![]() | Nutrition Guidelines (MSF, 1995, 191 p.) |
![]() | ![]() | (introduction...) |
![]() | ![]() | Preface |
![]() | ![]() | Part I: Nutrition Strategies in Emergency Situations |
![]() | ![]() | 1. Food crises |
![]() | ![]() | 2. Assessment of the nutritional situation |
![]() | ![]() | 3. Interventions: ensuring adequate general food availability and accessibility |
![]() | ![]() | 4. Interventions: selective feeding programmes |
![]() | ![]() | 5. Evaluation |
![]() | ![]() | Part II: Rapid Nutrition Surveys |
![]() | ![]() | 1. Introduction to anthropometric surveys |
![]() | ![]() | 2. Anthropometric measurements and indices |
![]() | ![]() | 3. Sampling methods |
![]() | ![]() | 4. Analysis, interpretation and recommendations |
![]() | ![]() | 5. Conclusions |
![]() | ![]() | Part III Selective feeding programmes |
![]() | ![]() | 1. Justification for selective programmes |
![]() | ![]() | 2. Criteria for admission and discharge to selective feeding programmes |
![]() | ![]() | 3. Screening and selection |
![]() | ![]() | 4.Treatment in a therapeutic feeding centre |
![]() | ![]() | 5. Treatment in supplementary feeding programmes |
![]() | ![]() | 6. Implementation and management of a feeding centre |
![]() | ![]() | 7. Registration and monitoring |
![]() | ![]() | 8. Evaluation of feeding programmes |
![]() | ![]() | 9. Food management |
![]() | ![]() | Annexes |
![]() | ![]() | Annex 1: Rapid assessment of the state of health of displaced populations or refugees (A.Moren - Medical News, No. 1) |
![]() | ![]() | Annex 2: Mid - Upper Arm Circumference (MUAC) |
![]() | ![]() | Annex 3: Nutritional status assessment in adults and adolescents |
![]() | ![]() | Annex 4: Agencies involved in food relief |
![]() | ![]() | Annex 5: Food composition table |
![]() | ![]() | Annex 6: GENERAL RATION: How to calculate the energetic value |
![]() | ![]() | Annex 7: Micronutrient deficiencies |
![]() | ![]() | Annex 8: Food basket monitoring methodology |
![]() | ![]() | Annex 9: Analyzing nutritional survey data |
![]() | ![]() | Annex 10: Drawing of a random number |
![]() | ![]() | Annex 11: Standardization of anthropometric measuring techniques |
![]() | ![]() | Annex 12: Data collection forms |
![]() | ![]() | Annex 13: W/H Reference tables |
![]() | ![]() | Annex 14: Selection of food items for selective feeding programmes |
![]() | ![]() | Annex 15: Oral rehydration for severely malnourished children |
![]() | ![]() | Annex 16a: Preparation of High Energy Milk |
![]() | ![]() | Annex 16b: Recipes for porridge for use in therapeutic and wet supplementary feeding programmes |
![]() | ![]() | Annex 16c: Recipes for premix for dry ration supplementary feeding programmes |
![]() | ![]() | Annex 17a:Example of a Therapeutic feeding centre |
![]() | ![]() | Annex 17b: example of layouth of a <<wet>> supplementary feeding centre |
![]() | ![]() | Annex 17c: Example of a DRY SFP |
![]() | ![]() | Annex 18a: Example of an Attendance register (tfp or SFP) |
![]() | ![]() | Annex 18b: Example of a Nutritional Status Monitoring (SFP) |
![]() | ![]() | Annex 19a: TFP individual monitoring card |
![]() | ![]() | Annex 19b: SFP individual monitoring card |
![]() | ![]() | Annex 19c: Individual card for Supplementary feeding centre |
![]() | ![]() | Annex 19d: Example of an individual card for dry blanket SFC |
![]() | ![]() | Annex 20: Feeding programme indicator graphs |
![]() | ![]() | Annex 22: MSF nutrition kits |
![]() | ![]() | Bibliography |
Food needs
The composition of rations and exact make-up of recipes depends on availability (from donors and local markets) and local acceptability (local food habits) of foods. See Annex 14 and 16 for suitable ration sizes, food commodities used and recipes.
Try to obtain the foods from donors with in - country food stocks:
- International organizations
- Bilateral donations
-
NGO's (see Annex 4)
If donors are unable to supply adequate quantities of food or supply essential items rapidly enough, essential commodities (cereals, pulses, oil, sugar) may be bought locally/regionally.
In order to prevent serious disruptions in the programme, due to irregular food supply, each feeding centre/programme should always have its own buffer stock, sufficient to cover needs for one to three months, depending on local storage and supply conditions.
Transport capacity is critical in the planning and location of feeding centres - a normal 4x4 pick-up can carry 1,000 kg, if roads are not too bad.
Calculations of monthly food needs for wet feeding centres should be based on the needs of a child with an average weight of 9 kg:
200 kcal/kg/day x 9 = 1.81/child/day - TFP Depends on food used in wet SFP.
Example:
If the initial survey estimated the number of severely malnourished children at 245, the food to be ordered for one month will be:
DSM: 80g x 1.81 x 245 children x 30 = 1058 kg = 1.058 Mt Oil: 60g x 1.81 x 245 x 30 = 794 kg = 0.794 Mt Sugar: 50g x 1.81 x 245 x 30 = 662 kg = 0.662 Mt
Estimates are increased by 10% to allow for losses during transport and preparation, so the total amount to be ordered in this example will be: DSM: 1.164 Mt, Oil: 0.875 Mt. Sugar: 0. 728 Mt, Total: 2. 767 Mt. This amount of food will require at least 3 trips by pick-up.
In addition, local foods need to be purchased for meals for carers.
For calculating food needs for one month for dry ration distribution programmes: average attendance: 150 children per week, dry ration for one child per day:
- 270 gram dry premix containing:
- WSB 140g
- DSM
50g
- 1250Kcal + 46g protein sugar 30g oil 50g food needs for one month for
150 children, including an addition of 10% for losses:
WSB |
(140 x 30 x 150) + 10% = 693 kg |
DSM |
(50 x 30 x 150) + 10% = 248 kg |
sugar |
(30 x 30 x 150) + 10% = 149 kg |
oil |
(50 x 30 x 150) + 10% = 248 kg |
Total |
= 1,338 kg |
this amount of food can be transported in 2 pick-up loads.
Actual consumption
The actual consumption of the commodities has to be checked in order to:
- adapt the theoretical calculation of the food needs to the
actual needs,
- compare the consumption with the number of beneficiaries to
control preparation of meals and unexplained losses of food.
Example of check on the actual consumption:
No. of children registered at the end of the month: 150
Calculated needs for this month (including 10% losses)
WSB |
140 x 30 x 150 +10% |
= 693 kg |
DSM |
50 x 30 x 150 +10% |
= 248 kg |
Sugar |
30 x 30 x 150 +10% |
= 149 kg |
Oil |
50x 30x 150+10% |
= 248 kg |
Actual consumption:
WSB |
700 kg |
Corresponds |
DSM |
300 kg |
20% Overconsumption |
Sugar |
200 kg |
> 30% Overconsumption |
Oil |
200 kg |
20% Underconsumption |
Stock management
Good management of the food stock is essential for the successful performance of a selective feeding programme. The store must be properly locked, foods carefully stacked and good ventilation ensured. Food stock management should be systematized so that there is stock rotation (old foods used before the new) and there are always sufficient quantities of ALL commodities in the buffer stock.
Only one person should be responsible for the store, and only with his approval can commodities be released from the storehouse; all commodities going in and out of the store must be systematically registered.
The supply and use of the different commodities must be summarized in a monthly stock balance.
FIGURE
At the end of each month, a physical count (stockcount) of the stocks should be made to cross - check the stock balance. The stockcount should equal the closing stock of the stock balance. If this is not the case, and differences are unacceptable, try to find out reasons and change the food management system accordingly.
The end - of - the - month stockcount should be taken as the opening stock for the next month.
Food Orders
The required food stock at the beginning of the month will depend on the extent of the predicted consumption as well as the size of the required buffer stock. The frequency and stability of the food supply determines the amount of food needed as a buffer stock. If a stable monthly supply can be guaranteed, a buffer of one month is sufficient (although 2 - 3 may be preferred). Large stocks should be avoided, because the management is more difficult, food has a limited shelf lifen, and for security reasons.
The quantity of food to be ordered each month, allowing for a one month buffer stock, can be calculated as follows:
Monthly Order = (2 x Monthly Consumption) - Stock Count
Example:
A feeding centre consumes 0.625 MT of sugar every month. There are 0.25 MT in stock at the end of the month. The next order will be: (2 x 0.625) - 0.25 = 1 MT.
(All food orders should be made in Metric Tonnes = 1000 kg)