Dietetian Action in Emergency 260910_NM Oke

8/3/2019 Dietetian Action in Emergency 260910_NM Oke

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Seminar Gizi Siaga Bencana

FK UB - 26 September 2010

Presented by Nurul Muslihah, M.Kes

Dietitian's Actionin Emergency


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EMERGENCY?


y Definisi Bencana (UU no 24 tahun 2007)

Peristiwa yang mengancam & mengganggukehidupan & penghidupan masyarakat yangdisebabkan baik oleh faktor alam, non alam,maupun manusia yang mengakibatkan timbulnyakorban jiwa manusia (vulnerability), kerusakanlingkungan (hazard), kerugian harta benda,dampak psikologis

y Bencana : gangguan mengancam & merusak(hazard) & kerentanan (vulnerability)


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EMERGENCY?


y Kategori Bencana (UU no 24 tahun 2007)

1. Bencana alam : gempabumi,tsunami,

gunungmeletus,banjir,kekeringan,

angintopan,&tanahlongsor

2. Bencana non alam : gagaltehnologi,

gagalmodernisasi,epidemi,dan

wadahpenyakit3. Bencana sosial : konfliksosialdanteror


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Types ofEmergencies

Natural Manmade

R

apid

onset

Slo

w

ons

et

drought

war

earthquake

terrorist

attack

cyclone

flood

famine

epidemic

volcano chemical

spill

plane crash

civil unrest


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Fase-fase Emergency


1. Fase Tanggap Darurat

(Tsunami Aceh : 26 Desember2004 26 Maret2005)

2. Fase Rehabilitasi dan rekonstruksi(Tsunami Aceh : 27 Maret2005 akhir2007)


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Emergency Indicators


IndicatorEmer Emergency Level

Angka Kematian > 2 orang per 10.000 jiwa per

hari

Status Gizi Anak > 10% anak BB/TB < 80%

Makanan < 2.100 Kkal/orang /hari

Kuantitas Air < 10 liter / orang / hari

Kualitas Air > 25 % menderita diare


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Indicators in Emergencies

1. Nutritional indicators: prevalence of wasting

y Weight for Height

y

Z scores (surveys)y MUAC (screening)

2. Mortality indicators

y Crude Mortality Rate (CMR)

y

Under 5 Mortality Rate (


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Nutrition Indices Review

Emergency

Con

tex

ts

Stunting

(Chronic)

Underweight

(Both)

Wasting (Acute)

Index H/A W/A W/H or MUAC

Moderate < -2 SD < -2 SD < -2 SD, 70 - 80%

Median, or MUAC

110 125*

Severe < - 3 SD < - 3SD < - 3SD,


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Establish Public Health Priorities in

the Emergency Phase

1. Initial Assessment

2. Measles Immunization

3. Water, Sanitation & HygienePromotion

4. Food & Nutrition

including Infant Feeding

in Emergencies

5. Shelter, Site Planning &

Energy

6. Health Care in ER Phase

- Minimum Initial Service

Package (MISP) for Maternal andnewborn health

7. Control of Communicable Disease& Epidemics

8. Public Health Surveillance9. Human Resources & Training

10. Coordination/Camp

Management


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Gizi/27 November 2008

/Nurul11

Emergency ResponseEmergency Responsey Operations in emergency response:

1. Commodity services & education

2. Population estimation & register

3. Site selection, planning & shelter

4. Commodity distribution

5. Health

6. Food and Nutrition

7. Water

8. Environment sanitation

9. Supplies and transport


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Role of Dietetians during emergencies


1. Rapid Assessment

2. Food Aid

Perencanaan

Pengembangan program

Monitoring & evaluasi program

Advocacy


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Rapid Assessments


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Rapid Health Assessment DataNeeds

in the Emergency Phase

1. Background;social,political,economicdata

2. Backgroundhealthdata

3. Affectedpopulationsizeanddemographics

4. Vitalhealthinformationy Mortalityrates

y Top5causesofMorbidity

y Risksfordiseaseoutbreaks

y Measles vaccinationcoverage(>95%or


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Rapid Assessment DataNeeds in the

Emergency Phase

Vital health information: Mortality rates

y Crude Mortality Rate (CMR), Under 5 (U5MR)

y Deaths per 10,000 persons per day

y When stable, deaths per 1,000 persons per month

y Age/Sex specific mortality rates

y Cause specific mortality rates

y Case fatality rates: measles, cholera

y Access to health services


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Rapid Assessment DataNeeds in the

Emergency Phase

Environment: Water

y Quantity of water

yQuality of water

y Accessibility

Sanitation

y Number of persons per latrine

yAccessibility and acceptability


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Team composition 3 6 persons, including national health authorities and affected pop

representatives, partner UN agencies, NGOs Multidisciplinary team with skills in:

Logistics

Water and sanitation

Nutrition

Health care

Education

Epidemiology

Security

Other expertise depending on situation


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Rapid Assessment in Emergencies

Key elements of a good rapid assessment output:

Timely

Clear recommendations stating:yWho should do what, when

State limitations of the data

Include a plan for surveys and surveillance


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Rapid Health Assessment Summary

Must be timely

Multi organizational and multi disciplined

Address basic needs:

Food

Water

Shelter

Health

Sanitation

Set immediate program priorities Examine in some degree the health and nutrition status of the affected

population


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Summary of Assessment Results

y Health

y Water and Sanitation

y Food Security and Distribution

y Shelter and resettlement plans

y Non-food items

y Livelihoody Logistics


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RAPID HEALTH ASSESSMENT IN NUTRITIONAL

EMERGENCIES

rapid

assessment

confirming the first information

identifying the main causes

assessing the severity

of the problem

identifyin measures to minimize

or prevent the emergency

ensuring monitoring

& surveillance


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RAPID HEALTH ASSESSMENT IN NUTRITIONAL EMERGENCIES

surveys : planning and implementing

1. which population is to be assessed

2. what is the smallest unit to be assessed

3. is there any need to analyze subgroups

4. which sampling methods will be used

5. which age groups

6. what will be the sample size

7. which indicators will be used

8. what persons, equipment, transport resources

9. workload : how many children/ cluster per day


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RAPID HEALTH ASSESSMENT IN NUTRITIONAL EMERGENCIES

surveys : planning and implementing

10. Training schedule: who, where..

11. who will supervise teams during survey

12. data analysis

13. who is responsible for logistics

14. report : what, who..

15. who is responsible for taking action on reports findings


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Contoh Kuesioner Rapid Assessment

1. CAMP

2. Shelter

3. Medical Service

4. Rumah Tangga5. Kesehatan

Contoh Kuesioner Rapid Assessment Tsunami ACEH

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FOOD and NUTRITIONNeeds in

Emergencies

1/31

/2012


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Gizi/27 November 2008/Nurul26

Food and Nutrition EmergencyFood and Nutrition Emergencyy Everyone has the right to a standard of living adequate for the health & well-

being of himself & of his family, including food (Universal Declaration ofHuman Right/UDHR, article 25-1)

y In Emergency situation:

a. Everyone to have access to adequate & safe food

b. Food assistance :- cover the overall nutritional needs of all population group

(quantity, quality & safety)

- meets the populations minimum energy, protein & fat requirements forsurvival & light physical activity

- nutritionally balanced- diversified, culturally acceptable, fit for human

consumption, and suitable for all sub groups

of the population


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Emergency Phases & PlanningEmergency Phases & Planningy Phase 1 of the emergency

(From the outset & during initial stages of the emergency i.e during initial rapid

assessment)

a. Adopt 2,100 kcal/person as a reference figure

b. Adjust the 2,100 kcal based on information available

immediately using the factors environmental temperature,

health & nutritional status, demographic characteristic, and

physical activity level

c. Ensure that food ration is adequate to address the protein, fat and

micronutrient requirements of the populationd. Consider food management issues and conditions

e. Establish a monitoring system to ensure adequacy of the ration


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Emergency Phases & PlanningEmergency Phases & Planningy Phase 2 of the emergency

(Situation stabilized)

a. Adopt 2,100 kcal/person as a reference figure

b. Adjust the 2,100 kcal based on information available

immediately using the factors environmental temperature,health & nutritional status, demographic characteristic, and

physical activity level

c. Ensure that food ration is adequate to address the protein, fat and

micronutrient requirements of the population

d. Consider food management issues and conditionse. Establish a monitoring system to ensure adequacy of the ration


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Planning A Food RationPlanning A Food Ration(Ransum makanan/bantuan pangan)(Ransum makanan/bantuan pangan)

1. Calculate Nutrition Requirement

a. The initial planning for energy requirement :2,100 kcal/person/day

b. Adjust based on the following issues:

* Temperature : add 100 kcal/day for every 5oC if daily

temperature below 20oC (i.e +100 kcal at 15oC, +200 kcal

at 10oC, +300 kcal at 5oC, +400kcal at 0oC)

* Physical Activity Level : add 140 kcal/day for moderate

activity, 350 kcal/day for heavy activity

* Age/sex distribution : if adult males > 50% from

all population, requirement are increased and if women &

children > 50%, requirement are reduced

(adjustment plus/minus 5%)


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1. Calculate Nutrition Requirement

c. Protein : 10-12% of energy in diet should be in

the form protein (i.e 52-63 gram protein)Fat/oil : at least 17% of energy in diet should be in

the form fat (i.e 40 gram of fat)

Micronutrients : a range of vitamins & minerals are required

for survival and good health


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2. Choosing commodities

a. The mix commodities must meet the energy, protein,

fat, and micronutrient requirements of the populationb. Local food habits

c. Prepare easily digestible energy-dense foods for young

children & easily chewed and digestible food for elderly

people

d. Ease of storage & use


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vemb

er 200

8/Nu

rul

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Sample daily rations for food aid reliant populations

ITEMSRATIONS (gram)

TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5

Cereal flour/rice/bulgur

Pulses

Oil (Vit A fortified)

Fish/meat

Fortified blended food *)Sugar

Iodized salt

Fresh vegetables-fruits

Spices

400

60

25

-

5015

5

-

-

420

50

25

20

40-

5

-

-

350

100

25

-

5020

5

-

-

420

60

30

30

-20

5

-

-

450

50

25

-

-20

5

100

5

Total (gram/day) 555 560 550 565 655

Energy (kcal)

Protein (gram & % kcal)

Fat (gram & % kcal)

2,113

58g,11%

43g,18%

2,106

60g,11%

47g,20%

2,087

73g,14%

43g,18%

2,092

45g,9%

38g,16%

2,116

51g,10%

41g,17%


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Commonly used Food Aid CommoditiesCommonly used Food Aid Commodities

1. Cereals : wheat, rice, sorghum/millet, maize2. Processed cereals : maize meal, wheat

flour, bulgur wheat

3. Blended Foods :- Corn soya blend (CSB)

- Corn soya milk (CSM)- Wheat soya blend (WSB)

- Soya fortified bulgur wheat- Soya fortified maizena meal- Soya fortified wheat flour- Soya fortified sorghum grits


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Commonly used Food Aid CommoditiesCommonly used Food Aid Commodities

4.Dairy Product : Dried skim milk (DSM), Dried wholemilk (DWM), Canned cheese, Therapeutic milk (TM)

5. Meat & fish : canned meat, dried salted fish, canned fish6.Oil & Fat : vegetable oil, butter oil7. Pulses : beans, peas, lentils8. Miscellaneous : sugar, dried fruit,

iodized salt


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Blended foodsBlended foods

Blended foods are a mixture of milled cereals & other ingredients suchas pulses, dried skimmed milk, sugar, oil, vitamin/mineral premix

Blended foods should meet the followinga. Palatability & taste : have a pleasant smell and be food that

children enjoyb. Shelf life : retain above qualities for 6 months from date of

manufacturec. Preparation : be easily prepared by adding boiling water and cooked

in 5-10 minutesd. Have moisture content < 10% and fibre < 5%e. Nutritional value per 100 g are 400 kcal, 15% energy from protein & 6% from fat


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Blended foodsBlended foods

Corn-soya blend (CSB) from USA maize, soya flour, soya oil,vitamin/mineral premix

Indiamix (India)

75% wheat & 25% soya or55% wheat, 25% soya, 20% sugar

Famix (Ethiopia)Maize pre cooked, soya flour, sugar, vitamin/mineral premix

Tenamix (Tanzania)Pre-cooked maize, soya, chikpea, sugar, vitamin/mineral premix


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Ready to eatmeals

y Keuntungan

a. Cepat dan mudah didistribusikan

b. Solusi tepat ketika fasilitas memasak tidak ada

c. Daya simpan lamad. Tinggi energi dan difortifikasi dengan vitamin & mineral (biskuit)

* Kelemahan

a. Umumnya bukan makanan yang biasa dikonsumsi

b. Mahal

c. Tidak cocol untuk theurapic feeding programme

(High protein & sodium)

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The nutritional needs for infant &The nutritional needs for infant &

young childrenyoung children1. Guiding principles for feeding infants (0-6 months) during

emergenciesa. All infants should be exclusively breast fed for the first six months

- initiate breastfeeding within one hour of birth- give a colostrums for baby- breastfeed exclusively for six months

b. The quantity, distribution, and use of breast substitute (infant formula) at emergencyshould be strictly controlled

2. Complementary feeding for 6-36 months old- 30-40% of energy from fat and 12% of energy from protein- Source food from basic food commodities and locally available food- Blended food (CSB,WSB)


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Nutritional relief : Selective feeding programsNutritional relief : Selective feeding programs

Provides additional food to specific groups

Supplementary feeding & Therapeutic feeding program

Findings

a. Food available at household level < 2,100 kcal/person/day* Improve general rations

b. Malnutrition rate 15% or

10-14% with general food ration below the mean energy

requirement or crude mortality rate > 1 per 10.000 per day or

high incidence respiratory or diarrhea disease* General ration plus

* Supplementary feeding general for all members of vulnerable group

(children, pregnant & lactating women)

* Therapeutic feeding program for severely malnourished individuals


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Basic emergency complementary

feeding support:

y Fortified blended foods (e.g.

CSB/WSB) in general ration

y Addition of inexpensive locally

available foods to the generalration

y Addition of micronutrient rich

foods to SFP rations

y Sprinkles/micronutrients


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Tantangan ke depan

1. Mampu membuat perencanaan dan analisa Rapid

Assessment

2. Mampu merancang dan M & E suatu program Gizi

3. Mengembangan Ready Eat to Meal untuk keadaanemergency



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www.themegallery.com


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Helen Keller International -

Tsunami

Tsunami Relief Initiatives

* SUM (Supplementation withVitamins and Minerals

* PEC (Primary Eye Care)



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Vitamin & Mineral yang disediakan:

y KapsulVitamin A

y Tablet Zinc untuk pengobatan

diare

y Multivitamin sprinkles (Vitalita)

y Kecap manis difortifikasi zat

besi (IFSS)


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Pentingnya dan Keuntungan Vitamin dan Mineraly Dampak yang besar.Vitamin A dan Zinc dapat menurunkan mortalitas dan morbiditas

pada anak. Zat gizi mikro lainnya seperti zat besi dan yodium juga sangat penting bagiperkembangan anak dan menurunkan morbiditas serta mortalitas.

y Biaya murahtermasuk transport dan distribusi

y Ruang penyimpanan yang sederhana.Tahan lama, dan membutuhkan tempat yangsedikit

y Membutuhkan sedikit atau bahkan tanpa persiapan.

y Mudah dibawa

y Menjadi jalan bagi upaya kesehatan dan bantuan lainnya.


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Respondingto Crisis

Screening New Approach

Acute Malnutrition

With ComplicationsWithout Complications

Oedema (+++) OR

Marasmic-Kwashiorker

OR WHM


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Respondingto Crisis

Supplementary Feeding

Acute Malnutrition

With ComplicationsWithout Complications

80% WHM, MUAC


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y Blankety Prevent malnutrition by providing a food

supplement to all members of vulnerable groups such as

children

Dietetian Action in Emergency 260910_NM Oke

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