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Working Group on Nutrition in Emergencies
FAO Building, Ville delle Terme di Caracalla, Rome, Italy Sunday, February
25, 2007
See below for the February 27 proceedings
Session 1: Introduction and Review of October 2006 NIEWG Meeting
(Appendix C)
Caroline Wilkinson, Action Contre la Faim (ACF)
Caroline Wilkinson reviewed the issues and action points addressed by NIEWG
at the October 2006 meeting in Rome, including the status of training tools on
the treatment of severe malnutrition, an update from the nutrition cluster, an
overview of the U.N. World Health Organization (WHO) Child Growth Standards, a
discussion on what determines a nutrition emergency, and a review of the NIEWG
action plan.
***
Presentation: Implications of WHO 2006 Growth Standards on Emergency
Nutrition Programs (Appendix D)
Andrew Seal, WHO
Andy Seal noted that since October 2006 there has been progress on
understanding the implications of the new WHO growth standards, but that much
works remains. For example, there has been no data on the public health
implications of using the new standards. Andy presented an overview of the
various international nutrition references, including the NCHS and MGRS
standards. He noted that the new WHO standards represent an extremely detailed
and careful construction of how child should grow given optimal nutrition.
Noting that WHO began reviewing the new standards prior to October’s NIWEG
and nutrition cluster meetings, Andy reported that many of the results were
similar to those of the NIEWG. Using graphical comparisons of admission cut off
points between the NCHS and WHO 2006 standards, Andy reported on key findings:
- Using weight for height (W/H) measurements, the WHO 2006 standards will
define more children as malnourished but an approximately equal number of
children as severely malnourished.
- Agencies using Z-score admission criteria with the WHO 2006 standards may
see five- to seven-fold increases in admissions.
- Adopting the WHO 2006 standards will result in a loss of comparability
with historical data sets. Similarly, defining a deviation from normal will be
difficult until wider data is gathered.
- The new data will be initially challenging for decision makers.
- Existing software does not yet account for the WHO 2006 standards.
- Some work is occurring to re-measure large data sets using the WHO 2006
standards.
Conclusions:
- Organizations adopting the WHO 2006 standards should not use percentage of
median cutoff rates to determine admission to emergency feeding programs.
- The practical implications of adopting the WHO 2006 standards need to be
thoroughly assessed before operational agencies begin implementing programs.
Furthermore, implementation should be coordinated among U.N. agencies and
non-governmental organizations (NGOs).
Questions and Discussion
- Need for more research
- The NIEWG agreed that much work is needed in determining how best to
apply the WHO 2006 standards. It was noted that the nutrition cluster has
funded research comparing the results of the NCHS middle upper arm
circumference (MUAC) with the WHO 2006 W/H method.
- Additional analyses and studies are ongoing. Resulted are expected
within the next 6 months.
- Andy noted that a review meeting is scheduled within the next year to
discuss the result of the various studies.
- Issuing a holding statement
- NIEWG discussed whether the group should issue a holding statement on
behalf of the SCN indicating that research is ongoing and recommending that
NGOs continue using the NCHS process (and do not implement the WHO 2006
process) until a review is completed.
- UNHCR indicated that response managers in refugee camps have been asking
about using the WHO 2006 standards. Save the Children / U.K (SC/UK) reported
that the organization had begun to analyze data using both methods.
- The Food Security and Agriculture Unit (FSAU) of the U.N. Food and
Agriculture Organization (FAO) indicated that the organization is currently
re-analyzing surveys using the new growth standards but would not issue any
reports until there was greater clarification of the roll-out.
- The Nutrition Cluster of the U.N. Children’s Fund (UNICEF) suggested
framing the statement as a positive set of recommendations on how to proceed
on both the programmatic and research sides.
- Other issues and topics
- It was noted that the variability in the standard deviation using the
WHO 2006 process is less than the NCHS variability. Andy indicated that a
simple conversion algorithm would be impossible.
- In order to identify appropriate treatments for malnourished children,
the need for adequate outcome data is as important as determining cut-off
points. It was noted that appropriate outcome data would only be obtained
following the implementation of the WHO 2006 guidelines.
Action Items
1. A small group, comprising the chair and others, will draft a set of
recommendations from the NIEWG and present them to the SCN on Tuesday. The two
main points are as follows: a) Recommend that implementing agencies refrain from
implementing the WHO 2006 standards, and b) Request additional research and
analysis into the use of the two methods.
***
Presentation: Integrating Community-based Therapeutic Care (CTC) into
routine health care in Niger (Appendix E)
Sean Baker, Helen Keller International (HKI)
Sean Baker provided an overview of HKI’s programs in Niger and its early work
with the Ministry of Health on vitamin A supplementation and nutrition focused
child survival activities. Following the 2005 crisis, he showed how HKI
implemented a CTC approach into its Essential Nutrition Action package in Diffa
delivered through public and community structures. He described the results of
HKI’s subsequent activities in Diffa, including increased recovery rates of
children under-five years. Sean also indicated that 86 percent of residents are
aware of CTC services and that the activities have had positive impacts on
reduced global acute malnutrition (GAM), increased maintenance of Vitamin A and
deworming medicine, greater use of insecticide treated nets (ITN), and higher
rates of exclusive breastfeeding.
Based on the experience in Niger, HKI concluded that CTC can be delivered as
part of larger package and at a large scale through health and community
structures in Niger and that more emphasis is needed on nutrition in the broad
development agenda in Niger, and also broadly throughout the Sahel. Sean noted
that the recent crisis opened a window of opportunity for the international
community to deliver quality nutrition services. Sean indicated that HKI’s
constraints and challenges included complacency on the part of the international
community to address the scale of the malnutrition issues, the need to maintain
a supply chain for CTC, shortage of public health personnel, slow pace of policy
change, and need to institutionalize long-term funding for CTC.
Questions and Discussion
- Sustainability of activities
- Sean noted that much decentralization is happening in Niger and that
local governments are controlling more resources. HKI is working with the
local governments to ensure buy-in to activities.
- Since the return to democracy, health workers have been continuously
paid, and the Government of Niger has decided to pay the heads of the health
posts.
- HKI is also working closely with affected populations such that they
demand the health services available through CTC.
- The issue was raised about the costs of sustaining nutrition-delivery
activities like CTC, ready-to-use therapeutic food (RUTF), and sprinkles
versus longer term investment, such as water activities and pastoralist
programs. Sean noted that this was a theoretical question as both approaches
are needed in parallel.
- Sean also reported that HKI’s health posts do attempt to ascertain
broader family livelihood and food security information.
- Cross Border Movement
- There is a need for integrated and multi-country approach to addressing
food insecurity to ensure that the delivery of services does not aggravate
population movements.
- Pastoral communities present a unique challenge to the delivery of
health care.
- Sean noted that in Diffa, cross border movement was normal and not the
result of crisis migration.
***
Presentation: Implementation of the Joint WHO/WFP/UNICEF statement on
preventing and controlling micronutrient deficiency in emergencies (Appendix
F)
Saskia de Pee, HKI
Saskia reviewed the recent U.N. statements on micronutrient deficiency and on
iron supplementation in malaria-prone areas. Saskia also reported on various
ways that HKI distributed micronutrient supplements in Aceh following the Indian
Ocean Tsunami, including through RUTF, fortified soy-sauce, sprinkles, and
tablets. Data confirmed that the sprinkles and supplements provided nutritional
coverage and reduced anemia. HKI concluded that micronutrient distribution is
feasible but requires a plan for rapid and efficient distribution.
Questions and Discussion
- Questions about HKI’s program
- Zinc has not been incorporated into the oral rehydration salts (ORS)
because zinc treatment takes approximately two weeks whereas children take
ORS for one or two days.
- HKI’s activities in Aceh were implemented after monitoring and
assessments indicated micronutrient deficiencies in local diets. Sprinkles
had already been developed for use in development activities, and HKI was
able to implement them in an emergency response.
- HKI noted that the program distributed four different types of products
for different reasons: vitamin A and zinc were distributed through existing
national campaigns. The soy sauce was an attempt to address the
micronutrient needs of adults. The only product targeted to children was the
sprinkles.
- Feedback on the U.N. statements
- The U.N. statement on iron supplementation in malarial areas was
criticized for not defining or classifying “malarious areas.” As such, there
is a need for additional clarification of the joint statement.
- The guidelines statements will be followed by a more detailed set of
guidelines, according to WHO.
- The statements would be stronger if they expressly acknowledged unknown
factors rather than product vague descriptions.
- General comments and lessons learned
- There is a need for transitional activities that link emergency relief
to longer term development. For example, supplements should continue
following the emergency phase until the individual diets contain sufficient
vitamins and minerals. However, since the diets rarely contain sufficient
micronutrients, the question arises as to how to transition the activities
to development partners.
- The program suggests the need for greater interaction between the food
security and agriculture community and the nutrition and health communities.
Action Items
1. There is a need for WHO to clarify whether zinc can be incorporate into
ORS.
2. There is a need for clarification about the use of iron in highly endemic
areas.
3. NIEWG will be active in dissemination the revised WHO guidelines on the use
of zinc and iron.
***
Presentation: Experiences from the field: integrated community approach
during nutrition emergencies (Appendix G)
Nuria Salse, Action Contre la Faim (ACF)
Nuria presented an overview of ACF’s 2005/2006 activities in Niger, including
an overview of the various interventions implemented, an assessment of those
activities, and lessons learned from the response. ACF’s initial activities
focused on immediate response through supplemental feeding centers, CTC,
protection rations, and staff training. A second phase of activities concerned
the integration and coordination of nutrition activities into health structures
and broad community mobilization. Assessing the response, Nuria noted positive
and negative outcomes, high initial impact but less sustained prevention
activities and community involvement. Nuria suggested that future responses
might focus initially on enhancing community mobilization, creating appropriate
protocols for addressing acute malnutrition, and integrating better into
existing health structures. This focus would achieve higher attendance and
coverage, earlier detection of children with complications, and greater
sustainability.
Questions and discussion
- • Using examples from Afghanistan and Sudan, the implementation of
participatory malnutrition problem trees was suggested as an excellent and
easy method for obtaining accurate and timely data while ensuring community
support for planned interventions. This process involves speaking with village
care workers, who are usually aware of local problems from very early on. This
method uses minimal resources to obtain high quality information, and it is
regarded as a good way to identify stake holders and integrate into the local
community from the outset.
- • Concerning coverage, it was noted that the entire NGO community can
rarely exceed 5 percent national coverage and must work with government
ministries. Reporting on high coverage in a particular area sends a misleading
message to national governments and donors about the reality on the ground.
- • Additional questions concerned ACF’s use of Red Cross volunteers and the
implementation of a protection ration.
- • USAID/OFDA noted that it was reviewing its nutrition programs in Malawi,
Niger, and Ethiopia, paying special attention on integration of CTC into the
national health system.
Action Items
1. ACF is working on creating better diagnostic tools and methodologies to
analyze social context.
***
Presentation: Overview of the Integrated Phase Classification
Grainne Moloney, FSAU
Grainne presented an overview of FSAU, including the history of the program
and the need for a common classification system. She indicated that FSAU is not
a data collection tool in itself but builds upon existing systems and
initiatives. Overall, IPC is a tool to enable a composite analytical statement
on food security nutrition and humanitarian situations for current situational
analysis and early warning, drawing on multiple indicators of human welfare and
livelihoods for consistent and meaningful analysis. The four primary outputs of
IPC are reference tables, analysis templates, maps, and standardized population
tables. The primary sources of IPC include feeding centers statistics, sentinel
sites, results from rapid assessments, and background information such as health
information system data, dietary diversity, and child care feeding practices.
The primary purpose of IPC information is to suggest to international
responders how to best target humanitarian and development activities, including
which locations to establish programs and which populations to address. She
noted that the IPC is a tool for summarizing and communicating situation
analysis based on common standards that link complex information to action.
While IPC is a “forum” for enabling technical consensus, it is not a method, an
information system, and a response analysis.
Questions and Discussion
- A question was raised about the IPC’s methodology. Grainne noted that
where specific data is unavailable, other indicators often tell similar
stories. IPC relies on a weighting system based on at least two different
services. Where background indicators suggest different situations, IPC looks
at longer term trends.
- A question was raised about how FSAU would be implemented and information
validated in places like Burkina Faso and Niger where far fewer information
resources are available. Grainne noted that IPC reports are the result of
consultative process, where preliminary drafts of reports are circulated among
partners who provide edits and recommendations. Grainne acknowledged that
there was a need for additional surveillance and trend analysis in
non-emergency prone areas.
- In terms of how FSAU manages sentinel surveillance sites without providing
any commodities to host communities, Grainne noted that the process is
challenging but that site staff are in constantly re-educating host
communities about the need for the service. FSAU is also translating tools
into Somali, and the sites randomly select and measure different children each
time.
- Coordinated through FAO, FSAU is being rolled out piecemeal in Indonesia
and Niger. An online forum is providing an opportunity for comments,
questions, and concerns about the roll-out. The process of setting up FSAU
goes through host governments and involves the recruitment of nutritionists to
the task force.
- In response to whether IPC favors one set of indicators over another,
Grainne noted that IPC does not externally promote specific indicators.
Action Item
1. It is essential for NIEWG members to participate in the online forum and
comment on the recommended indicators and relationship between indicators. The
forum can be accessed at INSERT URL.
***
Session 2 - Review of the October 2006 Work Plan
Caroline Abla, USAID Office of U.S. Foreign Disaster Assistance (USAID/OFDA)
- Caroline reviewed the 8 themes that were decided by the NIEWG in October.
- Valerie Gatchell indicated that the Community Based Management of Acute
Malnutrition group had made progress on several items since October,
including:
- Meeting with Medecins Sans Frontiers to discuss RUTF;
- Piloting a CTC in East Africa;
- Posting the CTC manual on the Valid website; and
- Beginning the process of translating the manual into French.
- There was much discussion about which parts of the work plan should be
pushed back to the SCN and to other working groups. There is a need to clarify
how the NIEWG themes relate to the other SCN working groups that cover the
same topics.
- Too many themed working groups might dilute the overall capacity of NIEWG
to contribute meaningfully to SCN.
- It was noted that the focal point for each themed group has responsibility
for implementing the group’s activities and recommendations. However, each
NIEWG member also has the responsibility to represent the group’s issues in
other working groups. Caroline noted that overall implementation and design of
the work plan is the responsibility of the working group’s chair and
co-chairs.
- Defining the purpose of NIEWG was raised as an issue. It was noted that
one of the NIEWG’s role is to address gaps that emerge from the other working
groups. It was also noted that unlike the other groups, which are largely
technical, NIEWG has a field-based component and can serve as a forum for the
exchange of best practices.
- There exists a need to step back, take stock of what is missing from the
wider nutrition response, identify gaps, and fill them.
- Donors have a need for guidance from NIEWG as to what kinds of standards
and technical quality protocols should be implemented and monitored.
Action Items
1. Combine Care Practices with Infant and Young Feeding. Beginning with best
practices for infants, the group will eventually address best practices for
children above two years of age.
2. Reanalyze the work plan, investigating whether there is a need for all of the
different sub-working groups.
3. Speak with the focal points of the NIEWG themed working groups about how to
proceed.
4. Define clear objectives for each of the themed working groups.
5. Appoint representatives from NIEWG to serve as focal points in each of the
other SCN working groups. The representatives will be able to voice NIEWG
concerns in the other sessions.
***
Session 3: Nutrition Cluster Readout
Bruce Cogill, Nutrition Cluster Coordinator, UNICEF
Bruce presented an overview of the U.N. cluster structure as emerging from
the U.N. reform process, including the need to respond to the needs of donors
and host-countries, and recognition for increased coordination and joint
responses at both global and local levels. Clusters are located in lead agencies
and are funded through those agencies by private donors. The nutrition cluster
has a $3 million work plan funded by 6 donors. Bruce indicated that the cluster
is currently programming $1 million and suggested that interested NIEWG members
should submit concept notes that focus on strengthening national and global
capacity.
The nutrition cluster has four focus countries. As emergencies unfold, such
as in Lebanon and Mozambique, additional nutrition clusters are initiated. The
cluster coordinator represents the interests and concerns of the cluster to
donors and within the lead agency. The cluster is also in the process of
developing a response tool kit and creating minimal standards in nutritional
response.
Questions and Discussion
- Bruce noted that the cluster takes into account the SMART initiative and
indicated that the tool kit is building upon and supporting existing tools and
initiatives.
- Addressing the role of disaster preparedness, Bruce indicated that each of
the institutions in the cluster is also focusing on mitigation and
preparedness as part of larger capacity building.
- There was consensus about the need to focus on preparedness resources.
- To share information and tools, the nutrition cluster is looking into
posting material on the IASC website.
***
Presentation: Interagency Supplementary Feeding Program (SFP) Review
Carlos Navarro Colorado (SC/France)
Carlos presented the findings of a five-year review of supplementary feeding
programs (SFP), which had sought to understand current practice, measure the
efficacy in recovery rates and impact at the community level, and analyze and
compare costs. He received voluntary data from 16 participating agencies,
cross-checked the calculations, reanalyzed the survey data, excluded certain
programs from the study, and triangulated the data based on third-party source.
The SFP review intends to describe the characteristics of emergency SFPs and
evaluate their effectiveness and efficacy through retrospective analysis of
reports and data generated by the programs in the last five years. All the
information used was volunteered by 12 international NGOs and two U.N. agencies.
The study is led by SC/UK and ENN with funding from USAID/OFDA, DCI and other
participating agencies.
The assessment’s main observations were as follows:
- Quality of the data and reports:
- Most reports lacked important information to fully understand the
programs, such as context, intervention protocols, presence or not of
similar programs in the same area, etc.
- Statistical reporting of programs is often incomplete and in many cases
reveals mistakes that could question the validity of the information
reported.
- Current practice
- The presentation continued with a brief overview of the characteristics
of the programs reported. The homogeneity of protocols and set ups and the
wide coverage of different countries and contexts covered by the review was
noted.
- Effectiveness (effect of SFPs in individual beneficiaries):
- Recovery rates had to be recalculated from available data for most
programs, owing to the common practice of reporting recovery rates after
exclusions of patients discharged as “non-response” (including transfers to
other structures). Using Sphere standards recommendations for calculation of
recovery rates, 64 percent of the programs had a recovery rate equal or
above 75 percent. After addition of exits “non-recovery” this went down to
39 percent. Overall, 69 percent of all exits were recovered, 17.9 percent of
defaulters and 0.5 percent deaths and 12.5 percent non-respondents.
- The range of performance in terms of recovery rates is wide, going from
the very successful programs to the very poor. Most of this variation seems
to be associated to the rate of defaulting, rather than to the mortality or
the “non-recovery” rate. This could indicate that, for most programs, the
quality of design and management are more problematic than the quality of
the protocols.
- The study of the effect of contextual factors, type of program and
protocol on the outcome of SFPs is difficult to analyze and interpret, given
the problems with the classification of these variables, and the homogeneity
of the sample in regard to some of them. However, some factors were
identified as potentially having a positive effect on outcome, including the
presence of General Food Distribution, the time since the start of the
crisis, and in programs addressed to non-displaced populations.
- Efficacy (effect of SFPs at the population level):
- The evaluation of the impact of the programs at the community level
(efficacy) concentrated in the analysis of nutrition surveys (around 350
reported in the database) and the evaluation of the ratio of moderate to
severe children admitted to centers (SFP and TFP) where this information was
available. Although no method is available today to ascertain change in
mortality and malnutrition rates from retrospective data, the presentation
proposed approaches to use the information available to get a better picture
of the evolution of the programs at the population level.
- The evaluation of cost-effectiveness of the programs was abandoned at an
early stage, given the impossibility to obtain enough accurate data on
costs.
Questions and Discussion
- General Comments
- It was noted that the study began as an overview of SFPs but became a
survey of how NGOs measure and report data. Carlos indicated that the survey
data also revealed a lot of information about SFPs and the NIEWG should not
only think about increasing the quality of reports.
- There exists a need for a common set of measurements with which
implementing partners report data.
- Methodological Issues
- Several issues were raised with the SFP survey in particular and with
the way the humanitarian community implements surveys. Specifically, it was
suggested that mortality rates be reported as “minimal mortality rates”
because data on defaulters is unknown. Data must take into account
prevalence since the ratio of moderate acute malnutrition to severe acute
malnutrition (wasting) changes radically depending on prevalence. Finally,
it was suggested that surveys need to account for ranges in confidence
intervals and the ways that kwashiorkor and oedema cases impact the data.
- The defaulting rate was stressed as the most important number because it
indicates the overall satisfaction of population with the activity. In
addition to the four existing labels, it was suggested that an “outcome
unknown” label be created. Carlos noted how minor changes in programs can
have major impacts on default rates.
- The need was expressed for a central repository for nutrition data.
- Next Steps
- The completed survey was designed to be retrospective, looking back.
However, SC/UK noted that the results have clear implications for follow-on
action. SC/UK and the Emergency Nutrition Network (ENN) are going to meet
and determine how use the survey. The final report will be written as soon
as possible.
- Concerning non-responders and defaulters, Carlos indicated there is a
need for additional information, including quantitative and qualitative
studies, about the groups, particularly why individuals defaulted or did not
respond.
- There is a need to study interventions that address moderate acute
malnutrition (MAM), such as complementary feeding and counseling on improved
local recipes.
- In improving the way that SFCs account for defaulters and non
responders, there is also a need to look at therapeutic feeding centers (TFC).
To date, TFCs do not report on transfers and non-responders.
- UNHCR reported on ongoing coordination initiatives between UNHCR, CDC,
and other donors to design health information system. The system will
include information on selective feeding program. UNHCR requested that the
work of SC/UK and ENN link into the UNHCR initiative.
1. Caroline Wilkinson (ACF-F) reviewed the issues and action points from the
October mid-term meeting and the pre-SCN session on Sunday, February 25
2. Carlos Navarro-Colorado provided the key highlights and findings of the
interagency review of Supplementary Feeding Programs (SFP)
3. Marie McGrath (ENN) and Lida Lhostka (IBFAN/GIFA) presented on infant
feeding in emergencies and on the Emergency Nutrition Network’s (ENN)
operational guidance
Comments and Discussion
- SCN Support: Caroline noted that NIEWG is seeking for the SCN to
collectively support the operational guidance. Several questions were raised
relating to the process of the meeting, including what sorts of comments and
feedback were expected. It was noted that not everyone has had a chance to
review the guidance. It was also noted the working group should propose
referring the issue to the constituent bodies who could then refer the matter
to the wider body.
- There was an expressed need for additional attention to the needs of
children between 0 and 6 months, including the possible formation of an
additional working group to focus on the needs.
- The Micro Nutrient initiative sought clarification of the section on use
of iron in malarial areas in Section 5.1.2 Marie noted that the operational
guidance reflects the position of the U.N. World Health Organization (WHO) in
a forthcoming publication. WHO clarified the forthcoming position and made
several specific text recommendations.
- It was noted that the evidence on the use of iron in fortified foods in
unclear. There is also a need to call strongly for treating both malaria and
anemia. WHO noted that the statement represented both concerns over iron and
the need to move forward with addressing malaria and anemia.
- The assembly agreed to support the IFE operational guidance Version 2.1
February 2007, with the recommended text edits to section 5.1.2, and recommend
it to the three constituencies for review and support.
Amendment to the Operational Guidance on Infant and Young Children in
Emergencies, Version 2.1, February 2007
Please substitute paragraph 5.1.2 with the following version and please
substitute endnote reference m with the following reference:
5.1.2 Where nutrient rich foods are lacking and until they become
available, multiple micronutrient supplements should be given to pregnant and
lactating women, and to children aged 6-59 months 1. However, in
malaria endemic areas, routine supplementation with iron and folic
acid containing preparations is not recommended in infants and young
children. The safety of iron preparations administered through home
fortification of complementary foods for infants and young children, i.e.
powders, crushable tablets, and fat-based spreads, is uncertain because of the
lack of sufficient research and experience. Current recommendations therefore
emphasise treating malaria as well as iron deficiency according to existing
guidelinesm.
4. Flora Sibanda-Mulder (UNICEF) presented a summary of the UNICEF led
consultative meeting with MSF and other partners on RUTF. The meeting was held
in Paris on 13 December 2006.
Comments and Discussion
- Concern was expressed that the adoption of [commercially/centrally
produced] ready-to-use food in supplemental feeding and in moderate acute
malnutrition was not taking into account indigenous knowledge and was
undermining local capacity to address malnutrition. FAO has a unit that is
addressing small scale food processing.
- The question was raised as to whether the SCN WG should be concentrating
on ideological principles at the expense of action in the field and saving
lives.
- The point was raised that local production of RUTF is a key component of
community-based therapeutic care (CTC). Moreover, decentralized production of
RUTF is enhancing local ownership and increasing local industry in places like
Ethiopia and Malawi.
- It was noted that there is limited evidence showing that RUTF helps people
suffering from HIV/AIDS. There is a need for a range of products to tackle
various nutritional issues.
- The group agreed that RUTF production should not be inhibited by patents
and that specific private companies should not be allowed to patent RUTF. It
was noted that in places like Ethiopia and Malawi, where local production was
established, competition helped reduce the consumer costs of RUTF by as much
as 20 percent.
- Mike Golden noted that the essential elements comprising Plumpy’Nut are
not patentable. Plumpy’Nut is simply F-100 flavored with peanut paste and
converted into a spread. F-100 is in the public domain, the idea of a spread
did not originate with Nutriset, and patenting peanut butter flavor is
ludicrous.
- Mike Golden called for greater focus and research into RUTF (perhaps even
a UNNUT – U.N. Nutrition Program or Unit) and noted that the success of RUTF
has demonstrated the positive results of providing high quality nutritious
food.
- Flora requested the assembled group to review Oxfam’s nutrition kits and
request for a partner to assume production of the kits.
1 Preventing and Controlling Micronutrient deficiencies in people
affected by the Asian Tsunami. Joint Statement by WHO and UNICEF. WHO 2005. For
further information, contact: Dr Bruno de Benoist. Nutrition for Health and
Development (NHD), WHO e-mail:
debenoistb@who.int http://www.who.int/
m iron supplementation of young children in regions where malaria
transmission is intense and infectious diseases highly prevalent. WHO statement.
http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/WHO_satement_iron.pdf
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