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Development, acceptability, and nutritional characteristics of a low-cost, shelf-stable supplementary food product for vulnerable groups in Kenya

In Uncategorized, Under-nutrition on October 15, 2012 at 8:14 am

 Kunyanga, Catherine; Imungi, Jasper; Okoth, Michael; Vadivel, Vellingiri; Biesalski, Hans Konrad

Food & Nutrition Bulletin, Volume 33, Number 1, March 2012 , pp. 43-52(10)

Abstract:

Background. Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

 Objective. To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

 Methods. Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

 Results. The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

 Conclusions. Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.

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Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA, but not amaranth grain flour, reduces anemia and iron deficiency in Kenyan preschool children.

In Under-nutrition on October 6, 2012 at 6:06 am

Macharia-Mutie CW, Moretti D, Van den Briel N, Omusundi AM, Mwangi AM, Kok FJ, Zimmermann MB, Brouwer ID

J Nutrition 142: 1756-1763, 2012

Abstract 

Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder (MNP) containing low doses of highly bioavailable iron to control iron deficiency anemia (IDA) in children.

We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children. In a 16-wk intervention trial, children (n = 279; 12-59 mo) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of iron/meal; phytate:iron molar ratio 5:1); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of iron/meal; phytate:iron molar ratio 3:1); or unrefined maize porridge with MNP (MNP group; 6.6 mg iron/meal; phytate:iron molar ratio 2.6:1; 2.5 mg iron as NaFeEDTA).

Primary outcomes were anemia and iron status with treatment effects estimated relative to control. At baseline, 38% were anemic and 30% iron deficient.

Consumption of MNP reduced the prevalence of anemia [-46% (95% CI: -67, -12)], iron deficiency [-70% (95% CI: -89, -16)], and IDA [-75% (95% CI: -92, -20)]. The soluble transferrin receptor [-10% (95% CI: -16, -4)] concentration was lower, whereas the hemoglobin (Hb) [2.7 g/L (95% CI: 0.4, 5.1)] and plasma ferritin [40% (95% CI: 10, 95)] concentrations increased in the MNP group. There was no significant change in Hb or iron status in the amaranth group.

Consumption of maize porridge fortified with low-dose, highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children. In contrast, fortification with amaranth grain did not improve iron status despite a large increase in iron intake, likely due to high ratio of phytic acid:iron in the meal.

Undernutrition among Kenyan children: contribution of child, maternal and household factors

In Under-nutrition on May 7, 2012 at 7:45 am

Constance A Gewa and Nanette Yandell

Public Health Nutrition June 2012 15 : pp 1029-1038  

Abstract

Objective To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s.

“Design Demographic and Health Survey data, multistage stratified cluster sampling methodology.

“Setting Rural and urban areas of Kenya.

“Subjects A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya.

“Results Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children.

“Conclusions The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on children’s nutritional status varies with children’s age.”

Internship Opportunities with the WFP – Ethiopia

In Over-nutrition, Under-nutrition on September 5, 2018 at 7:00 pm

Background

Ethiopia has made important development gains over the past two decades, reducing poverty and expanding investments in basic social services. However, food insecurity and under-nutrition still hinder economic growth. In 2015 it ranked 174 out of 188 in the UNDP Human Development Report. The country is also home to the second largest refugee population on the continent; it currently hosts 909,000 registered refugees from South Sudan, Somalia, Sudan, Eritrea and Kenya. 2016 was a challenging year for Ethiopia as it suffered from the worst El Niño impact in the last 50 years. The onset of El Niño combined with failed Belg (spring harvest) and Meher (main harvest) rains in 2015 left 10.2 million people in need of emergency food and nutrition assistance. While the Government and partners averted a major humanitarian catastrophe, the drought has left a negative legacy on many families, who lost livestock and other productive assets. The residual needs from the past year have been compounded by a new and devastating drought which hit Ethiopia and other parts of the Horn of Africa in early 2017. In  August 2017, the Government of Ethiopia released the Mid-Year Humanitarian Requirements Document which outlined the need to support 8.5 million people with emergency food, nutrition, health, water and education programmes. WFP supports the Ethiopian Government through a range of life-saving and resilience-building activities as well as providing assistance in refugee camps. We use food, cash, nutrition assistance and innovative approaches to improve nutrition, empower women, build local capacities and enhance preparedness to climate-related shocks.

 

Opportunity – WFP Ethiopia Country Office seeks (1) graduate (BSc), and post-graduate (MSc) students looking for field-based dissertation topics, (2) BSc and MSc students already graduated within a year, looking for opportunity hands-on work experience, and (3) researchers looking for settings where to develop operational research topics. Background: Nutrition/Public Health/Epidemiology, Food Technology, Communication, Social Sciences, Logistics, Engineering, Economy and any other field related to food and nutrition.

 

More information

  • What? The interns will be integrated into WFP existing and/or about-to-start programmes. The potential areas include (1) integrated nutrition and food security surveillance, (2) treatment of moderate acute malnutrition, (3) development of social behavioural change communication to reduce stunting and wasting, (4) interlinkages between HIV and malnutrition, (5) food fortification, (6) nutrition advocacy, strategic evidence-based policy- and decision-making, (7) social protection in food insecure households.
  • When? Candidate can apply anytime during the year.
  • Where? According to the Terms of Reference (ToR) and the deliverables of the internship, the candidate will be placed either at WFP Country Office (Addis Abeba) and/or at the provincial Sub-Offices.
  • Supervised by who? Administratively the interns will be supervised by a WFP line manager. The ToR and the deliverables will be agreed by and with the candidate, eventually with the tutor of the institution of origin and WFP.
  • For how long? The duration of the internship will depend on the nature of the ToR and its deliverables.
  • Which kind of support? WFP has limited resources for support to internship programmes. Therefore, candidates are encouraged to rely on their own means of support for living, and international / national travel costs. WFP can cover at least the intern health insurance. Additional WFP support can be put under consideration in case of strong candidatures.
  • I am interested. How to apply? For an initial contact, get in touch with both Filippo Dibari (filippo.dibari@wfp.org) and Pauline Akabwai (pauline.akabwai@wfp.org). Note that the email subject should be reading exactlyinternship at WFP’). Be ready to submit curriculum vitae (one page max), provide specific evidence of your skills, undertake a written test and an interview, share reference contact details.

 

For further reading – Ethiopia nutrition profile – source: Global Nutrition Report 2017 (link  or under request) and WFP Ethiopia Country Profile (Link)

Nutrition Key to Developing Africa’s “Grey Matter Infrastructure”

In Over-nutrition, Under-nutrition on May 29, 2017 at 6:13 am

from IPSnews

AfDB President Akinwumi Adesina adressing delegates at the nutrition event while Ambassador Kenneth Quinn, World Food Prize Foundation, listens. Credit: Friday Phiri/IPS


AHMEDABAD, India, May 24 2017 (IPS) – Developing Africa’s ‘grey matter infrastructure’ through multi-sector investments in nutrition has been identified as a game changer for Africa’s sustainable development.

Experts here at the 2017 African Development Bank’s Annual Meetings say investing in physical infrastructure alone cannot help Africa to move forward without building brainpower.

“We can’t say Africa is rising when half of our children are stunted.” –Muhammad Ali Pate

“We can repair a bridge, we know how to do that, we can fix a port, we know how to do it, we can fix a rail, we know how to do that, but we don’t know how to fix brain cells once they are gone, that’s why we need to change our approach to dealing with nutrition matters in Africa,” said AfDB President, Akinwumi Adesina, pointing out that stunting alone costs Africa 25 billion dollars annually.

Malnutrition – the cause of half of child deaths worldwide – continues to rob generations of Africans of the chance to grow to their full physical and cognitive potential, hugely impacting not only health outcomes, but also economic development.

Malnutrition is unacceptably high on the continent, with 58 million or 36 percent of children under the age of five chronically undernourished (suffering from stunting)—and in some countries, as many as one out of every two children suffer from stunting. The effects of stunting are irreversible, impacting the ability of children’s bodies and brains to grow to their full potential.

On a panel discussion Developing Africa’s Grey Matter Infrastructure: Addressing Africa’s Nutrition Challenges” moderated by IFPRI’s Rajul Pandya-Lorch, experts highlighted the importance of urgently fighting the scourge of malnutrition.

Laura Landis of the World Food Programme (WFP) said the cost of inaction is dramatic. “We have to make an economic argument on why we need action,” she said. “The WFP is helping, in cooperation with the African Union and the AfDB, to collect the data that gets not just the Health Minister moving, but also Heads of State or Ministers of Finance.”

The idea is to get everyone involved and not leave nutrition to agriculture and/or health ministries alone. And panelists established that there is indeed a direct link between productivity and growth of the agriculture sector and improved nutrition.

Baffour Agyeman of the John Kuffuor Foundation puts it simply: “It has become evident that it is the quality of food and not the quantity thereof that is more important,” calling for awareness not to end at high level conferences but get to the grassroots.

Assisting African governments to build strong and robust economies is accordingly a key priority for the AfDB. But recognizing the potential that exists in the continent’s vast human capital, the bank included nutrition as a focus area under its five operational priorities – the High 5s.

And to mobilise support at the highest level, the African Leaders for Nutrition (ALN) initiative was launched last year, bringing together Heads of State committed to ending malnutrition in their countries.

As a key partner of this initiative, the Bill and Melinda Gates Foundation foresees improved accountability with such an initiative in place. “ALN is a way to make the fight against malnutrition a central development issue that Ministers of Finance and Heads of State take seriously and hold all sectors accountable for,” said Shawn Baker, Nutrition Director at the Foundation.

However, African Ministers of Finance want to see better coordination and for governments to play a leading role in such initiatives to achieve desired results. “Cooperation and coordination are key between government and development partners,” said Sierra Leone’s Finance and Economic Development Minister Momodu Kargbo. “Development partners disregard government systems when implementing programmes whereas they should align and carefully regard existing government institutions and ways of working.”

Notwithstanding the overarching theme of Africa rising, Muhammad Ali Pate, CEO of Big Win Philanthropy, says, “We can’t say Africa is rising when half of our children are stunted.” He pointed out the need to close the mismatch between the continent’s sustained GDP growth and improved livelihood of its people.

With the agreed global SDG agenda, Gerda Verburg, Scaling Up Nutrition Movement Coordinator sees nutrition as a core of achieving the goals. “Without better nutrition you will not end poverty, without better nutrition you will not end gender inequality, without better nutrition you will not improve health, find innovative approaches, or peace and stability, better nutrition is the core,” she says.

Therefore, developing Grey Matter Infrastructure is key to improving the quality of life for the people of Africa. But it won’t happen without leadership to encourage investments in agriculture and nutrition, and more importantly, resource mobilization for this purpose.

CGIAR: Call for concept notes: nutrition-relevant policy and action in eastern Africa

In Under-nutrition on October 7, 2014 at 7:37 am

from CGIAR web pageOctober 3, 2014 by

The Transform Nutrition Research Consortium, a network which seeks to transform thinking and action on nutrition among research, operational, and policy communities in South Asia and eastern Africa, invites proposals for studies of up to 24 months duration which will add to the evidence base on nutrition-relevant policy and action in eastern Africa.

 

The challenge

Nutrition is foundational to the achievement of major social and economic goals, including many international development goals. Undernutrition in early life is responsible for 45% of under-five child deaths, reduced cognitive attainment, increased likelihood of poverty and is associated with increased maternal morbidity and mortality.

 

Child stunting rates in eastern Africa are among the highest in the world. The four countries in this call (Kenya, Ethiopia, Uganda and Tanzania) are home to around 13 million stunted children, and among the highest burden countries in the world. Ensuring food and nutrition security in the region can only occur through a combination of targeted “nutrition-specific” interventions and wider “nutrition-sensitive” development interventions, backed up by enabling policy, political and institutional environments, and processes. Political commitment to address undernutrition is growing in the region (all four countries, for example, have signed up to the SUN Movement) and nutrition policies and action plans are being drawn up or revised.

 

While progress is being made, much more can be done. Scoping work within both Transform Nutrition and A4NH have clearly revealed major operational and policy-related knowledge gaps that broadly relate to the thematic focus of this call. This call for concept notes is thus intended to help fill these knowledge gaps, through locally-relevant research undertaken by research organizations from the region.

 

Click here to download the Call for Research Concept Notes.

 

This call seeks to engender a wider sense of engagement in nutrition-relevant research among national and regional stakeholders in four countries of eastern Africa: Kenya, Ethiopia, Uganda and Tanzania. We seek high quality research proposals on at least one of the following research themes:

 

Theme 1: How can nutrition-specific interventions be appropriately prioritized, implemented, scaled up, and sustained in different settings?

Theme 2: How can agriculture and the wider agri-food systems become more nutrition-sensitive and have a greater impact on nutrition outcomes?

Theme 3: How can enabling (policy and institutional) environments for nutrition be cultivated and sustained?

 

Cross-cutting issues include: governance, inclusion (socio-economic and gender equity) and fragility. Gendered approaches are especially important for proposals under Theme 2.

 

Eligibility criteria and important considerations:

  • Applicants are encouraged to familiarize themselves with work underway or completed by Transform and A4NH (accessible via websites above) to maximize “value added” and complementarity with ongoing work, and avoid duplication.
  • Applicant organisations must be legally registered entities in one of the four focal countries, capable of receiving and managing funds.
  • Joint applications by more than one organization are encouraged, but one local organization must be specified as the lead.
  • An organisation may submit more than one application, and an individual may be involved in multiple proposals, but any individual may be the lead researcher on only one application.
  • Partner organizations within Transform Nutrition or A4NH may collaborate in proposed studies, but they are exempt from leading the call, and funds for their participation will need to be separately sourced.
  • Research studies may be of 6-24 months duration.
  • The requested budget for each study should lie in the range: $50,000 – $150,000. Studies that are more expensive may be considered so long as there is guaranteed co-funding to meet requirements beyond this range.
  • Each of the three themes has its own budget ceiling of $150,000.
  • It is expected that 3-6 studies (in total) will be funded through this call, with at least one study from each theme.

 

Evaluation criteria

  • quality of the concept note and proposed research
  • relevance and “value added” with regard to Transform and A4NH’s work
  • value for money
  • internal capacity (for high quality research and efficient project management)
  • clearly specified policy relevance and potential for impact

 

Format of concept notes

Please submit a concept note of no more than 3 pages (single-spaced) that clearly states:

  • problem statement (including which theme(s) the project responds to),
  • context (including what is known already),
  • objectives and research questions,
  • study design and methods to be used,
  • expected outputs, outcomes and impact,
  • lead researcher, core research team and partners (CVs not required at this stage)
  • timeframe,
  • indicative budget (with breakdowns of personnel, travel and other expenses.)

No additional material will be considered.

 

Review and selection process

The following process will be adopted:

  1. Applicant organizations are invited (through this call) to respond by 21 November 2014, and according to specified eligibility and evaluation criteria, and format, with a concept note.
  2. Concept notes will be screened against these criteria and quality filters by a review team comprising members of TN and A4NH, to select a shortlist.
  3. Shortlisted applicants will be invited to prepare detailed research proposals (by 15 January 2015)
  4. These proposals will again be reviewed by the review panel, using a standard scoring system before 30 January 2015.
  5. The winning research proposals will then be announced.
  6. Contracts will be agreed with lead organizations in February 2015.
  7. Studies will start no later than 1 March 2015.

 

Concept notes should be emailed to Sivan Yosef (IFPRI) at s.yosef@cgiar.org

All queries concerning this call should be addressed to Catherine Gee at c.gee@cgiar.org

 

*Final deadline for concept notes is 21 November 2014, (23:59 GMT).

UNICEF – 2013 Global: Evaluation of Community Management of Acute Malnutrition (CMAM): Global Synthesis Report

In Under-nutrition on March 29, 2014 at 5:29 am

from UNICEF web page

Executive summary

(download)

Background:

Approximately 20 million children are affected by severe acute malnutrition (SAM) worldwide – some residing in countries facing emergencies and many others in non-emergency situations. Children suffering from malnutrition are susceptible to death and disease and they are also at greater risk of developmental delays.
Treatment of SAM has evolved as a major development intervention over several decades. Alongside other partners, UNICEF works to ensure that women and children have access to services, including through timely provision of essential supplies – especially therapeutic foods for the treatment of SAM. The advent of ready to use therapeutic food (RUTF) and a community-based approach – community management of acute malnutrition (CMAM) – has made it possible to treat the majority of children in their homes.
CMAM is generally a preventive continuum with four components: 1) community outreach as the basis; 2) management of moderate acute malnutrition (MAM); 3) outpatient treatment for children with SAM with a good appetite and without medical complications; and, 4) inpatient treatment for children with SAM and medical complications and/or no appetite. A key objective of CMAM is progressive integration of all four preventive components into national health systems. By the end of 2012, governments in 63 countries had established partnerships with UNICEF, WFP, WHO, donors, and NGO implementing partners (IPs) for CMAM. The Ministries of Health (MoH) assume leadership and coordination roles and provide the health facilities.
UNICEF’s inputs for CMAM include policy development, commitment of funds, coordination, and technical support available to the MoH and other implementing partners. UNICEF has made significant investments to scale up treatment of SAM through CMAM including procurement of therapeutic foods, medicines, and equipment. UNICEF currently procures approximately 32,000 MT of RUTF annually which represents an investment of over 100 million dollars.

Purpose/ Objective:

This evaluation is the first systematic effort by UNICEF to generate evidence on how well its global as well as country level CMAM strategies have worked, including their acceptance and ownership in various contexts and appropriateness of investments in capacity development and supply components. The evaluation was conducted by a team of independent external evaluators and included comprehensive assessments of CMAM in five countries (Chad, Ethiopia, Kenya, Nepal and Pakistan) and drawing synthesized findings and recommendations based on broader research and a global internet survey targeting all countries implementing CMAM. A wide range of stakeholders, including national and international partners, beneficiaries, and donors, participated in the exercise. The resulting conclusions and recommendations are intended to strengthen UNICEF’s contributions to CMAM and to support governments, UN agencies, NGOs and other stakeholders in modifying CMAM policy and technical guidance for both emergency and non-emergency contexts.

Methodology:

The evaluation scope consists of two interrelated components. First, the evaluation undertook detailed analyses of CMAM in Chad, Ethiopia, Kenya, Nepal and Pakistan. The criteria of relevance, effectiveness, efficiency, sustainability and scaling up were applied to CMAM components and to cross-cutting issues. Data were obtained from secondary sources, health system databases, and observations during visits to CMAM intervention areas. The community perspective was analysed through collection of opinions from caretakers, extended family, community leaders, and community-based health workers in addition to stakeholders from government and assistance agencies. Quantitative data were analysed to determine whether performance targets were met and qualitative data supported the analysis. Secondly, building upon case study evidence, broader research resulted in compiled lessons, good practices and recommendations for UNICEF and partners globally. A global internet survey targeting all 63 countries implementing CMAM, helped to triangulate and validate conclusions from the five country case studies.

Findings and Conclusions:

1. Relevance of CMAM Guidance and Technical Assistance
• The CMAM approach is appropriate to address acute malnutrition, particularly to the degree that CMAM is being sustainably integrated into the national health system.
• Demand for CMAM services has increased; efficient use of community resources for prevention and identification and referral of children with MAM and SAM contributes to demand.
• National contributions to CMAM are growing but scale up (expansion) is challenged by funding constraints for regular programming and reliance on emergency funds and external sources of assistance.
• Global UNICEF and WHO guidance for SAM treatment has contributed to development of national guidelines which offer high value in promoting district ownership. However, lack of agreement on the best approach to address MAM has contributed to inconsistency among countries for MAM management and concomitantly, prevention of SAM.
• Global and national guidance is generally adequate for treatment protocols but lacking or fragmented regarding: planning and monitoring, integration of CMAM, equity and gender, community assessment and mobilization, and MAM management.
• Technical support has resulted in significant gains in process, coverage and outcomes; creation of parallel systems is not sustainable and slows national ownership.
• Within UNICEF overall, there has been effective support for fund mobilization, emergency nutrition response, and supporting nutrition protocols; expansion of regional roles is important to meet national technical assistance needs.
• Capacity development has significantly promoted quality of services […]

2. CMAM Effectiveness and Quality of Services

3. Promoting Equity in Access

4. Progress and Issues related to National Ownership

5. Efficiency – Costs, Supply and Delivery of RUTF

6. Sustainability and Scaling Up (Expansion of CMAM)

[see Executive Summary for more information]

Recommendations:

Overall, the evaluation recommends that UNICEF continue to promote and support CMAM as a viable approach to preventing and addressing SAM, with an emphasis on prevention through strengthening community outreach and integrating CMAM into national health systems and with other interventions.

Ownership and Integration, Strategy and Policy, Guidelines
• UNICEF should continue to work with governments, WFP, WHO, IPs, and other stakeholders to secure a common understanding on the most effective means of addressing MAM in order to unify approaches, to strengthen community-based preventive measures, and to prevent SAM and relapses into SAM.
• Establish a guideline or framework for integration of CMAM into the health system and with other interventions that is useful at national level when based on capacity assessments and integrated with national health, nutrition and community development strategies.
• Facilitate coordination and technical support at regional/national level to expand or develop national CMAM guidelines as CMAM is integrated with other interventions such as IYCF.

Performance and Quality of Services
• Strengthen community outreach by ensuring adequate investment in CMAM awareness raising activities and their integration with outreach for other public health interventions.
• Decentralize nutrition information systems to strengthen data collection and analysis at district level supporting and reinforcing the MoHs’ lead role and joint accountability among the MoH and partners for improving quality.
• Define a standardized monitoring system to assess the quality of the CMAM services to inform the MoH, UN partners, IPs and other stakeholders where more capacity is needed.

Equity in Planning and Coverage
• Strengthen planning for CMAM through conducting community assessments, and greater use of joint integrated results-based planning exercises and mapping information […].

Study suggests 258,000 Somalis died due to severe food insecurity and famine; Half of deaths were children under 5

In Under-nutrition on May 25, 2013 at 1:08 pm
Issued: May 2, 2013 – FSNAU website.

 

NAIROBI/WASHINGTON May 2, 2013 — A new study estimates that famine and severe food insecurity in Somalia claimed the lives of about 258,000 people between October 2010 and April 2012, including 133,000 children under 5.

Jointly funded and commissioned by the United Nations Food and Agriculture Organization’s (FAO) Food Security and Nutrition Analysis Unit for Somalia (FSNAU) and the USAID-funded Famine Early Warning Systems Network (FEWS NET), the study is the first scientific estimate of the death toll from the food security emergency. The study suggests:

  • An estimated 4.6 percent of the total population and 10 percent of children under 5 died in Southern and Central Somalia.
  • Lower Shabelle, Mogadishu, and Bay were hardest hit, with the proportion of children under 5 who died in these areas estimated to be about 18 percent, 17 percent, and 13 percent, respectively.
  • Mortality peaked at about 30,000 excess deaths per month between May and August 2011 (see figure).

“With the expertise of two renowned institutions, we now have a picture of the true enormity of this human tragedy,’’ said Mark Smulders, Senior Economist for FAO. “Lessons drawn from this experience will help the international community, together with the people of the region, build a stronger and more resilient future.”

Lead authors of the study were Francesco Checchi, an epidemiologist and senior lecturer at the London School of Hygiene and Tropical Medicine, and Courtland Robinson, a demographer and Assistant Professor at the Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

“By nature, estimating mortality in emergencies is an imprecise science, but given the quantity and quality of data that were available, we are confident in the strength of the study,” said Chris Hillbruner, Decision Support Advisor for FEWS NET. “It suggests that what occurred in Somalia was one of the worst famines in the last 25 years.”

The study set out to quantify mortality attributable to severe food insecurity and famine, as well as when and where most deaths occurred. Other issues, such as the humanitarian response, were not evaluated. The study covered all of southern and central Somalia, the areas most affected by the 2010-11 drought, subsequent spikes in staple food prices, and constraints on humanitarian access. Mortality among new refugees arriving to camps at Dadaab, Kenya and Dollo Ado, Ethiopia was also assessed.

To capture the full scope of the emergency, the study considered a 28-month time period, from April 2010 to July 2012. However, the mortality estimates relate specifically to October 2010 to April 2012.

The figures are in addition to the 290,000 “baseline” deaths estimated to have occurred in the same area during the same period. That baseline, which includes conflict-related deaths, represents a mortality rate that is twice as high as the sub-Saharan average.

Compared to the 1992 Somalia famine, in which an estimated 220,000 people died over 12 months, the death toll for the recent event was higher. But the earlier famine is considered more severe because a larger percentage of the population died.

Download Technical Release (PDF, 264KB)

 

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Development of a crossover-randomized trial method to determine the acceptability and safety of novel ready-to-use therapeutic foods (ahead of print)

In Under-nutrition on September 19, 2012 at 5:07 pm

by Dibari F, Bahwere P, Huerga H, Irena AH, Owino V, Collins S, Seal A.

Nutrition (article in press).

Abstract

Objective: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy’nut) designed for pediatric treatment.

Methods: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg/m^2, 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded.

Results: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05).

Conclusion: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries.

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Mobile phone technologies to improve the prevention and treatment of malnutrition?

In Under-nutrition on August 23, 2012 at 8:56 am

Source: Rapid SMS – http://www.rapidsms.org/

In 2011, WHO reports:

The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.

A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks.” (download the entire doc)

(To learn more about m-Health, read this paper from the WHO Bulletin: Point of care in your pocket: a research agenda for the field of m-health)

The same WHO document mentions a wide range of  applications, but regretfully does not include the treatment or the prevention of malnutrition, although the potential is there. These are few examples:

  • In Kenya, in 2009, the Millennium Villages Project and the Columbia University looked into the use of SMS to support the community-based management of acute malnutrition in children under five. The pilot study concludes that “an
 SMS
 based
 approach,
 using
 a
 system
 like
 ChildCount,
 can
 lead
 to
 improved
 maintenance
 of
 child‐specific
 anthropometric 
records
, which 

effectively 
help in 
monitoring 
a 
community’s
 health”
 (see the entire doc)
  • In Malawi, more recently, “UNICEF deployed SMS to address serious constraints within the national Integrated Nutrition and Food Security Surveillance (INFSS) System, which was facing slow data transmission, incomplete and poor quality data sets, high operational costs and low levels of stakeholder ownership.  Health workers now enter a child’s data, and through an innovative feedback loop system, Rapid SMS instantly alerts field monitors of their patients’ nutritional status. Automated basic diagnostic tests are now identifying more children with moderate malnutrition who were previously falling through the cracks.  This system also increased local ownership of the larger surveillance program through two-way information exchange.  Operational costs for the Rapid SMS system are significantly less than the current data collection system. The Government of Malawi is considering a national scale-up later this year” (read more here)
  • In the last 2 years, the same organization (Rapid SMS) has successfully piloted in Ethiopia a RUTF stock reporting and request system. This has the potential for improving the communications of stock levels and requests up the supply chain and consequently for avoiding supply breaks (more info here at page 42, and here)
  • WFP focuses on the prevention and treatment of moderate acute malnutrition and has also been involved with innovations using cash/vouchers and SMS for monitoring the implementation of programmes and for monitoring cases of malnutrition (read more at page 24 of this document)
  •  In 2011, UNICEF and Valid International undertook a “Global Mapping Review of Community-based Management of Acute Malnutrition” (with a focus on Severe Acute Malnutrition). In countries of interest, the same document suggests a review of innovative technologies to improve information flow to national level. Those include the use of Rapid SMS to improve timeliness and quality of reporting.  “Many countries have started or are recommending use of Rapid SMS“, because “the large number of centres makes compilation & transmission difficult”. For this reason, moving “towards Rapid SMS to improve transmission” is crucial.

Some of the organizations with promising capacities to design SMS platforms, and helping in fighting malnutrition, are listed here:

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Note that:

the Forum on Community-based Management of Acute Malnutrition will be preparing a more detailed Technical Brief on the subject of M-health and E-health in the coming months.

Feel free to contact the Forum, if you are interested in m-health & nutrition, or in any other aspect related to Community-management of Acute Malnutrition.

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Question: you know any other experience in this area of nutrition and m-health? Worth reporting on this blog? Please, share that: leave a comment (down here), or contact me.

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