This document discusses nutrition emergencies and interventions. It defines a nutrition emergency as any situation where widespread threats to life, health and subsistence exist beyond an individual or community's coping capacity. Multiple forms of malnutrition are present in emergencies, including wasting, stunting, micronutrient deficiencies and obesity. The goals of nutrition interventions in emergencies are to reduce malnutrition indicators, prevent micronutrient deficiencies, and ensure access to adequate nutrition. A variety of interventions are used including food assistance, management of acute malnutrition, micronutrient delivery, and infant and young child feeding support. However, meeting nutrition targets in emergencies remains a challenge.

1. KNOWLEDGE FOR THE BENEFIT OF HUMANITY
ADVANCED NUTRITION (HFS4352) NUTRITION IN EMERGENCIES Do we know what works?
Mohd Razif Shahril, PhD
School of Nutrition & Dietetics
Faculty of Medicine and Health Sciences
Universiti Sultan Zainal Abidin
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2. Outline
•Introduction
•What is nutrition emergency?
•The scale of emergency nutrition activities
•Nutrition programme elements in emergencies
•The challenge of meeting nutrition targets
•Conclusion
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3. Introduction
•Multiple forms of malnutrition present in the context of crisis
–Wasting
–Severe stunting
–Micronutrient deficiencies
–Obesity
•Humanitarian response has evolved rapidly since 2000, leading to calls for greater focus on the generation of rigorous data on effectiveness.
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4. What is nutrition emergency?
•Any situation where there is an exceptional and widespread threat to life, health and basic subsistence, which is beyond the coping capacity of individuals and the community
•‘Complex emergency’
–a major humanitarian crisis of a multi-causal nature, essentially from internal or external conflict and which requires an international response that extends beyond the mandate or capacity of any single agency
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5. What is nutrition emergency?
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Classification system
Level
Mortality and malnutrition indicator
UN SCN thresholds 1995
Alert
CMR 1/10,000/day
U5MR 2/10,000/day
Wasting 5–8%
Severe
CMR 2/10,000/day
U5MR 4/10,000/day
Wasting >10%
CMR = Child Mortality Rate
U5MR = Under 5 y/o Mortality Rate

6. What is nutrition emergency?
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FSNAU/FAO integrated food security phase classification (IPC), 2007
Generally food secure
CMR < 0.5/10,000 /day
Wasting* < 3% (<-2SD WHZ)
Stunting < 20% (<-2SD HAZ)
Moderately/
Borderline Food Insecure
CMR < 0.5/10,000/day
U5MR < 1/10,000/day
Wasting* > 3% but <10%
Stunting 20-40% (<-2SD HAZ), increasing
Acute food and livelihood crisis
CMR 0.5-1 /10,000/day
U5MR 1-2/10,000/day
Wasting* 10-15% (>-2SD WHZ), > than usual, increasing
Humanitarian emergency
CMR <1-5 / 10,000/day, >2x baseline rate, increasing
U5MR > 2-10/10,000/day
Wasting* > 15% (>-2SD WHZ), > than usual, increasing
Famine/
Humanitarian catastrophe
CMR >2/10,000/day (e.g., 6,000/1,000,000 /30 days)
Wasting* >30%

7. What is nutrition emergency?
•Vulnerability to nutrition emergencies;
–Existing health and nutrition situation greatly affects how vulnerable a population is to a nutritional emergency
–HIV and AIDS increases food insecurity, poverty, and even has negative effects on labor force and agriculture at large scale
–Poverty and urban pressure overcrowding, inadequate drinking water, substandard sanitation facilities and infrastructure, exposure to urban pollution and hazardous materials, landlessness, and frequent food shortages
–Climate change may have an increasing impact leading to more frequent famines in the future
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8. What is nutrition emergency?
•Triggers for nutrition emergencies;
–Natural disasters affect food availability and access, disrupt health systems, destroy WASH systems
–Conflict can lead to Nutrition Emergencies in many ways due to lack of access to food, health, WASH, etc.
–Political crises and economic shocks contribute to Nutrition Emergencies through discrimination of ethnic groups or inadequate political decisions (China famine in the late 50s)
–Global food prices fluctuations have caused increased levels of poverty, food insecurity and resulting under nutrition
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9. What is nutrition emergency?
•Who is most vulnerable in emergencies?
–Physiological vulnerability: children less than 5, older people, people affected by chronic diseases, gender
–Geographical vulnerability: flood or drought-prone areas, conflict front lines
–Political vulnerability: discrimination, persecution
–Internal displacement and refugee status: 26 million IDPs, 16 million refugees at the end of 2010 (minus the Arab spring displacements).
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10. What is nutrition emergency?
•Types of malnutrition during emergencies?
–The major concern in emergencies is the increased risk of moderate and severe acute malnutrition because acute malnutrition is strongly associated with death
–In many long-term emergencies levels of other forms of malnutrition (stunting and underweight) are often high
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11. What is nutrition emergency?
•(cont.) Types of malnutrition during emergencies?
–Stunting inhibits a child from reaching his or her full physical and mental potential
•Can have a major impact on work output and national development
•Is becoming an increasingly important measure of nutritional wellbeing in some emergencies
–Micronutrient deficiencies are common in emergencies, particularly in affected people dependent on food rations
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12. The scale of emergency nutrition
•Goals of nutrition action in emergencies typically include;
a)Reducing levels of wasting to below conventionally- defined emergency rates of thresholds
b)Reducing and/or preventing micronutrient deficiencies, because these markedly increase mortality risks
c)Reducing the specific vulnerability of infants and young children in crises through the promotion of appropriate child care, with special emphasis on infant and young child feeding practices
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13. The scale of emergency nutrition
•(cont.) Goals of nutrition action in emergencies typically include;
d)preventing a life-threatening deterioration of nutritional status by ensuring access by emergency- affected populations to adequate, safe and nutritious foods that meet minimum nutrient needs
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14. Nutrition programme elements
•Choice of actions from a more comprehensive portfolio of intervention includes (but not limited) the following;
a)General food assistance
b)Management of severe acute malnutrition
c)Management of moderate acute malnutrition
d)Delivery of micronutrients
e)Infant and young child feeding in emergencies
f)Treatment of diarrhoea with oral rehydration therapy/ zinc
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15. Nutrition programme elements
•(cont.) Choice of actions from a more comprehensive portfolio of intervention includes (but not limited) the following;
g)Prevention and treatment of vitamin A deficiency
h)Food and nutrition assistance for people living with HIV
i)The psychosocial components of nutrition
j)Nutritional care for groups with special needs
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16. The challenge
•Developing countries will not be able to break out of poverty and sustain economic growth
–large segments of their population fail to secure the nutrition needed for a healthy and productive life.
•The goal of addressing stunting and wasting is unlikely to be achieved without progress in countries requiring large-scale humanitarian action
–Investment needed to move rapidly on a post-crisis trajectory
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17. (cont.)The challenge
•Important way to reduce child mortality requires concerted efforts
–aimed at expanding the coverage and effectiveness of both institutional and community-based programs focused on treatment and prevention of stunting and wasting.
•The specific contribution of actions address nutritional deficiencies in humanitarian contexts has to be understood
–as an essential contribution to the international community’s overall nutrition agenda.
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18. Conclusion
•Emergency interventions continue to improve in terms of coverage, scale of operations, reporting standards and effectiveness,
–‘no response’ is never an option
•Immediate nutrition needs are usually acute, large scale and have complex determinants
–Combination of intervention to focus on different target groups
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19. Thank You
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