NUTRITION IN EMERGENCIES

Advisory Group on Research in Emergencies

In June 1998, a WHO Advisory Group on Research in Emergencies was established as the result of an earlier consultation in October 1997 on “Applied Health Research Priorities in Complex Emergencies.” The October consultation formulated research priorities in seven areas: nutrition, reproductive health, communicable diseases, health service management, information, mental health and ethics. The consultation recommended several mechanisms for follow-up, one of which was to set up an advisory group. The Division of Emergency and Humanitarian Action (EHA) acted upon this recommendation and organised a meeting of experts with extensive knowledge of emergency management and research. EHA has assumed the Secretariat of this group but WHO is expected to continue playing a major role.

The Advisory Group will encourage research in emergency situations. The group will strive to improve practice based on the results of research conducted with the eventual objective of improving health outcomes in emergencies.

The terms of reference for the advisory group are:

à To appraise research proposals according to scientific, technical and ethical aspects.

à To advocate for good research in emergencies with donors, research institutions and service providers.

à To make an inventory and pre-review of proposals.

à To assist with the development and approval of generic proposals for research to be conducted in the early stages of emergencies.

à To provide advice to donors on priority research in different areas of interest.

à To co-ordinate and facilitate dialogue and liaison between interested persons, groups and institutions.

à To provide and disseminate the research evidence on which guidelines and standards for good practice can be based.

à To encourage the practical application of new research evidence.

The list of nutrition related research topics that was compiled at the October consultation was a result of grouping rather than prioritising. A range of needs exist, from generic questions such as determining the risk factors for developing marasmus or kwashiorkor, to socio-economic criteria for identifying vulnerable groups (individuals, families and households) in a specific setting. Some research issues will be of concern to more than one area, and can only be developed through co-operation between different specialities. An example is the relationship between mental health of a caretaker and nutritional status of the individual receiving care. To arrive at joint project proposals, the Group can assist liaison between scientists and practitioners in different specialist areas.

For more information on the Group or to submit proposals, please contact the Secretary: Danielle Deboutte, WHO, Emergency and Humanitarian Action, Room 6111, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Email [email protected]

Low Cost Extrusion Cooking

Machinery for low-cost extrusion cooking has recently been developed at Lille University, France. The equipment is relatively inexpensive (final price is expected to be less than US$ 12,000), low-capacity (between 20 to 50 kg/h) and easy to operate and maintain. It has been developed for operation by small communities such as small enterprises in developing countries, or community-level production of precooked flours in refugee situations.

Extrusion cooking is a process whereby raw materials are fed into an extruder then progressively compressed, milled, blended, melted (and therefore cooked), shaped and extruded. Fortification usually occurs after the process, in a separate blender. Thus, if dedicated to the production of precooked and fortified blended flours, a classical extrusion line should require, at least: one mill, one blender, one extrusion cooker, another mill and another blender.

Most precooked flours used in emergency situations are processed in factories located in donor countries. This could lead to delays in product delivery and problems in quality deterioration during transportation.

The availability of low-cost equipment would facilitate the local production of flours for use in emergencies. This has several advantages:

à it directly benefits local economies by using local skills and products;

à it benefits relief interventions by decreasing their logistical costs and by improving the overall acceptability of the product;

à it enhances the rehabilitation/development phase by contributing to technology transfer (training of local operators and initiation of sustainable economic activities using the technology of extrusion cooking).

An experimental prototype of the equipment is operational at Lille University. The University is working with development and relief NGOs that are likely to use and/or promote such technology in the field. It has also identified different equipment manufacturers who have an interest in developing an industrialised version of the prototype. A collaboration has been initiated with the department of Food Engineering at CSIRO-Sydney which is working on extrusion technologies.

At this stage, Lille University can offer:

à technical expertise and counseling on the process of extrusion;

à training (theoretical and practical) of operators in any aspect related to extrusion cooking including engineering, nutritional, and microbial

Currently, additional funding is being sought to continue the development of this low-cost extrusion equipment.

For information on technical advice, or training please contact: Dominique Bounie Email: [email protected]

Action contre la Faim

Action contre la Faim est une organisation non-gouvernmentale (anciennement AICF) cr en 1979, qui privile l’action directe sur le terrain par des rnses cibl et adapt associant les quatres secteurs complntaires de la lutte contre la faim: la nutrition, la santl’eau et la sritlimentaire Action contre la Faim1 dispense depuis quatre ans une formation istance sur la planification et la gestion de programmes de nutrition, intitul‘Urgence nutritionelle et malnutrition sre’. Cette formation, qui se dule sur six mois (de janvier uin), est pre pour les personnes de formation mcale ou para-mcale, mais reste ouverte out public intssar le th de la malnutrition.

Chaque participant ret quatre modules par courrier. Chaque module est envoyn dt de mois, accompagn’excercices. Aprcorrection personnalisdes exercices, ces devoirs sont retournau candidat, accompagnde leurs corrig L’ipe pgogique est composde professionnels de la santublique, nutrition, pgogie, socio-anthropolgie et d’hydraulique.

A la fin de cet enseignement istance, le participant doit e capable de:

* dnir les concepts de base en nutrition;
* planifier une action nutritionnelle;
* riser une enqu nutritionnelle anthropomique;
* prnir la dtrition des populations isque;
* corriger l’t nutritionnel des malnutris sres;
* assurer le suivi mcal d’un malnutri sre.

Une attestation de stage sera dvrsur la base des notes obtenues aux diffnts devoirs.

Les droits d’inscription s’vent .000FF. La prochaine session dte en janvier 99 et le dossier d’inscription est envoyer avant le 30.11.98. Pour des renseignements et/ou inscriptions, adressez-vous sabelle Beauquesne ou Marie-Laure Glatka ction Contre la Faim.

Action contre la Faim, Dpt Nutrition/Formation, 4, rue Niepce, 75014 Paris, FRANCE, Tel: (33) 1.43.35.88.88 Fax: (33) 1.43.35.88.00 Email: smtp: «[email protected]

FANta

The Academy for Educational Development (AED), with subcontractors Cornell University and Tufts University, has been awarded a five-year, $30 million food and nutrition cooperative agreement by the U.S. Agency for International Development (USAID). The Food and Nutrition Technical Assistance Project (FANta) is designed to maximize the impact of food security and nutrition programmes of USAID, Private Voluntary Organizations (PVOs), and host governments in developing countries.

FANta is USAID’s only comprehensive nutrition and food security project and has been designed to complement and extend the nutritional impact of its other projects covering micronutrients, breastfeeding, and maternal and neonatal nutrition. It will provide the analytical framework and multisectoral technical assistance programmes needed to address and remove the barriers that limit a household or an individual’s ability to achieve food security.

To maximise the impact of these programmes, FANta specialists will advocate for increased investment in food security and:

à support interventions, such as child survival, infant and child feeding, micronutrient initiatives, agricultural productivity and microenterprise credit programmes, that have nutritional improvement as a goal

à design comprehensive, cost-effective, and demand-driven technical assistance programmes which can bring about measurable changes in the nutritional status of target populations

à work to strengthen the technical capacity of USAID and the community of PVOs and cooperatives which implement food aid programmes in support of food security, and

à refine and expand approaches to identify indicators and measurement techniques for problem analysis, targeting, monitoring and evaluation.

The FANta project will provide “one-stop shopping” for technical services to USAID and its implementing partners and will support strategies which link different resource streams, including the Title II food aid resources. Technical assistance will be offered to USAID-priority countries, to programmes which have the potential to impact nutritional status, and to on-going USAID initiatives, including the Greater Horn of Africa Initiative, Africa Food Security Initiative, and the US Plan of Action on Food Security.

In addition to providing guidance on measuring the performance and impact of programmes, the FANta team will encourage Missions, host governments and PVOs to adopt proven approaches and engage in policy dialogue which addresses nutrition concerns. To assist PVOs in improving their food security and nutrition strategies, FANta will:

à provide technical assistance to strengthen programmes

à develop tools and materials to guide programme managers

à conduct training programmes for key managers and technical staff to improve their ability to develop, implement, and evaluate appropriate interventions

à develop replicable model programmes and strategies, and

à identify and disseminate best practices.

The FANta team have solid track records as managers and implementers of large-scale projects, technical expertise in food security and nutrition, and extensive experience in programme design, management, and evaluation.

The FANta team will collaborate with USAID, the PVO community, donors, host country governments, and local non-governmental organizations (NGOs) to yield joint programming of activities, increased investment in food security and nutrition, and identification of best practices. FANta subcontractors, Cornell and Tufts, will focus on select policy and technical areas, operations research, and meta analyses. Food Aid Management (FAM), the consortium of Title II PVOs, will assist the project in assuring a strong partnership with PVOs.

Dr. Bruce Cogill, Project Director, and Dr. Anne Swindale, Deputy Project Director, are the project’s senior managers. For FANta reports, publications, or additional information, contact Communication & Information Specialist at: Food and Nutrition Technical Assistance Project, Academy for Educational Development, 1255 23rd St., NW, Suite 400, Washington, DC 20037, Phone: (202) 884-8700, Fax: (202) 884-8977, Email: As of March 1, 1999, FANta will have the following address: Food and Nutrition Technical Assistance Project, Academy for Educational Development, 1825 Connecticut Ave., NW, Washington, DC 20009 Phone: (202) 884-8000, Fax: (202) 884-8400, Email: [email protected]

International Meeting on Infant Feeding in Emergency Situations

A meeting on Infant Feeding in Emergency Situations took place in Split, Croatia in October, 1998. The meeting was facilitated by the International Baby Food Action Network (IBFAN) which has been working on the issue of infant feeding in emergencies for some years. Other participants were from international NGOs, local NGOs from emergency-affected areas and UN agencies.

The plenary included Dr. Aileen Robertson, Acting Regional Advisor for Nutrition, WHO Europe, who declared that “emergency situations can be public health opportunities”. Dr. Marcos Arana (Defensoria del derecho a la Salud, Mexico) described man-made and natural emergencies affecting the Chiapas region in recent years and the problems caused by public appeals for artificial feeding products and inappropriate NGO responses. Mary Lung’aho of the LINKAGES project (USA) contrasted two emergency settings and Nomajoni Ntombele (also LINKAGES) reminded us that central to the training of health professionals responding to emergencies should always be the mother and the child. Dr. Sanja Petrovic, co-ordinator of Stope Nade for Croatia and Bosnia/Herzegovina gave an overview of existing policies and guidelines applicable to mother and child health in an emergency situation. Lola Gostelow (Save the Children, UK) outlined the problems in co-ordinating the approaches to an emergency and suggested accessing existing structures such as the SPHERE project in an attempt to address the issue of inconsistent infant feeding policies and practices.

The main speakers were followed by a short plenary on the role of the media in humanitarian operations, featuring David Meiklejohn, Head of Information for UNICEF/UK and Cassie Knight of the Reuter Foundation. Ms Knight introduced an innovative news service specifically for humanitarian aid organisations called AlertNet <www.alertnet.org>.

The speakers set the theme for the working groups which covered: implementing policies and guidelines; training materials; research needs and methods; integrated approach; counselling skills; and the role of the media. The working group on “integrated approach” was central to the meeting, bringing together recommendations of the other working groups to develop an action plan for a more integrated approach to infant feeding in emergencies.

Some of the more significant recommendations of the working groups were:

à To produce a common policy on infant feeding in emergencies and to draw up guidelines for the procurement, distribution and use of artificial infant feeding products, similar to those which exist for drugs for medical use.

à To commission a handbook on infant feeding for emergency workers and to produce a video for advocacy to decision-makers.

à To identify and prioritise gaps in existing research such as the effect of stress and maternal nutrition on breastfeeding and the cost effectiveness of different approaches to infant feeding. It was stressed that this research should be independently funded, without the involvement of infant food manufacturers, and that collaboration on data collection should be encouraged among agencies.

à To include in each team of aid workers responding to emergencies at least one trained breastfeeding counsellor (e.g. 18 hour course in breastfeeding management). Steps for successful breastfeeding (similar to the 10 Steps of the BFHI) should be implemented in MCH clinics in refugee camps.

à Agencies should make efforts to identify local breastfeeding resource people, especially those who exist in African countries.

à To include media training as part of induction training for aid workers. A Code of Conduct for agencies dealing with the media responding to humanitarian emergencies should be drawn up.

à To bring together the above recommendations into a cohesive action plan which includes advocacy to existing UN and NGO structures to integrate infant feeding into emergency response programmes at all levels.

An International Working Group was formed to implement the recommendations and to ensure follow-up activities. The meeting co-ordinators, Margreet Houdijk and Gill Ryan (IBFAN), were nominated to work on the formation of this group. It is hoped that the papers from the meeting will be disseminated as widely as possible and will be available on AlertNet (date TBA). A draft of the report will be ready by the end of January 1999.

For further information, please contact: Margreet Houdijk, Wemos, Email: [email protected] Gill Ryan, Baby Milk Action, Email: [email protected]