5. nutrition in emergencies
TRANSCRIPT
KNOWLEDGE FOR THE BENEFIT OF HUMANITY
ADVANCED NUTRITION (HFS4352)
NUTRITION IN EMERGENCIES Do we know what works?
Mohd Razif Shahril, PhD
School of Nutrition & Dietetics
Faculty of Medicine and Health Sciences
Universiti Sultan Zainal Abidin
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Outline
• Introduction
• What is nutrition emergency?
• The scale of emergency nutrition activities
• Nutrition programme elements in emergencies
• The challenge of meeting nutrition targets
• Conclusion
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Introduction
• Multiple forms of malnutrition present in the
context of crisis
– Wasting
– Severe stunting
– Micronutrient deficiencies
– Obesity
• Humanitarian response has evolved rapidly
since 2000, leading to calls for greater focus on
the generation of rigorous data on effectiveness.
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What is nutrition emergency?
• Any situation where there is an exceptional and
widespread threat to life, health and basic
subsistence, which is beyond the coping
capacity of individuals and the community
• ‘Complex emergency’
– a major humanitarian crisis of a multi-causal nature,
essentially from internal or external conflict and which
requires an international response that extends
beyond the mandate or capacity of any single agency
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What is nutrition emergency?
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Classification system Level Mortality and malnutrition
indicator
UN SCN thresholds 1995
Alert
CMR 1/10,000/day
U5MR 2/10,000/day
Wasting 5–8%
Severe
CMR 2/10,000/day
U5MR 4/10,000/day
Wasting >10%
CMR = Child Mortality Rate U5MR = Under 5 y/o Mortality Rate
What is nutrition emergency?
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FSNAU/FAO integrated
food security phase
classification (IPC), 2007
Generally food secure
CMR < 0.5/10,000 /day Wasting* < 3% (<-2SD WHZ) Stunting < 20% (<-2SD HAZ)
Moderately/ Borderline Food Insecure
CMR < 0.5/10,000/day U5MR < 1/10,000/day Wasting* > 3% but <10% Stunting 20-40% (<-2SD HAZ), increasing
Acute food and livelihood crisis
CMR 0.5-1 /10,000/day U5MR 1-2/10,000/day Wasting* 10-15% (>-2SD WHZ), > than usual, increasing
Humanitarian emergency
CMR <1-5 / 10,000/day, >2x baseline rate, increasing U5MR > 2-10/10,000/day Wasting* > 15% (>-2SD WHZ), > than usual, increasing
Famine/ Humanitarian catastrophe
CMR >2/10,000/day (e.g., 6,000/1,000,000 /30 days) Wasting* >30%
What is nutrition emergency? • Vulnerability to nutrition emergencies;
– Existing health and nutrition situation greatly affects how vulnerable a population is to a nutritional emergency
– HIV and AIDS increases food insecurity, poverty, and even has negative effects on labor force and agriculture at large scale
– Poverty and urban pressure overcrowding, inadequate drinking water, substandard sanitation facilities and infrastructure, exposure to urban pollution and hazardous materials, landlessness, and frequent food shortages
– Climate change may have an increasing impact leading to more frequent famines in the future
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What is nutrition emergency?
• Triggers for nutrition emergencies;
– Natural disasters affect food availability and access,
disrupt health systems, destroy WASH systems
– Conflict can lead to Nutrition Emergencies in many
ways due to lack of access to food, health, WASH,
etc.
– Political crises and economic shocks contribute to
Nutrition Emergencies through discrimination of
ethnic groups or inadequate political decisions (China
famine in the late 50s)
– Global food prices fluctuations have caused
increased levels of poverty, food insecurity and
resulting under nutrition
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What is nutrition emergency?
• Who is most vulnerable in emergencies?
– Physiological vulnerability: children less than 5,
older people, people affected by chronic diseases,
gender
– Geographical vulnerability: flood or drought-prone
areas, conflict front lines
– Political vulnerability: discrimination, persecution
– Internal displacement and refugee status: 26
million IDPs, 16 million refugees at the end of 2010
(minus the Arab spring displacements).
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What is nutrition emergency?
• Types of malnutrition during emergencies?
– The major concern in emergencies is the increased
risk of moderate and severe acute malnutrition
because acute malnutrition is strongly associated with
death
– In many long-term emergencies levels of other forms
of malnutrition (stunting and underweight) are often
high
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What is nutrition emergency?
• (cont.) Types of malnutrition during
emergencies?
– Stunting inhibits a child from reaching his or her full
physical and mental potential
• Can have a major impact on work output and national
development
• Is becoming an increasingly important measure of nutritional
wellbeing in some emergencies
– Micronutrient deficiencies are common in
emergencies, particularly in affected people
dependent on food rations
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The scale of emergency nutrition
• Goals of nutrition action in emergencies typically
include;
a) Reducing levels of wasting to below conventionally-
defined emergency rates of thresholds
b) Reducing and/or preventing micronutrient
deficiencies, because these markedly increase
mortality risks
c) Reducing the specific vulnerability of infants and
young children in crises through the promotion of
appropriate child care, with special emphasis on
infant and young child feeding practices
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The scale of emergency nutrition
• (cont.) Goals of nutrition action in emergencies
typically include;
d) preventing a life-threatening deterioration of
nutritional status by ensuring access by emergency-
affected populations to adequate, safe and nutritious
foods that meet minimum nutrient needs
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Nutrition programme elements
• Choice of actions from a more comprehensive
portfolio of intervention includes (but not limited)
the following;
a) General food assistance
b) Management of severe acute malnutrition
c) Management of moderate acute malnutrition
d) Delivery of micronutrients
e) Infant and young child feeding in emergencies
f) Treatment of diarrhoea with oral rehydration therapy/
zinc
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Nutrition programme elements
• (cont.) Choice of actions from a more
comprehensive portfolio of intervention includes
(but not limited) the following;
g) Prevention and treatment of vitamin A deficiency
h) Food and nutrition assistance for people living with
HIV
i) The psychosocial components of nutrition
j) Nutritional care for groups with special needs
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The challenge
• Developing countries will not be able to break
out of poverty and sustain economic growth
– large segments of their population fail to secure the
nutrition needed for a healthy and productive life.
• The goal of addressing stunting and wasting is
unlikely to be achieved without progress in
countries requiring large-scale humanitarian
action
– Investment needed to move rapidly on a post-crisis
trajectory
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(cont.)The challenge
• Important way to reduce child mortality requires
concerted efforts
– aimed at expanding the coverage and effectiveness of
both institutional and community-based programs
focused on treatment and prevention of stunting and
wasting.
• The specific contribution of actions address
nutritional deficiencies in humanitarian contexts
has to be understood
– as an essential contribution to the international
community’s overall nutrition agenda.
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Conclusion
• Emergency interventions continue to improve in
terms of coverage, scale of operations, reporting
standards and effectiveness,
– ‘no response’ is never an option
• Immediate nutrition needs are usually acute,
large scale and have complex determinants
– Combination of intervention to focus on different
target groups
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