SESSION 2.3 Problems in Nutrition 12/7/2018 2.3 EMERGENCY NUTRITION PROBLEMS Weighing a child using the Salter scale 12/7/2018

Problem 1: Malnutrition can become epidemic in displaced populations, when normal access to food is cut off and rates of infectious disease rapidly increase. 12/7/2018 UNHCR photo, L. Taylor, Upper Lofa Country Liberia, 1993

High energy Utilization Malnutrition High energy Utilization Lowered Resistance Poor Appetite Infection Measles Diarrhea Pneumonia Malaria A vicious cycle 12/7/2018

Problem 2: The underlying causes of malnutrition in the affected population are not understood or addressed. 12/7/2018 UN photograph, Operation Lifeline Sudan, August 1998

conceptual model of the causes of malnutrition in emergencies LACK OF FOOD DISEASE Household Food Security Social and Care Environment Public Health family and community resources and control Formal and informal infrastructure Context Potential resources 12/7/2018 After UNICEF model - see Sphere page 76

Problem 3: Standardized food baskets are not nutritionally adequate for everyone UN photo, Roghani Refugee Camp, Afghan/Pakistan border, December - 2001 12/7/2018

SESSION 2.3 Problems in Nutrition 12/7/2018 Daily Energy Requirements AVERAGE DAILY REQUIREMENT: 2100 Kcal/person/day Based on WHO technical Report No. 724 and UN Pop. Data, mid 1995 12/7/2018 nutrition InterWorks/UNHCR 8

Problem 4: It is difficult to determine and administer the starting and stopping of selective feeding programs for the severely malnourished 12/7/2018 WFP photo /Ramin Rafirasme - Sierra Leone - Makeni nutritional/ therapeutic centre.

MUAC as QUICK Screening Tool MUAC of all children aged 6 - 59 months MUAC < 13.5 cm or oedema MUAC > 13.5 cm Not referred unless at high risk Referred to central WfH assessment WfH > 80% WfH 70 - 79% WfH < 70% NOT admitted to feeding programme Supplementary feeding Programme Therapeutic Feeding Programme 12/7/2018

Problem 5: Lack of political will to fund adequate nutritional programmes in cases where no other adequate access to sufficient nutrition is available or accessible. UN photo - UN Security Council Meeting 12/7/2018

Problem 6: Normally diverse food sources are replaced by standard rations resulting in severe micronutrient deficiencies, even when overall calorie requirements are met. www.echt.chm.msu.edu www.healthcentral.com signs of SCURVY 12/7/2018

Signs of pellagra… Cassal's necklace Photo: P. Delchevalerie http://www.ennonline.net/fex/10/fa12.html 12/7/2018

Problem 7: Food types provided through international mechanisms often do not match customary foods, and so may be traded at a loss, or wasted. 12/7/2018

Problem 8: Heightened malnutrition leads to excess mortality. O N D J F M A M J J A S O N D J F M A M J 88 89 90 0 % 5 % 10 % 15 % 20 % 25 % 30 % 35 % 5 10 15 20 25 30 35 Prevalence of acute malnutrition in children under 5 CMR = Deaths / 10,000 / day 12/7/2018 Malnutrition and mortality data from Hartisheik A, Ethiopia (after Noji)

Problem 9: It is often difficult, and sometimes impossible to conduct a credible nutrition survey upon which to design suplementary feeding programmes. UNHCR photo 12/7/2018

SPHERE and SUDAN 1998…? 1. Read the Background documents provided about Sphere, MSF, and Sudan in 1998. 2. What are the facts of the case? 3. What are the primary arguments made against the Sphere Standards and Indicators in this case? 4. What are the key arguments made for the use of Sphere Standards and Indicators in this case. 5. What conclusions can you make? 12/7/2018

CONCLUSIONS Nutrition and malnutrition are fields based on, and requiring, trained professional nutritionists Even so, avoiding serious malnutrition,is based on and requires meeting basic standards of service in many other sectors, such as water, sanitation, health, and shelter. While this information does not make you professional nutritionists, it does raise your ability to better understand the inter-related nature of nutrition/malnutrition and the other service support sectors 12/7/2018