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Food and nutrition in emergency
(Mat og ernæring i sultkatastrofer)
LectureERN 2110- UiO og SERN 2200
April 2012Ingrid Barikmo
Oslo and Akershus University CollegeHøgskolen i Oslo og Akershus
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.
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
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
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
BASIC PRINCIPLES (cont)
A standard food ration
Community participation
Monitoring, adjusting and
targeting
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))
ANNEX 1: Energy requirements for emergency-affected populations
Developing country profile (demography and anthropometry); Kilocalories per day
Age/sex group (years)
Malea Femalea Male & Femalea
% of total population
Energy requirement per caput
% of total population
Energy requirement per caput
% of total population
Energy requirement per caput
0 1.31 850 1.27 780 2.59 820
1b 1.26 1,250 1.20 1,190 2.46 1,220
2b 1.25 1,430 1.20 1,330 2.45 1,380
3b 1.25 1,560 1.19 1,440 2.44 1,500
4b 1.24 1,690 1.18 1,540 2.43 1,620
0–4 6.32 1,320 6.05 1250 12.37 1,290
5–9 6.00 1,980 5.69 1730 11.69 1,860
10–14 5.39 2,370 5.13 2040 10.53 2,210
15–19 4.89 2,700 4.64 2120 9.54 2,420
20–59c 24.80 2,460 23.82 1990 48.63 2,230
60+c 3.42 2,010 3.82 1780 7.24 1,890
Pregnant 2.4 285 (extra) 2.4 285 (extra)
Lactating 2.6 500 (extra) 2.6 500 (extra)
Whole Population 50.84 2,250 49.16 1910 2,080
Source: WHO. The management of nutrition in major emergencies. Geneva, 2000.a: Adult weight: male 60 kg, female 52 kg.b: Population estimates for years 1, 2, 3 and 4 are not available from UN. Estimates for these years were made by interpolation between the figures given by UN for 0 year and 5 years.c: The figures given here apply for “light” activity level (1.55 x BMR for men, 1.56 x BMR for women). (The BMR [basal metabolic rate] is the rate of energy expenditure of the body when at complete rest [e.g. sleeping]. It is estimated at 1,355 kcal/person/day.)
Environmental temperature (Omgivelsestemperatur)
Health and nutritional status (Helse- og
ernæringsstatus)
Demographic characteristics (Demografiske forhold)
Physical activity level (Fysisk
aktivitetsnivå)
ADJUSTING THE INITIALPLANNING FIGURE FOR ENERGY(Justering av de første planleggingstallene for energi)
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
with light activitiy
2. A basic ration should also be:– Nutritional balanced (ernæringsmessig
balansert)
– Diversified (variert)
– Cultural acceptable (kulturelt akseptabel)
– Fit for human consumption (passe
for menneskelig konsum)
– Easily digestible for children and
other affected vulnerable
groups (være lett fordøyelig for barn og andre
sårbare grupper)
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)
Table 2: Examples of adequate full rations in terms of energy, protein and fat for populations entirely reliant on food assistance
ITEMS RATIONS
(quantity in g)
Example 1 Example 2 Example 3 Example 4 Example 5
Cereal 400 450 350 400 400
Pulses* 60 60 100 60 50
Oil (vit. A fortified) 25 25 25 30 30
Fish/meat - 10 - 30 -
Fortified blended foods 50 40 50 40 45
Sugar 15 - 20 - 25
Iodized salt 5 5 5 5 5
Energy: kcal 2,113 2,075 2,113 2,146 2,100
Protein (in g and in % kcal) 58 g; 11% 71 g; 13% 65 g; 12% 55 g; 10% 65 g; 12%
Fat (in g and in % kcal) 43 g; 18% 43 g; 18% 42 g; 18% 42 g; 17% 39 g; 17%
* Not all types of pulses are acceptable to all populations; therefore, the most familiar type of pulse must be resourced for the population.
Food Basket and the needs for women 19 to 50 years/day
La necesidad de la mujer de 19 a 50 años, por día Energía: 2200 kcal
Calcio: 1000 mgVitamina A: 500 µg
Proteina: 66gHierro: 20 a 59 mgVitamina C: 45 mg
0
10
20
30
40
50
60
70
Proteinas, g Hierro, mg Vit C, mg
Necesidad de la mujerde 19 a 50 años pordía
Obtenido 2008 si125000 ben
Obtenido 2008 si160000 ben
0
500
1000
1500
2000
2500
Energia, kcal Calcio,mg Vit A,µg
Necesidad de la mujer de19 a 50 años por día
Obtenido 2008 si 125000ben
Obtenido 2008 si 160000ben
Food Basket adapted
Opción 5
0
500
1000
1500
2000
2500
Energia, kcal Calcio,mg Vit A,µg
Necesidad de mujeres 19-50 años para día
Canasta básica adaptadapara día
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
Opción 5
010
2030
4050
6070
Proteinas, g Hierro, mg Vit C, mg
Necesidad de mujeres 19-50 años para día
Canasta básica adaptadapara día
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
Opción 6
0
500
1000
1500
2000
2500
3000
Energia, kcal Calcio,mg Vit A,µg
Necesidad de mujeres 19-50 años para día
Canasta básica adaptadapara día
Opción 6
0
20
40
60
80
100
120
Proteinas, g Hierro, mg Vit C, mg
Necesidad de mujeres 19-50 años para día
Canasta básica adaptadapara día
FortificationVegetable oil Vitamin A and D
Salt Iodine
Wheat and maize flour Vitamin A, thiamine (B1), riboflavin (B2), niacin, folic acid and iron
Blended foods (WSB;CSB) Vitamin A, thiamine (B1), riboflavin (B2), niacin, folic acid, vitamin C and B12, iron, calcium and zinc
STRATEGY STRENGTHS WEAKNESSES REMARKS/ EXAMPLES
1. Inclusion of fortified food items in the general ration
-Reaches a large number of recipients. -Interventions can be implemented rapidly. -Cost effective.
-Limited to food-aid commodities that are suitable vehicles for micronutrients. -Need to be sustained until access to fresh food improves.
-Oil with vitamin A, fortified flours. -Requires active participation of the food industry and donor. -Need to ensure fortification specifications are met (quality control).
2. Promoting the production of vegetables and fruit
-Supports self-reliance. -Provides fresh foods of preferred choice.
-Requires population to have access to land, water and agricultural inputs.
-Cultivation of homestead gardens or communal garden plots.
3. Promoting beneficial food-preparation practices
-May support indigenous food-preparation practices in some situations.
-Introduced practices may be unfamiliar to the population and therefore require substantial communications.
-Fermentation, sprouting grains and pulses.
Table 5: Response options to address micronutrient needs
Table 5: Response options to address micronutrient needs (cont)
STRATEGY STRENGTHS WEAKNESSES REMARKS/ EXAMPLES
4. Providing fresh food items in general ration (or facilitating access to fresh foods)
-Improves palatability and quality of ration.
-Expensive and logistically difficult. -May increase market prices at local or regional level. -Feasibility of providing for whole population unlikely.
-Fresh foods provided must be rich in micronutrient(s).
5. Food diversification: adding to the ration a food rich in a particular vitamin or mineral( e.g. ground nuts, dried fish).
-Reaches a large number of recipients. -Interventions can be implemented rapidly.
-Needs to be sustained until access to fresh food improves. -Food safety and quality control can be difficult
-Restricted to foods that the population is familiar with and that contain the relevant micronutrients.
6. Distribution of vitamin/mineral supplements
-Can be very effective if linked with immunizations or health programmes (e.g. vitamin A).
-Distribution system needs to be maintained. -May be expensive and time-intensive if relying on an independent distribution system.
-Distribution of some specific micronutrient supplements such as vitamin C may be better suited to treatment rather than preventive measures.
Bilateral pitting edema
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.
Types of Feeding Programs
Selective Feeding ProgramsCTC (Community Therapeutic
care), Mother and Child Programms
Targeted Supplementary Feeding Program
a 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)
General Food Distribution (Food basket)
Supplementary Feeding Program (SFP)
Outpatient Therapeutic Program (OTP)
severe acute malnutrition (SAM) (curative)
Stabilisation centre (SC)SAM with
complications(curative)
What kind of foods and fortification (Hva slags matvarer og tilsetninger)
Fortified Blended Foods (FBFs)
Ready-to-Use Foods (RUFs)
Micronutrient Powder or “Sprinkles”
High Energy Biscuits (HEBs)
Compressed food bars
Fortified Blended 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.
Ready-to-Use Foods (RUFs)
Peanut and oil based ready to eat-food For prevention of malnutrition
– before – nothing– now –
- Plumpy doz, Plumpy butter 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
Outpatient treatment
with RUTF (Plumpy nut)
Micronutrient Powder 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
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 Compressed food 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
Nyttige internettadresser
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
