1. SESSION 2.3 Problems in Nutrition
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2.3
EMERGENCY NUTRITION PROBLEMS
Weighing a child using the Salter scale
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2. Problem 1:
Malnutrition can become epidemic in displaced populations, when normal access to food is cut off and rates of infectious disease rapidly increase.
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UNHCR photo, L. Taylor, Upper Lofa Country Liberia, 1993

3. High energy Utilization
Malnutrition
High energy Utilization
Lowered
Resistance
Poor Appetite
Infection
Measles
Diarrhea
Pneumonia
Malaria
A vicious
cycle
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4. Problem 2: The underlying causes of malnutrition in the affected population are not understood or addressed.
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UN photograph, Operation Lifeline Sudan, August 1998

5. 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
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After UNICEF model - see Sphere page 76

6. Problem 3: Standardized food baskets are not nutritionally adequate for everyone
UN photo, Roghani Refugee Camp, Afghan/Pakistan border, December
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7. SESSION 2.3 Problems in Nutrition
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Daily Energy Requirements
AVERAGE DAILY REQUIREMENT: Kcal/person/day
Based on WHO technical Report No. 724 and UN Pop. Data, mid 1995
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nutrition
InterWorks/UNHCR 8

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

9. MUAC as QUICK Screening Tool
MUAC of all children aged 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 %
WfH < 70%
NOT admitted to feeding programme
Supplementary
feeding Programme
Therapeutic Feeding Programme
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10. 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
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11. Problem 6: Normally diverse food sources are replaced by standard rations resulting in severe micronutrient deficiencies, even when overall calorie requirements are met.
signs of SCURVY
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12. Signs of pellagra… Cassal's necklace Photo: P. Delchevalerie
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13. Problem 7: Food types provided through international mechanisms often do not match customary foods, and so may be traded at a loss, or wasted.
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14. 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
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Malnutrition and mortality data from Hartisheik A, Ethiopia (after Noji)

15. Problem 9: It is often difficult, and sometimes impossible to conduct a credible nutrition survey upon which to design suplementary feeding programmes.
UNHCR photo
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16. 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?
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17. 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
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