Menu ENN Search

Issue 28 Editorial

This issue of Field Exchange features four field articles about community based therapeutic care of the severely malnourished, a type of programming that is increasingly being rolled out by humanitarian agencies.

The article by Josephine Querubin from ACF-USA is about a home based treatment (HT) programme in Upper Nile and Bahr el Ghazal in southern Sudan, introduced following drought and a large returnee influx. HT was adopted as previous experiences of using the centre based therapeutic feeding model had been poor with high defaulter rates and low coverage. Although the HT programme appears to have been very successful, it was reliant upon a large network of home visitors for screening and referrals so that maintaining a large cadre of field staff working under arduous circumstances and difficult terrain was a significant challenge.

The article by Milton Tectonidis and his colleagues from MSF describes their experience of scaling up an outpatient therapeutic feeding programme in Naradi and Zinder provinces in Niger following drought and dramatic millet price inflation. The programme served 63,000 severely malnourished children and was the largest intervention of it's kind in MSF history. Programme outcome indicators were very good with cure rates of 91% and mortality rates as low as 3.2%. The authors suggest the experience demonstrates that in countries with high endemic rates of child wasting, the vast majority of severely malnourished children can be treated with weekly surveillance and RUTF.

A third field article by Tina Krumbein, Veronika Scherbaum, and Hans Konrad Biesalski describes the production of RUTF made from local produce for use in a rural hospital in Kumi, Uganda. Hospital staff coped well with the production process and, most importantly, costs were easily absorbed within the hospital budget so that production was sustainable.

An article by Gwyneth Hogley Cotes from GOAL describes the impact of high levels of insecurity on CTC and SFP programming in Kutum and Jebel Mara in Darfur. Programmes were frequently disrupted due to logistical and communication constraints. Consequently, programme effectiveness was significantly reduced, i.e. reduced coverage, poor weight gains and reduced cure rates. Furthermore, insecurity increased the overall cost of the programme. GOAL adopted a number of strategies to combat these problems. The programme was decentralised so that access was improved and services could continue if agency staff couldn't get to programme sites. Locally based field nutrition staff were trained and employed to continue running services, on their own if necessary. GOAL also developed strong communication channels with communities, leaders and authorities. This was facilitated by employing large numbers of nutrition outreach workers.

A fifth field article shares programme experiences following the recent Pakistan earthquake. The piece by Leah Richardson, Moazzem Hossain, and Kevin Sullivan discusses the experience of conducting a nutrition survey in very difficult terrain and various methodological adaptations that were employed to get round practical constraints.

The research section in this issue of Field Exchange covers a number of interesting areas.

There are some disturbing findings from two micronutrient studies conducted on long-term refugee populations in east, southern and northern Africa. One study found that refugees were consuming excessive amounts of iodine and that there was an urgent need for revising salt iodisation levels. The second study determined that levels of anaemia and vitamin A deficiency were unacceptably high. In three out of five camps surveyed, over 60% of individuals were anaemic while levels of Vitamin A deficiency were between 21-60% in the five camps. Over the past few decades it has generally been micronutrient problems like scurvy, beri-beri or pellagra that have been highlighted. Vitamin A and iron deficiency have rarely been assessed. These findings point to the need for more routine monitoring of iodine, iron and vitamin A status amongst displaced populations - especially the long term displaced.

Another research piece describes the Malawi government experience of utilising 'commodity options contracts' to safeguard against price volatility. These contracts involve payment of a premium in exchange for the right, but not the obligation, to either buy or sell a commodity at a predetermined price for a particular period of time into the future. The contract signed by the Malawian government with Standard Bank of South Africa in September 2005 allowed for the purchase of a maximum of 60,000 tonnes of maize at a cost of approximately $18m - enough to meet the food gap if donor and private sector commercial imports did not reach anticipated levels. In response to continued evidence of shortages in the market and concern about rising local prices, the government exercised the first tranche of the options contract on 7th of October, buying 30,000 tonnes of maize. It exercised the second tranche on 15th of November, when it bought the remaining 30,000 tonnes. Malawi's early experience with options contracts was largely positive. The majority of the purchased maize was used to meet humanitarian needs and did not reach the commercial market. The maize helped to avoid severe shortfalls in the humanitarian pipeline. Additionally, by the time of delivery in December 2005/January 2006, prices had risen by between $50-$90 a tonne above the ceiling price of the contract while transport costs had also increased.

There is also a summary in the research section of a recent HPG paper written about the current emergency affecting the Greater Horn of Africa, where an estimated 11 million are at risk due largely to drought and conflict. The authors argue that although early warning systems worked well, late, inappropriate or insufficient responses occurred due to inadequate preparedness, capacity imbalances between food aid and livelihoods programming and funding constraints. There was far too great a bias towards food aid programming, and longer-term livelihoods programming was only small-scale. These findings mirror those of an earlier study also reported in Field Exchange (Levine S and Chastre C, 2004)1 on interventions conducted in the Gt Lakes region between 1996-2001.

This issue also carries a letter from Andy Seal and Marko Kerak concerning the new WHO growth standards. After careful comparison with the existing NCHS/WHO standards and application to a number of refugee data sets from Africa and Asia, the authors assert that in spite of the theoretical advantages of the new standards, there are potentially serious implications for emergency needs assessment and feeding programmes that have not as yet been addressed. For example, eligibility for therapeutic feeding programmes may be increased by up to 500-600%. Their conclusion is that operational agencies need to urgently work together to achieve consensus on the way ahead before these new standards find their way to the field.

Finally, the ENN has received charity status in the UK and four trustees join the Directors Board to oversee our charitable work. They are Dr Bruce Laurence, Director of Public Health in the north-east of England and former Medical Director with the NGO, Merlin; Victoria Lack, Lecturer in Public Health and Primary Care at City University, London who has previously spent years working in the field with ACF; Nigel Milway, a senior executive with British Telecom for over 14 years who now heads up his own leadership and coaching consultancy; and last but not least Arabella Duffield, currently a nutrition advisor with SC UK who has previously worked with the ENN on a number of projects. In the November issue of Field Exchange we'll include a more detailed look at the ENN and plans for its future.


Jeremy Shoham
Editor

Any contributions, ideas or topics for future issues of Field Exchange? Contact the editorial team on email: office@ennonline.net

Show footnotes

1Levine S and Chastre C et al (2004). Missing the point. An analysis of food security interventions in the Great Lakes. Humanitarian Practice Network Paper, Number 47, July 2004. See summary in Field Exchange 23, p9

More like this

FEX: Market-based contracts protect against price rises in Malawi alliance initiative

Summary of research1 Getting water in the drought affected landscape in Malawi Commodity options contracts are typically used to hedge against price volatility. They operate...

FEX: Evaluation of the Wajir Relief Programme 1996-98

Published Evaluation OXFAM (UK and Ireland) were engaged in relief work in Wajir District of Kenya from September 1996 until October 1998. The interventions were a response to...

FEX: A Market Support Programme to Address an Urban Food Crisis in Zimbabwe

By: Kristy Allen Kristy Allen-Shirley is the Communications Coordinator for the Consortium for Southern Africa Food Security Emergency (C-SAFE), based in Johannesburg, South...

FEX: Fortified maize meal improves vitamin A and iron status in refugees

Summary of published field trial1 Premixing at the refugee camp site Nangweshi refugee camp was opened in 2000 in response to the influx of refugees fleeing the Angolan civil...

FEX: Huambo: an impending disaster?

By Anna Taylor SCF-UK Update on the current situation The last edition of Field Exchange included an account of discussions on how food aid should be targeted in the siege...

FEX: Analysis of the 1996 Konzo outbreak in Democratic Republic of Congo

Summary of published paper1 A recently published article documents and analyses a Konzo outbreak in south west Democratic Republic of Congo (DRC) in 1996. Konzo is a distinct...

FEX: Issue 30 Editorial

Many pieces in this issue of Field Exchange strengthen our understanding of best practice in nutritional emergencies. We highlight four in this editorial. Victoria Sibson from...

FEX: Potential of Using QBmix to Prevent Micronutrient Deficiencies in Emergencies

By Evelyn Depoortere, Epicentre Evelyn Depoortere is currently a medical epidemiologist for Epicentre. Previously she worked on several MSF missions, including Southern Sudan...

FEX: Production of Pre-cooked Fortified Blended Foods in Kenya: A Success Story

Author: Goete Hertz, Supply Officer, UNICEF Emergency Programme in Kenya 1992-1995. Now head of Product Development in House of Menji, Nairobi The use of supplementary...

FEX: Strengthening analysis of the nutrition situation through linking food security and nutrition information: Pitfalls and potentials

By Claire Chastre and Sonya le Jeune Claire Chastre is the SC(UK) Regional Food Security Adviser based in Nairobi. Sonya le Jeune is the SC(UK) Food Security Programme...

FEX: Comparison of Weight-for-Height Based Indices for Assessing the Risk of Death

Summary of Published Paper Mortality rates among children with severe malnutrition vary considerably between different treatment centres. This variation is due to differences...

FEX: Issue 31 Editorial

A mother attending a MSF programme in Niger One of the longest raging debates in nutrition continues in the letters section of this issue of Field Exchange. Put simply, does...

FEX: Issue 13 Editorial

Dear Readers, The first in a new series of articles appears in this issue of Field Exchange. 'Embracing Cultures', written by Ariana Curdy will, over the next few editions...

FEX: From the editor

An aerial view of Darfur, Sudan The role of data and analytical tools in guiding and evaluating emergency programming figures strongly in this issue of Field Exchange. There...

FEX: Postscript to 'Production of fortifed blended foods in Kenya'

We asked Peter Djikhuizen from WFP to comment on this article. He made the following points: The successful exercise of establishing local factories for UNIMIX in Kenya was...

FEX: Cost of the Diet – novel approach to estimate affordability of a nutritious diet

A woman cooking at home in Tanzania By Abigail Perry, Save the Children UK Abigail Perry currently works for Save the Children UK as a nutrition adviser based in London,...

FEX: Editorial

Dear readers, Following ENN's bumper issue of Field Exchange on the response to the Syria crisis (issue 48) this issue has reverted to our more normal non-thematic format...

FEX: Maternal micronutrient status and decreased infant growth

Summary of published research1 Lusaka in Zambia is the location for a recent study on maternal micronutrient status and decreased growth of infants born during and after the...

FEX: Recurrent pellagra in Angola

Summary of report* Since March 1999, successive waves of people have arrived in the town of Kuito, Angola, displaced by fighting in their native Bie province. As a result,...

FEX: Rapid impact on malnutrition through a multi-faceted programme in Wolayita, Southern Ethiopia

By Kate Sadler Kate Sadler undertook her MSc in Public Health and Nutrition at LSHTM. She has spent over 3 years working for Concern Worldwide in Burundi, Rwanda and...

Close

Reference this page

Jeremy Shoham (). Issue 28 Editorial. Field Exchange 28, July 2006. p1. www.ennonline.net/fex/28/fromtheeditor

(ENN_2230)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.