1 selective feding programmes session 20. 2 selective feding programme there are two mechanisms...

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SELECTIVE FEDING PROGRAMMES

SESSION 20

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SELECTIVE FEDING PROGRAMME

• There are two mechanisms through which food may be provided– General Food Distribution– Selective Feeding Programmes

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SELECTIVE FEEDING PROGRAMMES

• The GFR, in pracctice, rarely provides sufficient food to allow for catch-up weight gain for those already malnourished

• SPFs are therefore a “safety net” for those whose families cannot cope and are not sustained by the general ration

• SFP do not usually reduce the prevalence of moderate malnutrition

• The main objective is to reduce the prevalence of severe malnutrition and mortality.

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SELECTIVE FEEDING PROGRAMMES

There are two forms of selective feeding programmes:

• Supplementary Feeding

• Therapeutic Feeding Programmes

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SUPPLEMENTARY FEEDING PROGRAMMES

Supplementary feeding programmes (SFPs)• Provide nutritious food in addition to the

general ration• Supplementary Feeding Programmes (SFPs)• They aim to rehabilitate malnourished

persons or to prevent a deterioration of nutritional status

• SFPs are short-term measures and should not be seen as a means of compensating for an inadequate general food ration.

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Target Population• Children <5 years, Pregnant women, Lactating

women up to six months, those suffering from chronic wasting illnesses.

SFPs comprise two different types:• Targeted SFPs: the aim is to prevent the

moderately malnourished becoming severely malnourished and to rehabilitate them.

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Supplementary Feeding Programmes

• Blanket feeding programmes: Aim is to prevent widespread malnutrition and to reduce excess mortality among those at-risk by providing a food/micronutrient supplement for all members of the group

• Supplementary food can be distributed – On-site feeding – Take home or dry ration

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Take-home rations:• Require less resources• Carries less risk of cross-infection• Takes less time to establish• Less time consuming for mother to attend• Responsibility for feeding within the family• Particularly appropriate for dispersed populations

who have had to travel long distances on a daily basis

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On-site feeding me be justified:

• Food supply in the household is limited

• Firewood and cooking utensils are in short supply

• Security situation is poor and beneficiaries are at-risk when returning home carrying weekly supplies of food

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TARGETED SUPPLEMENTARY FEEDING PROGRAMMES

Objective• Rehabilitate moderately malnourished 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

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When to start• Malnutrition prevalence of 10-14% global

acute malnutrition among children• Many malnourished individuals due to poor

food security and high rates of disease and prevalence of 5-9% global acute malnutrition in the presence of aggravating factors

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• Moderately malnourished children under five years of age

Between 70% and 80% if the median weight for height OR

Between –3 and –2 Z weight-for-height Malnourished individuals (based on weight-for-

height, BM1, MUAC) or clinical signs:• Older children 5-10 year • Adolescents• Adults and the elderly persons• Medical referrals

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Criteria for admission cont.

• Referrals from TFC

• Selected pregnant women and nursing mothers until 6 months, using MUAC <22 cm

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Criteria for discharge:• Children who have maintained at least 85%

of medium 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

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When to close?• When all the following criteria are safisfied• General food distribution is adequate (meeting

planned nutritional requirement)• Prevalence of acute malnutrition is below 10%

without aggravating factors• Control measures for infectious diseases are

effective• Deterioration in nutritional situation is not

anticipated

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Criteria for closing cont.

• In cases where the prevalence of acute malnutrition is below 5% (in the presence of aggravating factors) but the absolute number of malnourished children may still be considerable, the closure of TSFPs may not be appropriate

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BLANKET SUPPLEMENTARY FEEDING PROGRAMMES

Objective:

• Aimed primarily to prevent deterioration in the nutritional status of the population, but also reduce the prevalence of acute malnutrition in children under five years thereby reducing mortality and morbidity

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• No need when there is an adequate general ratio

• Necessary when nutritional needs are not met by the general ration or other ways

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When to set up Blanket SFPs:• At the onset of an emergency when the GFR

distribution systems are not adequately in place• Problems in delivering/distributing the GFR• Prevalence of 10-14% acute malnutrition in

presence of aggravating factors• To provide micronutrient-rich food to the target

population in times of deficiency outbreaks

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Criteria for admission• All children younger than 5 or 3 years using the

height as a cut-off point (5 years=110 cm, 3 years=90cm)

• 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)

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When to close• 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

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FOOD COMMODITIES USED IN SFPs

1. The size and the type of daily food supplement will depend on the adequacy of GFR, the malnutrition rate and the feeding programme modalities

2. Food must be energy-dense and rich in micronutrients, culturally appropriate, easily digestible and palatable eg Corn Soya Blend (CSB), Unimix, Famix

3. In situations when cooking may not be feasible, ready to eat items, such as high-energy biscuits or locally made snacks, can be used.

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FOOD COMMODITIES USED IN SFPs

4. Energy-dense foods that contain at least 100 kcal per 100 g with at least 30% of the energy coming from fat. Unimix, Famix, CSB have a fat content of only 6% and thus about 10g of oil should be added to 100 g blended food during preparation, and be distributed as a dry pre-mix or cooked porridge

5. No use of fresh milk or milk powder in a take-home ration because it discourages breastfeeding and the danger bacterial contamination. Mix powdered milk with cereal flour and suga

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FOOD COMMODITIES USES IN SFPs

6. On-site feeding or wet ration should provide from 500 to 700 kcals of energy per person per day, including 15 to 25 g or protein

7. Take-home or dry ration should provide from 1,000 to 1,200 kcal per person per day and 35 to 45 protein

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MONITORING AND EVALUATION OF SFPs

Done through:

• Nutrition surveys

• Growth monitoring

• Regular collection of feeding centre statisistics

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MONITORING AND EVALUATION OF SFPs

• Indicators:

• Recovery rate acceptable >70% alarming <50%

• Death rate acceptable <3 per month, alarming >10

• Defaulting <15%, alarming >30%

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THERAPEUTIC FEEDING PROGRAMMES (TFPs)

Objective:

• To provide treatment to severely malnourished individuals to reduce the risk of excess mortality and morbidity

• It consists of intensive medical and nutritional treatment

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When to start?

• When the number of severely malnourished individuals cannot be treated adequately in other facilities

• The availability of trained staff is a prerequisite for establishing TFPs.

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• Criteria for admission• Children younger than 5 years of age (or less than

110 cm in height) who are severely malnourished (weight-for-height less than –3z scores or less than 70% of the median and/or with oedema)

• Severely malnourished children older than 5 years, adolescents and adults. Use of BM1<16

• Low birth weight (LBW) babies• Orphans younger than one year (only when

traditional care practices are inadequate)

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Criteria for admission cont.• Mother of children younger than one year with

breastfeeding failure• Criteria for discharge: Refer a child to SFP when he/she:• Maintains a weight-for-height>=75% of the

reference of >=-2.5 score for two consecutive weeks

• Shows a good appetite and is free of illness

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When to close:

• Number of patients in decreasing (for e.g. drops below 20)

• Adequate medical and nutritional treatment in either a clinic or a hospital is available

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Nutritional Rehabilitation• Phase 1: Acute Phase (Intensive Care)• 24-hour in-patient care• Control of infection and dehydration• Control of hypoglycaemia and hypthermia• Frequent feeds with TM (10-12 times/day) • Only milk-based diets given• Diet contains 75 kcal/100ml and is called F75

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• Phase 2: Rehabilitation Phase– Providing at least 6 meals per day to regain weight– Medical care continues– Mothers trained to care for the children at home– Diet (F100) is designed to for rapid catch-up in weight– Cereal-based porridge, made of blended (fortified), oil

and sugar is given– High-energy biscuits and gradual introduction to family

diet

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• Monitoring and Evaluation• Recovery Rate, acceptable 75%, alarming <50%• Death rate; acceptable <10, alarming >15• Defaulter; acceptable <15, alarming >25• Weight gain (g/kg/day); acceptable >=8,

alarming<8• Coverage; >50-70%; alarming <40%• Mean length of stay; <3-4 wks; >6 wks

1 selective feding programmes session 20. 2 selective feding programme there are two mechanisms...

Documents

available slide

f75 slide

family diet slide

weight medical care

inadequate general food

nutritious food

sufficient food

general ration sfp