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Niger 2005

Niger 2005. "… ‘regular’ starvation has to be distinguished from violent outbursts of famines …" (Amartya Sen, Poverty & Famines 1981). Operations Questions. Dr Milton Tectonidis, London 2006. July 2001-2004. MSF Maradi Program. Six outpatient centres One inpatient centre.

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Niger 2005

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  1. Niger 2005 "…‘regular’ starvationhas to be distinguished fromviolent outbursts of famines…" (Amartya Sen, Poverty & Famines 1981) Operations Questions Dr Milton Tectonidis, London 2006

  2. July 2001-2004 MSF Maradi Program Six outpatient centres One inpatient centre Severe + special cases only Ready to Use Therapeutic Foods (RUTF) 9,632 admissions 83.5% cure rate 2004

  3. March 2005 DAKAR, 21 December (IRIN)Due to poor rains and a severe locust outbreak, Niger this year registered a record grain deficit of 223,487 tons. Clear Signs (W12) peak period 2004

  4. April - May 2005 May 25, 2005MSF Launches Emergency Operation to Combat Malnutrition in Niger EPICENTRE SURVEYS GAM 19.6 (28.2), SAM 2.9 (4.1) GAM 19.3 (28.5), SAM 2.4 (4.4) U5MR 2.2 – 2.4/10,000/d

  5. 2005 Niger Nutritional Surveys January to September

  6. May 2005 MSF Niger Emergency Strategy Steve Collins Angola 2002 Darfur 2004 NEW SC & OTC (RUTF)+ Protection & Discharge RationsMarch 2005 (Dakoro)May 2005 (Aguié, Tessaoua, Mayahi) TARGETED BLANKET FEEDINGlate July 2005 (Maradi) late Sept 2005 (Zinder)

  7. July 25, 2005 Preventing Severe Malnutrition in Maradi, Niger The first distribution finally took place on Saturday, July 23… July - October 2005 Inpatient centres Outpatient points Family rations Targeted blankets Pediatric units Support to OPDs October 26 2005 - The Targeted Supplementary Feeding Initiative in Zinder A joint effort of MSF, UNICEF and the World Food Programme.

  8. 2005 Hunger gap Malnutrition in Maradi • 39,158 admissions • 60% of admissions in 13 weeks • 95% of admissions < 85 cm • 40%+ between 75 & 85 cm Program indicators 2005 91.4% cure rate 3.2% death rate 4.7% default rate

  9. December 2005 A recent survey… confirms that the children of Niger still face high levels of malnutrition. Malnutrition rates range from 9% to 18%, and inadequate infant and young child feeding practices are likely causes. Cultural factors and social behaviours, such as inadequate infant and young child feeding practices, have a major impact...

  10. Malnutrition conceptual framework FOOD CARE or HEALTH ? The most common cause of protein-energy malnutritionis parents’ poor child feeding and caring practices….” World Bank 2006

  11. Food availability in Niger Maradi 2001 2005 Maradi, Tahoua 1984 1987 Zinder 1997

  12. Food accessibility in Niger Hunger gap Prices

  13. ITEM QUANTITE C ereal 400 gr Pulse 60 gr Oil 25 gr CSB 100 gr Sugar 15 gr Salt 5 gr TOTAL 605 gr Food quality & dietary deficiency Deluxe WFP ration 2261 kcal 12% proteins 20 % lipids monotonous cereal-pulse diets dietary diversification food fortification nutrient supplementation

  14. Type I nutrients specific signs of deficiency Type II nutrients growth failure Nutrient deficiency, growth & malnutrition Mike Golden nitrogen, essential amino acids sodium, potassium, chloride phosphorus, sulphur zinc, magnesium tissue repair and growth ceases no convalescence from illness anorexia and wasting iron, copper, selenium calcium, iodine vitamins A, B, D, E, K

  15. Nutrient deficiency, growth & malnutrition R. Shrimpton. The timing of growth failure (data from 39 studies) 60 million wasted 130 million underweight 150 million stunted

  16. Ready to Use Therapeutic Foods (RUTF) Nutrient dense pastes (equivalent to F-100 + Fe) Ready to eat No added water – contamination free Individualised packaging Increased capacity Outpatient treatment Multiple, decentralized sites Include the "moderates" Improved results Early diagnosis (recruitment) Expanded coverage Quality referral care Designed to encourage rapid weight gain

  17. MSF Emergency Nutrition current strategies therapeutic feeding + targeted food aid 2004 protection rations 2005 discharge family rations 2005 blanket feeding 2006 therapeutic feeding

  18. MSF Emergency Nutritioncurrent strategies Angola 2002 TFC + blanketsDarfour 2004 TFC + OTC + protection rations (+ blankets) Niger 2005 SC +OTC + protection rations + food ration (+ blankets) NUTRITION therapeutic feeding Acute malnourished family rations At risk blanket feeding General population FOOD AID QualityCoverage general distribution

  19. Acute malnutrition - further work Deinstitutionalize Simplify ACUTE MALNUTRITION W/H < 80% MUAC < 110 mm Edema MUAC/edema only ? adjustable thresholds include other age groups COMPLICATED NON-COMPLICATED Inpatient Outpatient ANOREXIA Severe pathology Apathy APPETITE No severe pathology Alert strengthen referral capacity discharge quickly adjust discharge criteria lighten follow-up

  20. Anthropometry – individual risk Extend benefits RUTF ? Treatment by illness episode ? acute weight loss

  21. Anthropometry – individual risk Extend benefits "healthy" reference children rural village age peers child with pertussis RUTF ? Treatment by illness episode ? poor & incomplete catch-up growth

  22. Anthropometry – population risk Extend benefits South Sudan 1993 Herwaldt et al. 70% U5 < -2 ZS RUTF ? Therapeutic Blanket ? Maradi Niger 2005 Up to 25% incidence of severe malnutrition (50% for < 85 cm)

  23. MSF nutrition new therapeutic products & strategies micronutriments +/- calories RUTF RUSF pregnancy & lactation "acute" malnutrition TARGETED SUPPLEMENT RAPID WEIGHT GAIN RUSF Nutrients illness episode convalescence weight loss weaning foods HIV-TB chronic disease ration supplement

  24. MSF emergency nutrition Strategy (who is at risk ?)Targeting (what supplement ?) RUTF for rapid weight gain Acute malnourished Acute weight loss At risk groups RUSF for specific target group General population General ration quantity & quality

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