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Niger 2005. "… ‘regular’ starvation has to be distinguished from violent outbursts of famines …" (Amartya Sen, Poverty & Famines 1981). Operations Questions. Dr Milton Tectonidis, London 2006. July 2001-2004. MSF Maradi Program. Six outpatient centres One inpatient centre.

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slide1

Niger 2005

"…‘regular’ starvationhas to be distinguished fromviolent outbursts of famines…"

(Amartya Sen, Poverty & Famines 1981)

Operations

Questions

Dr Milton Tectonidis, London 2006

slide2

July 2001-2004

MSF Maradi Program

Six outpatient centres

One inpatient centre

Severe + special cases only

Ready to Use Therapeutic Foods (RUTF)

9,632 admissions

83.5% cure rate

2004

slide3

March 2005

DAKAR, 21 December (IRIN)Due to poor rains and a severe locust outbreak, Niger this year registered a record grain deficit of 223,487 tons.

Clear Signs (W12)

peak period 2004

slide4

April - May 2005

May 25, 2005MSF Launches Emergency Operation to Combat Malnutrition in Niger

EPICENTRE SURVEYS

GAM 19.6 (28.2), SAM 2.9 (4.1)

GAM 19.3 (28.5), SAM 2.4 (4.4)

U5MR 2.2 – 2.4/10,000/d

slide5

2005

Niger Nutritional Surveys January to September

slide6

May 2005

MSF Niger Emergency Strategy

Steve Collins

Angola 2002

Darfur 2004

NEW SC & OTC (RUTF)+ Protection & Discharge RationsMarch 2005 (Dakoro)May 2005 (Aguié, Tessaoua, Mayahi)

TARGETED BLANKET FEEDINGlate July 2005 (Maradi) late Sept 2005 (Zinder)

slide7

July 25, 2005 Preventing Severe Malnutrition in Maradi, Niger

The first distribution finally took place on Saturday, July 23…

July - October 2005

Inpatient centres

Outpatient points

Family rations

Targeted blankets

Pediatric units

Support to OPDs

October 26 2005 - The Targeted Supplementary Feeding Initiative in Zinder

A joint effort of MSF, UNICEF and the World Food Programme.

slide8

2005

Hunger gap

Malnutrition in Maradi

  • 39,158 admissions
  • 60% of admissions in 13 weeks
  • 95% of admissions < 85 cm
  • 40%+ between 75 & 85 cm

Program indicators 2005

91.4% cure rate

3.2% death rate

4.7% default rate

slide9

December 2005

A recent survey… confirms that the children of Niger still face high levels of malnutrition.

Malnutrition rates range from 9% to 18%, and inadequate infant and young child feeding practices are likely causes.

Cultural factors and social behaviours, such as inadequate infant and young child feeding practices, have a major impact...

slide10

Malnutrition conceptual framework

FOOD

CARE

or

HEALTH ?

The most common cause of protein-energy malnutritionis parents’ poor child feeding and caring practices….”

World Bank 2006

slide11

Food availability in Niger

Maradi

2001

2005

Maradi,

Tahoua

1984

1987

Zinder

1997

slide13

ITEM

QUANTITE

C

ereal

400 gr

Pulse

60 gr

Oil

25 gr

CSB

100 gr

Sugar

15 gr

Salt

5 gr

TOTAL

605 gr

Food quality & dietary deficiency

Deluxe WFP ration

2261 kcal

12% proteins

20 % lipids

monotonous cereal-pulse diets

dietary diversification

food fortification

nutrient supplementation

slide14
Type I nutrients

specific signs of deficiency

Type II nutrients

growth failure

Nutrient deficiency, growth & malnutrition

Mike Golden

nitrogen, essential amino acids

sodium, potassium, chloride

phosphorus, sulphur

zinc, magnesium

tissue repair and growth ceases

no convalescence from illness

anorexia and wasting

iron, copper, selenium

calcium, iodine

vitamins A, B, D, E, K

slide15

Nutrient deficiency, growth & malnutrition

R. Shrimpton. The timing of growth failure (data from 39 studies)

60 million wasted

130 million underweight

150 million stunted

slide16

Ready to Use Therapeutic Foods (RUTF)

Nutrient dense pastes (equivalent to F-100 + Fe)

Ready to eat

No added water – contamination free

Individualised packaging

Increased capacity

Outpatient treatment

Multiple, decentralized sites

Include the "moderates"

Improved results

Early diagnosis (recruitment)

Expanded coverage

Quality referral care

Designed to encourage rapid weight gain

slide17

MSF Emergency Nutrition current strategies

therapeutic feeding + targeted food aid

2004 protection rations

2005 discharge family rations

2005 blanket feeding

2006 therapeutic feeding

slide18

MSF Emergency Nutritioncurrent strategies

Angola 2002 TFC + blanketsDarfour 2004 TFC + OTC + protection rations (+ blankets)

Niger 2005 SC +OTC + protection rations + food ration (+ blankets)

NUTRITION

therapeutic feeding

Acute malnourished

family rations

At risk

blanket feeding

General population

FOOD AID

QualityCoverage

general distribution

slide19

Acute malnutrition - further work

Deinstitutionalize

Simplify

ACUTE MALNUTRITION

W/H < 80%

MUAC < 110 mm

Edema

MUAC/edema only ?

adjustable thresholds

include other age groups

COMPLICATED

NON-COMPLICATED

Inpatient

Outpatient

ANOREXIA

Severe pathology

Apathy

APPETITE

No severe pathology

Alert

strengthen referral capacity

discharge quickly

adjust discharge criteria

lighten follow-up

slide20

Anthropometry – individual risk

Extend benefits

RUTF ?

Treatment by illness episode ?

acute weight loss

slide21

Anthropometry – individual risk

Extend benefits

"healthy" reference children

rural village age peers

child with pertussis

RUTF ?

Treatment by illness episode ?

poor & incomplete catch-up growth

slide22

Anthropometry – population risk

Extend benefits

South Sudan 1993

Herwaldt et al.

70% U5 < -2 ZS

RUTF ?

Therapeutic Blanket ?

Maradi Niger 2005

Up to 25% incidence of severe malnutrition (50% for < 85 cm)

slide23

MSF nutrition

new therapeutic products & strategies

micronutriments +/- calories

RUTF

RUSF

pregnancy & lactation

"acute" malnutrition

TARGETED SUPPLEMENT

RAPID WEIGHT GAIN

RUSF

Nutrients

illness episode

convalescence

weight loss

weaning foods

HIV-TB

chronic disease

ration supplement

slide24

MSF emergency nutrition

Strategy (who is at risk ?)Targeting (what supplement ?)

RUTF for rapid

weight gain

Acute malnourished

Acute weight loss

At risk groups

RUSF for specific target group

General population

General ration quantity & quality