evidence-based blog of Filippo Dibari

Posts Tagged ‘nutrition in emergencies’

What are the implications for humanitarian programming of responding to stunting in protracted emergency contexts, and what should we be doing about it?

In Under-nutrition on June 3, 2016 at 7:43 am

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from ENN

A number of recent reviews of crises, including Syria (ENN 2014), Lebanon and the Ukraine (GNC-ENN 2015) have raised questions about the humanitarian nutrition response in contexts where levels of wasting are not elevated or high in terms of emergency thresholds, but where stunting is prevalent.

ENN decided to investigate the implications of operating in situations of protracted crisis where levels of stunting may be high and of concern. This brief investigation included a review of documents and informal discussions with a number of nutrition focal points in some of the donors and agencies. The purpose is to begin to explore the issues and pose questions and in so doing get the issue of stunting in protracted contexts higher up the nutrition agenda

Download: Stunting-Brief-2015_WEB_01022016.pdf (PDF, 1.3mb)

IYCF-E Toolkit: Rapid start-up resources for emergency nutrition personnel

In Under-nutrition on September 22, 2014 at 6:00 pm

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From Save the Children web site.

Disruption and displacement of populations in emergency situations greatly impacts the health and nutrition status of infants and young children. During emergencies, even in previously healthy populations, the rates of child mortality can soar up to 70 times higher than average and child morbidity and crude mortality rates can increase by 20% in 2 weeks due in particular to diarrhea and consequent malnutrition; the youngest babies being the most vulnerable. The Lancet demonstrated that optimal breastfeeding and complementary feeding could reduce child mortality in children under five more than any other preventative measure by up to 26%. In emergencies, this potential to save children’s lives through optimal breastfeeding and complementary feeding could be even higher. In emergencies, the total infant mortality rate for infants under 1 year is 12-53% higher than normal. In emergencies, feeding practices can be undermined by displacement, insecurity, lack of privacy and poor access to adequate nutrition for both mother and child. Adequate nutrition and care of children has been identified as one of the key factors to promote child health and stability and IYCF-E support has consequently become a major strategy in reducing child morbidity and mortality during humanitarian emergency response.

As stated above, malnutrition is one of the major threats to child survival during an emergency and for those who survive it, it can also have tremendous consequences on their cognitive, social, motor skill, physical and emotional development. If caught in time malnutrition can usually be treated but this is not always the case. Further management of acute malnutrition in infants is complicated by a lack of evidence and knowledge about diagnosis and the most appropriate treatment protocols in different contexts. For a myriad of reasons prevention of malnutrition must be the goal, with treatment as a safety net. The best way to prevent malnutrition is through ensuring optimal feeding and care for children through supporting exclusive breastfeeding, appropriate complementary foods, and a supportive care environment – the backbone of IYCF-E programming. 

Table of Contents
 

London: HUNGER TALKS (Fri, 19th Oct 2012) – open to public

In Under-nutrition on October 1, 2012 at 8:42 am

From the Conference Brochure:

Action Against Hunger and Birkbeck University are pleased to welcome you to HUNGER TALKS, a one day event that we hope will become a regular feature in the nutrition calendar.

“The aim of HUNGER TALKS is to bring together leading voices from the frontlines of the fight against hunger.

“In this first instalment, HUNGER TALKS will look at hunger from a broad perspective; not only from a Nutrition or Food Security & Livelihoods perspective, but by exploring ways in which these two come together.

“This year’s HUNGER TALKS will focus on what it means to integrate Nutrition and Food Security & Livelihoods in the 21st century, where the opportunities lie and where the challenges may lie.

“To do so, we have invited a panel of fi very experienced and innovative speakers:

Saul Guerrero – Chair man

Abigail Perry – DFID

Stephen Spratt – Research Fellow, IDS

Mark Davies – Programme Manager Social Protection, IDS

Filippo Dibari – Valid International/UCL (Institute of Global Health)

Leena Camadoo – TWIN

Click here  for the bio of the speakers, the programme details and the location.

The participation is OPEN to anybody interested.

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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NB: You wish to follow up this or other topics from this blog? Type your email in the rectangle at the bottom/right side of this page.

Save the Children (NGO) about treatment of Acute Malnutrition: Minimum Reporting Package User Guidelines

In Under-nutrition on August 21, 2012 at 10:46 am

(download the entire doc)

“These minimum Reporting Package (MRP) User Guidelines are intended to outline the definitions, reporting categories and performance indicators for monitoring and reporting on three feeding programmes using the MRP software.

“The programmes are: targeted Supplementary Feeding Programmes (SFPs), Outpatient Therapeutic Programmes (OTPs) and Stabilisation Centres (SCs).

“There is also guidance on interpreting and taking action on programme performance indicators.

“The audience for the guidelines are nutrition programme coordinators and M&E staff of NGOs involved in the monitoring and reporting process.”

On this blog you can find more information about management of acute malnutrition, and ready to use foods for undernutrition treatment.
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NB: You wish to follow up this or other topics from this blog? Type your email in the rectangle at the bottom/right side of this page.

Shame: AID FOR NUTRITION

In Under-nutrition on August 19, 2012 at 10:15 am

The organization Action Against Hunger has released a brave, land marking “detailed analysis of current spending on nutrition and of the adequacy of current aid reporting systems“.

Despite the issues related to data collection, the results are striking:

  • “Investment in nutrition is inadequate. Current investments in proven nutrition interventions account for approximately 1% of the estimated US$11.8 billion required to tackle undernutrition
  • “44% of investments in direct nutrition interventions were allocated to projects to reduce micronutrient deficiencies, 40% to treat malnourished children with special foods and 14% to promote good nutritional practices
  • “Comprehensive programmes which deliver the full package of direct nutrition interventions were inadequate (only 2% of funding)
  • “Nutrition programmes were mainly delivered through the health sector or in response to humanitarian crises. Few are delivered through development programmes indicating the reactive, short-term and unpredictable nature of aid for nutrition
  • The “data indicates that aid is not necessarily directed to the countries with the highest burden (in terms of caseload) of undernutrition, particularly in the Africa region
  • “Fulfilment of individual donor commitments varied widely. Collectively, there was a negative trend indicating that donors failed to deliver 11% of their commitments”

The same document reports also important recommendations for the future.

Download the entire paper, here

Context-specific choice of food aid items (USAID)

In Under-nutrition on August 12, 2012 at 10:22 am


(click directly on the flowchart for an enlarged view)

In a recent document (2011), USAID, in collaboration with the UN Global Nutrition Cluster, UNHCR WFP and other organizations, suggest which type of programme and food commodities are more adequate.

However, it was concluded that there is no one food product that can meet every kind of programming goal, and no one programming approach that fits all needs.

The same panel  developed decision trees and few flow charts to help policy makers and donors in taking more informed decisions about programmes and choice of food-products.

The original program guidance is available here, whereas another version of the same, visible above, was adjusted in one chapter of my PhD thesis.

Open Source: a spread sheet application for planning, calculating and monitoring the Nutritional Value of food

In Under-nutrition on August 11, 2012 at 11:49 am

The planning, calculation, and monitoring application for food assistance programmes, NutVal 3.0 has an expanded database of commodities and products, and new population sub-groups to use for asssessing the adequacy of food assistance. NutVal is designed to run on Excel 2003 and later versions.

Download the most recent version of NutVal

NutVal was developed UNHCR, WFP, IGH/UCL and Global Nutrition Cluster.

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This blog hosts other posts related to the use of nutritional software.

How to design, pre-test and trial low cost, local RUTF products to rehabilitate severely malnourished children and adults

In Under-nutrition on August 9, 2012 at 3:55 pm

The latest number of Field Exchange, a journal published by ENN, contains a summary of a recent research paper describing how to use “Linear programming to design low cost, local RUTF” with the aid of Microsoft Excel software.

Whereas the original paper abstract can be found on The Journal of Nutrition web site, in the Field Exchange journal (issue 43, part 1), the article summary is available (for free) at page 36, including an “adapted” flow chart with the step sequence proposed for the design (see beneath), the pre-testing and the trialling of these products, currently in high demand in feeding programmes around the world.

The authors of the original paper are Filippo Dibari (author also of this blog), El Hadji I. Diop, Steven Collins, and Andrew Seal from Valid International and the University College of London.

More information about the Linear Programming, applied to the field of nutrition, is also available from another post in this same blog.

How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition

In Under-nutrition on August 1, 2012 at 6:23 pm

by José Guimón and Pablo Guimón

from Technological Forecasting and Social Change; Volume 79, Issue 7, September 2012, Pages 1319–1327

Abstract

Since the turn of the 21st century ready-to-use therapeutic food (RUTF) has emerged as the preferred solution to treat acute malnutrition without complications. RUTF is a more appropriate technology than formerly prevalent powdered milk solutions because it enables outpatient care, simpler treatment protocols and production in the field. In this paper we analyze the forces driving the diffusion of RUTF as an innovation to treat child malnutrition and discuss the main features characterizing the new technological regime that results from its wide adoption. We combine the theoretical discussion and the review of secondary sources with insights from field research in Ethiopia, encompassing personal interviews with relevant parties and direct observation of how RUTF works in practice. This technology assessment exercise enables us to suggest some opportunities for policy intervention.

Another less recent version of the same paper is available here.

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