![Page 1: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/1.jpg)
Niger 2005
Dr Milton Tectonidis, London 2006
OperationsQuestions
"…‘regular’ starvation has to be distinguished from violent outbursts of famines…"
(Amartya Sen, Poverty & Famines 1981)
![Page 2: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/2.jpg)
MSF Maradi Program
Ready to Use Therapeutic Foods (RUTF)
July 2001-2004
Six outpatient centresOne inpatient centreSevere + special cases only
9,632 admissions83.5% cure rate
2004
![Page 3: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/3.jpg)
Clear Signs (W12)
March 2005 DAKAR, 21 December (IRIN) Due to poor rains and a severe locust outbreak, Niger this year registered a record grain deficit of 223,487 tons.
peak period 2004
![Page 4: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/4.jpg)
GAM 19.6 (28.2), SAM 2.9 (4.1)
GAM 19.3 (28.5), SAM 2.4 (4.4)
U5MR 2.2 – 2.4/10,000/d
April - May 2005
EPICENTRE SURVEYS
May 25, 2005MSF Launches Emergency Operation to Combat Malnutrition in Niger
![Page 5: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/5.jpg)
Niger Nutritional Surveys January to September 2005
![Page 6: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/6.jpg)
NEW SC & OTC (RUTF)+ Protection & Discharge Rations March 2005 (Dakoro)May 2005 (Aguié, Tessaoua, Mayahi)
TARGETED BLANKET FEEDINGlate July 2005 (Maradi) late Sept 2005 (Zinder)
Angola 2002Darfur 2004
May 2005 MSF Niger Emergency Strategy
Steve Collins
![Page 7: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/7.jpg)
Inpatient centresOutpatient points
Family rationsTargeted blankets
Pediatric unitsSupport to OPDs
July - October 2005
July 25, 2005 Preventing Severe Malnutrition in Maradi, Niger The first distribution finally took place on Saturday, July 23…
October 26 2005 - The Targeted Supplementary Feeding Initiative in Zinder A joint effort of MSF, UNICEF and the World Food Programme.
![Page 8: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/8.jpg)
Hunger gap
Malnutrition in Maradi
39,158 admissions60% of admissions in 13 weeks95% of admissions < 85 cm40%+ between 75 & 85 cm
91.4% cure rate3.2% death rate
4.7% default rate
2005
Program indicators
2005
![Page 9: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/9.jpg)
A recent survey… confirms that the children of Niger still face high levels of malnutrition.
Malnutrition rates range from 9% to 18%, and inadequate infant and young child feeding practices are likely causes.
Cultural factors and social behaviours, such as inadequate infant and young child feeding practices, have a major impact...
December 2005
![Page 10: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/10.jpg)
Malnutrition conceptual framework
The most common cause of protein-energy
malnutrition is parents’ poor child feeding and
caring practices….”
FOODCARE
orHEALTH
?
World Bank 2006
![Page 11: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/11.jpg)
Population, Cereal Production & Food Aid
Niger 1980- 2005
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Years
Cer
eal
(met
ric
tons
)
0
2000
4000
6000
8000
10000
12000
14000
Popu
lati
on (
thou
sand
s)
Maradi, Tahoua19841987
Zinder1997
Maradi20012005
Food availability in Niger
![Page 12: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/12.jpg)
Food accessibility in Niger
Hunger gapPrices
![Page 13: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/13.jpg)
Deluxe WFP ration2261 kcal
12% proteins20 % lipids
ITEM QUANTITE Cereal 400 gr Pulse 60 gr Oil 25 gr CSB 100 gr Sugar 15 gr Salt 5 gr TOTAL 605 gr
102 100
143
38
117
34
222
144
82
130109
020
4060
80100
120140
160180
200
Ene
rgy
Pro
tein
Fat
Vit
A -
retin
ol
Vit
C
Fol
ic A
cid
Nia
cin
equ.
(B3,
PP
)
Rib
o-fla
vin
(B2)
Thi
amin
(B1)
Cal
cium Iron
Percentage
Food quality & dietary deficiencymonotonous cereal-pulse diets
dietary diversificationfood fortification
nutrient supplementation
![Page 14: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/14.jpg)
Type I nutrientsspecific signs of deficiency
Type II nutrientsgrowth failure
iron, copper, seleniumcalcium, iodine
vitamins A, B, D, E, K
nitrogen, essential amino acids
sodium, potassium, chloridephosphorus, sulphur
zinc, magnesiumtissue repair and growth ceases
no convalescence from illness
anorexia and wasting
Nutrient deficiency, growth & malnutrition
Mike Golden
![Page 15: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/15.jpg)
R. Shrimpton. The timing of growth failure (data from 39 studies)
60 million wasted
Nutrient deficiency, growth & malnutrition
130 million underweight150 million stunted
![Page 16: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/16.jpg)
Nutrient dense pastes (equivalent to F-100 + Fe)Ready to eatNo added water – contamination freeIndividualised packaging
Increased capacityOutpatient treatmentMultiple, decentralized sitesInclude the "moderates"
Improved resultsEarly diagnosis (recruitment)Expanded coverageQuality referral care
Ready to Use Therapeutic Foods (RUTF)
Designed to encourage rapid weight gain
![Page 17: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/17.jpg)
MSF Emergency Nutrition current strategies
2005 blanket feeding2006 therapeutic feeding
2004 protection rations2005 discharge family rations
therapeutic feeding + targeted food aid
![Page 18: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/18.jpg)
General population
At risk
Acute malnourished
general distribution
blanket feeding
therapeutic feeding
QualityCoverage
NUTRITION
FOOD AID
family rations
MSF Emergency Nutrition current strategiesAngola 2002 TFC + blanketsDarfour 2004 TFC + OTC + protection rations (+ blankets)Niger 2005 SC + OTC + protection rations + food ration (+ blankets)
![Page 19: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/19.jpg)
ACUTE MALNUTRITION W/H < 80%
MUAC < 110 mmEdema
COMPLICATED NON-COMPLICATED
ANOREXIASevere pathology
Apathy
Inpatient Outpatient
APPETITENo severe pathology
Alert
MUAC/edema only ?adjustable thresholds
include other age groups
DeinstitutionalizeSimplify
adjust discharge criterialighten follow-up
strengthen referral capacitydischarge quickly
Acute malnutrition - further work
![Page 20: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/20.jpg)
Anthropometry – individual risk
acute weight loss
RUTF ?Treatment by
illness episode ?
Extend benefits
![Page 21: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/21.jpg)
Anthropometry – individual risk
"healthy" reference children
rural village age peers
child with pertussis
poor & incomplete catch-up growth
RUTF ?Treatment by
illness episode ?
Extend benefits
![Page 22: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/22.jpg)
I ncidence of admissions by district/ canton Maradi 2005
Districts / Cantons Under 5 pop Admissions Incidence (/ 1000/ yr)
District Guidam Roumdji 78452 11 303 144,1
Guidan Roumdji Town 2357 111 47,1
Guidan Roumdji 11901 2741 230,3
Chadakori 15855 1264 79,7
Tibiri Maradi 18432 4040 219,2
Saé Saboa 14879 1602 107,7
Guidan Sori 15027 1545 102,8
Maradi Niger 2005Up to 25% incidence of severe malnutrition (50% for < 85 cm)
South Sudan 1993Herwaldt et al.70% U5 < -2 ZS
Anthropometry – population risk
RUTF ?Therapeutic Blanket ?
Extend benefits
![Page 23: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/23.jpg)
pregnancy & lactation
new therapeutic products & strategies
micronutriments +/- calories
"acute" malnutrition
illness episodeconvalescence weight loss
weaning foods
HIV-TBchronic diseaseration supplement
MSF nutrition
RAPID WEIGHT GAIN TARGETED SUPPLEMENT
RUTF RUSF
Nutrients
RUSF
![Page 24: Niger 2005 Dr Milton Tectonidis, London 2006 Operations Questions "…‘regular’ starvation has to be distinguished from violent outbursts of famines…" (Amartya](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d9d5503460f94a86e00/html5/thumbnails/24.jpg)
Acute weight loss
General population
Acute malnourished
General ration quantity & quality
RUTF for rapid weight gain
Strategy (who is at risk ?)Targeting (what supplement ?)
RUSF for specific target group
At risk groups
MSF emergency nutrition