Food and nutrition in emergency (Mat og ernæring i sultkatastrofer)

1. Food and nutrition in emergency (Mat og ernæring i sultkatastrofer) Lecture ERN 2110- UiO og SERN 2200 April 2012 Ingrid Barikmo Oslo and AkershusUniversity CollegeHøgskoleniOslo ogAkershus

2. http://www.fao.org/docrep/013/i2050e/i2050e.pdf

5. Publicnutrition in complexemergencies, Lancet2004; 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.

6. IASCInter-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 needs-based relief and protection, in a more effective and timely manner

7. 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

8. 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

9. BASIC PRINCIPLES (cont) • A standard food ration • Community participation • Monitoring, adjusting and targeting

10. 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))

12. ADJUSTING THE INITIALPLANNING 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)

13. 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 withlightactivitiy

14. 2. A basic ration should also be: • Nutritional balanced (ernæringsmessigbalansert) • Diversified (variert) • Cultural acceptable (kultureltakseptabel) • Fit for human consumption (passe for menneskeligkonsum) • Easily digestible for children and other affected vulnerable groups (værelettfordøyelig for barn ogandresårbaregrupper)

15. 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)

17. FoodBasket and theneedsforwomen19 to50 years/day 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

18. 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

19. 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

23. Fortification

24. Table 5: Response options to address micronutrient needs

25. Table 5: Response options to address micronutrient needs (cont)

28. Bilateral pittingedema

29. 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.

30. Types of Feeding Programs General Food Distribution (Food basket) Selective Feeding ProgramsCTC (Community Therapeutic care), Mother and Child Programms Outpatient Therapeutic Program (OTP)severe acute malnutrition (SAM) (curative) Supplementary Feeding Program (SFP) Targeted Supplementary Feeding Programa food supplement for moderately malnourished children and for pregnant and lactating women (more curative) 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) Stabilisation centre (SC)SAM with complications(curative)

32. What kind of foods and fortification (Hvaslagsmatvarerogtilsetninger) • FortifiedBlended Foods (FBFs) • Ready-to-Use Foods (RUFs) • MicronutrientPowder or “Sprinkles” • HighEnergy Biscuits (HEBs) • Compressedfoodbars

33. FortifiedBlended 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.

34. Ready-to-Use Foods (RUFs) • Peanut and oil based ready to eat-food Outpatienttreatmentwith RUTF (Plumpy nut) • For prevention of malnutrition • before – nothing • now –- Plumpydoz, Plumpybutter • 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

35. MicronutrientPowder 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

36. 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 • Compressedfood 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

43. Nyttigeinternettadresser • 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