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10.07 | Shared Experiences for Best Practices in ECD

Annual Report 2006-2007 (PDF)

Shared Experiences for Best Practices in ECD

An Article from Action Against Hunger

Nutrition Programs

Nutrition: saving lives through innovative, integrated solutions...

All of our programs at Action Against Hunger are centered on nutritional rescue. As we see it, proper nutrition is essential to a healthy and rewarding life. And to stay healthy, the food we eat should be of sufficient quantity and quality to satisfy our needs (energy utilization + loss + reserve), neither more nor less.

In addition, children need specific nutrients to fuel growth. Malnourished children will stop growing and become ill. ACF distributes food and sets up Therapeutic Feeding Centers to treat severely malnourished children (as well as adults) who are sometimes literally hours from death. These centers, at the heart of our emergency programs, rescue children through rigorous programs of medical treatment. (Obesity is also a form of malnutrition, but at ACF we use the word "malnutrition" to indicate under-nourishment.)

Malnutrition occurs in either of two forms:

• Chronic malnutrition can occur gradually and last for generations. It's the consequence of a continuously unbalanced diet lacking fundamental nutrients.
• Acute malnutrition occurs suddenly and is immediately dangerous. It's the result of a severe lack of food. If intense treatment is not administered immediately, acute malnutrition can lead to death.

Acute malnutrition is life-threatening due to dehydration, hypoglycemia, hypothermia, and infection. Malnourished patients are particularly vulnerable to infection because of poor immunological response, changes in body composition, loss of energy reserves, vitamin and mineral deficiencies, and the pathological effects of stress arising from hunger.

At our Therapeutic Feeding Centers, treatment is divided into three phases:

• Initial Acute phase: We begin feeding beneficiaries immediately with sugar water, which may be the only food a malnourished child's system can tolerate. As soon as possible, we introduce F-75 therapeutic milk, whose formula was developed by members of ACF's Scientific Committee. Small doses are given eight to 12 times a day. F-75 restores basic metabolism without overtaxing weakened bio-cellular mechanisms. It prepares the body to gain weight quickly. This phase can last a week or more. If diseases are present, the patient receives appropriate treatments.
• Intermediate phase: This phase lasts for four days and again involves eight to 12 meals daily. The only food given is F-100 therapeutic milk, which contains a greater concentration than F-75 has of energy-supplying nutrients, lipids, and protein.
• Rehabilitation phase: This lasts for 15 to 20 days. A patient's meals are cut back to six a day, and patients one-year-old and up are given, along with F-100 milk, a porridge most commonly made from corn flour, soybean flour, oil, and sugar. In addition, patients may receive Plumpy'nut, which is nutritionally similar to F100. It's a high-energy, semi-solid food based on peanuts and is more suitable for older children and adults.

The United Nations recommends our nutrition-rescue protocol to all humanitarian organizations. Typically, the protocol's three phases taken together last for one month. Then, if weight-gain has been satisfactory (patients weigh at least 85% of their expected weight), patients are discharged either to their homes or to Supplementary Feeding Centers that treat moderate malnourishment. Once patients leave ACF centers, they are urged to return periodically for monitoring during the next six months. To motivate discharged patients, they receive free rations of porridge each time they return.

Because we require that a parent remain with a child throughout treatment in a Therapeutic Feeding Center, family demands can sometimes make 30 days of treatment impossible. So in recent years, ACF has initiated home treatment programs for children whose only serious medical problem is undernourishment. Typically, a severely malnourished child remains at the Center for the first two phases of treatment, but after that, the child's mother is instructed how to feed her recovering child at home according to our therapeutic regimen. ACF workers visit the child at home once each week to ensure that recovery is continuing and that the home environment isn't working against the child's recovery. The child must also return to the Therapeutic Feeding Center weekly so that his or her weight gain can be measured accurately.

ACF runs Supplementary Feeding Centers for beneficiaries who are only moderately malnourished. These Centers distribute food rations and educate families in proper nutrition and healthcare. To ensure that recovered beneficiaries remain healthy, our teams at these centers attempt to determine the causes of moderate malnutrition and to correct them through programs in water-and-sanitation and food security or by alerting a medical NGO of the need for medical interventions.

We also help prevent malnutrition in developing communities through child-growth monitoring and nutritional surveys. We work with health centers and other relief organizations to find children who are malnourished, and we take random samples of entire communities to identify undernourished populations. When we determine that our aid is warranted, we sometimes go house-by-house examining all the children in town to find those in need of nutritional care. We determine this by measuring upper-arm circumference or the ratio of height to weight and comparing these measurements to the standards of healthy children.

And finally, in all our nutritional programs we educate and train. We educate mothers and fathers in the importance of good nutrition for their growing children. And we train local medical staff how to recognize and treat malnutrition. We also educate community leaders.