NUTRITIONNUTRITION

Nutrition is always a key concern in Nutrition is always a key concern in emergency management.emergency management.

Every emergency is a nutritional Every emergency is a nutritional emergencyemergency

In developing countries inadequate In developing countries inadequate nutrition and infectious diseases can nutrition and infectious diseases can make populations especially make populations especially vulnerable to malnutrition in vulnerable to malnutrition in emergenciesemergencies

MEASURES NEEDEDMEASURES NEEDED To ensure that the food and nutrition needs of To ensure that the food and nutrition needs of

disaster-stricken populations, refuges, or disaster-stricken populations, refuges, or internally displaced persons are adequately internally displaced persons are adequately met.met.

To ensure adequate nutrition in both the relief To ensure adequate nutrition in both the relief phase and the subsequent rehabilitation and phase and the subsequent rehabilitation and development phasesdevelopment phases

Nutrition is always a key concern in Nutrition is always a key concern in emergency management. The engagement of emergency management. The engagement of local health services and authorities is local health services and authorities is emphasized as the best strategy for building emphasized as the best strategy for building national capacity and ensuring rapid recovery.national capacity and ensuring rapid recovery.

MAJOR NUTRITIONAL MAJOR NUTRITIONAL DEFICIENCY DISEASESDEFICIENCY DISEASES

Protein-energy malnutrition,Protein-energy malnutrition, Iron-deficiency anemia,Iron-deficiency anemia, Vitamin A deficiency,Vitamin A deficiency, Iodine deficiency disordersIodine deficiency disorders Beriberi,Beriberi, Pellagra, andPellagra, and Scurvy.Scurvy.

THE GENERAL RATIONTHE GENERAL RATION

Is the food ration given to everyone Is the food ration given to everyone in the affected population in the affected population irrespective of age and sex; that is, irrespective of age and sex; that is, all receive the same quantity and all receive the same quantity and type of food .type of food .

STRATEGIES OF PREVENT STRATEGIES OF PREVENT MICRONUTRIENT MICRONUTRIENT

DEFICIENCIESDEFICIENCIES Promoting the production of fresh fruit Promoting the production of fresh fruit

and vegetablesand vegetables Adding a food to the ration that is rich in Adding a food to the ration that is rich in

vitamins and minerals (Such as fortified vitamins and minerals (Such as fortified blended food), which is now routine blended food), which is now routine practice in many refugee situations.practice in many refugee situations.

Promoting access to sources of food rich Promoting access to sources of food rich in micronutrients, such as groundnuts as in micronutrients, such as groundnuts as a source of niacin in a maize- based a source of niacin in a maize- based ration.ration.

Providing fortified foods in a ration, Providing fortified foods in a ration, including iodized salt and vegetable including iodized salt and vegetable oil fortified with vitamin Aoil fortified with vitamin A

Distributing a prophylactic dose a Distributing a prophylactic dose a vitamin A infants and young children vitamin A infants and young children every six months in refugee and every six months in refugee and displaced populations.displaced populations.

WHAT TO DO ?WHAT TO DO ?

Provide individual treatment and Provide individual treatment and secondary prevention for the identified secondary prevention for the identified casescases

If deficiency diseases are prevalent on a If deficiency diseases are prevalent on a large scale use the following population large scale use the following population approachapproach

Advocate changes in general ration Advocate changes in general ration composition and quantities composition and quantities

consider technical possibilities and costs consider technical possibilities and costs of food fortificationof food fortification

Stimulate garden project etc.Stimulate garden project etc. Mass supplementation of the Mass supplementation of the

population with vitamin tablespopulation with vitamin tables Vitamin supplementation outreach Vitamin supplementation outreach

campaigns through health service campaigns through health service activities feeding centres,OPD, activities feeding centres,OPD, vaccination campaigns).vaccination campaigns).

Monitor the extent and trends in the Monitor the extent and trends in the disease disease

THE IDEAL DISTRIBUTION THE IDEAL DISTRIBUTION SYSTEMSYSTEM

Should be safe and easily accessible to the Should be safe and easily accessible to the intended beneficiaries.intended beneficiaries.

Safe: organized in such a way that the Safe: organized in such a way that the system is free of treat to all who use it, with system is free of treat to all who use it, with particular attention to women and the particular attention to women and the vulnerable vulnerable

Accessible: distribution points are close to Accessible: distribution points are close to where people line and are located in places where people line and are located in places which do not restrict the access of which do not restrict the access of particular groups. The timing of particular groups. The timing of distributions should suit all the intended distributions should suit all the intended beneficiaries beneficiaries

Inform and involveInform and involve They must know they should receive, how They must know they should receive, how

much, when and how.much, when and how. The themselves can be the best montors The themselves can be the best montors

and controllers of the distribution process.and controllers of the distribution process. They should be able to see the distribution They should be able to see the distribution

process for themselvesprocess for themselves They (women and men) should be involved They (women and men) should be involved

directly, at all levels of the distribution directly, at all levels of the distribution process.process.

The family, as a natural unit, is the target of The family, as a natural unit, is the target of distribution. This applies to food and non-distribution. This applies to food and non-food items. However, in some situations food items. However, in some situations distribution can be done more effectively distribution can be done more effectively through groups of families or other through groups of families or other community structures.community structures.

Irregularities in the distribution cycle Irregularities in the distribution cycle undermine the confidence f the undermine the confidence f the beneficiaries and increase their need to beneficiaries and increase their need to circumvent the system.circumvent the system.

In camps, aim is to have at least 1 In camps, aim is to have at least 1 distribution site per 20,000 refugees.distribution site per 20,000 refugees.

A distribution system should allow A distribution system should allow beneficiaries to collect rations close to beneficiaries to collect rations close to where they live and at regular intervals of where they live and at regular intervals of about one month.about one month.

For dispersed populations refugees should For dispersed populations refugees should not have to travel more than 5 to 10 km to not have to travel more than 5 to 10 km to distribution sitesdistribution sites

In camps, refugees should not have to In camps, refugees should not have to travel far to the distribution sites. The travel far to the distribution sites. The centre should be located as close as centre should be located as close as possible t the beneficiaries, and not more possible t the beneficiaries, and not more than-5km awaythan-5km away

Distribution of dry uncooked ration Distribution of dry uncooked ration in bulk is usually the most desirable in bulk is usually the most desirable mass cooked food distribution for mass cooked food distribution for the general ration should be avoidedthe general ration should be avoided

Have a minimum of 2 staff per 1,00 Have a minimum of 2 staff per 1,00 beneficiaries.beneficiaries.

Avoid payment in kind for distribution Avoid payment in kind for distribution workers. It makes monitoring difficult. In workers. It makes monitoring difficult. In times of shortages, vulnerable people may be times of shortages, vulnerable people may be deprived of the commodities in order to pay deprived of the commodities in order to pay staff.staff.

In the early stages of a new programme, In the early stages of a new programme, particularly in large emergencies, effective particularly in large emergencies, effective control over distribution may not be possible. control over distribution may not be possible. However, from the start, each action should However, from the start, each action should contribute to process where by stable control contribute to process where by stable control is progressively establishedis progressively established

The importance of nutrition The importance of nutrition assessmentassessment

It is a fundamental management tool It is a fundamental management tool for calculating food needsfor calculating food needs

Monitoring the adequacy of food Monitoring the adequacy of food access and intake, andaccess and intake, and

Ensuring adequate food Ensuring adequate food procurementsprocurements

Methodology for measuring Methodology for measuring malnutritionmalnutrition

Target audience for assessmentTarget audience for assessment Advice on body measurements andAdvice on body measurements and Clinical indicators of malnutritionClinical indicators of malnutrition Precise instruction for conducting Precise instruction for conducting

rapid nutritional surveys.rapid nutritional surveys. Individual screening, andIndividual screening, and Nutritional surveillanceNutritional surveillance

Planning, organization,Planning, organization,

Delivery of general feeding Delivery of general feeding programmesprogrammes

Aimed at the affected population as Aimed at the affected population as a whole.a whole.

Composition of general ration Composition of general ration calculated to meet the population' calculated to meet the population' minimum require4ments for energy, minimum require4ments for energy, protein, fat, and micronutrients.protein, fat, and micronutrients.

Selective feeding Selective feeding programmesprogrammes

The supplementary feeding of The supplementary feeding of vulnerable groups andvulnerable groups and

The therapeutic feeding of The therapeutic feeding of individuals suffering from deficiency individuals suffering from deficiency diseases.diseases.

MOST IMPORTANT MOST IMPORTANT DEFICIENCIES IN DEFICIENCIES IN

EMERGENCIESEMERGENCIES Vitamin A deficiency:Vitamin A deficiency:

1.1. Xerophthalmia and night blindness Xerophthalmia and night blindness are the main identifiable symptoms are the main identifiable symptoms of severe vitamin A deficiency .of severe vitamin A deficiency .

2.2. ““Bitot –spots" (dry patches on the Bitot –spots" (dry patches on the conjunctive)conjunctive)

3.3. Adequate supply of vitamin A is Adequate supply of vitamin A is essential as its deficiency leads to essential as its deficiency leads to increased risk of death.increased risk of death.

Vitamin B1 (thiamine) deficiencyVitamin B1 (thiamine) deficiency1.1. Beri – Beri is the full clinical picture of a Beri – Beri is the full clinical picture of a

deficiency of vitamin B1 .there are two deficiency of vitamin B1 .there are two different clinical pictures of beri – beri.different clinical pictures of beri – beri.

2.2. Dry beri – beri bilateral peripheral Dry beri – beri bilateral peripheral polyneuntis, with evolution to flaccid polyneuntis, with evolution to flaccid paralysis.paralysis.

3.3. Early deficiency symptoms are less Early deficiency symptoms are less specific fatigue, anorexia, abdominal specific fatigue, anorexia, abdominal discomfort.discomfort.

Vitamin C (ascorbic acid ) deficiency Vitamin C (ascorbic acid ) deficiency

Scurvy : typical signs are painful joints Scurvy : typical signs are painful joints and swollen. Bleeding gums and and swollen. Bleeding gums and possible petechia or hemorrhages .A possible petechia or hemorrhages .A trial treatment with high doses of trial treatment with high doses of vitamin C should rapidly alleviate vitamin C should rapidly alleviate the symptoms.the symptoms.