Emergency Nutrition

See Also: Food Aid; HIV/AIDS; Infant & Child Nutrition; Community Therapeutic Care

Emergency response is a critical program area for USAID and its partners. Inadequate food and nutrition programming make huge numbers of people vulnerable to illness and death in the short term. In the long-term, undernourished and under-stimulated populations are not equipped to fully benefit form even the best development programming, resulting in lost opportunities during the post-emergency phase. Crisis and recovery cycles impact countries to such an extent that intervention, prevention, and mitigation strategies all remain critical and increasing attention has been paid to the concept of developmental relief. Considerable gaps also persist in standardization, technical advances, and collaboration despite great strides over the past decade. These challenges include training at all levels, common methodologies and reporting mechanisms, and translation of current technical knowledge into effective practical programs in the field.

FANTA's emergency nutrition model promotes emergency phase interventions that build local capacity, increase community resilience, and promote a rapid return to sustainable development. Similarly, FANTA emphasizes prevention and mitigation strategies so that communities are better able to cope, minimizing and containing conflict in the event of repeated shocks. Linking relief to development in practice requires greater resource integration and innovative interventions that can be replicated and scaled up. FANTA works to promote a better understanding of the collection, reporting, and use of nutritional data in emergencies.

FANTA collaborates with USAID's Bureau for Democracy, Conflict and Humanitarian Assistance (DCHA) Office of Foreign Disaster Assistance (OFDA), Office of Food for Peace (FFP), Office of Policy, Planning and Management (PPM), the Bureau for Health, Office of Health Infectious Disease and Nutrition (HIDN), and international partners to strengthen implementation of emergency relief programming and developmental relief. FANTA helps USAID Mission and PVO partners strengthen reporting for more effective emergency programming and advance USAID's goals of monitoring the nutritional status of children under five. Focus areas include strategic planning, revision and development of reporting mechanisms, and links with the United Nations System Standing Committee on Nutrition (SCN) in the production of the Nutrition Information in Crisis Situations (formerly RNIS).

	A brief description of each publication is provided below. By choosing the publication title, you are able to read a detailed description and to download the publication.

1. Precision, Time, and Cost: A Comparison of Three Sampling Designs in an Emergency Setting (2008) An article reporting on the FANTA and SC/US field test in Sudan, "Precision, Time, and Cost: A Comparison of Three Sampling Designs in an Emergency Setting", has been published in Emerging Themes in Epidemiology.

2. Review of Community-based Management of Acute Malnutrition (CMAM) in the Post-emergency Context: Synthesis of Lessons on Integration of CMAM into National Health Systems (2008): With Community Management of Acute Malnutrition (CMAM) incorporated into government health facilities and protocols to varying degrees in Ethiopia, Malawi and Niger, USAID's FANTA Project undertook a comprehensive review of the challenges, successes and lessons learned from the experience in these three countries. The synthesis report discusses recommendations for successful and sustainable integration of CMAM, outlining specific steps donors, Ministries of Health, the UN and NGOs can take to facilitate the process and next steps needed to expand the knowledge and evidence base for CMAM integration.

3. Sudan Food Assistance Transition Study (2008): The report provides an analysis of the key issues related to food insecurity and the high rates of malnutrition in Southern Sudan and the Three Areas (Abyei, the Nuba Mountains and Blue Nile). It examines current Title II activities and recommends how to increase their impact on food security and nutrition. The study proposes possible steps for addressing food security through development of an integrated food security strategy and by leveraging Title II and Disaster Assistance funds in a complementary manner that emphasizes the multiple transitions taking place in the areas of livelihoods, education, health, nutrition, institutions and security.

4. Community-based Therapeutic Care (CTC): A Field Manual (October 2006): Community-based Therapeutic Care (CTC): A Field Manual provides program managers, practitioners, and technical specialists addressing severe acute malnutrition with the essential design, implementation and evaluation protocols for implementing the CTC approach. As the CTC model is evolving, this first edition does not provide a step-by-step workbook for implementers, but rather offers a solid foundation to build CTC programs at local and national levels. The manual is a product of a collaboration between Valid International, Concern Worldwide, USAID’s FANTA Project, and Development Cooperation Ireland. Support for FANTA for the development of CTC and the production of the manual came from the Office of Foreign Disaster Assistance (OFDA) and the Office of Health, Infectious Diseases and Nutrition at the U.S. Agency for International Development.

5. Food and Nutrition Bulletin Volume 27, No. 3: Proceedings of an Informal Consultation on Community-based Management of Severe Malnutrition in Children (September 2006) : A special supplement was produced by the United Nations University publication Food and Nutrition Bulletin to present the proceedings of the 2005 WHO and Standing Commitee on Nutrition (SCN)'s informal consultative meeting on community-based management of severe malnutrition in children in Geneva. With support from FANTA, the meeting brought together some 50 international experts and representatives from the World Food Program (WFP), the United Nations High Commissioner for Refugees (UNHCR), the Red Cross, research institutions, major international non-governmental organizations, and representatives of ministries of health. The consultation agreed on guiding principles for the implementation of community-based management of severe acute malnutrition and next steps for updating global recommendations and country level health policies for the inclusion of management of severe acute malnutrition as an essential intervention towards achieving the MDGs for poverty and child mortality reduction. Next steps include the creation of field guidelines and training modules will be developed based on the general principles, conclusions, and recommendations derived from the meeting, which, if implemented on a large scale, will prevent thousands of child deaths.

6. New FANTA Anthropometric Bookmark (June 2006): In 2002, the first FANTA anthropometric bookmark was produced to offer simple, at-a-glance information on basic anthropometric concepts. The bookmark was very popular and further updated in 2004. This year, FANTA has produced a second bookmark that presents clear information useful in emergency situations such as malnutrition classification and cutoffs with commonly used eligibility criteria for selective feeding programs.

7. Community Therapeutic Care Inter-Agency Meeting, February 28-March 2, 2005: FANTA collaborated with partner organizations Save the Children USA and Concern Worldwide to coordinate a three-day Inter-agency Meeting on Community Therapeutic Care (CTC) in Washington, DC. The meeting provided a forum for implementing agencies, academics, and donors to explore issues and challenges in the implementation of CTC, and to develop mechanisms to ensure quality and coordination in future CTC programs. Specifically, the meeting had two primary objectives: 1) learn from current CTC field experience to identify issues and challenges in implementation, scale up, and transitioning; and 2) establish cross-agency mechanisms for improving and ensuring the quality of CTC implementation. Sessions included presentations from a number of implementing agencies, as well as donors, and emphasized experience to date in Ethiopia, Sudan, Malawi and Bangladesh. The presentations and meeting agenda are available for download.

8. Operational Challenges of Implementing Community Therapeutic Care (2005): This 2005 Field Exchange Special Supplement of the Emergency Nutrition Network (ENN) summarizes key elements of the presentations and discussions that emerged from the Inter-Agency Workshop on Community Therapeutic Care (CTC) held in March 2005. The workshop, held in Washington, DC, was a follow-up to a meeting held in Dublin in October 2004. Community Therapeutic Care (CTC), a community-based approach for managing large numbers of acutely malnourished people, is gaining attention as a viable alternative to the traditional therapeutic feeding centers (TFCs). First implemented in 2000 in Ethiopia, CTC programs have reached their five-year mark, with efforts now focusing on integrating the approach into national protocols for treating severely malnourished people. In response to the growing numbers of agencies and Ministries of Health implementing CTC, a consortium of U.S. NGOs, the FANTA Project, Concern Worldwide, Save the Children U.S., and Valid International organized a workshop to identify issues and challenges in implementation, integration and scaling up of CTC programming, and discuss mechanisms to ensure quality control over CTC programming. Participants included representatives of a broad cross-section of organizations including U.S. and European NGOs, USAID, the Ethiopian and Malawian Ministries of Health, the World Health Organization and academia, as well as the private sector.

9. Community-based Therapeutic Care (CTC) (2004): The Emergency Nutrition Network (ENN) has published Community-based Therapeutic Care (CTC), a special supplement to the November 2004 issue of ENN's Field Exchange. The supplement is a collection of articles that provide a wide range of evidence-based perspectives from people who have been involved in CTC programs over the last four years. Specifically, the articles present the impact and effectiveness of the CTC model in different contexts through lessons learned from case studies in Ethiopia, Malawi and North and South Sudan. Additionally, the CTC program has included substantial research on the development of locally produced Ready to Use Therapeutic Food to reduce costs of the program and increase sustainability. More recent work has focused on adapting the CTC approach for the care of HIV infected individuals.

10. Technical Note No. 8, Community Therapeutic Care (CTC): A new approach to managing acute malnutrition in emergencies and beyond (2004): Community Therapeutic Care (CTC) is a new approach to managing acute malnutrition in emergencies and beyond. Conceived by Valid International, CTC seeks to address some of the challenges that traditional center-based approaches face. It aims to provide rapid, effective, low cost assistance that is least disruptive to affected communities and builds a foundation to link relief and development interventions for long-term solutions to food insecurity and threats to public health. CTC aims to treat the majority of the severely malnourished at home, build local capacity to better manage care of acutely malnourished children, and address repeated cycles of relief and recovery. This technical note responds to the frequently asked questions associated with CTC. It describes the CTC approach, implementation, and the role of Ready to Use Therapeutic Food (RUTF). It summarizes results to date and outlines ongoing and planned activities.

11. Treating the Severely Malnourished: The Community Therapeutic Care (CTC) Approach (2004): Community Therapeutic Care (CTC) is a community-based approach of care for managing large numbers of acutely malnourished people in times of stress. The CTC approach treats the majority of the severely malnourished at home and uses outreach teams to promote community participation and behavioral change. CTC aims to build community capacity to manage and to better respond to repeated cycles of relief and recovery. Providing appropriate therapeutic foods containing the right mix of nutrients that will aid in recuperation is central to the home-based care of the severely malnourished. Ready to use therapeutic foods (RUTF) have been specially designed for the treatment of severe acute malnutrition. RUTF can be manufactured locally thereby increasing availability and reducing costs.

12. Community Therapeutic Care Workshop in Dublin (October 2003): FANTA collaborated with partner organizations Concern Worldwide and Valid International to coordinate a workshop in Dublin, Ireland, from October 8 to 10, focusing on the Community Therapeutic Care (CTC) approach. CTC is a community-based approach for treating acutely malnourished people in times of stress, providing fast, effective, low-cost assistance. FANTA provides technical assistance and supports monitoring of the program in Ethiopia, Sudan, and Malawi with funds from the Office of Foreign Disaster Assistance (OFDA) of USAID's Bureau for Democracy, Conflict and Humanitarian Assistance, and the Office of Health, Infectious Disease and Nutrition (HIDN) of USAID's Bureau for Global Health. The workshop brought together approximately 70 key players in severe malnutrition management including program implementers, technical advisors, academics, bilateral donors and multilateral agencies such as the United Nations Children's Fund (UNICEF) and the United Nations World Food Program (WFP).

13. Tajikistan Food Aid Review (2003): A USAID Food for Peace team assessed the implications of the potential close-out of USDA's food programs in Tajikistan and recommended appropriate uses of food aid, including Title II resources. The Tajikistan Food Aid Review identifies the underlying causes of high reported rates of chronic and acute malnutrition; key factors that support and constrain food availability and access; whether current food aid programming is responding appropriately to the current situation and is still recommended; and key constraints in implementing food security and food aid programs.

14. Caring for Severely Malnourished Children (2003): Many severely malnourished children still die unnecessarily due to inadequate in-patient care. This new book, supported by FANTA with funding from USAID's Bureau for Global Health and published by TALC (Teaching Aids at Low Cost), describes the ten treatment steps needed to manage these children successfully. It is based on guidelines developed by the World Health Organization and on training modules prepared for nurses in Africa. It takes into account the limited resources in many hospitals and health centers, and the fact that many malnourished children are also HIV positive. It is a suitable manual for nurses and other pediatric health workers in developing countries, for their trainers and supervisors, and for those working in emergency situations and is available from TALC.

15. A Review of the Advances and Challenges in Nutrition in Conflicts and Crises over the Last 20 Years (2002): The main purpose of this paper is to assess the principal advances made over the past years in nutrition in conflicts and crises and to propose direction for further advances in the field. The term ‘advances’ refers to developments in technical knowledge and nutrition policy and practice. The Project Cycle Management is used as a framework for presenting these advances and the challenges that remain. It is hoped that this will contribute to the development of a plan of action for the international community that will accelerate the pace of advances in the field of emergency nutrition: advances that will lead to significant improvements in relieving the suffering, death and degradation of disaster-affected communities. The first step in this process would be a plan of action developed through the collaboration of bilateral agencies, UN Agencies, and NGOs through the UN ACC/Sub-Committee on Nutrition.

16. Standardized Monitoring and Assessment of Relief and Transitions (SMART) Workshop (July 2002): Standardized Monitoring and Assessment of Relief and Transitions (SMART) is a U.S. inter-agency global initiative to improve the reporting, monitoring and evaluation of humanitarian assistance interventions. This initiative aims to provide implementing partners and the broader humanitarian community with a range of tools to support humanitarian program assessment. In July 2002, the Food and Nutrition Technical Assistance Project (FANTA), with funding from USAID, organized and conducted a workshop on Standardized Monitoring and Assessment of Relief and Transition -- the SMART Technical Working Sessions. For the first time, U.S., Canadian, and European private voluntary organizations (PVOs) and non-governmental organizations (NGOs), international organizations, academia and donors met to review and resolve problems of using assessment tools and methodologies in emergency situations.

17. Assessment of Nutritional Status of Adolescents in Emergency-Affected Populations (2000): According to the UN Standing Committee on Nutrition's Assessment of Nutritional Status of Adolescents in Emergency-Affected Populations, more accurate identification of adolescent nutritional status relative to other vulnerable groups will yield both more effective distribution of relief food and valuable dietary opportunities among displaced and emergency-affected populations. The supplement suggests new methods for determining undernutrition cut-off points and proposes adjustments for ethnic differences with less regard for pubertal maturity and relative physical development.

18. Assessment of Nutritional Status of Adults in Emergency-Affected Populations (2000): According to the UN Standing Committee on Nutrition's Assessment of Nutritional Status of Adults in Emergency-Affected Populations, current World Health Organization standards for identifying undernutrition are inappropriate in this setting, leading to misdiagnosis and numbers of needless admissions to therapeutic feeding centers. Based on awareness of relevant social factors and situation-specific criteria, the supplement recommends interim measurement techniques that should be used until further research can be conducted.

19. Resources for Emergency Food Aid Managers: Resources include manuals, training curricula, websites and journal articles. A range of emergency food aid management topics are covered: logistics, targeting, monitoring and evaluation and nutritional and food security assessments.

20. Conference on Emergency Relief Diets 1999: FANTA co-sponsored a three-day conference on "Enhancing the Nutritional Quality of Relief Diets." This conference focused on what can be done to address the inadequate provision of micronutrients in large relief programs. Recent outbreaks of scurvy due to Vitamin C deficiency in refugee camps highlight the need for better technical and logistical support. Recommendations were made for the need to establish protocols for ensuring nutrient needs are met.

*Please note that links to these sites do not imply that FANTA supports either the organization listed or the views and content presented.

Center of Excellence in Disaster Management and Humanitarian Assistance [http://www.coe-dmha.org]
The Center of Excellence in Disaster Management and Humanitarian Assistance supports disaster relief and humanitarian assistance through research, education and training with a focus on civil and military cooperation in the Asia Pacific region. Daily reports on disaster management and assistance and links to publications and training programs are provided.

Emergency Nutrition Network (ENN) [http://www.ennonline.net/index.html]
The Emergency Nutrition Network (ENN) aims to improve the effectiveness of emergency food and nutrition interventions by providing a forum for the exchange of field level experiences and current research between staff, academics, researchers and organizations working in the food and nutrition sector in emergencies.

NutritionNet [http://www.nutritionnet.net]
This website aims to provide online discussion between nutritionists, humanitarian assistance personnel, academics, NGOs and donors about nutrition in the emergency context. Visitors register with NutritionNet and use their login information on subsequent visits.

Internal Displacement Monitoring Centre [http://www.internal-displacement.org/]
Launched by the Norwegian Refugee Council, the Internal Displacement Monitoring Centre integrates and reports on information and statistics associated with IDPs worldwide. The site contains a database that provides background, factual, analytical, and cultural information on IDPs in selected countries. Information on their Global IDP Training Project, links to related organizations, and a listing of their publications are also provided.

Integrated Regional Information Network (IRIN) [http://www.irinnews.org]
Another strong UN website, this time from the Integrated Regional Information Network. IRIN, a unit of the UN Office for the Coordination of Humanitarian Affairs, provides information about sub-Saharan Africa and the Caucasus and Central Asia from a regional perspective, to foster greater awareness and understanding of regional issues and events and to contribute to better-informed and more effective humanitarian action and media coverage, including emergency preparedness and advocacy. The site provides daily and weekly humanitarian news updates, archived by country and date. For those looking for specific information about food or other issues, the site has a home page link to the Relief Web search engine, which finds articles from IRIN and similar news sources and services.

Médecins Sans Frontières/Doctors Without Borders (MSF) [http://www.msf.org/]
MSF is an international humanitarian aid organisation that provides emergency medical assistance to populations in danger in more than 80 countries

Nutrition Information in Crisis Situations (NICS) [http://www.unsystem.org/scn/Publications/html/rnis.html]
The Nutrition Information in Crisis Situations (NICS) Series (formerly RNIS) site features quarterly reports on the nutrition situation of refugee and displaced populations in sub-Saharan Africa and parts of Asia. It is an activity of the ACC/SNN which is the focal point for harmonizing the policies and activities in nutrition of the entire UN system.

ReliefWeb [http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm]
ReliefWeb provides time-critical humanitarian information on Complex Emergencies and Natural Disasters.

The SPHERE Project Humanitarian Charter and Minimum Standards in Disaster Response [http://www.sphereproject.org/]
The Sphere Project was launched in 1997 by a group of humanitarian NGOs and the Red Cross and Red Crescent movement. Sphere is based on two core beliefs: first, that all possible steps should be taken to alleviate human suffering arising out of calamity and conflict, and second, that those affected by disaster have a right to life with dignity and therefore a right to assistance. Sphere is three things: a handbook, a broad process of collaboration and an expression of commitment to quality and accountability.

Standardized Monitoring and Assessment of Relief and Transitions (SMART) [http://www.smartindicators.org/] is a U.S. inter-agency global initiative to improve the reporting, monitoring and evaluation of humanitarian assistance interventions. This initiative aims to provide implementing partners and the broader humanitarian community with a range of tools to support humanitarian program assessment.

UNICEF - United Nations Children's Fund [http://www.unicef.org/]
UNICEF is mandated by the United Nations General Assembly to advocate for the protection of children's rights, to help meet their basic needs and to expand their opportunities to reach their full potential. UNICEF is guided by the Convention on the Rights of the Child and strives to establish children's rights as enduring ethical principles and international standards of behaviour towards children.

United Nations High Commissioner for Refugees (UNHCR) [http://www.unhcr.ch/]
Excellent website from the United Nations High Commissioner for Refugees, who is mandated by the United Nations to lead and coordinate international action for the world-wide protection of refugees and the resolution of refugee problems. The World section provides map- and text-based access to country-specific information about refugees and their states of origin. The Statistics and Issues sections are also useful, but specific information about food issues is difficult to find because the site lacks its own search engine. The Official UN Web Site locator at the bottom of the home page, however, has a link to UNIONS, the easy-to-use search system for all on-line UN organizations.

United Nations System Standing Committee on Nutrition (SCN) [http://www.unsystem.org/scn/]
The United Nations System Standing Committee on Nutrition is the focal point for harmonizing the policies and activities on nutrition of the UN system. Its role is to serve as a coordinating mechanism, for exchange of information and technical guidance, and to act dynamically to help the UN respond to nutritional problems. The site provides links to SCN news and reports on nutrition worldwide.

USAID Famine Early Warning System (FEWS) [http://www.fews.net/]
The Goal of the Famine Early Warning Systems Network (FEWS NET) is to strengthen the abilities of African countries and regional organizations to manage risk of food insecurity through the provision of timely and analytical early warning and vulnerability information. FEWS NET is a USAID-funded activity that collaborates with international, national, and regional partners to provide timely and rigorous early warning and vulnerability information on emerging or evolving food security issues.

USAID Humanitarian Response [http://www.usaid.gov/our_work/humanitarian_assistance/]
The Humanitarian Response section has information about USAID’s Title II, Title III and International Disaster Assistance Programs, information about specific country missions, situation reports and strategy papers, and a searchable Commodities Reference Guide. This Guide contains detailed fact sheets and information about the availability and characteristics of 28 different food commodities, storage and shelf life specifications, and how to control damage to these food commodities. The homepage also has links to the 2002 U.S. International Food Assistance Report, USAID’s Office of Food for Peace, and Office of U.S. Foreign Disaster Assistance.

USAID Office of US Foreign Disaster Assistance (OFDA) [http://www.usaid.gov/our_work/humanitarian_assistance/disaster_assistance/]
The Office of US Foreign Disaster Assistance assesses the need for US assistance in foreign disasters. OFDA works with USAID Missions to provide grants and field assistance through US Embassies and non-governmental and international organizations. OFDA also sponsors the development of early warning system technology and training programs to strengthen the ability of foreign governments to rely on their own resources. The website has reports on recent disasters, training information, and links to other resources.

Valid International [http://www.validinternational.org/pages/] is a United Kingdom-based consulting firm focusing on operational research in emergency situations. The Community Therapeutic Care (CTC) program is managed by Valid International with support from FANTA.

World Food Program (WFP) [http://www.wfp.org/]
A useful website from the frontline food aid organization of the United Nations. The world's largest international food aid organization, the World Food Program buys goods and services from developing countries in an effort to spur their economies, and focuses in particular on efforts to help women, children and the elderly. The site features reports and newsletters on policy themes such as gender issues, and the homepage also has links to detailed information about WFP’s emergency operations and development projects, resources and appeals, country strategy outlines, situation reports and evaluations and studies. The site also has a large database of WFP statistics on projects, resources, global food aid and procurement.

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