Carlos Navarro-Colorado SC-UK, ENN

1. Current practice in the treatment of Moderate Malnutrition in emergencies. Reflections from an Interagency retrospective study (the SFP-review). Carlos Navarro-Colorado SC-UK, ENN Hanoi, 01.03.08 Supported by: OFDA, CDI

2. Retrospective analysis of SFP data: • field data from SFPs • implemented between 2002 and 2005 • focus on children 6 to 59 months • acute and chronic emergencies • Objectives: • to describe current practice • to describe efficacy of SFPs (individual effect) • to describe effectiveness of SFPs (population impact) • analyse programme and context factors affecting efficacy and effectiveness

3. Programmes: • 16 agencies identified and sent reports • more than 100 programmes considered • from 22 countries • 82 included in the description of current practice • 67 had enough data to recalculate indicators with common criteria and evaluate efficacy. • Data: • extracted and compiled from narrative and statistical reports • all data cleaned, checked and re-classified (age group, admission criteria...) • all exit indicators re-calculated with standard criteria

4. Covering all range of emergency settings... • long-standing and recent, • displaced, and stable populations • camps, rural and urban populations • ... and Intervention setups • with and without GFD • with and without Therapeutic care • Protocols: • all targeted feeding, with standard criteria for admission and discharge (weight for height and/or MUAC) • most distributed fortified flours (CSB, UNIMIX...) • with oil and sugar in different rations

5. Worrying number of problems with data collection and reporting, lack of standardisation on use of definitions and calculation of indicators, inappropriate collation and presentation of data and some common mistakes...

6. EFFICACY: exit statistics, 67 SFPs. SFPs with recovery rate above 75 %: - 64 % using Sphere calculations - 39 % including “non-response” (recalculation) Pooled data (376 179 children in 61 SFPs) : Recovered69.1 % (260 034) Defaulted17.9 % (67 366) Died 0.46 % (1 763) Non-response 12.5 % (47 016)

7. Median recovery rate and duration of stay of recovered children (by programme):

12. EFFECTIVENESS:

13. Conclusions Efficacy: • Out of 67 SFPs, less than 40 % have a recovery rate above 75 % • Overall 69 % of children recovered. • Defaulter rate appears to be the main determinant of recovery rate. • programme design and management ? • population’s opportunity costs ? • Possible role in effectiveness of: GFD, time since the crisis, chronic nature of context and presence of displaced populations.

14. Need of Effectiveness data: • From field programmes • From Field trials (“intention to treat”) • (including Population rates and Coverage of programmes) • Need research in Programme Performance • Provision, Utilisation and Coverage • Design and management of programmes • Need to understand Opportunity Costs • And choices being made by populatoins and beneficiaries • For any programme involving regular distributions • Need to increase “external validity” of trials • Great variety of contexts where results will be applied • Trials in different settings, multi-programme trials. • Need criteria to decide which intervention in which context

15. Reducing mortality: • Improvements on food quality: • Will reduce non-respondents and deaths • May reduce defaulting, but how much ? • Moving from individual to population approach • First field evidence arising. • Improving and adapting design of programmes to take into account population and context • Ready to Use Foods... Ready to Use Strategies ?