1. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Nutrition in Emergencies A staple food - Cereals Protein rich food – Peas, beans or lentils Source of fat - Vegetable oil A source of micronutrients - Blended food Spices & condiments Dr. Mariam Alwaili In-charge of clinical nutrition MOH

2. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Malnutrition and death Outcomes Inadequate dietary intake Disease Immediate causes Insufficient health services and unhealthy environment Inadequate access to food Social and Care Environment Underlying causes Formal and non-formal institutions I n a d e q u a t e e d u c a t i o n Political and ideological superstructure Economic structure Potential resources Basic causes Conceptual Framework for the Causes of Malnutrition in Society

3. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 1.Protein-Energy Malnutrition Common Nutritional Problems 2. Micronutrient Malnutrition Vitamin A Deficiency (VAD) Iron Deficiency Anemia (IDA) Iodine Deficiency Disorders (IDD) 3. Communicable disease 4. Non-communicable disease

4. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Growth Monitoring Breastfeeding & Complementary feeding Food Security Nutrition Information Education Vitamin A Food Fortification Vitamin A and Iron Supplementation Omani code Guidelines

5. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Programme Interventions in Emergencies

6. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Overview of Programs General Food Distribution Selective Feeding Programs Supplementary Feeding Programs Therapeutic Feeding Programs Food Security Interventions Disease control measures

7. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Overview of Feeding Programs General Feeding Programs - For populations dependent - Full or partial food basket - Wet or dry rations

8. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman The “Food Basket” For an initial emergency period and/or for a population entirely dependent on external food aid. – 2,100 kcal/person/day – 10-12% of total energy from protein – At least 17% of total energy from fat – Recommended micronutrient intakes

9. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Overview of Feeding Programs Selective Feeding Programs  Supplementary Feeding Programs  Therapeutic Feeding Programs  Usually target vulnerable groups: » Malnourished children and individuals » Pregnant and lactating women » TB/HIV/other chronically ill patients If general ration or food intake not sufficient to meet special needs

10. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Reduce the demand for micronutrients – infection prevention and treatment reduction in measles/TB, hookworm improve hygiene immunization deworming malaria control Availability of ORS – increased exposure to sun Increase supply of micronutrients in the diet or by supplementation THESE SHOULD HAPPEN SIMULTANEOUSLY Disease control measures

11. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Overview of Feeding Programs Food Security Interventions …gardening/income generation, etc… Support for gardening projects, income generation, etc. Improve access to micronutrient rich foods by growing, trading, purchase, etc. Increase dietary diversity

12. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Meet the populations minimum nutritional requirements Diversified What Are the Characteristics of an Adequate Ration? Acceptable and broadly familiar Easily digestible for children Economic in terms of fuel requirements, preparation time and waste Fit for human consumption

13. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Distribution systems should be: Equitable Regular Accountable Transparent Secure

14. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Minimum response in every emergency

15. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman What must I do to protect and support safe and appropriate IFE?

16. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Offer ‘safe places’ for breastfeeding and feeding support

17. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Prioritise pregnant and lactating women for shelter, food, water and security

18. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Make sure every newborn initiates breastfeeding within 1 hour of birth

19. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Ensure access to safe and adequate complementary foods, appropriate to needs and context

20. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Locate technical capacity Wet nurse relactates an abandoned baby (Myanmar, 2008) Unaccompanied infants with no source of breasmilk (Rwanda, 1994)

21. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Donated (free) or subsidised supplies of breastmilk substitutes (e.g. infant formula) should be avoided. Donations of bottles and teats should be refused in emergency situations. Any well-meant but ill-advised donations of breastmilk substitutes, bottles and teats should be placed under the control of a single designated agency. Operational Guidance on IFE, v2.1, Feb, 2007 Do not seek or accept donations of BMS, bottles & teats But Gov should special cases

22. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

23. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Key priorities Scale up existing life saving treatment of acute malnutrition programs Capitalize on high impact low cost interventions such as breast feeding, complementary feeding and Vitamin A supplementation; Building capacity of national institutions in nutrition emergency preparedness, response and mitigation; Targeting under 5 children, pregnant and lactating women, and vulnerable groups (elderly, disable people etc….)

24. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Standard Guidelines for designing and monitoring feeding programs SPHERE UNHCR/WFP Guidelines for Selective Feeding Program in Emergency Situations

25. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman NUTRITION PREPAREDNESS IN EMERGENCY NUTRITION PREPAREDNESS IN EMERGENCY

26. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman How to Prepare Individual Be prepared to be self sufficient for at least 72-Hours. – Food – Water – Shelter – Medications – Hygiene items Keep it together, updated/rotated and accessible.

27. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 5 gallon bucket with hygiene items Ready made Dried food Water Propane heater Dishes, pots & pans Tarps Propane Lantern Battery lantern with batteries Propane Charcoal Canned food Sleeping bag Camp stove & misc. items (rope, tools, matches, propane) Extra BBQ Propane tank Tent, cots, sleeping bag. EXAMPLE OF 4-PERSON 72-HOUR KIT Sheets, blankets, towels, & pillows

28. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Key priorities Scale up existing life saving treatment of acute malnutrition programs Capitalize on high impact low cost interventions such as breast feeding, complementary feeding and Vitamin A supplementation; Building capacity of national institutions in nutrition emergency preparedness, response and mitigation; Targeting under 5 children, pregnant and lactating women, and vulnerable groups (elderly, disable people etc….)

29. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Group work 1. What information on nutrition needs do you need to know of affected people? 2. With whom would you need to coordinate to find out more about the situation? 3. What information did you got from risk assessment study 4. What intervention measures would you make based on the information that you have? 5. what is your contingency plan. 6. What is your recommendation

30. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Coming together is a beginning; Keeping together is progress; Working together is success!