–59c
24.80
2,460
23.82
1990
48.63
2,230
60+c
3.42
2,010
3.82
1780
7.24
1,890
Pregnant
2.4
285 (extra)
2.4
285 (extra)
Lactating
2.6
500 (extra)
2.6
500 (extra)
49.16
1910
Whole
Population
50.84
2,250
2,080
Source: WHO. The management of nutrition in major emergencies. Geneva, 2000.
a: Adult weight: male 60 kg, female 52 kg.
b: Population estimates for years 1, 2, 3 and 4 are not available from UN. Estimates for these years were made by interpolation between the
figures given by UN for 0 year and 5 years.
c: The figures given here apply for “light” activity level (1.55 x BMR for men, 1.56 x BMR for women). (The BMR [basal metabolic rate] is the
rate of energy expenditure of the body when at complete rest [e.g. sleeping]. It is estimated at 1,355 kcal/person/day.)
ADJUSTING THE INITIAL
PLANNING FIGURE FOR ENERGY
(Justering av de første planleggingstallene for energi)

Environmental temperature
(Omgivelsestemperatur)

Health and nutritional status (Helse- og
ernæringsstatus)

Demographic characteristics
(Demografiske
forhold)

Physical activity level
(Fysisk aktivitetsnivå)
Basic ration
(Basisrasjon)
1. An adequate ration is defined to meet the
minimum requirements for: (En tilstrekkelig rasjon er
definert til å kunne møte minimumsbehovene for):
– energy
– protein
– fat
– micronutrients
with light activitiy
2. A basic ration should also be:
– Nutritional balanced
– Diversified
(ernæringsmessig balansert)
(variert)
– Cultural acceptable
(kulturelt akseptabel)
– Fit for human consumption
(passe for
menneskelig konsum)
– Easily digestible for children and
other affected vulnerable groups
lett fordøyelig for barn og andre sårbare grupper)
(være
The content in ”The Food Basket”

Should give minimum
– energy: 2100 kcal/day
– protein: 10-12% of total energy
– fat: minimum 17% of total energy
– micronutritiens: ”safe level” in according to
UNHCR/UNICEF/WFP/UNHCR guidelines
annex 2)
Table 2: Examples of adequate full rations in terms of energy, protein and fat for populations entirely reliant
on food assistance
ITEMS
RATIONS
(quantity in g)
Example 1
Example 2
Example 3
Example 4
Example
5
Cereal
400
450
350
400
400
Pulses*
60
60
100
60
50
Oil (vit. A fortified)
25
25
25
30
30
-
10
-
30
-
Fortified blended foods
50
40
50
40
45
Sugar
15
-
20
-
25
Iodized salt
5
5
5
5
5
2,113
2,075
2,113
2,146
2,100
Protein (in g and in %
kcal)
58 g; 11%
71 g; 13%
65 g; 12%
55 g; 10%
65 g; 12%
Fat (in g and in % kcal)
43 g; 18%
43 g; 18%
42 g; 18%
42 g; 17%
39 g; 17%
Fish/meat
Energy: kcal
* Not all types of pulses are acceptable to all populations; therefore, the most familiar type of pulse must be resourced for the population.
Food Basket and the needs for
women 19 to 50 years/day
2500
70
Necesidad de la mujer
de 19 a 50 años por
día
60
50
40
Obtenido 2008 si
125000 ben
30
2000
Necesidad de la mujer de
19 a 50 años por día
1500
Obtenido 2008 si 125000
ben
1000
Obtenido 2008 si 160000
ben
20
Obtenido 2008 si
160000 ben
10
0
Proteinas, g
Hierro, mg
Vit C, mg
500
0
Energia, kcal
Calcio,mg
Vit A,µg
La necesidad de la mujer de 19 a 50 años, por día
Proteina: 66g
Hierro: 20 a 59 mg
Vitamina C: 45 mg
Energía: 2200 kcal
Calcio: 1000 mg
Vitamina A: 500 µg
Food Basket adapted
Opción 5
kg/pers/mes
 Wheat
4
 Wheat fortified
5
 Pasta
1
 Rice
2
 Lentils
2
 Oil
0.5
 Oil fortified
0.5
 Sugar
1
 Canned fish in oil
1
 Potato
1
 Carrot
1
 Onion
1
 Apple
1
Opción 5
70
60
50
40
30
20
10
0
Necesidad de mujeres 19
-50 años para día
Canasta básica adaptada
para día
Proteinas, g
Hierro, mg
Vit C, mg
Opción 5
2500
2000
1500
Necesidad de mujeres 19
-50 años para día
1000
Canasta básica adaptada
para día
500
0
Energia, kcal
Calcio,mg
Vit A,µg
Enriched adapted Food Basket
Opción 6
kg/pers/mes
 Wheat
2
 Wheat fortified
6
 Barley
1
 Pasta
1
 Rice
2
 Lentils
1
 Soya beans
1
 Oil
0.5
 Oil fortified
0.5
 Sugar
1
 Milk
5
 Canned fish in oil
2
 Potato
3
 Carrot
3
 Onion
2
 Apple
1
 Orange
1
 Tomato, tetra pack
1
 Cheese
1
Opción 6
120
100
Necesidad de mujeres 19
-50 años para día
80
60
Canasta básica adaptada
para día
40
20
0
Proteinas, g
Hierro, mg
Vit C, mg
Opción 6
3000
2500
Necesidad de mujeres 19
-50 años para día
2000
1500
Canasta básica adaptada
para día
1000
500
0
Energia, kcal
Calcio,mg
Vit A,µg
Fortification
Vegetable oil
Vitamin A and D
Salt
Iodine
Wheat and maize flour
Vitamin A, thiamine (B1),
riboflavin (B2), niacin, folic
acid and iron
Blended foods (WSB;CSB)
Vitamin A, thiamine (B1),
riboflavin (B2), niacin, folic
acid, vitamin C and B12, iron,
calcium and zinc
Table 5: Response options to address micronutrient needs
REMARKS/
EXAMPLES
STRATEGY
STRENGTHS
WEAKNESSES
1. Inclusion of fortified
food items in the
general ration
-Reaches a large
number of
recipients. Interventions can
be implemented
rapidly. -Cost
effective.
-Limited to food-aid
commodities that
are suitable
vehicles for
micronutrients. Need to be
sustained until
access to fresh
food improves.
-Oil with vitamin A,
fortified flours. Requires active
participation of
the food industry
and donor. -Need
to ensure
fortification
specifications are
met (quality
control).
2. Promoting the
production of
vegetables and
fruit
-Supports self-reliance.
-Provides fresh
foods of preferred
choice.
-Requires population
to have access to
land, water and
agricultural
inputs.
-Cultivation of
homestead
gardens or
communal garden
plots.
3. Promoting beneficial
food-preparation
practices
-May support
indigenous foodpreparation
practices in some
situations.
-Introduced practices
may be unfamiliar
to the population
and therefore
require substantial
communications.
-Fermentation,
sprouting grains
and pulses.
Table 5: Response options to address micronutrient needs (cont)
REMARKS/
EXAMPLES
STRATEGY
STRENGTHS
WEAKNESSES
4. Providing fresh food
items in general ration (or
facilitating access to fresh
foods)
-Improves palatability
and quality of ration.
-Expensive and
logistically difficult. May increase market
prices at local or regional
level.
-Feasibility of providing
for whole population
unlikely.
-Fresh foods provided
must be rich in
micronutrient(s).
5. Food diversification:
adding to the ration a food
rich in a particular vitamin
or mineral( e.g. ground
nuts, dried fish).
-Reaches a large number
of recipients. Interventions can be
implemented rapidly.
-Needs to be sustained
until access to fresh food
improves. -Food safety
and quality control can be
difficult
-Restricted to foods that
the population is familiar
with and that contain the
relevant micronutrients.
6. Distribution of
vitamin/mineral
supplements
-Can be very effective if
linked with
immunizations or health
programmes (e.g. vitamin
A).
-Distribution system
needs to be maintained. May be expensive and
time-intensive if relying
on an independent
distribution system.
-Distribution of some
specific micronutrient
supplements such as
vitamin C may be better
suited to treatment rather
than preventive measures.
Bilateral pitting edema
Public nutrition in complex emergencies, Lancet 2004; 364: 1899–909
The prevalence of acute malnutrition should be interpreted in the context of:
•mortality
•coping strategies
•disease
•seasonality
•other factors.
Efforts continue to improve analysis of underlying causes of malnutrition and
consideration of a wider range of non-food aid interventions, which should help
to avoid the food-first bias in programming.
Types of Feeding Programs
General Food Distribution (Food basket)
Selective Feeding Programs
CTC (Community Therapeutic care),
Mother and Child Programms
Supplementary Feeding
Program (SFP)
Blanket Supplementary Feeding
Program
a food supplement for ALL members of
a particular group e.g. children under-5
years, pregnant and lactating mothers,
(more preventive)
Outpatient Therapeutic
Program (OTP)
severe acute malnutrition
(SAM) (curative)
Targeted Supplementary
Feeding Program
a food supplement for moderately
malnourished children and for
pregnant and lactating women
(more curative)
Stabilisation
centre (SC)
SAM with
complications
(curative)
What kind of foods and fortification
(Hva slags matvarer og tilsetninger)

Fortified Blended Foods (FBFs)

Ready-to-Use Foods (RUFs)

Micronutrient Powder or “Sprinkles”

High Energy Biscuits (HEBs)

Compressed food bars
Fortified Blended Foods (FBFs)

What are they?
FBFs are blends of partially precooked
and milled cereals, soya, beans, pulses
fortified with micronutrients (vitamins
and minerals). Special formulations may
contain vegetable oil or milk powder.
– Corn Soya Blend (CSB) is the main
blended food distributed by WFP but Wheat
Soya Blend (WSB) is also sometimes used.

When and where used?
In food assistance programs to
prevent and address nutritional
deficiencies.
– They are generally used in WFP
Supplementary Feeding and Mother and
Child Health programs.
– Also, to provide extra micronutrients to
complement the general ration.
Ready-to-Use Foods (RUFs)

Peanut and oil based ready to eatfood

For prevention of malnutrition
– before – nothing
– now –
- Plumpy doz, Plumpy butter

Outpatient
treatment
with RUTF
(Plumpy nut)
For treatment of moderate malnutrition (MAM)
– Supplementary'Plumpy

For treatment of severe acute malnutrition
(MAS):
– Before – F100
– Now – Plumpy Nut
(and with complications F75 and F100)

For prevention of malnutrition – adults
– Plumpy soy
Micronutrient Powder or
“Sprinkles”
What is it?
A tasteless powder containing the
recommended daily intake of 16 vitamins
and mineral for one person. Can be
sprinkled onto home-prepared food after
cooking just before eating. (WFP)
 When?
Useful when fortification of cereal flour
cannot be implemented or when it is
inadequate for specific groups, for example
anemia among women


Other
dry
foods
High Energy Biscuits (HEBs)
– What are they?
Wheat-based biscuits which provide 450kcal with
a minimum of 10 grams and max of 15 grams of
protein per 100 grams, fortified in vitamin and
minerals.
– When and where used?
In the first days of emergency when cooking
facilities are scarce.
– Easy to distribute and provide a quick solution to
improve the level of nutrition.
– School meal/snack

Compressed food bars
– What are they?
Bars of compressed food, composed of baked
wheat flour, vegetable fat, sugars, soya protein
concentrate and malt extract.
– When and when used?
Used in disaster relief operation when local food
can’t be distributed or prepared. Should not be
used for children under 6 months and in the first
2 weeks of treatment of severe malnutrition.
– How used?
Can be eaten as a bar straight from the package
or crumble into water and eaten as porridge.
Drinking water must be provided as the bars are
very compact and dry
Nyttige internettadresser
http://www.wfp.org/
http://www.unicef.org/
 http://www.unhcr.org
 http://www.who.int/en/
 http://www.fao.org/
 http://www.unscn.org
 http://www.sphereproject.org
 http://www.fantaproject.org/
 http://www.reliefweb.int/w/rwb.nsf

