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Niger 2005
"…‘regular’ starvation has to be distinguished from
violent outbursts of famines…"
(Amartya Sen, Poverty & Famines 1981)
Operations
Questions
Dr Milton Tectonidis, London 2006
July 2001-2004
MSF Maradi Program
Six outpatient centres
One inpatient centre
Severe + special cases only
Ready to Use Therapeutic Foods (RUTF)
2004
9,632 admissions
83.5% cure rate
March 2005
Clear Signs (W12)
DAKAR, 21 December (IRIN) Due to poor rains
and a severe locust outbreak, Niger this year
registered a record grain deficit of 223,487 tons.
peak period 2004
April - May 2005
May 25, 2005
MSF Launches Emergency Operation to Combat Malnutrition in Niger
EPICENTRE SURVEYS
GAM 19.6 (28.2), SAM 2.9 (4.1)
GAM 19.3 (28.5), SAM 2.4 (4.4)
U5MR 2.2 – 2.4/10,000/d
Niger
Nutritional Surveys January to September
2005
May 2005
MSF Niger Emergency Strategy
Steve Collins
Angola 2002
Darfur 2004
NEW SC & OTC (RUTF)
+ Protection & Discharge Rations
March 2005 (Dakoro)
May 2005 (Aguié, Tessaoua, Mayahi)
TARGETED BLANKET FEEDING
late July 2005 (Maradi)
late Sept 2005 (Zinder)
July - October 2005
Inpatient centres
Outpatient points
Family rations
Targeted blankets
Pediatric units
Support to OPDs
July 25, 2005 Preventing Severe Malnutrition in Maradi, Niger
The first distribution finally took place on Saturday, July 23…
October 26 2005 - The Targeted Supplementary Feeding Initiative in Zinder
A joint effort of MSF, UNICEF and the World Food Programme.
2005
Malnutrition in Maradi
Hunger gap
39,158 admissions
60% of admissions in 13 weeks
95% of admissions < 85 cm
40%+ between 75 & 85 cm
Program indicators 2005
91.4% cure rate
3.2% death rate
4.7% default rate
December 2005
A recent survey… confirms that the children of Niger still face high levels of malnutrition.
Malnutrition rates range from 9% to 18%, and inadequate infant and
young child feeding practices are likely causes.
Cultural factors and social behaviours, such as inadequate infant and
young child feeding practices, have a major impact...
Malnutrition conceptual framework
FOOD
CARE
or
HEALTH ?
The most common cause of
protein-energy malnutrition
is parents’ poor child feeding
and caring practices….”
World Bank 2006
Food availability in Niger
Population, Cereal Production & Food Aid
3500000
14000
3000000
12000
2500000
10000
Maradi
2001
2005
2000000
1500000
1000000
500000
Maradi,
Tahoua
1984
1987
Zinder
1997
8000
6000
4000
2000
0
0
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Years
Population (thousands)
Cereal (metric tons)
Niger 1980-2005
Food accessibility in Niger
Hunger gap
Prices
Food quality & dietary deficiency
Deluxe WFP ration
2261 kcal
12% proteins
20 % lipids
monotonous cereal-pulse diets
143
130
109
102
144
117
100
82
Iron
Calcium
Thiamin
(B1)
Ribo-flavin
(B2)
34
Niacin equ.
(B3, PP)
Folic Acid
Vit C
Vit A retinol
Fat
Protein
38
Energy
Percentage
222
200
180
160
140
120
100
80
60
40
20
0
ITEM
Cereal
Pulse
Oil
CSB
Sugar
Salt
TOTAL
QUANTITE
400 gr
60 gr
25 gr
100 gr
15 gr
5 gr
605 gr
dietary diversification
food fortification
nutrient supplementation
Nutrient deficiency, growth & malnutrition
Mike Golden
Type II nutrients
growth failure
Type I nutrients
specific signs of deficiency
iron, copper, selenium
calcium, iodine
vitamins A, B, D, E, K
nitrogen, essential amino acids
sodium, potassium, chloride
phosphorus, sulphur
zinc, magnesium
tissue repair and growth ceases
no convalescence from illness
anorexia and wasting
Nutrient deficiency, growth & malnutrition
R. Shrimpton. The timing of growth failure (data from 39 studies)
60 million wasted
130 million underweight
150 million stunted
Ready to Use Therapeutic Foods (RUTF)
Nutrient dense pastes (equivalent to F-100 + Fe)
Ready to eat
No added water – contamination free
Individualised packaging
Increased capacity
Outpatient treatment
Multiple, decentralized sites
Include the "moderates"
Improved results
Early diagnosis (recruitment)
Expanded coverage
Quality referral care
Designed to encourage rapid weight gain
MSF Emergency Nutrition current strategies
therapeutic feeding + targeted food aid
2004 protection rations
2005 discharge family rations
2005 blanket feeding
2006 therapeutic feeding
MSF Emergency Nutrition current strategies
Angola 2002 TFC + blankets
Darfour 2004 TFC + OTC + protection rations (+ blankets)
Niger 2005 SC + OTC + protection rations + food ration (+ blankets)
NUTRITION
Acute malnourished
At risk
therapeutic feeding
family rations
blanket feeding
General population
Quality
Coverage
FOOD AID
general distribution
Acute malnutrition - further work
Deinstitutionalize
Simplify
ACUTE MALNUTRITION
W/H < 80%
MUAC < 110 mm
Edema
MUAC/edema only ?
adjustable thresholds
include other age groups
COMPLICATED
Inpatient
NON-COMPLICATED
Outpatient
ANOREXIA
Severe pathology
Apathy
APPETITE
No severe pathology
Alert
strengthen referral capacity
discharge quickly
adjust discharge criteria
lighten follow-up
Anthropometry
– individual risk
Extend benefits
RUTF ?
Treatment by
illness episode ?
acute weight loss
Anthropometry
– individual risk
Extend benefits
"healthy" reference children
rural village age peers
child with pertussis
RUTF ?
Treatment by
illness episode ?
poor & incomplete catch-up growth
Anthropometry
Extend benefits
– population risk
South Sudan 1993
Herwaldt et al.
70% U5 < -2 ZS
RUTF ?
Therapeutic Blanket ?
Maradi Niger 2005
Up to 25% incidence of severe
malnutrition (50% for < 85 cm)
Incidence of admissions by district/canton Maradi 2005
Districts / Cantons
Under 5 pop
Admissions
Incidence (/1000/yr)
District Guidam Roumdji
Guidan Roumdji Town
78452
11 303
144,1
2357
111
47,1
Guidan Roumdji
11901
2741
230,3
Chadakori
15855
1264
79,7
Tibiri Maradi
18432
4040
219,2
Saé Saboa
14879
1602
107,7
Guidan Sori
15027
1545
102,8
MSF nutrition
new therapeutic products & strategies
micronutriments +/- calories
RUTF
RUSF
pregnancy & lactation
"acute" malnutrition
RAPID WEIGHT GAIN
illness episode
convalescence
weight loss
RUSF
TARGETED SUPPLEMENT
Nutrients
HIV-TB
chronic disease
ration supplement
weaning foods
MSF emergency nutrition
Strategy (who is at risk ?)
Targeting (what supplement ?)
Acute malnourished
RUTF for rapid
weight gain
Acute weight loss
At risk groups
General population
RUSF for specific
target group
General ration
quantity & quality