Download The World Declaration and Plan of Action for Nutrition

Nutrition in Disasters
Dr. Sergei Koryak
WHO EHA Coordinator
December 9, 2007
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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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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9 December 2007
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
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9 December 2007