Docstoc

Nutrition in - Emergency Nutrition Network

Document Sample
Nutrition in - Emergency Nutrition Network Powered By Docstoc
					 Nutrition in
Emergencies

 Marie McGrath,
   Emergency
Nutrition Network
Emergency Nutrition Network
(ENN)
   Set up in 1996 by humanitarian agencies
   To develop sectoral memory and learn
    from experiences in emergency nutrition
    and food security
   Field Exchange
   www.ennonline.net
              Terminology

Underweight          Stunting        Marasmus

        Micronutrient deficiencies

         Wasting                Kwashiorkor

      Under-nutrition Over-nutrition

    Micronutrients        Macronutrients
           Importance of nutrition in
                 emergencies
   Biafran war (1967-
    1970)
       1 million civilians died
   Ethiopian famines
    1980s
       Mobilised aid

                                   Tumultuous scenes at food distribution
                                   sites in Ethiopia.
                                   Ken Bailey, Field Exchange 12, 2001
     Why is nutrition in emergencies
               important?
   Protection of nutritional status
    in emergencies humanitarian
    right (international law)
   Acutely malnourished - more
    sick
   Sick more likely to get
    malnourished
   Emergencies impact on range
    of factors – increase risk of
    malnutrition, illness
    (morbidity) and death
    (mortality)
    Malnutrition and risk of illness and
                  death
   Not infectious disease……. implicated in half child deaths in the world
   Some emergencies result in very high levels of severe malnutrition
   „Cut-offs‟ for severe malnutrition is threshold where mortality risk rises
    sharply

   Risk of death of malnourished associated with disease patterns – malaria,
    diarrhoea, measles, ARI, HIV and AIDS
   Nutritional status also affected by reduced food intake due to worsening
    food security

   Relationship between malnutrition and mortality is complicated
        Other factors affect mortality
   Important to interpret mortality data with nutrition and health information
        Crude Mortality Rate (CMR): <1.0/10,000 individuals/day
        Under-five Mortality Rate (U5MR): <2.0/10,000 U5s/day
                                    South Sudan, 1998

                                         Mortality rates in Awok
        Deaths per 10,000 per day




                                    30
                                    25
                                    20
                                                                     <5 MR
                                    15
                                                                     CMR
                                    10
                                                          Onset
                                    5                     SD 1
                                                          epidemic
                                    0
                                           ay



                                      A uly
                                       M b
                                             n




                                      ct t
                                           ne
                                             il
                                           ch




                                           er
                                            st
                                     O ep
                                         Fe



                                          pr
                                         Ja




                                        gu
                                         M




                                        ob
                                        Ju
                                        ar




                                         J



                                        S
                                        A




                                       u
                                                   1998




   U5MR rose faster than CMR.
   July, outbreak of dysentery and CMR caught up with U5MR.
   July nutrition survey: 80% acute malnutrition (WH <-2 zscores).
   October nutrition survey: 48% acute malnutrition, partially
    explaining continued high mortality despite dysentery under control.
          What are the causes of
              malnutrition?
   Immediate causes….individual
   Underlying……..households/communities
   Basic….society
   UNICEF conceptual framework to
    determine causes of malnutrition
UNICEF Conceptual framework of
         Malnutrition
    Broad-based approaches to tackle
              malnutrition
   Not just lack of food – complex mix of
    factors
   Interventions to „cure‟ individuals and
    prevent death
   Interventions to „prevent‟ malnutrition rates
    rising
       Heath, healthy environment
       Ensuring food security (ability of household to
        access food)
   Public nutrition approach
                  What is an emergency?
                                                        MSF „top ten‟ under-reported
                                                        1.    Violence in Central Africa
   Extraordinary-urgent-sudden                               Republic
                                                        2.    TB deaths on increase
   Emergency – disaster – crisis                       3.    Conflict in Chechnya
                                                        4.    Conflict in Sri Lanka
    An unforseen and often sudden event that            5.    …….
    causes great damage, destruction and human
    suffering, CRED, 2007
                                                        In 2006, the „top ten‟ accounted
                                                              for 7.2 minutes out of
   Complex – major humanitarian crisis, multi-               14,512 minutes on three
    causal, essentially political nature, system              major US TV network
    wide response needed                                      nightly newscasts.

   „Loud‟ v „silent‟                                   Five of the countries never
        Impartiality - basis of and in proportion to         mentioned at all.
         need?????
    What is a nutrition emergency?
   Classification systems
       Severity using acute MN as an indicator of distress
       UN-SCN thresholds (1995)
       ODI (2003)
       FSAU/FAO Integrated food security phase classification (2006)
       Howe and Devereux Famine Magnitude Scale 2004 (6 „stages‟)
            Food security (CME<0.2/10,000/d and wasting <2.3%)
            Food crisis conditions (CMR>=0.5 but<1/10,000/d and/or wasting
             >=10% but <20% and/or oedema)
            Extreme famine conditions (CMR>=15/10,000/d)
       When to respond?
            Thresholds for emergency interventions: ODI and FSAU
            SMART – reliable and consistent data and reporting
    Where do emergencies occur?
   Largest famines (excess
    deaths) in Asia
       China 1958-1962, 30 million
        people died
       North Korea, 3.5 million
        people
   Most nutritional
    emergencies chronic and
    „invisible‟
   Allocation of food aid not
    just wasting:
    2000-2004: emergency food aid
      went to just 6 countries:
      Ethiopia, Sudan, Afghanistan,
      Angola, Iraq, North Korea
                What are the causes?
   Emergencies where acute malnutrition rates rise are usually directly
    caused by severe shortages of food combined with disease epidemics.
   Vulnerability
        Poverty, chronic food insecurity, poor infrastructure……………..developing
         countries
   HIV and AIDS
        Majority of humanitarian crisis in countries where rates already high
        Emergencies can increase the risk of infection, eg rape and sexual
         explotation in conflict areas
        Affects agricultural production (labour loss), intensifies poverty (assets
         stripped)
        No clear associations between malnutrition rates and HIV and AIDS at
         population level
   Climate change
        Average global temperatures rising, other ecological changes…increase
         nutrition emergencies and famine?
        Climate vulnerability analysis into frameworks
    Triggers for nutrition emergencies
   Natural disasters
        floods, hurricanes
        Droughts develop more slowly
        Earthquakes large mortality, less dramatic effect on food
         security
   Conflict
        War „tactics‟ can block access to food/health services
        Destroy infrastructure, food production
   Political crisis and economic shocks
        Zimbabwe
             Drought, floods, disruption of farming activities due to political
              strife, national mismanagement of grain reserves….vulnerability
        Individual vulnerability may be linked to social or political status
    Who most nutritionally vulnerable
          in emergencies?
   Physiological
       U2‟s, pregnant and
        lactating, elderly
   Geographical
   Political
   Internal displacement
    and refugees
       Around 9.2 million
        refugees and 25
        million IDPs worldwide
Increased deaths (mortality)                                                       AND because IFE 1/1
                                                                                   infants and
Daily deaths per 10,000 people in selected refugee                                 children are the
situations 1998 and 1999                                                           most vulnerable...
                                                                                 people of all ages

                                                                                 children under 5 years
    Deaths/10,000/Day




                                   Camp location

                        Refugee Nutrition Information System, ACC/SCN at WHO, Geneva
                                                                                                                                                           IFE 1/2
Risks of death highest for the youngest

at therapeutic feeding centres in Afghanistan, 1999
  Deaths as % of admissions




                                                                        Age (months)


                              Golden M. Comment on including infants in nutrition surveys: experiences of ACF in Kabul City. Field Exchange 2000;9:16-17
                                                                         IFE 1/3
Risk of death higher for malnourished children

Distribution of 12.2 million deaths among children
under 5 years old in all developing countries, 1995




                                                      WHO Geneva, 1995
What types of malnutrition occur in
          emergencies?
   Acute malnutrition (wasting), especially in young
    children
       Measured as weight-for-height/presence of bilateral oedema
       Moderate acute (MAM): WH>=70%-<80% WH or >=-3 - <-2 z
        score
       Severe acute (SAM): WH<70% or <-3 z score
       U5 acute MN as proxy
   Micronutrient deficiencies
       Clinical, sub-clinical
       Dietary diversity
   Chronic malnutrition (stunting)
       Inhibits full mental and physical potential
       Small mothers have small babies
                       Marasmus
                  („wasting malnutrition‟)


   Severe form acute
    malnutrition
   Generally wasted
   Thin arms
   Thin face, “old man”
   Ribs visible
   Sunken eyes
   Lack of skin turgor
   May be alert but irritable
Source: Unknown
   Kwashiorkor
(oedematous malnutrition)
   Kwashiorkor
       Severe form of acute
        MN
       Clinical signs include
        oedema (bilateral foot
        oedema, can spread to
        other parts of body)
       Cracked and peeling
        skin, changes in hair
        colour and texture,
        lethargy and misery
        Micronutrient deficiencies
   Iron deficiency (anaemia)
   Vitamin A deficiency
    (xeropthalmia)
   Iodine deficiency
   Vitamin C deficiency
   Niacin deficiency
    (pellagra)
   Thiamine deficiency (beri-
    beri)
   Riboflavin deficiency
    (ariboflavinosis)            Haemacue survey in Tanzania,
                                 Field Exchange, Issue 28, July 2006
Source: UNHCR   Source: A Seal, Field
                Exchange 32, Ethiopia,
                2004
     Micronutrient deficiencies




                                  Signs of scurvy: blackness of the
Pellagra (niacin deficiency),     legs indicative of haemorrhage.
Angola                            Northern Afghanistan, Field
Field Exchange 30, Angola, 2007   Exchange 13, 2001
             Nutrition Assessment
   Establish prevalence
    of malnutrition
       30x30 cluster
   Identify potential
    causes
   Decide on appropriate
    interventions
       Rapid assessment
                                   ACF coverage survey, Uganda,
       Nutrition surveys          Field Exchange 34, 2008
       Nutritional surveillance
ACF, Uganda, Field Exchange 34, 2008
Nutrition Response in emergencies

   Curative, eg therapeutic care
   Preventative, eg improving water supply
    and sanitation to prevent disease
    epidemics
   Food and non-food interventions

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:11/16/2011
language:English
pages:30