Acceptability and use of cereal-based foods in refugee camps: case studies from Nepal, Ethiopoa and Tanzania
By Catherine Mears with Helen Young
Outbreaks of scurvy, pellagra and beri beri among refugees in the 1980s caused a public outcry, as many of these more unusual deficiency diseases were thought to have been all but eradicated. Humanitarian agencies sought a wide range of solutions including micronutrient fortification of foods to overcome these deficiency diseases.
A recently completed research project focused on two strategies that are currently employed to enhance micro-nutrient intake of emergency affected populations; I) the inclusion of fortified blended food in the refugee food rations and ii) the fortification of cereals at local or household level - in particular the opportunities for the fortification of cereals with micronutrients at local or household level. Presently, inclusion of fortified blended foods in the general ration is a much more commonly adopted strategy than fortification of cereals.
This research represents an unusual and probably unique collaboration between an international Non Governmental Organization (Oxfam UK/I); the United Nations High Commissioner for Refugees, the Micronutrient Initiative and the World Food Programme.
Field studies were undertaken in three sites (Bhutanese refugees In Nepal, Somali refugees in Ethiopia, and Burundi refugees in Tanzania). Qualitative methods were used, including key informant interviews, observation, semi-structured interviews, briefing and de-briefing sessions, and review of secondary sources.
All sites had a history of acute malnutrition
and micronutrient deficiency and the planned ration was found to be deficient
in micronutrients. A proportion of the food rations was sold by refugees
in all sites, although blended food was sold on a very small scale,relative
to the sale of other commodities . The items purchased by refugees
were mostly food items, principally vegetables and more of the same or
an alternative staple.
No preparation methods were observed, which seemed to be more than usually detrimental to the micronutrient content of the ration food, except multiple washing of rice (Nepal) and sieving of blended food (only by a small minority). Cooking methods of blended food varied between sites but were appropriate, even though it was only in Nepal that refugees had been explicitly informed about the fact that blended food were pre-cooked so that cooking time could be adapted accordingly.
A preferential bias in food allocation to men was implied as women described the pattern of allocation and consumption at meal times. However, blended food was used and valued in all sites as a complementary food for infants. All members of the household in all sites, were said to be eating blended food, but children tended to be given another serving later in the day if they asked. This is not the same as saying that it was mostly eaten by children.
Acceptability of blended foods was
influenced by a wide range of factors. Familiarity was associated strongly
with acceptability, but unfamiliarity did not always indicate low acceptability.
Blended food appeared to be highly acceptable, even though the product
'per se' was not familiar, it was easily recognisable as a porridge and/or
fashioned into an already familiar dish. The perceived and actual quality
of the blended food and/or the cereal staple, was an issue in all sites.
Acceptability was also affected by the identification of a particular ration
food with a visible improvement in health conditions in Nepal and in all
sites blended food was identified with a nutritious porridge they had known
before. Resale value influenced the level of acceptance of the staple grain.
The resale value of blended food was relatively low.
Acceptability was affected by whether refugees perceived the food item to be in the ration at the expense of the reduction or removal of another commodity. There was also a considerable degree of pragmatism expressed by refugees when reflecting on their situation. Familiar foods and cooking methods were largely maintained, but not to the exclusion of innovations which were understood to be beneficial, such as parboiling rice, or using improved stoves.
The feasibility of fortifying the staple cereal at regional (before distribution), camp (after distribution), and household (after distribution) level was considered. The study concluded,that regional level fortification would require adequate milling capacity relatively close to the refugee population, a medium to long term commitment by donors, and considerable technical and management expertise at the milling site. It would be most appropriate where milled cereal was highly acceptable and mostly eaten, not sold or exchanged. Camp level fortification would require adequate, affordable and accessible camp level milling capacity for the total population, and training and close monitoring of mill technicians, with particular reference to the even mixing of the fortification mix. It would be most appropriate where the staple grain was eaten in milled form and highly acceptable, or if not, was sold or exchanged to obtain an alternative whole grain eaten in milled form.
Fortification of cereal at the time of
grinding or pounding at household level did not appear to be a feasible
option due to limitations such as time, containers, space, and standard
measures. Furthermore, when not sold or exchanged, the staple grain was
not always milled to flour prior to consumption, or if so, was taken to
the machine mill. However a household level fortification mix in the form
of a salt could be added during cooking as salt and/or spices were used
routinely in all sites. Use and acceptability of such an additive would
need to be researched.
The study protocol had anticipated that the focus for review of blended food as a strategy would be on aspects of its use and acceptability. The study did not reveal major problems with either of these aspects but did highlight some technical and operational issues of quality control and timely supply of the locally produced products. As anticipated, the strategy of cereal fortification was shown to involve major issues of technical and operational feasibility in the two African sites. However the study revealed aspects of cereal use and acceptability which would also need to be considered for successful implementation of cereal fortification .
Report available from Oxfam GB:Publication
date:March 1998-06-02 Price: £12.95
Extent: c160 pp ISBN: 0 85598 402 3
More like this
FEX: The use and acceptability of micronutrient enriched foods
A study by Oxfam, UNHCR and Micronutrient Initiative. Emergency general rations supplied by the international aid community have frequently failed to supply adequate amounts...
FEX: Sale of Food Aid as Sign of Distress not Excess
Summary of Published Paper In February 1996, WFP reduced rations for refugees in Uvira, Zaire by 20% when visiting donors noted that food aid, primarily maize and oil, was...
FEX: In-country Capacity for Food Fortification
Report summary The Micronutrient Initiative of Canada commissioned a study which employed a team from the Refugee Policy Group. The study involved, a mission to East Africa to...
FEX: Food Preparation an Obstacle to Education
This article is written by Betty Kidan Muni who is a field officer working for SCF with women's groups in south Sudan*. Background Betty Kidan (author of the article)...
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: Milling vouchers in Dafur to optomise food aid
By Hanna Mattinen and Loreto Palmaera Hanna Mattinen has been Food Aid Advisor at the ACF headquarters since 2005, with a focus on food assistance and cash-based...
FEX: Funding to Test Out Camp Level Milling and Fortification Equipment
The World Food Programme (WFP) have just secured funding to implement a pilot study to try out a 'containerised' milling unit at refugee camp level. This unit will also allow...
en-net: Evidence for the linking livelihood and nutrition interventions
I am wondering about evidence linking livelihood and nutrition interventions. My primary concern is prevention of malnutrition in young children. I like the voucher systems...
FEX: Small Scale Fortification Network!
The idea for an international network on the subject of small scale food fortification sprang from the Micronutrient Initiative meeting recently held in Canada. Local NGOs...
FEX: Summary of the revised joint WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies
Effective from the 1st of January 1998 a new ration planning figure will be used for all new emergency operations by WFP and UNHCR and for ongoing programmes where ration...
en-net: Nutritional implications of consumption of unmilled grain
Hello colleagues, When unmilled grain is provided to a refugee or emergency affected population, and there are insufficient grinding mills, some of the grain will be consumed...
FEX: Completing the Jigsaw Puzzle: Joint Assessment Missions (JAM)
By Allison Oman Allison is the Senior Regional Nutrition and Food Security Officer for UNHCR based in Nairobi, Kenya. She works with countries in the region to give technical...
FEX: WFP Assessment Mission
Children Posing next to a flag made out of the sacks used by WFP to drop food in Koch, upper Nile A three month assessment mission to Bahr El Gazal Region in Southern Sudan...
NEX: Cash transfers for Somali refugees: experiences from a pilot programme in Ethiopia
Samuel Tadesse Samuel is working as a Nutrition and Food Security Consultant with UNHCR Ethiopia. He has more than 15 years experience in humanitarian response programs,...
FEX: Between a Rock and a Hard Place? Responding to IDP Food Needs in Uganda
Bundibugyo - July 1999 by Amanya Michael Ebye, ActionAid Uganda Philippa Howell is the Research & Programme Learning Officer in the Emergencies Unit, of ActionAid based in UK....
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...
NEX: Delivering high-quality, locally produced and fortified blended food products in West Africa
Sofia Condes is a public health economist working for GAIN in the Food Policy and Finance Team, with a focus on francophone Africa and Latin America. Jennifer Dahdah is a...
FEX: Thiamine Deficiency and its Prevention and Control in Major Emergencies
Review in progress WHO are finalising a report on Thiamine Deficiency and its Prevention and Control in Major Emergencies This is a comprehensive review which is unique in...
FEX: The experience of multi-storey gardens in Ethiopian refugee camps
By Mulugeta WTsadik An example of gardening in a camp setting Mulugeta WTsadik is food security and nutrition officer with UNHCR Ethiopia since 2004. She has a degree in rural...
FEX: Wild Foods — Blessing or Burden?
Caroline Gullick recently completed an MSc project looking at different aspects of wild foods. The field research was conducted amongst the Dinka (Monjeng) Tribe of Northern...
Reference this page
Catherine Mears with Helen Young (). Acceptability and use of cereal-based foods in refugee camps: case studies from Nepal, Ethiopoa and Tanzania. Field Exchange 4, June 1998. p8. www.ennonline.net/fex/4/acceptability