1 Inpatient careOutpatient CareSFP

Using Plumpy Doz to prevent malnutrition ? South-Sudan 2011 From Relief to Self-Reliance Nutrition and Food Security Department Alexandra Rutishauser-Perera and Stien Gijsel All content in this document is the property of International Medical Corps and should not be reproduced without prior written consent.

Plumpy Doz PPD in SS Ready to use supplementary food (RUSF) originally developed to reduce the incidence of acute Malnutrition during at-risks periods. Recommended daily dose: 3 teaspoonfuls. 3 times a day. Pot of 325g : Quantity required for one child in one week. Particularly suited to children aged 6 to 36 months

PPD ( which programs) PPD in SS Can help reduce the incidence of Global Acute Malnutrition in regions affected by serious food insecurity. Mainly suited to humanitarian emergencies with a large number of under 3 at risk of Malnutrition. Can be associated with Blanket feeding. Provide daily dose of micronutrients, high quality proteins and essential fatty acids.

5 Inpatient careOutpatient CareSFP Catching Acute Malnutrition Early Plumpy Doz

South Sudan context 20 years of civil war, peace agreement 2005 Independent since mid 2011 Plagued with intertribal fighting Akobo County Agro-pastoralist community Very remote, and challenging environment Limited coverage of targeted SFP programmes (<30% of need)

South Sudan program IMC Primary Health Care centre Full Community Management of Acute Malnutrition (CMAM) for returnees and communities from mid-2011 Kala Azar ( in one HF)

Strategy for PPD National Strategy designed by WFP Only for 6-24 months due to restricted supply and link with the 1,000 days approach Plumpy doz intervention during the hunger gap of 2011 Planned for 6 months (April – September), reality June – October) No TSFP during the intervention

Community sensitization: a big component of the program Meetings Announcements Posters Public speaking Requires a Strong IYCF component

Post Distribution Monitoring Random selection of children in the community (60/month during this intervention). Control the acceptance of the product, the quantity of PPD remaining in the house, the hygiene and IYCF practices.

Context during and after the intervention Deterioration of the Food security with very bad crops High movement of population continuing today Increase of cattle raiding

Results The 2010 and 2011 post-harvest surveys show no significant difference Strong reason to believe that malnutrition rate would have been worst without the intervention

Successes Positive reception by thecommunity and beneficiaries Large coverage (estimated on %) Although movement of population, beneficiaries came on distribution days Perceived as food for children only– shared with other children (pots increased storage of supplies as used for lentils, herbs, oil etc….)

Challenges Double dipping and sharing Security Poor IYCF remained Malnutrition rates increased post-harvest, and hunger gap 2012

Food for thoughts Effectiveness and impact difficult to measure Underlying causes remain Dependency on foreign aid/supply

Study Defourny I, Minetti A, Harczi G, Doyon S, Shepherd S, et al. (2009) A Large-Scale Distribution of Milk- Based Fortified Spreads: Evidence for a New Approach in Regions with High Burden of Acute Malnutrition. Despite the annual hunger gap season, the prevalence of children with MUAC<110 mm between May and August decreased by half, rising slightly in September and October. The expected rise in new cases of malnutrition during the hunger gap period in 2007 was not only arrested, but reversed during the period of blanket distribution of RUF.

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