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Supplementary Feeding Programme - Current Guidelines

Circumstances leading to the setting up of SFPs (from WFP guidelines)
Blanket SFP Targeted SFP
A generalised SFP for prevention purposes maybe implemented in the absence of a full basic ration, under one or a combination of the following circumstances:
  • Problems in the delivery/distribution of the general ration
  • Prevalence of acute malnutrition among children under 5 (WFH z score <2 or <80% of reference median) above 15 to 20 percent.
  • Prevalence of acute malnutrition among children under 5 above 10 to 15 percent (WFH z score <-2 or 80 percent of reference median) plus aggravating factors.
  • Malnutrition problems linked to seasonality

The implementation of SFPs for selected individuals in vulnerable groups is required under the following circumstances:

  • Prevalence of acute malnutrition among children under 5 above 10 percent WFH z score <-2 or <80 percent of the reference median
  • Prevalence of acute malnutrition among children under 5 years above 5 to 9 percent WFH z score <-2 or <80 percent of the reference median, plus aggravating factors
  • Existence of TFP established to respond to a high percentage of severely malnourished children
Aggravating factors to be considered are the following: crude mortality above 1/10,000/day, epidemic of measles and high prevalence of respiratory or diarrhoeal disease, poor sanitation environment, unreliable food distribution system.

Criteria for entry and exit to and from SFPs - from MSF guidelines

Criteria for entry and exit from SFPs - from MSF Guidelines

 

Objectives of selective feeding programmes - from MSF guidelines
Programme Objectives Target Group
Targeted SFP
  • Reduction of % of severe acute malnutrition in under 5s
  • Reduction of under 5 mortality rates
  • 70% - 80% or -3 to - < -2 Z-Scores W/H (moderately malnourished children under 5 years)
  • Malnourished individuals above 5 years
  • Children discharged from a TFP
Blanket SFP
  • Prevention of further deterioration in the nutritional situation
  • Reduction of under 5 mortality rates
  • Children under 5 years in general
  • Pregnant and lactating women
  • Socially and / or medically needy individual cases
  • Elderly persons

Foods used in SFPs - from CONCERN Worldwide guidelines

The diets are based predominantly on porridges, local foods and family diet. Most foods should provide energy intakes of 100-200 kcal/100 ml. The percentage energy from protein should be approximately 12-16% to allow for catch-up growth to occur.

Supplementary porridges

Supplementary porridges, made up to 150 - 200 kcal per 100 ml can be made up in the centres using blended cereals or milled staples with legumes or rice. Most blended cereals provide approximately 350-400 kcal per 100 g of dry product.

If available, mineral and vitamin mixes for supplementary feeding should be added to porridges which are not pre-fortified.

Milks

HEM (100 kcal and 2.9g protein per 100 ml) can be given in wet SFPs (see table opposite). Minerals and vitamins should be added to milks. To make up 1 litre use 900 mls of water.

Dry milk powders should not be distributed as a dry ration on their own; milk powder can be added to a pre-mix for distribution. See example below for composition of dry ration premix.

  Phase 1 milk HEM (Phase II & III)
DSM (g/l) * 80
Oil (g/l) * 60
Sugar (g/l) * 50
protein per litre of milk (g) 10-12 28.8
Energy per litre of milk (kcal) 750 1000+
* No information available for recipe, use commercial product.

Local Foods and Family Diets

Emphasis should be placed on providing a supplementary diet based on locally available foods. If possible, vegetables purchased or grown locally should be included. A variety of recipes should be prepared with the community for wet feeding purposes. These recipes can be adapted to ensure they have adequate energy and protein content. Ease of use, accessibility and supply are important factors in selecting products for use in such recipes. Dry premix should be prepared using blended cereals that are available locally, examples given below.

An Example of the Composition of a Dry Ration Premix from CONCERN Worldwide Guidelines
Commodity Weight (g) /person/meal Weight (g) for 2 meals/day Weight (g) for one week for one person Quantity (kg) needed for 50 persons for 1 week
CSB *
DSM
Oil
Sugar
70
20
25 ml
10
140
40
50 ml
20
980
280
350 ml
140
49.0 kg
14.0 kg
17.5 litres
7 kg
Weight of premix **     1750 g
(approx. 1.8kg)
87.5 kg
(Approx. 90 kg)
Energy (kcal)
% Energy from protein
580 kcal
13 - 14 %
1160 kcal    
* or the other blended food such as WSB (wheat soya blend)
** can be rounded up to account for spillage and waste

High energy and protein biscuits

High energy and protein biscuits are suitable for use in SFPs. These biscuits increase the energy content of the supplementary diet significantly and are particularly useful in the beginning of the emergency operation.

Biscuits are a valuable commodity on the market and efforts should be made to prevent them being sold; they should be crushed or broken before being added to the dry ration premix.

Long-term dependence on high energy and protein biscuits should be avoided; biscuits are expensive and should not be given priority over locally available products. It is unlikely that families can afford these biscuits once food aid is no longer being provided. Every attempt should be made to use locally available foods.

Fruit

If available, fruit is a suitable supplement in a wet SFP and is a good source of vitamins. Children in therapeutic feeding programmes should have priority access to bananas.


When to Close Down Feeding Programmes

(MSF guidelines)

The decision to close down selective feeding programmes should only be made after a nutrition survey has clearly shown a significant decrease of global acute malnutrition in the population.

Prevalence of global acute malnutrition (-2 Z-scores W/H and /or oedema) among children under-five years old should be below 10%.

The following conditions should also be met:

Follow up nutrition surveys must be planned to detect any deterioration of the situation, even after closure of selective feeding programmes. this is especially important if the overall situation remains unstable.

Evaluation

(MSF Guidelines)
A brief overview of indicators often used for monthly reporting on SFPs is presented below:

Reporting Form Standard Indicators Comments/Interpretation
Attendance
Report
Total No. last month
Total no. this month
Total No. admissions
Total no. exits
Reflects size and expansion rate of programme (trends in attendance rates need to be graphed over time)
Attendance Rate % of those children enrolled who actually attend Reflects the acceptability/ value and accessibility of the programme
Coverage 5 of those children enrolled/attending out of estimated number * of the target group Reflects the acceptability/ value and accessibility of the programme
Mean length of Stay 1. For recovering children children
2. For those that die
3. For defaulters
1 = 2 reflect the quality of services. 3 reflects acceptability / accessibility
Weight Gain mean weight gain
g/kg body wt./month
Reflects the quality of the programme (on a sample of records)
Reasons for Exiting 1. % Recovered
2. %Died
3. % Defaulted
4. % Transferred
1, 2 + 4 reflect programme quality. 3 reflects acceptability / accessibility and quality
* the no. of children expected derived from anthropometric surveys

 

Reference values of proportions of exits </ br>(MSF guidelines)
Proportion of exits SFP Objectives SFP Alarming
Recovered >70% <50%
Deaths <3% >10%
Defaulters <15% >30%

 

These excerpts are from MSF, CONCERN Worldwide and WFP guidelines on supplementary feeding. The are not intended to provide a comprehensive overview but may be of use to as an additional resources.
For further information on complete guidelines contact: MSF: Medical Dept. Max Euweplein 40, PO Box 10014 - 1001 EA Amsterdam. Tel: (+31) 20- 520 87 00
CONCERN Worldwide: Upper Camden St, Dublin 2, Ireland
WFP: World Food Programme(OPE), Via Cristoforo Colombo 426, Rome, Italy

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Supplementary Feeding Programme - Current Guidelines. Field Exchange 2, August 1997. p23. www.ennonline.net/fex/2/guidelines

(ENN_3279)

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