KNOWLEDGE FOR THE BENEFIT OF HUMANITY

ADVANCED NUTRITION (HFS4352)

NUTRITION IN EMERGENCIES Do we know what works?

Mohd Razif Shahril, PhD

School of Nutrition & Dietetics

Faculty of Medicine and Health Sciences

Universiti Sultan Zainal Abidin

1

Outline

• Introduction

• What is nutrition emergency?

• The scale of emergency nutrition activities

• Nutrition programme elements in emergencies

• The challenge of meeting nutrition targets

• Conclusion

2

Introduction

• Multiple forms of malnutrition present in the

context of crisis

– Wasting

– Severe stunting

– Micronutrient deficiencies

– Obesity

• Humanitarian response has evolved rapidly

since 2000, leading to calls for greater focus on

the generation of rigorous data on effectiveness.

3

What is nutrition emergency?

• Any situation where there is an exceptional and

widespread threat to life, health and basic

subsistence, which is beyond the coping

capacity of individuals and the community

• ‘Complex emergency’

– a major humanitarian crisis of a multi-causal nature,

essentially from internal or external conflict and which

requires an international response that extends

beyond the mandate or capacity of any single agency

4

What is nutrition emergency?

5

Classification system Level Mortality and malnutrition

indicator

UN SCN thresholds 1995

Alert

CMR 1/10,000/day

U5MR 2/10,000/day

Wasting 5–8%

Severe

CMR 2/10,000/day

U5MR 4/10,000/day

Wasting >10%

CMR = Child Mortality Rate U5MR = Under 5 y/o Mortality Rate

What is nutrition emergency?

6

FSNAU/FAO integrated

food security phase

classification (IPC), 2007

Generally food secure

CMR < 0.5/10,000 /day Wasting* < 3% (<-2SD WHZ) Stunting < 20% (<-2SD HAZ)

Moderately/ Borderline Food Insecure

CMR < 0.5/10,000/day U5MR < 1/10,000/day Wasting* > 3% but <10% Stunting 20-40% (<-2SD HAZ), increasing

Acute food and livelihood crisis

CMR 0.5-1 /10,000/day U5MR 1-2/10,000/day Wasting* 10-15% (>-2SD WHZ), > than usual, increasing

Humanitarian emergency

CMR <1-5 / 10,000/day, >2x baseline rate, increasing U5MR > 2-10/10,000/day Wasting* > 15% (>-2SD WHZ), > than usual, increasing

Famine/ Humanitarian catastrophe

CMR >2/10,000/day (e.g., 6,000/1,000,000 /30 days) Wasting* >30%

What is nutrition emergency? • Vulnerability to nutrition emergencies;

– Existing health and nutrition situation greatly affects how vulnerable a population is to a nutritional emergency

– HIV and AIDS increases food insecurity, poverty, and even has negative effects on labor force and agriculture at large scale

– Poverty and urban pressure overcrowding, inadequate drinking water, substandard sanitation facilities and infrastructure, exposure to urban pollution and hazardous materials, landlessness, and frequent food shortages

– Climate change may have an increasing impact leading to more frequent famines in the future

7

What is nutrition emergency?

• Triggers for nutrition emergencies;

– Natural disasters affect food availability and access,

disrupt health systems, destroy WASH systems

– Conflict can lead to Nutrition Emergencies in many

ways due to lack of access to food, health, WASH,

etc.

– Political crises and economic shocks contribute to

Nutrition Emergencies through discrimination of

ethnic groups or inadequate political decisions (China

famine in the late 50s)

– Global food prices fluctuations have caused

increased levels of poverty, food insecurity and

resulting under nutrition

8

What is nutrition emergency?

• Who is most vulnerable in emergencies?

– Physiological vulnerability: children less than 5,

older people, people affected by chronic diseases,

gender

– Geographical vulnerability: flood or drought-prone

areas, conflict front lines

– Political vulnerability: discrimination, persecution

– Internal displacement and refugee status: 26

million IDPs, 16 million refugees at the end of 2010

(minus the Arab spring displacements).

9

What is nutrition emergency?

• Types of malnutrition during emergencies?

– The major concern in emergencies is the increased

risk of moderate and severe acute malnutrition

because acute malnutrition is strongly associated with

death

– In many long-term emergencies levels of other forms

of malnutrition (stunting and underweight) are often

high

10

What is nutrition emergency?

• (cont.) Types of malnutrition during

emergencies?

– Stunting inhibits a child from reaching his or her full

physical and mental potential

• Can have a major impact on work output and national

development

• Is becoming an increasingly important measure of nutritional

wellbeing in some emergencies

– Micronutrient deficiencies are common in

emergencies, particularly in affected people

dependent on food rations

11

The scale of emergency nutrition

• Goals of nutrition action in emergencies typically

include;

a) Reducing levels of wasting to below conventionally-

defined emergency rates of thresholds

b) Reducing and/or preventing micronutrient

deficiencies, because these markedly increase

mortality risks

c) Reducing the specific vulnerability of infants and

young children in crises through the promotion of

appropriate child care, with special emphasis on

infant and young child feeding practices

12

The scale of emergency nutrition

• (cont.) Goals of nutrition action in emergencies

typically include;

d) preventing a life-threatening deterioration of

nutritional status by ensuring access by emergency-

affected populations to adequate, safe and nutritious

foods that meet minimum nutrient needs

13

Nutrition programme elements

• Choice of actions from a more comprehensive

portfolio of intervention includes (but not limited)

the following;

a) General food assistance

b) Management of severe acute malnutrition

c) Management of moderate acute malnutrition

d) Delivery of micronutrients

e) Infant and young child feeding in emergencies

f) Treatment of diarrhoea with oral rehydration therapy/

zinc

14

Nutrition programme elements

• (cont.) Choice of actions from a more

comprehensive portfolio of intervention includes

(but not limited) the following;

g) Prevention and treatment of vitamin A deficiency

h) Food and nutrition assistance for people living with

HIV

i) The psychosocial components of nutrition

j) Nutritional care for groups with special needs

15

The challenge

• Developing countries will not be able to break

out of poverty and sustain economic growth

– large segments of their population fail to secure the

nutrition needed for a healthy and productive life.

• The goal of addressing stunting and wasting is

unlikely to be achieved without progress in

countries requiring large-scale humanitarian

action

– Investment needed to move rapidly on a post-crisis

trajectory

16

(cont.)The challenge

• Important way to reduce child mortality requires

concerted efforts

– aimed at expanding the coverage and effectiveness of

both institutional and community-based programs

focused on treatment and prevention of stunting and

wasting.

• The specific contribution of actions address

nutritional deficiencies in humanitarian contexts

has to be understood

– as an essential contribution to the international

community’s overall nutrition agenda.

17

Conclusion

• Emergency interventions continue to improve in

terms of coverage, scale of operations, reporting

standards and effectiveness,

– ‘no response’ is never an option

• Immediate nutrition needs are usually acute,

large scale and have complex determinants

– Combination of intervention to focus on different

target groups

18

Thank You

19