Nutrition Guidelines (MSF, 1995, 191 p.): Part III Selective feeding programmes: 1. Justification for selective programmes

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

1. Justification for selective programmes

Proper treatment of a patient with severe Protein-Energy Malnutrition (PEM) is crucial in order to avoid death. A review of hospital treatment provided to cases with severe malnutrition demonstrated that 20 - 30% of malnourished patients die in the hospital and a further one-third die after having left the hospital (after discharge or drop-out).

Some children reach the hospital too late and die almost immediately upon arrival. However, the great majority of deaths occur after the first days of hospitalization (usually 60 -70% of deaths) and should be preventable. Home based treatment of children with severe P EM has also proved to be largely unsuccessful, with high mortality rates, high rates of non-compliance and slow recovery.

During food crises, health services risk becoming overwhelmed by large numbers of severely malnourished: a specialized nutrition rehabilitation unit or Therapeutic Feeding Centre (TFC), attached to a hospital or health centre has proven to be the most effective means of managing such situations.

Adequate treatment of severe PEM is an intensive task. A combination of good quality medical care and a specialized feeding protocol is required.

A TFC comprises of an intensive care unit, where medical complications are treated, and where nutritional treatment is started. While in the intensive care unit, the child will receive 8 - 10 meals per 24 hours, day and night. When the child has passed the critical phase, he will be transferred to the day-care unit, which is open 8 - 9 hours a day, and where the child will receive 4 - 6 meals and medical care.

However, it is not always possible to organize a TFC in this way. Security problems, lack of competent staff or large numbers of severely malnourished children may mean that it is only possible to open day-care centres. Under these conditions, even though the intensive care of a 24-hour unit is lacking, the impact on mortality of daycare centres alone may still justify running a Therapeutic Feeding Programme (TFP).

In addition, Supplementary Feeding Programmes (SFPs) may be required to prevent moderately malnourished children becoming severely malnourished (targeted SFP) and to reduce the further deterioration of the nutritional situation (blanket SFP).

The planning and implementation of TFPs and SFPs is a step-by-step process. Although every situation has its own characteristics and requires a specific tailormade approach, these guidelines attempt to help the reader in making decisions to design and implement different types of feeding programmes.