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Session 7.2. Assessment 4: Working with Sectoral Indicators: Food & Nutrition

Session 7.2. Assessment 4: Working with Sectoral Indicators: Food & Nutrition. WFP Photo. Objectives. After completing this session, participants will be able to: Highlight the relationship between malnutrition and disease Describe an adequate basic ration

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Session 7.2. Assessment 4: Working with Sectoral Indicators: Food & Nutrition

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  1. Session 7.2. Assessment 4: Working with Sectoral Indicators: Food & Nutrition WFP Photo UNHCR/InterWorks - Emergency Management Training

  2. Objectives After completing this session, participants will be able to: • Highlight the relationship between malnutrition and disease • Describe an adequate basic ration • Review the standards and indicators used for determining nutritional status in the population • Understand the uses of special feeding programs and targeted interventions UNHCR/InterWorks - Emergency Management Training

  3. Malnutrition High energyUtilization Lowered Resistance Poor Appetite Infection • Measles • Diarrhea • Pneumonia • Malaria A vicious cycle UNHCR/InterWorks - Emergency Management Training

  4. Malnutrition: when a person can no longer maintain adequate performance in growth, pregnancy, lactation, work, and resisting and recovering from disease UNHCR/InterWorks - Emergency Management Training

  5. Death Rate Correlates with Malnutrition CMR Crude mortality rate D e a t h s Malnutrition Rate in Population UNHCR/InterWorks - Emergency Management Training

  6. Kwashiorkor - an extreme indicator from inadequate protein intake and/or the stress of infection Visible signs: • Edema - swelling • Flaking skin • Thin, light hair • more common among 3-5 year olds UNHCR/InterWorks - Emergency Management Training

  7. Energy, Calories, and Nutrients • Short for "Kilocalories” • Food energy UNHCR/InterWorks - Emergency Management Training

  8. Required Nutrients Protein: 4 kcals/gram Carbohydrates: 4 kcals/gram Fat: 9 kcals/gram Micronutrients: Vitamins and Minerals UNHCR/InterWorks - Emergency Management Training

  9. Kilocalories per gram of food UNHCR/InterWorks - Emergency Management Training

  10. All Guidelines and StandardsHighlight the Same Indicator • 2,100 Kilocalories Per Person Per Day as a gross planning figure UNHCR/InterWorks - Emergency Management Training

  11. Individual Need for Calories varies • Some people need 1,500 kcal/day….. • Some people need 5,000 kcal/day…... • What does the need depend on? UNHCR/InterWorks - Emergency Management Training

  12. Who has the greatest daily needs in kilocalories??? 1. Males - especially 15-19 years old 2. Lactating women 3. Pregnant women 4. Heavy physical activity 5. Severe cold weather UNHCR/InterWorks - Emergency Management Training

  13. Age Males Females Average group (kcal/day) (kcal/day) (kcal/day) % of pop. 0-4 yr 1320 1250 1290 12.37% Daily Energy Requirements 5-9 yrs. 1980 1730 1860 11.69% 10-14 yrs. 2370 2040 2210 10.53% 15-19 yrs. 2700 2120 2420 9.54% 20-59 yrs. 2460 1990 2230 48.63 60+ yrs. 2010 1780 1890 7.24 Pregnant 285 2.4% (extra) Lactating 500 2.6% (extra) AVERAGE DAILY REQUIREMENT: 2100 Kcal/person/day Based on WHO technical Report No. 724 and UN Pop. Data, mid 1995 UNHCR/InterWorks - Emergency Management Training

  14. Making a Basic Food Ration: What are our goals?2,100 kilocalories - adjusted for:17% fat10-12% proteinAll micronutrients - Something rich in vitamins and minerals - like blended foods (corn-soy blend) UNHCR/InterWorks - Emergency Management Training

  15. Let’s Design a Ration for a Refugee Population • Foods that are available • Foods that are reasonably priced • Foods that won’t spoil quickly • Foods that are acceptable • Foods that achieve nutrition objectives UNHCR/InterWorks - Emergency Management Training

  16. Major food item: Grain (staple) either wheat, maize, rice, sorghum or a flour (4 kcal/gram minus loss) • Food with protein: beans or lentils (4 kcal/gram minus loss) • Source of fat and energy: oil (9 kcal/gram) • Something rich in vitamins and minerals: Blended Food - Corn/Soy blend (3.8 kcal/gram) • Saltfor flavor and iodine (no calories) • Sugarfor flavor and energy (4 kcal/gm) UNHCR/InterWorks - Emergency Management Training

  17. Commodity Grams (/person/day) Rice 400 60 Corn-Soy-Blend 50 Vegetable Oil 25 Sugar 15 An Example Ration Pulses UNHCR/InterWorks - Emergency Management Training

  18. Food Aid Management Concerns • Do people have access to fresh foods and alternative foods? • Will they accept the food in their cultures? • What if there is not enough of the needed food? What can be substituted? • What about the food that is lost in grinding and cooking? • Do they have enough water, cooking fuel, grinding facilities and kitchen utensils? • Is the food safe? What about powdered milk? UNHCR/InterWorks - Emergency Management Training

  19. Example Difference between two families Family I Family II 1 Pregnant 2 Elderly 1 Lactating 1 Adult 2 Teenage 1 Child 1 Adult 1 Child Needs 2500 Calories 1700 Calories With ration of 2100 kcals, Family I will have a ration deficit and Family II a ration surplus. UNHCR/InterWorks - Emergency Management Training

  20. Micro-nutrient Deficiencies 1. Vitamin A - Blindness 2. Vitamin B1 - Beri-Beri(Thiamin) - Paralysis/Cardiac Failure/Death 3. Vitamin C - Scurvy - Bleeding/Anemia/Numbness/Death 4. Iron - Anemia, Paleness-Death 5. Niacin - Pellagra - Diarrhea/Dermatitis/Dementia/Death 6. Iodine - Goiter UNHCR/InterWorks - Emergency Management Training

  21. Most Micronutrient Deficiency Disease is Hidden Typical Refugee Population Observable, Clinically Evident Various Vitamin, Mineral Deficiencies No Deficiencies UNHCR/InterWorks - Emergency Management Training

  22. Vitamin & Mineral Deficiency Disease Epidemics will occur, predictably, in refugee crises What Indicators can we use to find them? UNHCR/InterWorks - Emergency Management Training

  23. Salter Scale Weight UNHCR/InterWorks - Emergency Management Training

  24. Height boards UNHCR/InterWorks - Emergency Management Training

  25. Mid-upper Arm Circumference or “MUAC” UNHCR/InterWorks - Emergency Management Training

  26. MUAC as QUICK Screening Tool MUAC of all children aged 6 - 59 months MUAC < 13.5 cm or oedema MUAC > 13.5 cm Not referred unless at high risk Referred to central WfH assessment WfH > 80% WfH 70 - 79% WfH < 70% NOT admitted to feeding programme Supplementary feeding Programme Therapeutic Feeding Programme UNHCR/InterWorks - Emergency Management Training

  27. Malnutrition Rates “Moderately” Malnourished: • < 80% of the reference value of Weight-for-Height “Severely” Malnourished: • < 70% of the reference value of Weight-for-Height UNHCR/InterWorks - Emergency Management Training

  28. >20% or 10 - 19% plus aggravating factors Serious! Supplementary feeding for all vulnerable. groups Therapeutic feeding for severely malnourished > 10% or 5-9% plus aggravating factors Alert!Suppl. feeding for selected individuals in vulnerable groups Therap. feeding for severely malnourished < 5% AcceptableNo need for population-wide programme Malnutrition Rates / Interventions UNHCR/InterWorks - Emergency Management Training

  29. What is an “aggravating factor?” • General food ration of < 2100 kcal/day • Crude mortality rate of > 1/10,000/day • Measles or whooping cough epidemic • High prevalence of respiratory or diarrheal diseases UNHCR/InterWorks - Emergency Management Training

  30. Our biggest enemy: loss of appetiteanorexialoss of appetiteshrunken stomach UNHCR/InterWorks - Emergency Management Training

  31. What are the most Important Things Given in Supplementary and Therapeutic Feeding? • Regular, hot, sweet, fluid meals (typically in the form of porridge or milk, with crackers) • Personal A t t e n t i o n UNHCR/InterWorks - Emergency Management Training

  32. In Extreme cases, Therapeutic Feeding will Focus on oral rehydration and high energy milk UNHCR/InterWorks - Emergency Management Training

  33. Sodium Chloride Salt 3.5 grams Sodium bicarbonate Baking soda 2.5 grams Potassium chloride Banana 1.5 grams Glucose sugar 20 grams Water (boil first!) 1 liter Oral Rehydration Salt formula(ORS) UNHCR/InterWorks - Emergency Management Training

  34. WFP Responsibilities UNHCR NOTE: Under the 2002 MOU, WFP will conduct 12 pilot cases where they disribute food directly to beneficiaries instead of UNHCR UNHCR/InterWorks - Emergency Management Training

  35. WFP/UNHCR MOU Responsibilities Basic Commodities (WFP) Complementary Commodities(UNHCR) - Cereals (Wheat, Rice, Maize) - Oils and Fats - Protein-rich Food(Beans/Peas or Nuts) - Canned Fish or Meat* - Dried Fish or Meat* - Salt* - Sugar - Fortified Blended Food - High Energy Biscuits - When recommended by the Joint Assessment Mission, UNHCR will supply: - Fresh Meat or Fish - Vegetables and Fruit - Condiments (Soy Sauce, Tomato Paste, etc.) - Spices - Dried skimmed milk (DSM) UNHCR/InterWorks - Emergency Management Training

  36. Joint Responsibilities (in consultation with Host Government) • Defining locations of EDPs • Monitoring overall food aid supply situation (through FASreps) • Constant exchange of information • Consultation for problem resolution WFP UNHCR UNHCR/InterWorks - Emergency Management Training

  37. CONCLUSION • Avoid serious malnourishment, by quickly establishing a satisfactory basic food ration • Treat serious malnutrition that does occur with special supplementary and therapeutic feeding programmes for those in need • Use commonly agreed indicators for assessing, designing, and monitoring food and nutrition programmes UNHCR/InterWorks - Emergency Management Training

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