Food and Nutrition Surveillance and Response in Emergencies

1. Food and Nutrition Surveillance and Response in Emergencies Session 22 Strategies to Prevent Micronutrient Deficiencies

2. 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)

3. 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

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

5. 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

6. 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.

7. 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

8. 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

9. 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.

10. 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

11. 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

12. Other support strategies: • Pre-positioning of relief foods for faster access and delivery to relief situations • Preparation of memoranda of understanding for acceptable nutritional responses (by WFP, UNHCR, UNICEF and others) • Issuance of minimum standards for relief response, including standards for food and nutrition (by SPHERE and others) • Monitoring, evaluation and reporting of nutritional situations – make response and action more accurate

13. 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

14. 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

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