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.
"…‘regular’ starvationhas to be distinguished fromviolent outbursts of famines…"
(Amartya Sen, Poverty & Famines 1981)
Dr Milton Tectonidis, London 2006
MSF Maradi Program
Six outpatient centres
One inpatient centre
Severe + special cases only
Ready to Use Therapeutic Foods (RUTF)
83.5% cure rate
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
May 25, 2005MSF Launches Emergency Operation to Combat Malnutrition in Niger
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
Niger Nutritional Surveys January to September
MSF Niger Emergency Strategy
NEW SC & OTC (RUTF)+ Protection & Discharge RationsMarch 2005 (Dakoro)May 2005 (Aguié, Tessaoua, Mayahi)
TARGETED BLANKET FEEDINGlate July 2005 (Maradi) late Sept 2005 (Zinder)
The first distribution finally took place on Saturday, July 23…
July - October 2005
Support to OPDs
October 26 2005 - The Targeted Supplementary Feeding Initiative in Zinder
A joint effort of MSF, UNICEF and the World Food Programme.
Malnutrition in Maradi
Program indicators 2005
91.4% cure rate
3.2% death rate
4.7% default rate
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...
The most common cause of protein-energy malnutritionis parents’ poor child feeding and caring practices….”
World Bank 2006
Food quality & dietary deficiency
Deluxe WFP ration
20 % lipids
monotonous cereal-pulse diets
specific signs of deficiency
Type II nutrients
Nutrient deficiency, growth & malnutrition
nitrogen, essential amino acids
sodium, potassium, chloride
tissue repair and growth ceases
no convalescence from illness
anorexia and wasting
iron, copper, selenium
vitamins A, B, D, E, K
R. Shrimpton. The timing of growth failure (data from 39 studies)
60 million wasted
130 million underweight
150 million stunted
Nutrient dense pastes (equivalent to F-100 + Fe)
Ready to eat
No added water – contamination free
Multiple, decentralized sites
Include the "moderates"
Early diagnosis (recruitment)
Quality referral care
Designed to encourage rapid weight gain
therapeutic feeding + targeted food aid
2004 protection rations
2005 discharge family rations
2005 blanket feeding
2006 therapeutic feeding
Angola 2002 TFC + blanketsDarfour 2004 TFC + OTC + protection rations (+ blankets)
Niger 2005 SC +OTC + protection rations + food ration (+ blankets)
W/H < 80%
MUAC < 110 mm
MUAC/edema only ?
include other age groups
No severe pathology
strengthen referral capacity
adjust discharge criteria
Treatment by illness episode ?
acute weight loss
"healthy" reference children
rural village age peers
child with pertussis
Treatment by illness episode ?
poor & incomplete catch-up growth
South Sudan 1993
Herwaldt et al.
70% U5 < -2 ZS
Therapeutic Blanket ?
Maradi Niger 2005
Up to 25% incidence of severe malnutrition (50% for < 85 cm)
new therapeutic products & strategies
micronutriments +/- calories
pregnancy & lactation
RAPID WEIGHT GAIN
Strategy (who is at risk ?)Targeting (what supplement ?)
RUTF for rapid
Acute weight loss
At risk groups
RUSF for specific target group
General ration quantity & quality