Priority Health interventions which impact Nutrition in Emergencies

1. Module 15 Priority Health interventions which impact Nutrition in Emergencies

2. Learning objectives • Understand how nutrition and health status is related to extreme poverty and vulnerability, how these are exacerbated by natural hazards • Be aware of the interventions required from other sectors to ensure optimal health and nutritional status in an emergency • Understand the importance of planning for host populations as well as emergency affected populations • Understand the importance of coordination between health and nutrition programme staff and how to better coordinate and/or integrate health and nutrition interventions • Understand how to plan for high impact nutrition and health interventions. 1

3. Globally >35% of under-five deaths are attributable to undernutrition Causes of Neonatal Deaths >35% attributable to undernutrition Other – 7% Tetanus – 1% Diarrhoea – 1% Sepsis – 17% Asphyxia – 23% Congenital – 12% Preterm – 38% 1

4. Framework of the causes of maternal and child under nutrition and its short-term consequences Source: Lancet series on Maternal and Child Undernutrition 2008 – adapted from Conceptual framework for analysing the causes of malnutrition, UNICEF, 1997 1

5. Reproductive Health and Undernutrition • Poor intra-uterine growth, low birth weight and subsequent suboptimal child growth and development are consequences of: • Poor maternal health • Inadequate diet (quantity & quality) before and during pregnancy • Lack of micronutrient supplementation • Multiple pregnancies, especially in quick succession • Early childbirth (<18 years) & older mothers (>35 years) are risk factors for both mother and child 1

6. Consequences of Maternal Undernutrition Source: UNICEF, 2006 1

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8. Major causes of morbidity and mortality in emergencies • Major causes of excess morbidity and mortality in emergencies are: acute respiratory infections, diarrhoeal diseases, malaria (where prevalent), measles and undernutrition • Meningococcal meningitis and typhoid may cause large scale epidemics in emergencies • Tuberculosis is also often critical in long term emergencies • Poor reproductive health, gender based violence (GBV) and its consequences, including HIV, are also a major concern • Trauma/injury, mental health and psychosocial issues also contribute to excess morbidity and mortality in emergencies. 1

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10. Child and Maternal Health in Emergencies • Emergencies exacerbate the severity and magnitude of childhood diseases. • Children under-5 have the highest mortality rates in refugee populations • In 1991 at the Turkey - Iraq border 63% of deaths of Kurdish refugees were in children • In 1992 during the famine in Somalia over 74% of <5 years died in IDP camps • Among Rwandan and Burundian refugees in DRC in 1996, 54% of all deaths were among children < 5 • Maternal health may also be negatively affected by a poor health environment, while maternal nutrition may be very seriously affected by inadequate quality and quantity of food. 1

11. Mental Health in Emergencies • Mental health and psychosocial issues in emergencies include: • Pre-existing social problems (e.g. extreme poverty, discrimination against or marginalisation of particular groups) • Emergency-induced social problems (e.g. family separation, disruption of social networks and/or community structures) • Humanitarian-induced social problems (e.g. undermining community structures or traditional support mechanisms) • Pre-existing psychological problems (e.g. mental disorders, alcohol abuse) • Emergency-induced psychological problems (e.g. grief, depression, anxiety including post traumatic stress disorder) • Humanitarian aid related problems (e.g. anxiety due to lack of information about food distribution ) 1

12. Health of the Elderly in Emergencies • The health and nutritional status of the elderly population is also affected in emergencies by issues such as: • loss, grief and depression, exhaustion and poor diet, exacerbating poverty, and chronic disease • Lack of access to appropriate medical treatment • Inadequate and inappropriate diet • Inability to cook 1

13. Health programming in emergencies and links to Nutrition • Health system should: • Provide equitable optimal access to health care • Ensure minimum level of care (quantity and quality) • Include components of health promotion from early stages involving communities (both males and females) • Consider needs for outreach activities (mobile clinics, particularly in case of outbreaks) • Integrate community participation and potential outreach community staff in planning, management, implementation , M&E of services. 1

14. Health programming in emergencies and links to Nutrition • Essential health services • Communicable diseases: their control requires a systematic approach and cooperation from various sectors (WASH, Food, Nutrition, Health, Shelter) • Malaria or tuberculosis are also diseases that have impact on nutrition and require multi-sector preventative measures • For all diseases, standards for case fatality rates are determined and should be maintained. 1

15. Case fatality rates *CFR as high as 21% have been reported in some conflict settings • If CFRs exceed these levels an immediate evaluation of control measures should be undertaken and corrective steps taken to ensure CFRs are reduced to and maintained at acceptable levels 1

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17. Health programming in emergencies and links to Nutrition • Child health is divided into: • Care of newborns (care at birth, early initiation of breastfeeding, health and immunization after birth, education and support for mothers) • Care of children (in line with WHO IMCI guidelines) which include: • Assess nutrition and immunisation status and potential feeding problems at the outpatient health facility level 1

18. Health programming in emergencies and links to Nutrition • Establishment of child-focused health interventions which address the major causes of excess morbidity and mortality • Where measles vaccination coverage is <90% or is unknown: • Mass measles vaccination campaign should be conducted for children 6 months to 15 years • Vit. A should be administered to children 6-59 months • A system should be set up to ensure that any newcomers to the area are vaccinated

19. Health programming in emergencies and links to Nutrition • Diarrhoeal diseases are a major cause of morbidity and mortality in emergency situations • often accounting for over 40% of deaths in an acute phase of an emergency • with 80% of these deaths occurring among children under 2 years of age • Prevention of outbreaks of Cholera and Shigella dysentery are of particular concern in emergencies • they are highly infectious diseases • if poorly managed can result in extremely high case fatality rates • Risk factors for diarrhoea include overcrowding, inadequate quantity and quality of water, poor personal hygiene, poor washing facilities, poor sanitation, poor cooking facilities and lack of soap 1

20. Health programming in emergencies and links to Nutrition • Diarrhoea control interventions in emergencies include: • provision of adequate quantities of safe drinking water • provision of facilities for safe disposal of human excreta • provision of adequate storage for cooked and uncooked food • appropriate cooking utensils and fuel for cooking • provision of soap for handwashing • promotion of optimal breastfeeding practices • provision of information on all of the above activities for prevention • Prompt diagnosis and appropriate treatment according to protocols and guidelines is essential to reduce and prevent excess mortality in emergencies. 1

21. Health programming in emergencies and links to Nutrition • Sexual and reproductive health should encompass: • A Minimum Initial Services Package (MISP), • Prevent, and manage the consequences of sexual violence • Support mothers breastfeed • Reduce the transmission of HIV • Prevent maternal and newborn morbidity and mortality • Begin planning for comprehensive RH services. • Then • Adolescent Reproductive Health • Family Planning • Maternal and Newborn Care including postpartum vitamin A supplementation • Gender Based Violence (protection and care) • STI Care • HIV Care. 1

22. Health programming in emergencies and links to Nutrition • Recommended intervention pyramid for mental health Examples: Mental health care by mental health specialists Basic mental health care by PHC doctors. Basic emotional and practical support by community workers Activating social networks communal traditional supports Supportive age-friendly spaces Advocacy for basic services that are safe, socially appropriate and that protect dignity 1

23. Key messages • Emergencies exacerbate severity and magnitude of childhood diseases and mortality rates are highest in children under five • The health and nutritional status of pregnant women significantly impact the health, well-being and nutritional status of their infants • The child is more likely to be born premature, with LBW and more vulnerable to illness and undernutrition if the mother is sick and undernourished or has multiparity • Humanitarian crises, increase vulnerability to HIV and negatively affect the lives of those people living with HIV • The role of operational health agencies in emergencies is to provide essential services that effectively reduce health risks. 1

24. Key messages • Establishment of good quality control of communicable diseases interventions has significant impact on health and nutritional status of an emergency-affected population • Implementation of key priority reproductive health interventions has a positive affect on the health, well-being and nutritional status of both infants and mothers • Provision of quality basic child health care at first line health facilities, supported by promotion of key infant and young child feeding and care practices will have a positive impact on the health and nutritional status of young children. 1