session 7.2. assessment 4: working with sectoral indicators: food & nutrition

UNHCR/InterWorks - Emergency Management Training 7.2.1.

Session 7.2.Session 7.2.

Assessment 4: Assessment 4: Working with Sectoral Working with Sectoral Indicators: Indicators:

Food & Nutrition Food & Nutrition

WFP Photo


ObjectivesObjectives

After completing this session, participants will be able After completing this session, participants will be able to:to:

Highlight the relationship between malnutrition and disease

Describe an adequate basic ration

Review the standards and indicators used for determining nutritional status in the population

Understand the uses of special feeding programs and targeted interventions


A vicious A vicious cyclecycle

• Measles• Diarrhea• Pneumonia• Malaria

LoweredLoweredResistanceResistance

Poor AppetitePoor Appetite

InfectionInfection

High energyHigh energyUtilizationUtilization

MalnutritionMalnutritionMalnutritionMalnutrition


Malnutrition:when a person can no longer maintain adequateperformance in growth, pregnancy, lactation, work, and resisting and recovering from disease


Death Rate Correlates with MalnutritionDeath Rate Correlates with Malnutrition

Malnutrition Rate in Population

D

e

a

t

h

s

CMRCrude mortality rate


Kwashiorkor - Kwashiorkor - an extreme indicatoran extreme indicatorfrom inadequate protein intake and/or the stress of from inadequate protein intake and/or the stress of

infectioninfection

Visible signs: Visible signs: Edema - swellingEdema - swelling Flaking skin Flaking skin Thin, light hairThin, light hair more common among 3-5 year oldsmore common among 3-5 year olds


Energy, Calories, and NutrientsEnergy, Calories, and Nutrients

Short for "Kilocalories”Short for "Kilocalories”

Food energyFood energy


Required NutrientsRequired Nutrients

Protein: Protein: 4 kcals/gram4 kcals/gram Carbohydrates: Carbohydrates: 4 kcals/gram4 kcals/gram Fat: Fat: 9 kcals/gram9 kcals/gram Micronutrients: Vitamins and Micronutrients: Vitamins and

MineralsMinerals


Kilocalories per gram of foodKilocalories per gram of food

4

4

9

0

0

0

0 2 4 6 8 10

Carbohyd

PROTEIN

FAT/OIL

WATER

SALT

ROUGHAGE


All Guidelines and StandardsAll Guidelines and StandardsHighlight the Same IndicatorHighlight the Same Indicator

2,100 Kilocalories Per 2,100 Kilocalories Per Person Per DayPerson Per Dayas a gross planning figureas a gross planning figure


Individual Need for Calories variesIndividual Need for Calories varies

Some people need 1,500 Some people need 1,500 kcal/day…..kcal/day…..

Some people need 5,000 Some people need 5,000 kcal/day…...kcal/day…...

What does the need depend on?What does the need depend on?


Who has the greatest daily needs in Who has the greatest daily needs in kilocalories???kilocalories???

1. Males - especially 15-19 years old1. Males - especially 15-19 years old

2. Lactating women2. Lactating women

3. Pregnant women3. Pregnant women

4. Heavy physical activity4. Heavy physical activity

5. Severe cold weather5. Severe cold weather


Daily Energy RequirementsDaily Energy Requirements

Agegroup

Males(kcal/day)

Females(kcal/day)

Average(kcal/day) % of pop.

0-4 yr 1320 1250 1290 12.37%

5-9 yrs. 1980 1730 1860 11.69%

10-14 yrs. 2370 2040 2210 10.53%

15-19 yrs. 2700 2120 2420 9.54%

20-59 yrs. 2460 1990 2230 48.63

60+ yrs. 2010 1780 1890 7.24

Pregnant 285 (extra) 2.4%

Lactating 500 (extra) 2.6%

AVERAGE DAILY REQUIREMENT: 2100 Kcal/person/day

Based on WHO technical Report No. 724 and UN Pop. Data, mid 1995


Making a Making a BasicBasic Food Ration: What are Food Ration: What are our goals?our goals?

2,100 kilocalories - adjusted for:2,100 kilocalories - adjusted for:17% fat17% fat

10-12% protein10-12% protein

All micronutrients - Something rich in All micronutrients - Something rich in vitamins and minerals - like blended vitamins and minerals - like blended

foods (corn-soy blend)foods (corn-soy blend)


Let’s Design a Ration for a Refugee PopulationLet’s Design a Ration for a Refugee Population

Foods that are availableFoods that are available Foods that are reasonably pricedFoods that are reasonably priced Foods that won’t spoil quicklyFoods that won’t spoil quickly Foods that are acceptableFoods that are acceptable Foods that achieve nutrition Foods that achieve nutrition

objectivesobjectives


Major food item:Major food item: Grain (staple) either wheat, Grain (staple) either wheat, maize, rice, sorghum or a flour (4 kcal/gram maize, rice, sorghum or a flour (4 kcal/gram minus loss)minus loss)

Food with protein:Food with protein: beans or lentils (4 beans or lentils (4 kcal/gram minus loss)kcal/gram minus loss)

Source of fat and energy:Source of fat and energy: oil (9 kcal/gram) oil (9 kcal/gram)

Something rich in vitamins and mineralsSomething rich in vitamins and minerals:: Blended Food - Corn/Soy blend (3.8 kcal/gram)Blended Food - Corn/Soy blend (3.8 kcal/gram)

SaltSalt for flavor and iodine (no calories)for flavor and iodine (no calories)

SugarSugar for flavor and energy (4 kcal/gm)for flavor and energy (4 kcal/gm)


An Example RationAn Example Ration

1515SugarSugar

2525Vegetable OilVegetable Oil

5050Corn-Soy-BlendCorn-Soy-Blend

6060

400400RiceRice

Grams (/person/day)Grams (/person/day)CommodityCommodity

Pulses


Food Aid Management ConcernsFood Aid Management Concerns Do people have access to fresh foods and alternative Do people have access to fresh foods and alternative

foods? foods?

Will they accept the food in their cultures? Will they accept the food in their cultures?

What if there is not enough of the needed food? What can What if there is not enough of the needed food? What can be substituted?be substituted?

What about the food that is lost in grinding and cooking?What about the food that is lost in grinding and cooking?

Do they have enough water, cooking fuel, grinding Do they have enough water, cooking fuel, grinding facilities and kitchen utensils?facilities and kitchen utensils?

Is the food safe? What about powdered milk?Is the food safe? What about powdered milk?


Example Difference between two familiesExample Difference between two families

Family IFamily I Family IIFamily II

1 Pregnant1 Pregnant 2 Elderly2 Elderly1 Lactating1 Lactating 1 Adult1 Adult2 Teenage2 Teenage 1 Child1 Child1 Adult1 Adult 1 Child1 Child

NeedsNeeds

25002500 Calories Calories 17001700 Calories Calories

With ration of 2100 kcals, Family I will have a ration With ration of 2100 kcals, Family I will have a ration deficit and Family II a ration surplus.deficit and Family II a ration surplus.


Micro-nutrient DeficienciesMicro-nutrient Deficiencies1.1. Vitamin AVitamin A - Blindness - Blindness

2.2. Vitamin B1 - Beri-BeriVitamin B1 - Beri-Beri(Thiamin)(Thiamin) - Paralysis/Cardiac Failure/Death - Paralysis/Cardiac Failure/Death

3.3. Vitamin CVitamin C - Scurvy - Scurvy - Bleeding/Anemia/Numbness/Death - Bleeding/Anemia/Numbness/Death

4.4. IronIron - Anemia, Paleness-Death - Anemia, Paleness-Death

5.5. NiacinNiacin - Pellagra - Pellagra - Diarrhea/Dermatitis/Dementia/Death - Diarrhea/Dermatitis/Dementia/Death

6. Iodine6. Iodine - Goiter - Goiter


Most Micronutrient Deficiency Most Micronutrient Deficiency Disease is HiddenDisease is Hidden

Typical Refugee Population

No DeficienciesVarious Vitamin, Mineral Deficiencies

Observable, Clinically Evident


Vitamin & MineralDeficiency Disease Epidemics will occur, predictably, in refugee crises

What Indicators can we use to find them?


Salter Salter ScaleScale

Weight


Height boardsHeight boards


Mid-upper Arm Circumference Mid-upper Arm Circumference or “MUAC”or “MUAC”


MUAC of all children aged 6 - 59 months

MUAC > 13.5 cm MUAC < 13.5 cm or oedema

Not referred unless at high risk

Referred to central WfH assessment

NOT admitted to feeding programme

Therapeutic Feeding

Programme

Supplementary feeding Programme

WfH > 80% WfH < 70%WfH 70 - 79%

MUAC as QUICK QUICK Screening Tool


<< 80% of the reference value of Weight-for-Height 80% of the reference value of Weight-for-Height

Malnutrition RatesMalnutrition Rates

<< 70% of the reference value of Weight-for-Height 70% of the reference value of Weight-for-Height

“Severely” Malnourished:

““Moderately” Malnourished:Moderately” Malnourished:


Malnutrition Rates / InterventionsMalnutrition Rates / Interventions

Serious! Supplementary feeding for all vulnerable. groups Therapeutic feeding for severely malnourished

Alert!Suppl. feeding for selected individuals in vulnerable groups Therap. feeding for severely malnourished

< 5% AcceptableNo need for population-wide programme

> 10%or5-9% plusaggravating factors

>20%or10 - 19% plusaggravatingfactors


What is an “aggravating factor?”What is an “aggravating factor?”

General food ration of < 2100 kcal/dayGeneral food ration of < 2100 kcal/day Crude mortality rate of > 1/10,000/dayCrude mortality rate of > 1/10,000/day Measles or whooping cough epidemicMeasles or whooping cough epidemic High prevalence of respiratory or diarrheal High prevalence of respiratory or diarrheal

diseasesdiseases


Our biggest enemy: Our biggest enemy: loss of appetiteloss of appetite

anorexiaanorexialoss of appetiteloss of appetite

shrunken stomachshrunken stomach


What are the most Important Things What are the most Important Things Given in Supplementary and Given in Supplementary and

Therapeutic Feeding?Therapeutic Feeding?

Regular, hot, sweet, fluid meals Regular, hot, sweet, fluid meals (typically in the form of porridge (typically in the form of porridge or milk, with crackers)or milk, with crackers)

Personal Personal A t t e n t i o nA t t e n t i o n


In Extreme In Extreme cases, cases,

Therapeutic Therapeutic Feeding will Feeding will

Focus on oral Focus on oral rehydration and rehydration and high energy milkhigh energy milk


Oral Rehydration Salt formulaOral Rehydration Salt formula(ORS)(ORS)

1 liter1 literWater (boil first!)Water (boil first!)

20 grams20 gramsGlucose Glucose sugar sugar

1.5 grams1.5 gramsPotassium chloridePotassium chloride

BananaBanana

2.5 grams2.5 gramsSodium bicarbonateSodium bicarbonate

Baking sodaBaking soda

3.5 grams3.5 gramsSodium Chloride Sodium Chloride SaltSalt


WFPWFP Responsibilities Responsibilities UNHCRUNHCR

MMoobbiilliizziinngg ““bbaassiicc ffooooddss ffoorr ggeenneerraall && sseelleeccttiivvee ffeeeeddiinngg::

MMoobbiilliizziinngg ccoommpplleemmeennttaarryy ffooooddss

DDeelliivveerriinngg bbaassiicc ffooooddss ttoo EEDDPPss

DDiissttrriibbuuttiinngg AALLLL ffooooddss ttoo ttaarrggeett bbeenneeffiicciiaarriieess

MMaannaaggiinngg EEDDPP wwaarreehhoouusseess

RReeppoorrttiinngg oonn ddiissttrriibbuuttiioonnss

MMiilllliinngg wwhhoollee ggrraaiinn cceerreeaallss,, wwhheerree nneecceessssaarryy

MMoobbiilliizziinngg nnoonn--ffoooodd iinnppuuttss ffoorr llooggiissttiiccss

MMoobbiilliizziinngg nnoonn--ffoooodd iinnppuuttss ffoorr ddiissttrriibbuuttiioonn aanndd eenndd uussee

NOTE: Under the 2002 MOU, WFP will conduct 12 pilot cases where they disribute food directly to beneficiaries instead of UNHCR


WFP/UNHCR MOU Responsibilities

Basic Commodities (WFP)

ComplementaryCommodities

(UNHCR)

- Cereals (Wheat, Rice, Maize)- Oils and Fats- Protein-rich Food

(Beans/Peas or Nuts)- Canned Fish or Meat*- Dried Fish or Meat*- Salt*- Sugar- Fortified Blended Food- High Energy Biscuits

- When recommended by the Joint Assessment Mission, UNHCR will supply:

- Fresh Meat or Fish- Vegetables and Fruit- Condiments (Soy Sauce, Tomato Paste, etc.)- Spices- Dried skimmed milk (DSM)


Joint ResponsibilitiesJoint Responsibilities(in consultation with Host Government)(in consultation with Host Government) Defining locations of EDPsDefining locations of EDPs Monitoring overall food aid supply situation Monitoring overall food aid supply situation

(through FASreps)(through FASreps) Constant exchange of informationConstant exchange of information Consultation for problem resolutionConsultation for problem resolution

UNHCR

WFPWFP


CONCLUSION• Avoid serious malnourishment, by quickly Avoid serious malnourishment, by quickly

establishing a satisfactory basic food rationestablishing a satisfactory basic food ration

• Treat serious malnutrition that does occur with Treat serious malnutrition that does occur with special supplementary and therapeutic feeding special supplementary and therapeutic feeding programmes for those in needprogrammes for those in need

• Use commonly agreed indicators for assessing, Use commonly agreed indicators for assessing, designing, and monitoring food and nutrition designing, and monitoring food and nutrition programmesprogrammes

session 7.2. assessment 4: working with sectoral indicators: food & nutrition

Documents

basic food ration

adequate basic ration

calories variessome

malnutritionmalnutrition

sectoral indicators

greatest daily needs

ave daily requirement

grain staple