|Nutrition Guidelines (MSF, 1995, 191 p.)|
|Part I: Nutrition Strategies in Emergency Situations|
Even if the overall food needs of a population are adequately met there may be inequities in the distribution system, disease and other social factors causing degrees of malnutrition in certain vulnerable groups
Vulnerable groups may be targeted to receive a food supplement in order to upgrade their diet to a level that responds to their increased needs.
Those that are already acutely malnourished must receive medical and nutritional attention in order to rehabilitate them to a healthy state.
The following decision tree can be used to help interpret the seriousness of the situation but should not be interpreted as a set of rules.
Figure 5: General guidelines to assist in decisions to implement nutrition programmes
(*) Aggravating factors to consider are:
- Mortality: Crude Mortality Rate (CMR) > 1 /10.000/day;
- Inadequate general food ration
- Epidemic of measles, shigella or other important communicable diseases
- Severe cold and inadequate shelter
Objectives of selective feeding programmes
The general objective of a therapeutic feeding programme (TFP) is to reduce mortality by taking care of those vulnerable groups at greatest risk of dying from causes related to malnutrition. Generally the target group is children less than 5 years with severe acute malnutrition.
The general objective of a targeted supplementary feeding programme (SFP) is to prevent the moderately malnourished becoming severely malnourished and thereby reduce the prevalence of severe acute malnutrition and associated mortality.
In a situation of a grossly inadequate general food supply, it may be necessary to organise a Blanket Supplementary Feeding Programme for all members of the vulnerable groups (for a short period of time). The objectives of this programme are to prevent widespread malnutrition and mortality. In this case the programme may include up to 40% of the total population ! In such a situation, however, first priority should be given to restoring the general food supply.
Other factors like general food supply, water and sanitation and general health services also have a major impact on the pattern of mortality, disease and malnutrition.
Objectives of feeding programmes should be specified to be realistic and feasible, and must therefore take into account the local conditions and project capacity.
In a displaced population, a nutrition survey among 6 - 59 month old children indicates 15% acute malnutrition (Confidence Interval 15 + 3%) (<-2 Z-Scores W/H and/or oedema) and 3-5% acute severe malnutrition (<-3 Z-Scores W/H and/or oedema). Mortality surveillance shows a crude mortality rate of 2/10,000/day and an under-five mortality rate of 4/10,000/day.
It is necessary to implement a TFP, targeting the severely acutely malnourished and a targeted SFP for the moderately acutely malnourished.
The target population (50,000) is settled in two camps, with well established health services in each camp, which are easily accessible for the entire population.
Therefore, it seems realistic to set the objectives of the TFP and SFP to: - a coverage of 90% of severely malnourished children,
- a coverage of 80% of moderately malnourished children,
- a recovery of 80% of children admitted to the TFP and 70% to SFP,
- a reduction of the mortality among severely malnourished children admitted to the TFP to below 5% and the reduction of the under 5 mortality rate to < 2/10,000/day,
- a reduction in the prevalence of severe acute malnutrition to < 2% (<-3 Z-Scores W/H +/or oedema).
All objectives should be reached within 3 months.
In another, newly displaced population, a nutrition survey also indicates 15% global acute malnutrition and 3% severe acute malnutrition in under-fives. As the accessibility of the feeding programme will be limited, because the people live in scattered small settlements and often at large distances (> 2 hours walking) from the health services, the programme objective of a reduction of the severe malnutrition rate to below 2% has been set for within 6 months, and coverage objectives are re-set.
Because of a crop failure last year, there is a severe food shortage in a rural population, while the next harvest (which is expected to be normal) is still 3 months away. The global acute malnutrition rate among under-fives, which at this moment is 9%, will increase rapidly if nothing is done.
A blanket supplementary feeding programme will be implemented for all children under 5 years, for a period of 4 months (until after the next harvest) with the objective of stopping any further deterioration in nutritional status until the harvest.