1 |1 | 9 december 2007 nutrition in disasters dr. sergei koryak who eha coordinator december 9, 2007
TRANSCRIPT
1 | 9 December 2007
Nutrition in Disasters
Dr. Sergei Koryak
WHO EHA Coordinator
December 9, 2007
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WHO input
• WHO monograph “The Management of nutritional emergencies in large populations” (1978)
• The World Declaration and Plan of Action for Nutrition (WHO and FAO, 1992)
• WHO manual – Rapid Health Assessment protocols for emergencies (1999)
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Emergencies and nutrition
• The occurrence of natural and man-made disasters risen dramatically in recent years with a growth in the numbers of refugees, displaced people and vulnerable communities
• All major emergencies threaten human life and public health resulting in food shortages and impairing the nutritional status of community.
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Vulnerable populations
• Among refugees and displaced populations, high rates of malnutrition and micronutrient deficiencies is associated with increased rates of mortality
• Governments should provide sustainable assistance to vulnerable populations and monitor their nutritional well-being, giving high priority to the control of diseases
(World declaration and Plan of Action for Nutrition, Rome, 1992).
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Developing Plans
• In response to the World Declaration, many countries have developed, or developing, a national plan of action for nutrition
• These plans include action for preparedness and capacity building for management of nutrition in emergencies
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Nutrition interventions
• It is important that nutrition-related interventions be viewed as an integral part of a comprehensive approach to emergency management in affected areas.
• Nutrition strategy should be included in overall emergency preparedness
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Role of health sector
• Provide education, advocacy and technical expertise to ensure vulnerability reduction and preparedness for appropriate nutrition-related relief, treatment and prevention of malnutrition
• Promote nutrition in the context of broader health, community rehabilitation and development policy
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Main functions of a national nutrition program
• To identify data, indicators and sources for nutritional surveillance and early warning
• To collect and analyze baseline data
• To define strategies, programs and technical standards for food surveillance
• To organize rapid assessments to determine the presence of nutritional emergency
• To develop continuing surveillance of nutritional status in emergencies
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Main functions of a national nutrition program
• To liaise with the emergency coordination cell and other health units and programs, exchanging information and plans
• To integrate nutrition activities in primary health care
• To liaise with other Ministries (agriculture, social welfare, community development, commerce, finances etc..) and participate in the activities of national coordination committees
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Nutritional requirements
• Basic energy and protein requirements are the primary concern
• Assessment of nutritional needs of the population is a fundamental management tool
• Mean daily per capita intake is 2100kcal and 46g of protein
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Basic principles
• To cover losses of each nutrient
• To take account of nutrient interactions in the diet
• To take account of environmental conditions
• Maintain physical size, growth, pregnancy, lactation
• Maintain activity including social activity
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Most vulnerable
• Pregnant and lactating women
• Infants and young children
• Families or individuals whose needs may not be fully met by a particular ration
• Elderly, widows and widowers
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Nutritional needs
2100 kcal for an adult who is:
• 169 cm (men) and 155 cm (women)
• Body mass index (BMI) is between 20 and 22
• Physical activity is light
Safe daily protein intake (cereals, vegetables…) should be 46g
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Dietary components
• Fat or oil provide 15% of total energy intake for men, 20% for women of reproductive age and 30-40% for children up to 2 years old
• It should comprise 17-20% of the ration
• Should include micronutrients (vitamins, iodine, iron, calcium etc..)
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Major diseases
Protein-energy malnutrition (PEM)
• Marasmus – severe wasting of fat and muscle, which the body breaks for energy – most common form of PEM
• Kwashiorkor – characterized by oedema accompanied by skin rash and changes in hair color (reddish)
• Marasmic kwashiorkor – combination of oedema and severe wasting
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Major diseases (cont)
Micronutrient deficiencies
• Iron deficiency and anaemia – most prevalent in young children
• Iodine deficiency – pregnant women and young children – different degrees of mental retardation
• Vit A deficiency – main cause of blindness
• Vit D deficiency - rickets
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Approaches
• Increasing daily ration and inclusion of fruits and vegetables
• Varying the composition of the food basket so it contains more micronutrient-rich food (dried beans, nuts, fruits, palm oil)
• Including micronutrient-fortified foods in the ration (cereals) enriched with Iron and Vit A and B
• Providing supplementation when there is likely to be a specific deficiency
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Assessment
• Communities – to assess the extent and severity of malnutrition including mineral and vitamin deficiencies and to decide whether and what type of feeding programs are needed
• Individuals – to screen for supplementary or therapeutic feeding and monitor nutritional progress
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Assessment indicators
• Weight-for-height the best for assessing and monitoring community nutritional status
• BMI (kg/m2) – used for assessing the status of adults
• Mid-upper arm circumference – can be used as an alternative method or initial screening
• Presence of oedema
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Reasons for measuring malnutrition in emergencies
Not all groups of people are equally affected. Therefore, determination of nutritional status is essential in three contexts:
• Initial rapid assessment – provides a basis for planning a food relief program
• Individual screening
• Nutritional surveillance – monitoring changes
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Population surveys
Information to be collected:
• Body measurements indicating nutritional status – usually weight for height, possibly arm circumference and presence of oedema
• Specific location
• Supplementary information (age, sex, length of time in current location, measles immunization, recent deaths in the household etc..)
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Organizing screening sessions
• Community should be informed, at least 24 hours in advance to allow arranging attendance of people.
• Severely malnourished individuals should be selected first
• A system of individual identification should be used
• Results should be recorded
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General feeding programs
• Should be organized when the population does not have access to sufficient food to meet its nutritional needs
• Providing rations that satisfy the full nutritional needs largely avoids the need for additional selective food distribution programs
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Food distribution
• Each person should have identification (list of names should be available)
• Proper arrangements should be done and people should be aware about amount of food they are entitled
• Food should be ordered in good time – quantity to feed 1000 people for 1 month is approximately 16.4 tonnes
• To eliminate personal bias, reliable individuals should be recruited from outside the community
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Outcome indicators
• The purpose of relief programs in food emergencies is not only to distribute food but also to prevent death and disease and improve nutritional status
• The only acceptable indicators of program success are data indicating decrease of malnutritio levels and death rates
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Complementary interventions
• Infections can contribute to a deterioration in nutritional status
• Conditions of emergencies (overcrowding, unsafe water supplies, poor sanitation, irregular health services) can contribute to the spread of infections.
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UN agencies active in the field
UN agencies involved in food distribution are
• WFP – World food program
• UNHCR – United Nations High Commissariat for Refugees
• UNICEF – United Nation Children Fund
As well as some Non-Governmental organizations (Red Crescent etc..)
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References
• “The Management of Nutrition in Major Emergencies” – WHO Geneva 2000
• “Management of severe malnutrition: a manual for physicians and other senior health workers” WHO Geneva 1998
• “Infant Feeding in Emergencies” Module 1 November 2001