United Nations System
Standing Committee on Nutrition

 

Thirty-First Session of the Standing Committee on Nutrition


Working Group on Nutrition in Emergencies

LaBouisse Hall, UNICEF, 3 UN Plaza, New York, Wednesday 24 March 2004 1545-1730

Co-chairpersons: Saskia van der Kam, Médecins Sans Frontières

Nutrition in Emergencies Working Group Chaired by Saskia van der Kam (Médecins Sans Frontières)

PART 1: WORK IN PROGRESS

The working group is guided by the UNICEF Conceptual Framework. The Working Group reviewed achievements over the past year and focused on:

1. Treatment of severe malnutrition

Although the management and treatment of severe malnutrition has improved considerably in the last decade there is still need for improvement in terms of efficiency of community based models and treatment of severely malnourished "forgotten" groups such as adolescents, adults and infants.

Adult malnutrition (Reporters: Bradley Woodruff (CDC) & Jane Knight (University of Aberdeen))

In 2001 the Working Group recommended development of methods

  • to measure prevalence of adult malnutrition in populations
  • to identify adults who are at risk, for enrolment in feeding programmes

In July 2000, the SCN published two reviews on assessment of adult and adolescent malnutrition (http://www.unsystem.org/scn/Publications/html/rnis.html). These indicated that research in depth is required in order to define anthropometric and contextual indicators and the cut off points.

New research will be jointly conducted by the University of Aberdeen, supported by Partners Research Emergency Nutrition (PREN), Humanitarian Scientific Advisory Group (includes Emergency Nutrition Network; CDC; Epicentre) and the NGO Support Group. The aim is to explore and develop a model to increase the robustness of current indicators of severe adult malnutrition during Complex Emergencies through a literature review (published and unpublished) and the analysis of data (including context). Agencies are requested to forward any related information including reports, raw data, patient cards, surveys and articles—the adult theme group will send out a data request information package including information on strict data security and confidentiality, in the meantime further information can be obtained from pren@abdn.ac.uk

Recommendation: To develop methods to assess adult malnutrition (Responsible: Jane Knight (University of Aberdeen))

Community based therapeutic treatment (CTC) Reporter: Kate Sadler (Valid International)

Last year the Working Group learnt about the community based therapeutic treatment (CTC), a new way of managing severe malnutrition. The Working Group will closely follow developments until CTC (and alternatives) are well developed and consolidated.

It has been observed that uncomplicated severe acute malnutrition is relatively manageable: improvement of the child is rapid and obvious using CTC. CTC potentially motivates care givers (mothers, fathers, health care workers) and gives credibility to health care systems. Experience in 2002-2003 shows outcome indicators below or close to sphere minimum standards.

Recommendation: To consolidate community treatment of severe malnutrition including an intervention framework, and a position on severely malnourished infants. Responsible: Valid International

2. Food security

The food security sector entails the availability and accessibility of proper quality and quantity of food on household level. This year the Working Group highlighted the issue of quality.

WFP’s goals on food aid in emergencies: In the coming three years WFP will prioritize saving lives in crisis situations, protect livelihoods/enhance resilience to shocks and support improved nutrition and health of vulnerable people. Among the ways to attain these are strengthening of partnership and results based management and supporting education/reduce gender disparity. In order to improve quality WFP investigates the efficacy of in-country fortification of food aid. Reporter: Rita Bhatia (WFP)

Evidence indicates that micronutrient deficiencies continue to affect populations livening in acute and protracted situations. UNHCR recognized that failure to address micronutrient malnutrition in long term African refugee programs suggests need for a review of policy and practice in agencies involved in refugee health and nutrition programmes. UNHCR is investigating micronutrient deficiency assessment methods, effective supplementation and specifically the use of iron cooking ports to increase the iron consumption, and the development of nutrient analysis software. In addition several NGOs are investigating ways of fortify food of displaced, refugees and PLWHA. Reporters : Andrew Seal (ICH) and Fathia Abdallah (UNHCR)

Recommendation:

  • To develop and integrate simple and robust methods into routine activities and operations to allow for monitoring and surveillance of the micronutrient content of the ration and the incidence of micronutrient deficiencies.
  • To develop ways of supplementation adapted to specific situations, such as in country fortification of food aid, distribution of supplements to vulnerable groups, fortification in the family pot.

Responsible : theme group micronutrients in emergencies

3. Care practices

Despite being part of the Conceptual Framework for years, the sector of care practices is underdeveloped in the agencies working in emergencies. Many agencies are addressing issues of care practices affecting the nutritional status of young children and their care takers but mainly in development contexts. Not only the practices themselves, but also the way they are performed (with affection and with responsiveness to children) are critical to children’s survival, growth and development.

Mental and social issues in caring practices Reporter: Cecile Bizouerne (Action Contre le Faim)

ACF investigated the psychoaffective/emotional relationship between caregiver-child. Outcomes from research in Sudan made clear that people from the same background can have divergent perceptions of the same context. In a chronic crisis both displaced and resident populations are vulnerable. Also highlighted is the relationship between alcoholism, family conflict and relapses. An investigation in Afghanistan (Kabul) of the causes of severe acute malnutrition of infants under 6 months showed that depression and anxiety—in a society with strict rules about marriage and gender roles—are important causal factors, besides the role of knowledge and beliefs and cultural practices regarding the methods of infant feeding.

Recommendation:

  • Compile details of mental/social support given by agencies in nutritional programmes to direct future activities in the area
  • Investigate these interventions in order to recommend the most effective and efficient and locally adapted ways addressing care practices in emergencies Responsible: Action Contre le Faim France

4. Infant and young child feeding in emergencies

Reporter: Mary McGrath (Emergency Nutrition Network)

Last year the theme groups reported on the preparation of training modules on infant feeding in emergencies. Training Module 1 Infant Feeding in Emergencies, for relief staff is widely used by health staff and individuals, as well as in training. Access is mainly through the ENN website, other venues will be explored. Module 2, containing technical information for health workers, is being finalized. New sections cover managing malnourished infants under 6 months, the management of artificial feeding in emergencies, and complementary feeding

Recommendation:

  • Identify gaps in evidence specifically for infant feeding issues (e.g. treatment of severe malnutrition in infants)

Responsible: Marie McGrath

5. Nutrition and disease (HIV/AIDS)

Reporter (of internal discussion): Saskia van der Kam

The Working Group continues to support the common knowledge and practice in public health to improve general health status, such as preventative and curative interventions and water and sanitation interventions. The Group has no specific theme group on the issue of diseases related to nutrition, although many organizations intervene in this sector. There are many new initiatives related to nutrition and people living with HIV/AIDS on the issue of food security and family support, as well as patient care. The SCN Working Group on Nutrition and HIV/AIDS has provided solid knowledge which is used in various nutrition interventions at the field level. The Nutrition in Emergencies Working Group would like to work with the Working Group Nutrition and HIV/AIDS to share some of the unique experiences and lessons learned during interventions addressing certain aspects of HIV/AIDS in emergency contexts. In this way the Emergency Working Group can fully profit form the valuable knowledge of the Nutrition and HIV/AIDS Working Group, and vice versa.

Recommendation:

A representative of the Working Group on Nutrition in Emergencies should join the Working Group on Nutrition and HIV/AIDS to ensure there is a physical and sustainable link between the two working groups. Responsible: Saskia van der Kam (MSF)

6. Capacity Development for Nutrition in Emergencies

Reporter: Annalies Borrel (Tufts)

Last year this theme group gave an extensive report, this year a paper handout updated was provided. Capacity development for nutrition in emergencies is defined as a process of change which is enabled through relevant and related changes in structures, processes, skills, attitudes and knowledge, that allow individuals, organizations to respond more effectively to the problem of malnutrition in emergencies. The methods used are the development of relevant policies, strategies, best-practice guidelines, curricula and training courses preferably developed in partnership with national structures and institutions in crisis-affected countries and which aim to improve national capacity.

A list of courses available which have a focus on emergency nutrition, has been compiled and is available on NutritionNet (www.nutritonnet.org). The list includes university, agency and NGO courses. The list will be updated next in June 2004. Various trainings have been conducted in various alliances with UN agencies (FAO, WHO, UNICEF, WFP), governments (Ethiopia, Afghanistan) and institutes (Tufts, CDC, Colombia, Univ. of Nairobi, Kenyatta Univ.). In addition to the training activities described above, there are several other capacity building and collective memory building initiatives:

  • The second edition of the Sphere manual is published, training is ongoing
  • SMART project is continuing.

PART 2: SUPPORT TO THE MDG’S

Working Group activities are organized by category from the UNICEF Causal Framework, where many sectors in nutrition are related, however, for clarity, only activities that directly contribute to the MDG’s are listed here:

1. Eradicate extreme poverty and hunger

Activities that are covered in the food security sector contribute directly to this MDG. This year the focus is on the availability and accessibility of micronutrients for population in emergencies. Nevertheless food availability and accessibility remains a point of interest that many agencies are working on.

2. Achieve universal primary education

Work in the sector caring practices and capacity building contributes to this goal directly. This year the focus is on the relationship care giver and caretaker. One of the caring aspects in a household is to ensure proper schooling for their members. Also food security is an important precondition for proper schooling; in food insecure situations children are often working in the fields and o the street instead of attending school.

3. Promote gender equality and empower women

Capacity building, community based treatment of severe malnutrition, improved care practices, including intervention to improve the mental health of caregivers contribute directly to this MDG.

4. Reduce child mortality

Efforts to improve treatment of severe malnutrition in new strategies (community treatment of severe malnutrition ) and for special groups (infants, adults), contribute directly to this goal. Improving care given to children is also an important contribution.

5. Improve maternal health

Treatment of severe adult malnutrition, and improved care, contribute directly to this goal

6. Combat HIV/AIDS, malaria, and other diseases

Compilation and deducting the lessons learned from nutrition interventions in AIDS programmes and strategies in nutritional programmes to combat HIV/AIDS directly contribute to this goal.

7. Ensure environmental sustainability

The Working Group promotes local production of products (therapeutic foods) and local fortification activities.

8. Development of global partnerships

The capacity development theme group contributes directly to this goal. In addition many strategies promoted by the Working Group envisage partnership with local communities (community treatment of severe malnutrition) and context specific interventions (adult malnutrition, HIV/AIDS).

PART 3: WORKING GROUP ORGANIZATION

The current chairs and secretariat are stepping down, henceforth the Working Group Nutrition and Emergencies will be chaired by:
Fathia Abdallah (UNHCR) abdallaf@unhcr.ch
Caroline Wilkinson (ACF France) cwilkinson@actioncontrelafaim.org

The Working Group is organized by theme group, each group has a focal point:

The theme groups expressed the wish to have more time to discuss several issues in depth. It has been proposed to plan a longer meeting in 2005, before the SCN annual meeting.