IV. Supplementary Feeding Programmes

TARGETED SUPPLEMENTARY FEEDING PROGRAMMES

Objective

27. Targeted Supplementary Feeding Programmes (SFPs) are directed at selected individuals who are at risk. Their aim is to:

· rehabilitate moderately malnourished children, adolescents, adults and elderly persons.

· prevent the moderately malnourished from becoming severely malnourished.

· Reduce mortality and morbidity risk in children under 5 years.

· provide a food supplement to selected pregnant and nursing mothers and other individuals at-risk.

· Provide follow-up to referrals from Therapeutic Feeding Programmes

Figure 3 explains the decision making framework concerning the implementation of Selective Feeding Programmes.

When to Start?

28. Targeted SFPs should be implemented when one or more of the following situations occur:

· There are large numbers of malnourished individuals ® prevalence of 10-14% acute malnutrition³ among children.

³ Prevalence of acute malnutrition (or: acute malnutrition rate) reflects the proportion of the child population (6 months to 5 years) whose weight-for-height is below -2 Z-scores or less than 80% of the median NCHS/WHO reference values, and/or oedema.

· There are large numbers of children predicted to become malnourished due to factors like poor food security and high rates of disease ® prevalence of 5-9% acute malnutrition in presence of aggravating factors⁴.

⁴ Aggravating factors are normally defined as inadequate general food ration, crude mortality rate above 1/10,000/day, epidemics measles or whooping cough, and high prevalence of respiratory or diarrhoeal diseases.

Criteria for Admission

29. The following target groups could be considered for admission to a Targeted SFP:

· Moderately malnourished children under 5 years:

® between 70% and 80% of the median weight-for-height or
® between -3 and -2 Z-scores weight-for-height

· Malnourished individuals (based on weight-for-height, Body Mass Index (BMI)⁵, Mid Upper Arm Circumference (MUAC)⁶ or clinical signs):

® older children (between 5 and 10 years)
® adolescents
® adults and elderly persons
® medical referrals

⁵ BMI: Body Mass Index defined as the (weight in kg)/(height in m)² for assessing the nutritional status of adolescents and adults.

⁶ MUAC: Circumference of the mid upper arm, used for rapid screening of children.

· Referrals from a Therapeutic Feeding Programme.

· Selected pregnant women (from date of confirmation of pregnancy) and nursing mothers (until 6 months after delivery), for instance using MUAC < 22 cm as a cut-off indicator for pregnant women.

Criteria for Discharge

30. The following are the criteria for discharge:

· Children who have maintained at least 85% of median weight-for-height for a period of two weeks (wet SFP) or one month (dry SFP).

· Individuals older than 5 years who have attained a stable and satisfactory nutritional status and who are free from disease.

31. Children and adults who have not shown signs of improvement after two weeks (wet SFP) or one month (dry SFP) should be assessed to find out the cause and if required should be referred for medical and community care.

When to Close?

32. Targeted SFPs can be closed when all of the following criteria are satisfied:

· General food distribution is adequate (meeting planned nutritional requirements).

· Prevalence of acute malnutrition is below 10% without aggravating factors.

· Control measures for infectious diseases are effective.

· Deterioration in nutritional situation is not anticipated.

· In some situations where prevalence of acute malnutrition is below 5% (in presence of aggravating factors) or 10% (with no aggravating factors) but the absolute number of malnourished children may still be considerable, the closure of Targeted SFP may not be appropriate. The same may apply in unstable and insecure situations, where these programmes may be maintained as a ‘safety net’.

Remarks It is essential to integrate Targeted SFPs with community health services from the onset of the emergency in order to facilitate the referral to these services for medical reasons. Also where the number of beneficiaries has become small, it may be more efficient to manage the beneficiaries through community health facilities. In the absence of Targeted SFPs, individual attention should always be given to malnourished children through other community health services.

BLANKET SUPPLEMENTARY FEEDING PROGRAMMES

Objective

33. Blanket Supplementary Feeding Programmes are aimed primarily to prevent a deterioration in the nutritional status of the population, but also to reduce the prevalence of acute malnutrition in children under 5 years thereby reducing the mortality and morbidity risk. They are meant to provide a food/micronutrient supplement for all members of groups at high risk of becoming malnourished.

34. When an adequate general ration is being effectively distributed, there is normally no need for Blanket SFPs. However, this may be done exceptionally when nutritional needs are not met by the general ration or other ways.

When to Start?

35. Blanket SFPs may be set up under one or a combination of the following circumstances:

· At the onset of an emergency when general food distribution systems are not adequately in place.

· Problems in delivering/distributing the general ration.

· Prevalence of acute malnutrition equal or greater than 15%.

· Prevalence of 10-14% acute malnutrition in presence of aggravating factors.

· Anticipated increase in rates of malnutrition due to seasonally induced epidemics.

· In case of micronutrient deficiency outbreaks, to provide micronutrient-rich food to the target population.

Criteria for admission

36. The primary target groups for Blanket SFPs are:

· All children younger than 5 or 3 years using height as a cut-off point (5 years = 110 cm; 3 years = 90 cm).

· Pregnant women from the time of confirmed pregnancy, and nursing mothers until maximum 6 months after delivery.

· Other at-risk groups (for instance sick and elderly persons).

When to Close?

37. Blanket SFPs can be closed when all following conditions are met:

· General food distribution is adequate and is meeting planned minimum nutritional requirements.

· Prevalence of acute malnutrition is below 15% without aggravating factors.

· Prevalence of acute malnutrition is below 10% in presence of aggravating factors.

· Disease control measures are effective.

Remarks Normally a maximum time limit of 3 months is envisaged for a blanket SFP because it is anticipated that by this time the situation will have improved (adequate food, epidemics are under control, and safe and sufficient water). The nutritional status of the population should be reviewed (e.g. through a nutrition survey) at this time.

Figure 3: Framework: Selective Feeding Programmes (Modified from: Nutrition Guidelines; MSF, 1995)