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    Food distribution and nutrition-specific programmes

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    Crises, natural disasters and conflict often result in food shortages and compromise the nutritional status of the victims, especially during the initial phase of a crisis or when assistance is slow to develop.
    Malnutrition is often the most serious public health problem, and one of the main direct or indirect causes of excess mortality.
    Aside from sufficient caloric intake, micronutrient deficiencies can develop or worsen, if they already exist.
    Supplying large quantities of food is a very complex operation with political implications, and can pose logistical and security problems.
    Food aid can be misappropriated or manipulated by certain groups or people, and used to control populations or individuals.
    The priority is therefore to tailor operations to the context. Each crisis is unique, and requires its own particular response.

    A) Provide adequate food rations
    A general distribution is organised when there is a food shortage that is causing, or might cause, increased acute malnutrition and excess mortality.
    MSF may conduct a general food distribution in an emergency, when there are no food operators present, though it is not really its area.
    A food ration is estimated to be 2100 kilocalories per person per day.

    It may consist of flour, oil and beans, or BP-5™-type emergency rations.

    Providing vitamin and mineral supplements as well helps remedy or prevent micronutrient deficiencies that can lead to conditions like scurvy, beriberi and pellagra.
    The distribution is done for each family, via the head of the family. The rations distributed are sometimes full rations and sometimes partial rations, depending on the estimated needs and logistical, financial, and political constraints.

    B) Prevent malnutrition in vulnerable groups
    Distributions of enriched flour or specialised products are intended for groups identified as vulnerable, such as young children and women who are pregnant or breastfeeding.
    By covering specific needs, these help prevent a deterioration in nutritional status.
    A specialised early childhood product may be distributed to each child, regardless of nutritional status; it meets his vitamin and mineral requirements and a small portion of his energy and protein requirements.

    C) Treat acute malnutrition
    The number of children with acute malnutrition can be estimated using the nutrition survey carried out during the initial assessment. In emergencies, these children are identified by measuring the mid-upper arm circumference and checking for oedema. The weight-for-height measurement can be added later.
    Severely malnourished children are treated in therapeutic feeding centres, either as inpatients where intensive care is also available ,

    or as outpatients.


    Medical and nutritional rehabilitation protocols are used; these contain the different phases and products, such as therapeutic milk and ready-to-use therapeutic foods.

    D) Evaluate the nutritional situation
    MSF evaluates its therapeutic feeding programme by analysing the collected data each week: how many children are present, the number of defaults and deaths, and the weight gain.
    Using community health workers, who are each responsible for one section of the site or camp, improves the detection of malnutrition cases, as well as defaulters, and deaths.

    During general food distributions, the quantity and quality of the rations distributed must be evaluated. This is called Food Basket Monitoring.

    In agreement with the distributing agency, surveys are carried out as people exit the food distribution site.
    Using a 30- to 35-family sample, these surveys are used to monitor whether the amounts received are appropriate and equitable between families.
    The basic ration should be at least 2100 kilocalories per person per day, with 20% from fats and 10% from protein.

    Information on the population’s dependence on food aid is obtained by talking with the traditional authorities and the displaced people themselves, and from frequent visits to the site or camp.

    Conclusion
    An appropriate general food distribution is essential in preventing excess mortality in crisis situations. Specialised therapeutic products allow rapid, effective nutritional rehabilitation of severely malnourished children.