nutrition in disasters

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