Nutrition in emergency (current view) Zuzana Derflerová Brázdová Masaryk University Brno Emergency situation •Natural: •-droughts, rains, floodings, earthquakes, volcanos, insect outbreak, plant diseases • •Manmade : -wars (civil or between countries), unrests, robberies, destruction of food production - •Other causes: •- Population growth exceeding production, overall poverty, malfunction of food transport, inequalities in resource allocation • • • Food market - Angola Angola 126 Water supply - Kenya Itibo01 (8) Land mines - Afghanistan Angola 254 IDP’camp, Chechnya Starvation •State, which due to prolonged lack of food creates adaptation problems to malnutrition • •--------------- • •Heathy man, weighing 70 kg, has approx. • 15 kg body fat ~ 135.000 kcal, • 1350 kcal/days for 100 days. Clinical signs of starvation •Thinness •Dry skin •Muscle loss •Shineless hair •Slow heart rate •Low blood pressure •Amenorrhoea, impotence •Spontaneous abortion •Oedemas •Anemics •Diarrhoea •Psychic and mental disorders Famine •Critical lack of food in certain area, which causes starvation and death of majority of population. • •In many cases affected only selected population groups. Consequences of famine •Starvation • •Population migration • •Epidemics (typhoid, plague, chickenpox, cholera, dysentery) • •Increased number of death due to infectional diseases (measles, tuberculosis) History of famines (I.) •1769/70, India. 10 million died (1/3 population) • •1840, Ireland. Restricted potatoe production. 1,6 million emigrated to U.S.A., the same number died. • •1941-44, Europe (Holland, Leningrad). • •1943, Benghal. 1 million died, 60 million hardly affected. History of famines (II.) •1958 – 61, China. 15-30 million died (droughts + floods deteriorated by economic and political chaos) • •1968 – 73, Africa, famine in Sahel (climate) • •1977, Africa, Ethiopia (climate) • •1990s: Bosna, Somalia, Angola, Liberia, Mozambique, south Sudan, Rwanda, Zaire • Basic criteria for food aid •Foods known and consumed in determined area •Distribution point should be as closed as possible •People to be informed of progress of famine, ways of food preparation etc. •Primary heath care incl. BF support •Monitoring of the data on availability of food, distribution, mortality rate and nutritional status Typical demographic distribution Age (yrs) <5 5 - 14 Women 15 - 44 Men 15 - 44 > 44 Distribution (%) 20 35 20 (out of this, 40% P+ L) 10 15 Orphans earning money by gathering the wood in land mines fields - Angola • Angola 208 Daily food supply •2100 kcal / day (not distinguished according age and gender) • •Approx. 500 kcal people are usually able to raise •10-12% total energy from protein •10 – 17 % total energy from fat •Adequate micronutrient intake from fresh or fortified food Food aid •Access to variety of foods (cereals, pulses or animal sources, fat) •Access to vitamin A, C and iron •Iodizied salt available for >90% population •Additional sources of niacin, if staple food is corn or sorghum •Additional sources of thiamin, if staple food is the rice •Additional sources of riboflavin, if the total intake is very restricted Recommendation for food aid (I.) •Make sure that there is available energy source for cooking and dishes •Food distribute weekly, maximum once a fourteen days •Breast milk substitutes are strictly forbidden! •Milk powder should be mixed in other food in advance •Add vitamin A and C, if there is no F + V •Increase the palatability of the meals (sugar, salt) Recommendation for food aid (II.) •Sometimes 300-500 kcal daily helps in prevention of severe starvation •Try to meet the highest standards of hygiene •Organize mobile kitchens or canteens •Food prices controled by the government •System of weekly news on the situation (sanitary level, potable water, personal hygiene, safe eating/catering) Food-for-work •If famine not present, food only for work (direction of WFP) • •Advantages: prevention of creation of mentality of dependent people •Disadvantages: hard work increases energy requirement. Several people disqualified, eg. children, elderly, sick, pregnant… Specific emergency •Leproserie in Africa • • • • • •Man affected by wet form of leprosy Angola 180 Risk groups •Children <5 yrs • •Pregnant and lactating women • •Elderly • •Sick, week, invalid, handicaped • •Additional risk sub-groups: HIV positive, mountain population etc. Waiting food supply… •The source of meat •Gorno Badachstan Pamir II Conclusion I. Famine prevention •Diversified economy • •Developed agriculture and food sector • •Effective intervention (control of crops diseases) •Functional management (government, infrastructure, health) Welfare… •Apartment building •in Kuito • • • • • • • •5 yrs after 28 yrs lasting civil war Angola 139 Conclusion II. Famine prevention •NGO participation • •Transport, roads… • •Safe food supply • •Suitable range of acceptable food • Conclusion III. Famine prevention • • • •Education for all! Classroom … • Angola 064