Nutrition in Emergencies

1. Nutrition in Emergencies Spices & condiments A source of micronutrients - Blended food Dr. Mariam Alwaili In-charge of clinical nutrition MOH Protein rich food – Peas, beans or lentils Source of fat - Vegetable oil A staple food - Cereals

2. Outcomes Immediate causes Malnutrition and death Inadequate dietary intake Insufficient health services and unhealthy environment Disease Social and Care Environment Underlying causes Inadequate access to food I n a d e q u a t e e d u c a t i o n Formal and non-formal institutions Basic causes Potential resources Economic structure Political and ideological superstructure Conceptual Framework for the Causes of Malnutrition in Society

3. Common Nutritional Problems • Protein-Energy Malnutrition 2. Micronutrient Malnutrition Vitamin A Deficiency (VAD) Iron Deficiency Anemia (IDA) Iodine Deficiency Disorders (IDD) 3. Communicable disease 4. Non-communicable disease

4. Growth Monitoring Breastfeeding & Vitamin A Complementary feeding and Iron Supplementation Nutrition Information Education Food Food Security Fortification Vitamin A Omani code Guidelines

5. Programme Interventions in Emergencies

6. Overview of Programs General Food Distribution Selective Feeding Programs Supplementary Feeding Programs Therapeutic Feeding Programs Food Security Interventions Disease control measures

7. Overview of Feeding Programs General Feeding Programs - For populations dependent - Full or partial food basket - Wet or dry rations

8. The “Food Basket” For an initial emergency period and/or for a population entirely dependent on external food aid. 2,100 kcal/person/day 10-12% of total energy from protein At least 17% of total energy from fat Recommended micronutrient intakes

9. Overview of Feeding Programs Selective Feeding Programs Supplementary Feeding Programs Therapeutic Feeding Programs Usually target vulnerable groups: Malnourished children and individuals Pregnant and lactating women TB/HIV/other chronically ill patients If general ration or food intake not sufficient to meet special needs

10. Reduce the demand for micronutrients infection prevention and treatment reduction in measles/TB, hookworm improve hygiene immunization deworming malaria control Availability of ORS increased exposure to sun Increase supply of micronutrients in the diet or by supplementation THESE SHOULD HAPPEN SIMULTANEOUSLY Disease control measures

11. Overview of Feeding Programs Food Security Interventions …gardening/income generation, etc… Support for gardening projects, income generation, etc. Improve access to micronutrient rich foods by growing, trading, purchase, etc. Increase dietary diversity

12. What Are the Characteristicsof an Adequate Ration? Acceptable and broadly familiar • Meet the populations minimum nutritional requirements • Diversified • Fit for human consumption • Easily digestible for children • Economic in terms of fuel requirements, preparation time and waste

13. Distribution systems should be: Equitable Regular Accountable Transparent Secure

14. Minimum response in every emergency

15. What must I do to protect and support safe and appropriate IFE?

16. Offer ‘safe places’ for breastfeeding and feeding support

17. Prioritise pregnant and lactating women for shelter, food, water and security

18. Make sure every newborn initiates breastfeeding within 1 hour of birth

19. Ensure access to safe and adequate complementary foods, appropriate to needs and context

20. Locate technical capacity Wet nurse relactates an abandoned baby (Myanmar, 2008) Unaccompanied infants with no source of breasmilk (Rwanda, 1994)

21. Do not seek or accept donations of BMS, bottles & teats • Donated (free) or subsidised supplies of breastmilk substitutes (e.g. infant formula) should be avoided. • Donations of bottles and teats should be refused in emergency situations. • Any well-meant but ill-advised donations of breastmilk substitutes, bottles and teats should be placed under the control of a single designated agency. • Operational Guidance on IFE, v2.1, Feb, 2007 But Gov should special cases

23. Key priorities Scale up existing life saving treatment of acute malnutrition programs Capitalize on high impact low cost interventions such as breast feeding, complementary feeding and Vitamin A supplementation; Building capacity of national institutions in nutrition emergency preparedness, response and mitigation; Targeting under 5 children, pregnant and lactating women, and vulnerable groups (elderly, disable people etc….)

24. Standard Guidelines for designing and monitoring feeding programs SPHERE UNHCR/WFP Guidelines for Selective Feeding Program in Emergency Situations

25. NUTRITION PREPAREDNESS IN EMERGENCY

26. How to Prepare Individual Be prepared to be self sufficient for at least 72-Hours. Food Water Shelter Medications Hygiene items Keep it together, updated/rotated and accessible.

27. EXAMPLE OF 4-PERSON 72-HOUR KIT Sheets, blankets, towels, & pillows 5 gallon bucket with hygiene items Water Ready made Dried food Propane heater Dishes, pots & pans Canned food Sleeping bag Battery lantern with batteries Propane Lantern Camp stove & misc. items (rope, tools, matches, propane) Propane Charcoal Extra BBQ Propane tank Tent, cots, sleeping bag. Tarps

28. Key priorities Scale up existing life saving treatment of acute malnutrition programs Capitalize on high impact low cost interventions such as breast feeding, complementary feeding and Vitamin A supplementation; Building capacity of national institutions in nutrition emergency preparedness, response and mitigation; Targeting under 5 children, pregnant and lactating women, and vulnerable groups (elderly, disable people etc….)

29. Group work • 1. What information on nutrition needs do you need to know of affected people? • 2. With whom would you need to coordinate to find out more about the situation? • 3. What information did you got from risk assessment study • 4. What intervention measures would you make based on the information that you have? • 5. what is your contingency plan. • 6. What is your recommendation

30. Coming together is a beginning; Keeping together is progress; Working together is success!