Food and Nutrition Surveillance and Response in Emergencies

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Food and Nutrition Surveillance and Response in
Emergencies

• Session 22
• Strategies to Prevent Micronutrient Deficiencies

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Introduction

• Micronutrient malnutrition results from a
  biological deficiency of one or more
  micronutrients essential for normal growth and
  development
• Most common micronutrient deficiencies of serious
  public health significance are Vitamin A, Iodine,
  Iron, Folic acid and Zinc (recently)

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• In emergencies, micronutrient malnutrition is
  commonly manifested as conditions like
• Scurvy (vitamin C) East and the Horn of Africa
• vitamin A deficiency - south Asia Africa
• Anemia (iron deficiency) - worldwide
• goitre (iodine Deficiency) world wide
• Pellagra (niacin deficiency) Southern Africa

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• Micronutrient inadequacies, even without
  appearance of classical deficiency disease,
  increase disease and mortality rates in
  populations relying solely on long-term food
  assistance programmes

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Overview of risk factors for micronutrient
deficiencies among emergency affected people

• Economic, political and technical factors factors
  deteriorate diet quality
• Availability of external assistance/resources for
  humanitarian action
• Accessibility to population
• Social environment
• Marginalisation of specific groups
• Seasonality e.g. scurvy in Somali camps in Kenya

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• Phase of emergency
• Duration of stay in camp e.g. in Ethiopia and
  Tanzania
• Health care and sanitation/crowding
• Availability of potable drinking water
• Communicable infections etc.

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Ration-Related Micronutrient Risks

• Inadequate nutritional quality and quantity of
  general ration fresh vegetables rarely
  distributed
• Diet monotony loss of appetite
• Acceptability of the ration
• Distribution and targeting problems

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Strategies to prevent micronutrient deficiencies
in emergencies

• In emergencies, micronutrient deficiencies are
  likely to be amplified where there may be
  restricted access to food.
• Micronutrient needs of malnourished refugees and
  displaced persons in need of nutritional
  rehabilitation are higher than those of normal
  populations

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• The three broad approaches to control of
  micronutrient deficiencies include
• Supplementation using capsules
• Food fortification or food enrichment
• Dietary diversity and quality improvement
• The UNHCR and WFP have implemented a number of
  strategies that fall under the above broad
  approaches - to prevent micronutrient
  deficiencies occurring in at-risk populations.

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• I order of priority
• Promoting production of fresh fruit and
  vegetables e.g. in Nepal
• Providing fresh food items in general ration,
  e.g. vegetables in the Balkans region
• Adding a food to the ration that is rich in
  vitamins and minerals e.g. fortified blended
  foods/premixes
• Promoting access to sources of food rich in
  micronutrients e.g. groundnut as a source of
  niacin in a maize-based ration

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• Providing fortified foods in the ration e.g.
  iodized salt and vegetable oil fortified with
  vitamin A
• Distributing a prophylactic dose of vitamin A to
  infants and young children every six months in
  refugee and displaced populations
• Research assessing how wild indigenous food foods
  may be used to prevent micronutrient deficiencies

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Other support strategies

1. Pre-positioning of relief foods for faster access
   and delivery to relief situations
2. Preparation of memoranda of understanding for
   acceptable nutritional responses (by WFP, UNHCR,
   UNICEF and others)
3. Issuance of minimum standards for relief
   response, including standards for food and
   nutrition (by SPHERE and others)
4. Monitoring, evaluation and reporting of
   nutritional situations make response and action
   more accurate

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• WHO, WFP and UNHCR have identified the following
  requirements for refugees in the initial phase of
  an emergency
• Vitamin A - 1666 IU (or 0.5 mg RE)
• Thiamine (B1) - 0.9mg (or 0.4mg/1000 kcal)
• Riboflavin (B2) - 1.4mg (or 6.6mg/1000 kcal)
• Niacin (B3) - 12mg (or 6.6mg/1000 kcal)
• Vitamin C - 28.0 mg
• Vitamin D - 3.2 3.8 µg calciferol
• Iron - 22 mg
• (low bioavailability 5- 9)
• Iodine - 150 µg

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• Constraints to implementing some of the
  strategies exist esp. promoting access to food
  through food production or other means
• Hence, investments in a range of strategies are
  likely to be more effective
• Choices may vary according to the situation

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• Despite the strategies employed, micronutrient
  deficiencies persist in refugee and displaced
  populations implying need for more effort.
• Major challenge HIV and infant feeding