The document describes a proposed development and education project called DEEPEN aimed at addressing severe acute malnutrition (SAM) in Ethiopia. The project has two main components: 1) Developing local sustainable nutrition production through ready-to-use therapeutic foods (RUTF) and 2) Educating communities on nutrition, sanitation, and health. A pilot will be conducted in Bale, Ethiopia through partnerships with organizations to train communities to identify SAM, produce RUTF, and promote education on topics like gardening and hygiene. The project aims to eventually expand throughout the region to help combat malnutrition.

1. Nirmal Choradia, Kruti Gandhi, Khushboo
Jhala, Jennifer Jones, Katie Smyrski
1

2. DEtermination to reach a goal…
Development and Education
With one DEvelopment in mind…
to DE
DEEPEN the lives of others
2

3. Development and Education for Evolving Processes
in Energy and Nutrition
3

4. 4

5.  Development and Education for Evolving
Processes in Education and Nutrition
2 Components:
1.) Developing a local sustainable form
of nutritional self-sustenance for SAM
individuals
2.) Educating the community about how
to live healthy, nutritional lifestyles
5

6. 1.) There are two corresponding phases in the first
developmental component:
 Identifying cases of Sever Acute Malnutrition in
children and providing an instant source of nutrition
through RUTFs
 Equipping the community to begin a local RUTFs
production facility with primitive tools
2.) There are 3 main topics addressed in the
second educational component:
 Home gardening
 Hygiene and sanitation
 Maternal and child health
6

7. A pilot study carried out in the zone of
Bale in the region of Oromiya based in
the city of Robe but directed towards a
nearby village
Why we chose Bale:
 Based on agriculture and already
implemented irrigation systems, it is
compliant with the infrastructure
needed to carry out our plan making it
feasible to build upon 2
 High prevalence of SAM cases 2
o Upon evaluation of this pilot study, we hope
to expand this to villages throughout the
region
7

8. •Lack of education is a serious
predicament resulting in
malnourishment because many are
illiterate and unknowledgeable about
nutrition, family planning, breast-
feeding and parenting
•Stat:In a specific study done on
elementary school education,
incorporation of a nutritional
education system decreased the
malnourishment rate from 36% to
29%6
•Feasibility
8

9. •RUTF – Ready to Use Therapeutic
Foods
•Stat: A six-week treatment of
RUTF is generally enough to carry
a child back to healthy
development. A study has shown
that 95% of malnourished children
on this type of treatment recover
in 6 to 8 weeks. One study has
shown that RUTF is an
improvement to milk based
formulas9
•Malawi, Bangladesh7
9

10.  Project
Coordinators will first teach the local
head community members the background of
SAM and how to identify cases.
 Once trained, community members will collect
baseline data on SAM cases and post-intervention
data on SAM cases
10

11. The Project
Coordinators will
then begin to teach
them the background
and process of
making RUTFs using
local, sustainable
materials
11

12.  WHO:
 a very low weight for height (below -3z scores of the
median WHO growth standards), by visible severe
wasting, or by the presence of nutritional edema5
 Target Audience: Children under age 5 showing these
symptoms
 Tape measure and scale provided by the program
12

13.  What the program provides:
 A production facility
 Containers and churners
 oil press
 CMV (vitamin) tablets
 Bee harvesting facility
 Goats
 Seeds
 Solvatten
*don’t be alarmed, yes, we did think about the
cost-analysis. (shown later).
13

14. Common New Formulation10
Formulation10 Goat Milk
Milk Powder Honey
Sugar Safflower Oil
Vegetable Oil Vitamins/Minerals
Vitamin/Minerals Peanut Butter
Peanut Butter
14

15.  Solar-powered
water filtration
 Up to 10 gallons of
purified water
every 4 hours
 Cheap - $35 per
system
 Lasts for up to 5
years11
15

16.  What is provided by NGO partnerships:
 MERLIN: Project Coordinators
 Language, established with Ethiopian government
 Heifer: goats
 Peace Corps: Bee harvesting techniques
 Nutriset: Vitamin and mineral supplements
 Helen Keller Institute: Seeds
 The Hunger Project: health and nutrition basis
for women
16

17.  Cultural issues:
 Bale is a predominantly Muslim and Christian region
 We did not find any religious or ethical conflicts
with the process of this program
 The food could be incorporated with local tribe
food such as porridge to alleviate possible bad
taste8
 Legal/ethical issues:
 By working through the already established NGOs,
legal issues of imposing on territory without
permission would be circumvented
 All the patents on RUTF production have either
been nullified or expired
17

18.  Toprevent excessive unsanitary practices
within the RUTF production process, a
separate facility aside from the actual village
residences will be built
 Some individuals have disliked the taste of
the nutritional paste. A common practice to
circumvent this problem is mixing it with a
local food –porridge, which has shown to
work
18

19.  Itis a sustainable program in which even
after the 1 million dollars is gone, the
program can still retain its infrastructure and
process within the village
 Regeneration of food – fuels the internal
economy
19

20. SWOT Analysis
D.E.E.P.E.N.
(Development & Education for Evolving Processes in Energy & Nutrition)
STRENGTHS WEAKNESSES
•Cost-effective compared to in-patient •Time constraint (wait for crops to grow)
treatment
•Community involvement: self-efficacy •Cultural values: women tend to be shy
•High rate of women’s participation during •Technology (Oil Press) very laborious to
program formulation operate, design not appropriate for women
•Multi-dimensional approach
OPPORTUNITIES THREATS
•Improve delivery turnaround (nutrition) •Limited funds
•Conduct a baseline study •Non-compliance
•Ministry of Agriculture, Food, and Fisheries •Program affected by displacement of
gender focal point to provide support people/livestock due to droughts/floods
•Educational advancements •Program affected by HIV/AIDS/diseases
•Job opportunities
20

21.  Home Base Cost:
 2 Project Managers – $80,000
 Electronics and Office Space – $9,000
 Transportation – $19,000
 Cost Per Village:
 RUTF Starter Ingredients – $4140
 Clean water – $2,100
 Production facility – $16,000
 Other – $2,000
Total: $132,240 for 1 village
21

22.  Home Base Cost:
 2 Project Managers – $80,000 per year
 Electronics and Office Space – $7,000
 Transportation – $4,000
 Cost for Village
 CMV - $150
22

23. I am
ambitious
powerful
I am
determined
I am.
Beautiful
resilient
I am Imaginative
23

24. 1.Photo
http://images.google.com/imgres?imgurl=http://www.runforwater.ca/images/media/Ethiopia_children2_Mark_Cho
w.jpg&imgrefurl=http://www.runforwater.ca/Media/PhotoDownloads.html&usg=__bd-zzHbp7UDFg4v4S7M_-
WC7zGk=&h=2056&w=3090&sz=2905&hl=en&start=18&um=1&itbs=1&tbnid=VtucGRIsvilnxM:&tbnh=100&tbnw=
150&prev=/images%3Fq%3DEthiopia%2Bchildren%26um%3D1%26hl%3Den%26rlz%3D1C1CHNG_enUS351U
S351%26gbv%3D2%26tbs%3Disch:1
2. Bale information
http://www.ocha-eth.org/Reports/downloadable/GoroBaleSNNPRFinalConcernFeb06.pdf
3. Photo 2
http://andybraner.typepad.com/.a/6a00e54ed0df52883301157249b4b9970b-800wi
4. Photo 3
http://www.runfororomia.com/images/oromia2.gif
5. Case definition of SAM
http://whqlibdoc.who.int/hq/1999/a57361.pdf
6. Nutritional fact education works
http://www.jstor.org/stable/994185?seq=7
24

25. 7. Bangladesh
Hossain et. Al. Experience in Managing Severe Malnutrition in a
Government Tertiary Treatment Facility in Bangladesh. J Health Pop
Nature. Feb 2009.
8. Porridge
http://www.compactforlife.com/bp-100-rutf-how-to-use/
9. RUTF works
http://www.worlded.org/WEIInternet/gwe/index.cfm
10. RUTF formulation
http://fex.ennonline.net/102/4-3-2.aspx
11. Water
http://www.solvation.se/
25

26. 26

27. NCHS/WHO normalized reference values for
weight-for-height and weight-for-length
27

28. • Vitamin A Supplementation program- design, implement and monitor programs
that deliver vitamin A to young children and to new mothers. Also promote
consumption of Vitamin A enriched foods.
• Homestead Food Production- increasing local food production systems by
creating gardens and poultry and livestock farms. Provides support as well as
start-up supplies.
• Food Fortification and Biofortification- developing packets to distrubute to
families to add supplements to foods being prepared in the home. Also
working on fortifying the plants that are being grown.
• Managing Acute Malnutrition- uses existing community structures and trains
community to identify cases of SAM. Uses inpatient for severe cases, and
outpatient such as RUTFs.
• Essential Nutrition Actions- breastfeeding promotion, prenatal nutrition,
iodine use, edema control, etc.
• http://www.hki.org/reducing-malnutrition/
28

29. • Nutrition Surveillance and Data Collection
• Pilot program initiated in two villages in Sudan in 1992. Aimed at training
local community members how to do nutrition surveillance and
socioeconomic analysis of women and children. Taught individuals how to
collect basic anthropometrics, food consumption data, market
conditions, and changes in family norms. Collected data every three
months.
• Results of this Pilot Program: Had succeeding in their main objectives.
Showed that community-based nutrition surveillance was cost effective.
Involving the community ensured sustainability.
• We should implement a training program similar to this one in Sudan.
Train local people to do the data collection. Had outside data analyst to
help with nutrition surveillance and analysis. This will help us monitor
and evaluate the effectiveness of our program.
• http://www.emro.who.int/Publications/EMHJ/0202/07.htm
29

30.  Merlin: international organization that focuses on
improving health care systems in impoverished nations.
Partnered with the Ethiopian Government to help improve
the nutrition of the country. Includes water collection and
sanitation, nutritional education and health promotion.
 Merlin established a nutrition program in the Bale region in Oromiya to combat
the problem of severe malnutrition.
 http://www.merlin.org.uk/Where-we-work/Ethiopia.aspx
 Heifer International: helps fight world hunger through
community involvement. Provides livestock to families that
can not regularly afford such luxuries.
 Offices in the near-by countries of Rwanda and Tanzania
 http://www.heifer.org
30

31.  Peace Corps: developed to help lesser developed countries
educate their people. Volunteers are trained with a
specific skill, then go into a country and teach their skill to
the local people.
 Past project in Malawi included teaching local how to properly harvest beehive
for the production of honey
 Peace Corps currently have a HIV/AIDS education projects located in Ethiopia
 http://www.peacecorps.gov/index.cfm?shell=learn.whatvol.env.sampleprojects
 Nutriset: focus is on providing developing countries with
vitamins and nutrients that they lack
 Collaborates with such organizations at PlumpyField and Edesia
 Provides vitamins and minerals to help establish RUTF production
31