Quality of Relief Diets: New ProductsDr. Buddhima LokugeDoctors Without Borders

Appropriate Complementary Foods

Updated by Brown & Dewey, Food Nutr Bull 2003

WHO: Brown, Allen & Dewey, 1998

InsufficientHealth Services &

Unhealthy Environment

undernutrition

DiseaseInadequate Dietary Intake

Inadequate Carefor Mothers

and Children

Inadequate Education

Resources & ControlHuman, Economic &

Organizational

PotentialResources

Political and Ideological Superstructure

Economic Structure

UnderlyingCauses

ImmediateCauses

BasicCauses

Manifestation

MultilateralInstitutions

Development Banks

IMF

BilateralInstitutions

PrivateSector

Inadequate Access to

Food

International Conference on Nutrition, Rome, 1992

• “Among refugees and displaced populations, high rates of malnutrition and micronutrient deficiencies associated with high rates of mortality continue to occur.

• Donor countries and involved organizations must therefore ensure that the nutrient content of food used for emergency food aid meets nutritional requirements”.

SC-UK, ENN study of Supplementary Feeding programsConclusions Efficacy:• Out of 67 SFPs, less than 40 % have a recovery rate above

75 %• Defaulter rate appears to be the main determinant of

recovery rate. – programme design and management ?– population’s opportunity costs ?

Maradi, NigerWasting 11.6% (18.5%)Stunting 62.2% (52.0%)U5MR 231/1000 (374/1000)

DHS 2006 (1998) Maradi Region

39,158 admissions (94% SEVERE)60% of admissions in 13 weeks95% < 85 cm height91.4% cure, 3.2% death, 4.7% default, 29 day length of stay64.5% direct into outpatient care

Maradi 2005

nutriment type Ideficiency disease

nutriment type II growth failure & wasting

systemic effects

MalnutritionGolden hypothesis

iron, copper, selenium, calcium, iodine, vitamins A, B, D, E, K

nitrogen, essential amino acids sodium, potassium, chloride,

phosphorus, sulfur, zinc, magnesium

Dense in nutrients (F-100 formula)Dense in energy (5x F-100)Ready to eat, no water neededDifficult to contaminateIndividual & adaptable packagingBetter capacity & coverageSimplified outpatient treatmentMultiple, decentralized sites

Better qualityEarly diagnosis (recruitment)Improved intensive care

Ready to Use Therapeutic Food

(RUTF)

Ready-to-use foodsNew therapeutic products & strategies

Seasonality severe malnutritionAdmissions of children with W/H < 70% (NCHS) weekly proportion of total inclusions in the year

Guidan Roumji, Niger, 2003-2005

0%

1%

2%

3%

4%

5%

6%

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

Week number

% o

f all

year

adm

issi

ons 2003

200420053-year Average

Targeted Distribution RUSF

Guidan Roumdji, 2007

Attendance/ Drop out from RUSF distribution

0

10,000

20,000

30,000

40,000

50,000

60,000

Beneficiaries 62,922 62,902 62,865 62,756 62,680

Drop out 0 20 57 166 242

May June July August Sept

Dr Mike Golden, Oct 2007

2007 2010 - 2012

20% WFP FOOD

FORTIFIED

100%+ MICRONUTRIENT

NEEDS MET

FORTIFICATION

COMPLEMENTARY FOODS

SPRINKLES

Corn Soy

BlendGeneral

Food BasketCereals, Pulses,

Legumes, Vegetable Oil, Salt, CSB

Nutrition StrategyWFP: FEEDING BETTER FOOD…

DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level.

+ micronutrients

Going beyond current paradigms and practice

Malnutrition: a neglected disease

• 2000 Further extension of treatment to outpatients by Collins and Concern

• 2004 Spearheaded by Valid International - use of outpatient management by many NGOs particularly Concern + SCF. Data presented to show dramatic increase in coverage and low mortality

• 2006 extension of treatment to moderately malnourished by MSF

• 2007: lipid based spreads used to prevent malnutrition at population level in Niger (MSF)

• 1994 First use of F100 in Rwanda after genocide. Results revolutionary! Extensive use of F100 and F75 by most NGOs (Grellety)

• 1995: refusal of patients in North Uganda to come for treatment (Lord’s Resistance Army kidnapping children) – need for ready-to-use food recognised by Grellety

• 1996: ACF scientific committee discussed options and developed the idea of a paste based on premixes seen in Liberia (Golden, Grellety, Briend)

• 1997: successful use of local fortified foods for treatment of SAM by ICDDRB (Kituri and Halva)

Local diets• Briend has shown by linear programming that it is not possible to get the same nutrient concentrations from local diets without fortification with some minerals and vitamins.

• The best diets contain a large variety of local foods mixed together

• However, addition of mineral and vitamin mix to mixtures of local foods can indeed result in a diet that emulates F100 and derivative diets

• There remains the problems of anti-nutrients and the necessity to test new diets against the gold standard (F100/RUTF).