1Inpatient care Outpatient Care SFP

Using Plumpy Doz to prevent malnutrition ?South-Sudan 2011

From Relief to Self-Reliance

Nutrition and Food Security Department

Alexandra Rutishauser-Perera and Stien Gijsel

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Plumpy Doz

PPD in SS

Ready to use supplementary food (RUSF) originally developed to reduce the incidence of acute Malnutrition during at-risks periods.

Recommended daily dose: 3 teaspoonfuls. 3 times a day.Pot of 325g : Quantity required for one child in one week.

Particularly suited to children aged 6 to 36 months

PPD ( which programs)

PPD in SS

Can help reduce the incidence of Global Acute Malnutrition in regions affected by serious food insecurity .

Mainly suited to humanitarian emergencies with a large number of under 3 at risk of Malnutrition.Can be associated with Blanket feeding.

Provide daily dose of micronutrients, high quality proteins and essential fatty acids.

5Inpatient care Outpatient Care SFP

Catching Acute Malnutrition Early

Plumpy Doz

South Sudan context • 20 years of civil war, peace agreement

2005• Independent since mid 2011• Plagued with intertribal fighting

Akobo County• Agro-pastoralist community • Very remote, and challenging environment• Limited coverage of targeted SFP

programmes (<30% of need)

South Sudan program IMC

• Primary Health Care centre• Full Community Management of

Acute Malnutrition (CMAM) for returnees and communities from mid-2011

• Kala Azar ( in one HF)

Strategy for PPD

• National Strategy designed by WFP• Only for 6-24 months due to restricted

supply and link with the 1,000 days approach

• Plumpy doz intervention during the hunger gap of 2011

• Planned for 6 months (April – September), reality June – October)

• No TSFP during the intervention

Community sensitization:a big component of the program

• Meetings• Announcements• Posters• Public speaking Requires a

Strong IYCF component

Post Distribution Monitoring

• Random selection of children in the community (60/month during this intervention).

• Control the acceptance of the product, the quantity of PPD remaining in the house, the hygiene and IYCF practices.

Context during and after the intervention

• Deterioration of the Food security with very bad crops

• High movement of population continuing today

• Increase of cattle raiding

Results• The 2010 and 2011 post-harvest surveys

show no significant difference• Strong reason to believe that malnutrition

rate would have been worst without the intervention

Successes• Positive reception by

the community and beneficiaries

• Large coverage (estimated on 95-100 %)• Although movement of population,

beneficiaries came on distribution days• Perceived as food for children only– shared

with other children• (pots increased storage of supplies as used

for lentils, herbs, oil etc….)

Challenges

• Double dipping and sharing• Security• Poor IYCF remained• Malnutrition rates

increased post-harvest, and hunger gap 2012

Food for thoughts• Effectiveness and impact difficult to

measure• Underlying causes remain• Dependency on foreign aid/supply

Study• Defourny I, Minetti A, Harczi G, Doyon S, Shepherd

S, et al. (2009) A Large-Scale Distribution of Milk-Based Fortified Spreads: Evidence for a New Approach in Regions with High Burden of Acute Malnutrition.

• Despite the annual hunger gap season, the prevalence of children with MUAC<110 mm between May and August decreased by half, rising slightly in September and October .

• The expected rise in new cases of malnutrition during the hunger gap period in 2007 was not only arrested, but reversed during the period of blanket distribution of RUF.

Thank you