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Quality of Relief Diets: New Products Dr. Buddhima Lokuge Doctors Without Borders

This article discusses the importance of appropriate complementary foods in relief diets and the role of organizations like Doctors Without Borders in ensuring nutritional requirements are met. It also explores the causes of undernutrition and the need for improved care for mothers and children. The article highlights the effectiveness of supplementary feeding programs and the potential of new therapeutic products and strategies in treating malnutrition.

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Quality of Relief Diets: New Products Dr. Buddhima Lokuge Doctors Without Borders

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  1. Quality of Relief Diets: New Products Dr. Buddhima Lokuge Doctors Without Borders

  2. Appropriate Complementary Foods WHO: Brown, Allen & Dewey, 1998 Updated by Brown & Dewey, Food Nutr Bull 2003

  3. Private Sector Bilateral Institutions Multilateral Institutions Development Banks  IMF Manifestation undernutrition Immediate Causes Inadequate Dietary Intake Disease Insufficient Health Services & Unhealthy Environment Inadequate Care for Mothers and Children Inadequate Access to Food Underlying Causes Inadequate Education Resources & Control Human, Economic & Organizational Basic Causes Political and Ideological Superstructure Economic Structure Potential Resources

  4. International Conference on Nutrition, Rome, 1992 • “Among refugees and displaced populations, high rates of malnutrition and micronutrient deficiencies associated with high rates of mortality continue to occur. • Donor countries and involved organizations must therefore ensure that the nutrient content of food used for emergency food aid meets nutritional requirements”.

  5. SC-UK, ENN study of Supplementary Feeding programsConclusions Efficacy: • Out of 67 SFPs, less than 40 % have a recovery rate above 75 % • Defaulter rate appears to be the main determinant of recovery rate. • programme design and management ? • population’s opportunity costs ?

  6. DHS 2006 (1998) Maradi Region Wasting 11.6% (18.5%) Stunting 62.2% (52.0%) U5MR 231/1000 (374/1000) Maradi, Niger

  7. Maradi 2005 39,158 admissions (94% SEVERE) 60% of admissions in 13 weeks 95% < 85 cm height 91.4% cure, 3.2% death, 4.7% default, 29 day length of stay 64.5% direct into outpatient care

  8. Malnutrition Golden hypothesis systemic effects nutriment type I deficiency disease nutriment type II growth failure & wasting nitrogen, essential amino acids sodium, potassium, chloride, phosphorus, sulfur, zinc, magnesium iron, copper, selenium, calcium, iodine, vitamins A, B, D, E, K

  9. Ready-to-use foods New therapeutic products & strategies Dense in nutrients (F-100 formula) Dense in energy (5x F-100) Ready to eat, no water needed Difficult to contaminate Individual & adaptable packaging Ready to Use Therapeutic Food (RUTF) Better capacity & coverage Simplified outpatient treatment Multiple, decentralized sites Better quality Early diagnosis (recruitment) Improved intensive care

  10. Seasonality severe malnutrition

  11. Targeted Distribution RUSF Guidan Roumdji, 2007

  12. Dr Mike Golden, Oct 2007

  13. WFP: FEEDING BETTER FOOD… Nutrition Strategy Corn Soy Blend FORTIFICATION 2007 2010 - 2012 20% WFP FOOD FORTIFIED 100%+ MICRONUTRIENT NEEDS MET General Food Basket Cereals, Pulses, Legumes, Vegetable Oil, Salt, CSB + micronutrients COMPLEMENTARY FOODS SPRINKLES DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level.

  14. Malnutrition: a neglected disease Going beyond current paradigms and practice

  15. 2000 Further extension of treatment to outpatients by Collins and Concern 2004 Spearheaded by Valid International - use of outpatient management by many NGOs particularly Concern + SCF. Data presented to show dramatic increase in coverage and low mortality 2006 extension of treatment to moderately malnourished by MSF 2007: lipid based spreads used to prevent malnutrition at population level in Niger (MSF)

  16. 1994 First use of F100 in Rwanda after genocide. Results revolutionary! Extensive use of F100 and F75 by most NGOs (Grellety) • 1995: refusal of patients in North Uganda to come for treatment (Lord’s Resistance Army kidnapping children) – need for ready-to-use food recognised by Grellety • 1996: ACF scientific committee discussed options and developed the idea of a paste based on premixes seen in Liberia (Golden, Grellety, Briend) • 1997: successful use of local fortified foods for treatment of SAM by ICDDRB (Kituri and Halva)

  17. Local diets Briend has shown by linear programming that it is not possible to get the same nutrient concentrations from local diets without fortification with some minerals and vitamins. The best diets contain a large variety of local foods mixed together However, addition of mineral and vitamin mix to mixtures of local foods can indeed result in a diet that emulates F100 and derivative diets There remains the problems of anti-nutrients and the necessity to test new diets against the gold standard (F100/RUTF).

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