Nutrition Month 2014 Presentation

2014 Nutrition Month
OUTLINE
1. Nutrition Month theme and objectives
2. Why nutrition in emergencies (NiE)
3. Nutrition management in emergencies
- Nutrition Cluster
- Minimum Nutrition Service Package
4. Current resources available
5. Preparedness checklists
6. Strengthening NiE preparedness
THE PHILIPPINES
WARM OCEAN WATERS
DEFORESTATION
COASTAL HOMES
RING OF FIRE
UNDERDEVELOPMENT
Available at: http://news.nationalgeographic.com/
THE PHILIPPINES
Annual Disaster Statistical Review 2012, CRED
Annual Disaster Statistical Review 2012, CRED
THE PHILIPPINES
To promote interventions to address nutritional
needs in emergencies and disasters including
preparedness, response and recovery
To mobilize responders to address gaps in
nutrition in emergency response
To increase awareness on coping and resiliency
strategies to prevent malnutrition and worsening
of nutritional status

Objectives of NM 2014
Nutrition services that are part of
emergency preparedness, response and
recovery to prevent deterioration of
nutritional status and death
Nutrition in emergencies (NiE)
Nutrition services include:
Nutritional assessment
Infant and young child feeding promotion,
protection and support
Management of acute malnutrition
Micronutrient supplementation
Other food or non-food-based interventions
Nutrition in emergencies (NiE)
To prevent death and protect the right of
nutrition
Malnourished population groups more
vulnerable to illness and death during
emergencies
Affected populations more likely to experience
malnutrition due to lack of food and water,
poor access to health services, civil insecurity,
inadequate delivery of assistance
Why is NiE important?
Philippines Nutrition Facts and Figures, 2011
19.5 % of Filipinos are anemic
55.7% infants 6-11 months most effected
42.5% pregnant women
15.2% of 6 mos-5 y/o children have Vitamin A
deficiency
Iodine level among pregnant women below
recommended level
66.9% households did not meet their dietary
energy requirements.
Source: DOST-FNRI. 2008 National Nutrition Survey.
Acute malnutrition
severe decline in nutritional status in short
period of time of insufficient intake of food
and/or from infections and other illnesses
marked by muscle wasting
Nutritional problems during
emergencies
Chronic malnutrition
long term effect of undernutrition
manifested by stunting and impaired
physical and mental development
emergencies
Micronutrient deficiencies Vitamin A, iron,
iodine
disrupted food supply
incidence of illnesses, particularly diarrhea,
which impairs nutrition absorption and
increases the need for these micronutrients
emergencies
Adoption of the National Policy on Nutrition
Management in Emergencies and Disasters
To guide actions for provision of quality
nutrition and related services to minimize risk
of further deterioration of nutritional status
NNC GB Resolution No. 2 s. 2009
Nutrition in emergencies
Institutionalization of the Cluster Approach in
the Philippine Disaster Management System,
Designation of Cluster Leads and their Terms of
Reference at the National, Regional and
Provincial Level
National Disaster Risk Reduction Management
Council Circular No. 5, Series 2
Nutrition in emergencies
Health
Nutrition NNC as Chair
Water, Sanitation and Hygiene (WASH)
Mental Health and Psychosocial Support
Implementation of Cluster Approach
DOH Department Order 2007-2492A s. 2007:
Creation of the Health Cluster with Sub-Clusters
on Nutrition, WASH and Health
Expanded Agency Partners
ARUGAAN
Role of Nutrition Cluster
To ensure that nutritional status of affected
populations will not worsen
Facilitates strategic collaboration and
comprehensiveness of emergency
management, resource mobilization and
integration of cross-cutting nutrition concerns
with other clusters
The Nutrition Cluster
National Nutrition
Cluster
National Level
Regional Nutrition
Cluster
Regional Level
Local Nutrition Cluster
Provincial/City
Municipal/
Barangay Level
Global Nutrition Cluster

Minimum Nutrition Service Package

Also called Recommended Nutrition Cluster
Response
Guide for the national, regional and local
nutrition clusters on actions for emergency
management
Timeline National/Regional
Nutrition Cluster
Local Nutrition
Cluster
Pre-disaster 1. Set up system for
updating logistics
2. Advocacy to
partners on
supplementary
feeding
3. Capacity building
on NiE
1. Formulate
emergency
preparedness plan
on nutrition
2. Capacity building
3. Resource mapping
and prepositioning


Timeline National/Regional/Local Nutrition Cluster
Alert Phase 1. Update resource inventory
Vitamin A capsules
Multiple micronutrient powders
Ferrous sulfate with folic acid tablets
IEC materials for nutrition
Mid-Upper Arm Circumference (MUAC)
tapes
Weighing scale
Weight-for-height reference table
Height board
Ready-to-use therapeutic food (RUTF)


Timeline National/Regional/Local Nutrition Cluster
Alert Phase 1. Update resource inventory
Ready-to-use Supplementary Food (RUSF)
Antibiotics, deworming tables
Human milk banks
Breastfeeding kit (container/katsa, feeding
cup with cover, food container with spoon
and fork, 1 L glass tumbler with cover, IEC
materials, birth registration form)
2. Mapping of partners using the 4Ws
Who, What, When and Where


Nutrition Cluster
Local Nutrition
Cluster
Pre-emptive
evacuation
phase (alert
warning)
1. Coordinate with
partners on
supplementary
feeding and
setting-up of
breastfeeding
spaces in
evacuation
centers
1. Set-up
supplementary
feeding for 6-59
months old
children, pregnant
and lactating
women


Nutrition Cluster
Local Nutrition
Cluster
Pre-emptive
evacuation
phase (alert
warning)
2. Alert notification
to health facilities
regarding
management of
severe acute
malnutrition
2. Vitamin A
supplementation
3. Set-up BF corners/
spaces in
evacuation centers
4. Activate teams


Nutrition Cluster
Pre-emptive
evacuation
phase (alert
warning)
3. Activate rapid
assessment
teams, IYCF
support groups
4. Pre-deployment
5. Conduct Cluster
coordination
meeting
5. Refer cases of severe
acute malnutrition
(SAM) with infections
to Integrated
Management of
Acute Malnutrition
referral hospitals
6. Conduct Cluster
coordination
meeting


Nutrition Cluster
Local Nutrition
Cluster
Within 24
hours of
impact
1. Deploy
assessment team
1. Deploy
Assessment team
2. Conduct Rapid
nutrition
assessment


Timeline National/Regional Nutrition
Cluster
Local Nutrition
Cluster
Within
25-71
hours
1. Establish contacts; gather
baseline and identify
immediate priorities
2. Assist in gap analysis &
planning of nutrition
interventions
3. Disseminate daily
situation report
1. Conduct
assessment of
Infant feeding
in emergencies
2. Cluster
coordination
3. Planning for
intervention


Nutrition Cluster
Local Nutrition
Cluster
More
than 72
hours
1. Provide technical
assistance
2. Resource
augmentation and
generation
3. Policy monitoring of
Milk Code (EO 51)
4. Lead/facilitate cluster
coordination
initiatives
1. Implement
nutrition
interventions
Rapid screening
for acute
malnutrition using
MUAC tape


Nutrition Cluster
Local Nutrition
Cluster
More
than 72
hours
5. Advocacy for services
6. Activate 3Ws
7. Technical assistance
for exit strategy
Blanket & targeted
supplementary
feeding
Integrated
management of
acute malnutrition
activity
components


Nutrition Cluster
More
than 72
hours
Promotion, protection &
support of IYCF in
emergencies
Micronutrient
intervention
2. Information
management
3. Referral for psychosocial
high-risk cases


Nutrition Cluster
More
than 72
hours
4. Referral to WASH, health
clusters and other
interventions
5. Cluster coordination
6. Policy monitoring of the
Milk Code (EO 51)
7. Develop exit strategy


To identify level of malnutrition in affected
area
To identify severe and moderate acute
malnutrition cases for immediate treatment
and referral
Nutrition Assessment
Within first 2 days following emergency
Gathering of anthropometric data
Mid-upper arm circumference (MUAC)
Weight and height
Sex, age
Presence of bilateral pitting edema
Target groups: Infants, preschoolers
Data provide magnitude and severity of crisis
Rapid Nutrition Assessment
Rapid assessment tool
Relief assistance
Shelter
Food security
Sanitation facilities
Health
Nutrition
Child protection
Communication
Access
Emergency education situation
Assessment of food security
access to food
Main sources of food
Percentage of households with food stocks
Life span of existing food stocks
Access to local markets
Availability of clean water at 15
liter/person/day
Nutrition
Presence of donated formula milk
Availability of other nutrition interventions
Micronutrient supplementation
Breastfeeding areas
Standardized Monitoring and Assessment of
Relief and Transitions (SMART)
Helps determine extent of emergency
response to meet needs of affected
population
Measures nutritional status of children
under 5 and mortality rate
Nutrition Interventions Against Malnutrition
FOOD BASED NON FOOD BASED
Food Ration or
Family Food Packs
Emergency School
Feeding
Food for Work
Supplementary
Feeding
Therapeutic Care

Cash for Work
IYCF E
Health and nutrition
services
Micronutrient
Supplementation and
Food Fortification

Feeding Program against Malnutrition
Blanket Supplementary
Feeding
Targeted Supplementary
Feeding
Provision of food
supplements to all identified
vulnerable groups
To prevent nutritional
deficiencies to affected
population and further
deterioration of nutritional
status of children identified
with moderate acute
malnutrition (MAM)
To improve moderately
malnourished children,
pregnant and lactating
women with infants less than
6 months of age, and those
individuals with medical
conditions
Protect malnourished
children under 5 y/o from
diseases/death
Vitamin A
Infants 6-11 months old (100,000 IU)
12-59 months old (200,000 IU)
Lactating mothers (200,000 IU)
children with severe diarrhea, pneumonia
and severely underweight unless given the
same dose in the past month
children with measles regardless when the
last supplementation was provided

Protocol for micronutrient supplementation
Iron
5 mg elemental iron/0.6 ml for low birth
weight infants starting from 2 to 6 months
1 tablet 60mg iron with 2.8 mg folic acid
weekly for non-pregnant and lactating
women 10-49 y/o
1 tablet 60 mg elemental iron with 400 mcg
folic acid daily to all pregnant women for 180
days starting from determination of
pregnancy

Iron
Therapeutic dose of iron supplements to
anemic patients less than 10 years old
10-49 years must be given 1 tablet of 60
mg elemental iron with 400 mcg folic acid
daily until hemoglobin level becomes
normal

Micronutrient Powder (MNP)
60 sachets for children 6-11 months
120 sachets for children aged 12-23 months
can also be given to children 24 59 months,
pregnant and lactating mothers
Oral rehydration solution and zinc supplements
Children with diarrhea, given not less than 10
days

Active nutrition screening through MUAC or
weight-for-height
Children 6-59 months old
11.5 cm to <12.5 cm, no edema are provided
with targeted supplementary feeding
<11.5cm with or without edema are
referred to therapeutic program
On screening
Within 1 week
After 2 months
1. Appropriate (IYCF) practices promoted,
protected and supported as infants and young
children are most vulnerable to illness and
death.
Exclusive breastfeeding in the first 6 months
Provision of appropriate, safe
complementary foods starting at 6 months
while continuing breastfeeding for two years
and beyond

Key concerns in feeding infants in
emergencies
2. Monitor Milk Code violations
Donations covered by law include infant
formula, bottles and teats
DOH Administrative Order 2007-0017
Guidelines on the Acceptance and
Processing of Local and Foreign Donations
during Emergencies and Disasters
emergencies
3. Establishment of Mother-Baby Friendly Spaces
in evacuation areas
Safe and comfortable venue
Avail of information, counseling and support
4. Wet nursing, tandem nursing, cross nursing,
feeding with donated breastmilk
emergencies
Mother-Baby Friendly spaces
1. infant formula are not sterile and may be
contaminated
2. lack of safe and clean water, utensils and fuel to
prepare formula and sterilize bottles and teats
3. insufficient knowledge on preparation and use of
artificial feeding may result to over or under
dilution of infant formula
Why donations of breastmilk substitutes
are not allowed during emergencies
5. infant formula does not contain protective
properties such as antibodies found in
breastmilk
6. poor sanitation increases risk of contamination
during preparation
7. supplies of infant formula are often not
sustainable after the emergency
Why donations of breastmilk substitutes
are not allowed during emergencies
1. Human resources/technical assistance
Global, National and Local Nutrition
Clusters
Barangay Nutrition Scholars
Infant and Young Child Feeding support
groups
Volunteers
Other organizations
Resources available during emergencies
2. Materials
NiE Training Manual for LGUs
Operational Guidelines on IYCF in
Emergencies
Documentation from DOH and other
local and international organizations
IEC materials on nutrition and nutrition
in emergencies
c. Sphere Handbook, Humanitarian Charter
and Minimum Standards in Humanitarian
Response
Universal standard for humanitarian
response (visit www.sphereproject.org)

d. Communication and reporting
National to local nutrition cluster
Global Nutrition Cluster
LGU Preparedness nutrition checklist
Packaging of Nutrition in Emergencies (NiE)
Training Kits and conduct of NiE and IYCF-E
training
Early Warning Information and Disaster Risk
Reduction and Management Orientation among
employees and residents
Inventory of essential micronutrients and other
resources
Implementation of Regular Program on Nutrition
Updating of database of NiE trained personnel
Cluster Coordination Meetings
Inventory of essential micronutrients and other
resources
Vitamin A capsules
Multiple micronutrient powders
Ferrous sulfate and iron with folic acid tablets
IEC for Nutrition
MUAC tapes
Weighing scale
Weight for height reference table
Height Board
Ready-to-Use Therapeutic Food (RUTF)
Ready-to-Use Supplementary Food (RUSF)
Antibiotics, deworming tablets
LGU Preparedness nutrition checklist
Store 3-day supply of:
Water stored in clean plastic bottles (2 L for drinking and
2 L for food preparation and cleaning per person, per day)
canned sardines/meat/fruits/vegetables
canned juices/milk for adults
cup noodles
dried fish/fruits
high energy foods peanut butter, crackers, jelly
foods for infants/elderly/persons on special diet
comfort foods biscuits, hard candy, instant cereal, instant
coffee
paper cups, plates and plastic utensils

Family emergency
preparedness checklist

Families with breastfeeding children should
prepare BF Kit with:
malong
feeding cup with cover
food container with spoon and fork
1 liter glass tumbler with cover
IEC materials
Birth registration form

Family emergency
preparedness checklist

1. Organize local nutrition clusters, identify roles
and responsibilities and lines of authority
2. Build capacity of local nutrition clusters on
cluster coordination and nutrition in
emergencies management
3. Give attention to rapid nutrition assessment
4. Foster participation of other sectors
Ways to strengthen nutrition in
emergencies preparedness/response
5. Strengthen logistic systems and ensure
availability of supplies
6. Establish human milk banks
7. Early detection of cases of moderate and
severe acute malnutrition
8. Organize and sustain IYCF support groups
Ways to strengthen nutrition in
emergencies preparedness/response
Lets do our part!

Provide for the future

Donate
Be informed
Be concerned and save lives
Spread the message

Be alert, be prepared
For more details:

National Nutrition Council
2332 Chino Roces Ave Extn., Taguig City
http://www.nnc.gov.ph
facebook.com/nncofficial
youtube.com/user/NNC1974
info@nnc.gov.ph
Tel. (02) 843-0142 Fax. 843-5818

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