Screening Mid-upper arm circumference (MUAC) MUAC<110mm

Community therapeutic care Appetite test

Health interventions Key health interventions that impact on nutritional status Exclusive breastfeeding Vitamin A supplementation Integration of health and nutrition programmes, eg reproductive health, MCH Preventing epidemics (diarrhoea, malaria, dysentery, measles, meningitis) WASH Avoiding overcrowding Vector control Essential health services Improving nutritional status of population Vaccination (measles and meningitis)

Infant and Young Child Feeding in Emergencies Nina Berry/SCUK, Myanmar Cyclone Response, 2008

Times more likely to die Protection by breastfeeding is greatest for the youngest infants WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5 IFE 1/4 Times more likely to die if not breastfed Risk of death if breastfed is equivalent to one. Age in months

Risks of not breastfeeding Infants 6 weeks – 6 months 10.5 times more likely to die if not breastfed. Diarrhoea and ARTI 3 fold higher risk for hospitalisation for any cause. Bahi R, et al. Bull of WHO 2005;83 (6):418-426 (Multi-centre cohort study) There are two ways you need to look at this – breastfeeding affords protection and there are real risks associated with not breastfeeding. Why is artificial feeding dangerous? - formula itself, water to make it up, feeding method and not immunological benefits of b/feeding Even in previously healthy populations child morbidity and crude mortality can increase by 20% in as little as 2 weeks in emergencies Even in US study 2004 in non-emergency children who were never breastfed had a 21% greater risk of dying in the postneonatal period than those who were breastfed – breastfeeding could save 720 post neo-natal deaths in US each year. Chen A, Rogan WJ, Breastfeeding adn the risk of postneonatal death in the US. Pediatrics 113:435-439, 2004. Bangladesh risk of death from ARTI was 2.4 times greater for partially and not breastfed than for exclusively breastfed. Arifeen, Blanck, Atbeknab et al, Exclusive breastfeeding reduces acute respirator infection and diarrhea deaths among infants in Dhaka slums. Pediatrics 108:e67, 2001 Aceh