nutrition month 2014 presentation
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2014 Nutrition Month
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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
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THE PHILIPPINES
WARM OCEAN WATERS
DEFORESTATION
COASTAL HOMES
RING OF FIRE
UNDERDEVELOPMENT
Available at: http://news.nationalgeographic.com/
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THE PHILIPPINES
Annual Disaster Statistical Review 2012, CRED
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Annual Disaster Statistical Review 2012, CRED
THE PHILIPPINES
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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 resiliencystrategies to prevent malnutrition and worsening
of nutritional status
Objectives of NM 2014
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Nutrition services that are part of
emergency preparedness, response and
recovery to prevent deterioration ofnutritional status and death
Nutrition in emergencies (NiE)
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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)
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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?
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Philippines Nutrition Facts and Figures, 2011
Why is NiE important?
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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 Adeficiency
Iodine level among pregnant women below
recommended level 66.9% households did not meet their dietary
energy requirements.
Why is NiE important?
Source: DOST-FNRI. 2008 National Nutrition Survey.
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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
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Chronic malnutrition
long term effect of undernutrition
manifested by stunting and impairedphysical and mental development
Nutritional problems during
emergencies
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Micronutrient deficienciesVitamin A, iron,
iodine
disrupted food supply
incidence of illnesses, particularly diarrhea,
which impairs nutrition absorption and
increases the need for these micronutrients
Nutritional problems during
emergencies
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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
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Institutionalization of the Cluster Approach inthe 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
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Health
NutritionNNC 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-Clusterson Nutrition, WASH and Health
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Expanded Agency Partners
ARUGAAN
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Role of Nutrition Cluster
To ensure that nutritional status of affected
populations will not worsen
Facilitates strategic collaboration andcomprehensiveness of emergency
management, resource mobilization and
integration of cross-cutting nutrition concernswith other clusters
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The Nutrition Cluster
National Nutrition
Cluster
National Level
Regional NutritionCluster
Regional Level
Local Nutrition ClusterProvincial/City
Municipal/Barangay Level
Global Nutrition Cluster
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Minimum NutritionService Package
Also called Recommended Nutrition Cluster
Response
Guide for the national, regional and local
nutrition clusters on actions for emergencymanagement
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Timeline National/Regional
Nutrition Cluster
Local Nutrition
Cluster
Pre-disaster 1. Set up system for
updating logistics2. Advocacy to
partners on
supplementary
feeding3. Capacity building
on NiE
1. Formulate
emergencypreparedness plan
on nutrition
2. Capacity building
3. Resource mappingand prepositioning
Minimum NutritionService Package
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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)
Minimum NutritionService Package
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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, IECmaterials, birth registration form)
2. Mapping of partners using the 4Ws
Who, What, When and Where
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local NutritionCluster
Pre-emptive
evacuationphase (alert
warning)
1. Coordinate with
partners onsupplementary
feeding and
setting-up of
breastfeedingspaces in
evacuation
centers
1. Set-up
supplementaryfeeding for 6-59
months old
children, pregnant
and lactatingwomen
Minimum NutritionService Package
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Timeline National/Regional
Nutrition Cluster
Local Nutrition
Cluster
Pre-emptive
evacuationphase (alert
warning)
2. Alert notification
to health facilitiesregarding
management of
severe acute
malnutrition
2. Vitamin A
supplementation3. Set-up BF corners/
spaces in
evacuation centers
4. Activate teams
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local Nutrition Cluster
Pre-emptive
evacuation
phase (alertwarning)
3. Activate rapid
assessment
teams, IYCFsupport groups
4. Pre-deployment
5. Conduct Cluster
coordination
meeting
5. Refer cases of severe
acute malnutrition
(SAM) with infectionsto Integrated
Management of
Acute Malnutrition
referral hospitals
6. Conduct Cluster
coordination
meeting
Minimum NutritionService Package
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Timeline National/Regional
Nutrition Cluster
Local Nutrition
Cluster
Within 24
hours ofimpact
1. Deploy
assessment team
1. Deploy
Assessment team2. Conduct Rapid
nutrition
assessment
Minimum NutritionService Package
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Timeline National/Regional Nutrition
Cluster
Local Nutrition
Cluster
Within
25-71hours
1. Establish contacts; gather
baseline and identifyimmediate priorities
2. Assist in gap analysis &
planning of nutrition
interventions3. Disseminate daily
situation report
1. Conduct
assessment ofInfant feeding
in emergencies
2. Cluster
coordination3. Planning for
intervention
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local NutritionCluster
More
than 72
hours
1. Provide technical
assistance
2. Resource
augmentation and
generation
3. Policy monitoring ofMilk Code (EO 51)
4. Lead/facilitate cluster
coordination
initiatives
1. Implement
nutrition
interventions
Rapid screening
for acute
malnutrition usingMUAC tape
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local NutritionCluster
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 malnutritionactivity
components
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local Nutrition Cluster
More
than 72
hours
Promotion, protection &
support of IYCF in
emergencies
Micronutrient
intervention
2. Informationmanagement
3. Referral for psychosocial
high-risk cases
Minimum NutritionService Package
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Timeline National/RegionalNutrition Cluster
Local 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
Minimum NutritionService Package
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To identify level of malnutrition in affected
area
To identify severe and moderate acute
malnutrition cases for immediate treatment
and referral
Nutrition Assessment
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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
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Rapid assessment tool
Relief assistance
Shelter
Food security
Sanitation facilities
Health
Nutrition
Child protection
Communication
Access
Emergency education situation
Rapid Nutrition Assessment
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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
Rapid Nutrition Assessment
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Nutrition Presence of donated formula milk
Availability of other nutrition interventions
Micronutrient supplementation
Breastfeeding areas
Management of acute malnutrition
Rapid Nutrition Assessment
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Standardized Monitoring and Assessment ofRelief and Transitions (SMART)
Helps determine extent of emergency
response to meet needs of affectedpopulation
Measures nutritional status of children
under 5 and mortality rate
Rapid Nutrition Assessment
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Nutrition Interventions Against Malnutrition
FOOD BASED NONFOOD BASED
Food Ration or
Family Food Packs
Emergency SchoolFeeding
Food for Work
SupplementaryFeeding
Therapeutic Care
Cash for Work
IYCFE
Health and nutritionservices
Micronutrient
Supplementation andFood Fortification
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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 nutritionalstatus 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
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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
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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 acidweekly for non-pregnant and lactating
women 10-49 y/o
1 tablet 60 mg elemental iron with 400 mcgfolic acid daily to all pregnant women for 180
days starting from determination of
pregnancy
Protocol for micronutrient supplementation
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Protocol for micronutrient supplementation
Iron Therapeutic dose of iron supplements to
anemic patients less than 10 years old
10-49 years must be given 1 tablet of 60mg elemental iron with 400 mcg folic acid
daily until hemoglobin level becomes
normal
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Protocol for micronutrient supplementation
Micronutrient Powder (MNP) 60 sachets for children 6-11 months
120 sachets for children aged 12-23 months
can also be given to children 2459 months,pregnant and lactating mothers
Oral rehydration solution and zinc supplements
Children with diarrhea, given not less than 10
days
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Active nutrition screening through MUAC orweight-for-height
Children 6-59 months old
11.5 cm to
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Management of acute malnutrition
On screening
Within 1 week
After 2 months
K i f di i f t i
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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 monthswhile continuing breastfeeding for two years
and beyond
Key concerns in feeding infants in
emergencies
Key concerns in feeding infants in
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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
Key concerns in feeding infants in
emergencies
Key concerns in feeding infants in
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3. Establishment of Mother-Baby Friendly Spacesin evacuation areas
Safe and comfortable venue
Avail of information, counseling and support
4. Wet nursing, tandem nursing, cross nursing,
feeding with donated breastmilk
Key concerns in feeding infants in
emergencies
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Mother-Baby Friendly spaces
Why donations of breastmilk substitutes
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1. infant formula are not sterile and may becontaminated
2. lack of safe and clean water, utensils and fuel to
prepare formula and sterilize bottles and teats3. 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
Why donations of breastmilk substitutes
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5. infant formula does not contain protectiveproperties such as antibodies found in
breastmilk
6. poor sanitation increases risk of contaminationduring preparation
7. supplies of infant formula are often not
sustainable after the emergency
Why donations of breastmilk substitutes
are not allowed during emergencies
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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
il bl d i i
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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
il bl d i i
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c. Sphere Handbook, Humanitarian Charter
and Minimum Standards in Humanitarian
Response
Universal standard for humanitarianresponse (visit www.sphereproject.org)
d. Communication and reporting National to local nutrition cluster
Global Nutrition Cluster
Resources available during emergencies
LGU P d t iti h kli t
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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
LGU P d t iti h kli t
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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
Family emergency
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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 foodspeanut butter, crackers, jelly
foods for infants/elderly/persons on special diet
comfort foodsbiscuits, hard candy, instant cereal, instant
coffee
paper cups, plates and plastic utensils
Family emergency
preparedness checklist
Family emergency
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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
Ways to strengthen nutrition in
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1. Organize local nutrition clusters, identify roles
and responsibilities and lines of authority
2. Build capacity of local nutrition clusters oncluster 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
Ways to strengthen nutrition in
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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
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Lets do our part!
Provide for the future
Donate
Be informed
Be concerned and save lives
Spread the message
Be alert, be prepared
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For more details:
National Nutrition Council
2332 Chino Roces Ave Extn., Taguig City
http://www.nnc.gov.phfacebook.com/nncofficial
youtube.com/user/NNC1974
info@nnc.gov.phTel. (02) 843-0142 Fax. 843-5818
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