Nutrition Flashcards

1
Q

Learning Objectives

A
  • To appreciate nutritional needs in humanitarian emergencies
  • Understand the terms Food Security & Nutrition security
  • To be able to assess nutritional status in populations at risk
  • To recognise the relevance of malnutrition and related diseases
  • Appreciate the challenges that humanitarian disasters pose outside “simple” supply of food.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Food Security

A

A situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. Based on this definition, four security dimensions can be identified: food availability, economic and physical access to food, food utilisation and stability over time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Food insecurity

A

A situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth, development and an active and healthy life. IT may be caused by the unavailability of food, insufficient purchasing power, inappropriate distribution or inadequate use of food at the household level. Food insecurity, poor conditions of health, sanitation, inappropriate care and feeding practices are the major causes of poor nutritional status. Food insecurity may be chronic, seasonal or transitory.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe Nutritional security

A
  • A tributary of food security
  • People need enough to eat and they need enough of the right kind of foods when they need them
  • Nutrition needs are met for each individual according to their needs
  • Nutrient needs vary throughout the life cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does nutritional needs vary between individuals?

A
  • Nutritional needs vary by age, gender and whether pregnant or breastfeeding
  • Therefore nutritional security must be analysed either individually or at least by vulnerable groups
  • Pregnant and breastfeeding women, infants 0-6 months & 6-23 months, adolescent girls, adolescent boys to a lesser extent and individuals with chronic illness
  • Vulnerability is both socio-economic (less economic power) and…
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List Countries at risk of extreme food insecurities

A
  • Afghanistan
  • Eritrea
  • Somalia
  • Ethiopia
  • Burundi
  • Chad
  • South Sudan
  • DR Congo
  • Haiti
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does this fit into Humanitarian Emergencies?

A
  • “A disaster is an occurrence disrupting the normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the affected community.”
    -EXISTING PROBLEMS ARE AMPLIFIED
  • Mortality and morbidity…
  • A third to half of deaths associated with malnutrition
  • Increased rates of some diseases (measles)
  • Increased susceptibility amongst some diseases (HIV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define Fragile states

A

“fundamental failure of the state to perform functions necessary to meet citizens’ basic needs and expectations. Fragile states are commonly described as incapable of assuring basic security, maintaining rule of law and justice, or providing basic services and economic opportunities for their citizens”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define Protracted crisis

A

“Those environments in which a significant proportion of the population is acutely vulnerable to death, disease and disruption of livelihoods over a prolonged period of time. The governance of these environments is usually very weak, with the state having a limited capacity to respond to, and mitigate, the threats to the population, or provide adequate levels of protection.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the snowball effect?

A
  • The proportion of undernourished people is about three times as high in countries in protracted crisis as in other developing countries
  • Protracted crisis are fundamentally different from the model of acute disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe what is likely to happen by 2030

A
  • “By 2030 nearly two thirds of the world’s poor will be living in states now deemed “fragile” (like Congo and Somalia).
  • In Somalia, Ethiopia and Eritrea, human failings mean a severe drought has tipped millions into famine. It’s a textbook case of why things go wrong. War begets poverty, leaving food unaffordable. Devastated infrastructure destroys both food production and the ability to truck in emergency food.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does climate change play a role in food and nutritional security? (PART 1)

A
  • Natural disasters more frequent and intense Extreme weather-related disasters are bound to become more frequent and have a disproportionate toll on poor, weak and elderly people.
  • Water scarcer and harder to access: Changing rainfall patterns are likely to cause severe water shortages and/or flooding as well as accelerate land degradation.
  • Melting of glaciers are likely to lead to flooding and soil erosion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does climate change play a role in food and nutritional security? (PART 2)

A
  • Increases in productivity harder to achieve.
  • Rising temperatures will cause shifts in crop growing seasons and to have a negative influence on yields and livestock numbers and productivity, which affect food security, and changes will place more people at risk from diseases.
  • The effects of climate change are predicted to drive up prices of major food crops in many developing countries (UNDP 2007)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How will climate change affect everyone?

A
  • Growing risk of humanitarian crisis – Climate change cuts into global food supply, so raises the risk of rising food prices, food insecurity, political instability and conflict.
  • Climate change has already diminished the global food supply with declining global crop yields especially for wheat, raising new concern about whether production can keep up with population growth.
  • Climate change will make it harder for developing countries to emerge from poverty and will create “poverty pockets” in rich and poor countries.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the aims for food security

A
  • Identify major food and nutrition problems:
    – Assess populations/subpopulations particularly at risk
    – Assess rates of undernutrition and malnutrition
    – Assess risk factors for malnutrition in complex emergencies
  • To reduce mortality associated with malnutrition and to improve the nutrition status of the affected population and prevent their situation from deteriorating.
  • Ensure food supplies are familiar and culturally appropriate to the affected population.
  • Foster transition to affected populations developing self-sufficient food security.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List the key components of the initial assessment for food security

A
  • Primary Data collection
  • Secondary Data collection
17
Q

Describe the primary data collection

A
  • Primary Data Collection
  • Prevalence of acute malnutrition in children aged between 6 months and 5 years, based on mid-upper arm circumference (MUAC) and bilateral oedema
  • To assess key infant feeding practices, specifically breastfeeding of infants younger than 6 months
18
Q

Describe the secondary data collection

A
  • Secondary Data Collection or Key informants
  • Information on nutrition situation of the country of origin & country of asylum
  • Cultural habits that might affect their food preferences or intake eg vegetarian diets
  • Characteristics of the refugee population that might influence the effectiveness of coping strategies or early interventions eg farming skills, food storage and fuel
  • Specific vulnerabilities, eg women eat last older people etc.
  • Local and national capacity to lead or support the response
19
Q

What is an anthropometric assessment?

A
  • Assess children between 6 months and 5 years, based on mid-upper arm circumference and bilateral oedema at registration and reception areas
  • MUAC - circumference of the left upper arm at the mid-point between the elbow and shoulder (to the nearest mm using standard MUAC tape)
  • > 140mm – normal
  • 115 – 125mm – moderate malnutrition
  • <115 – severe malnutrition
  • Weight for height (WFH) Z score can be assessed (accurate but complex, needs reference population–Sphere)
  • Bilateral oedema - apply gentle thumb pressure to the tops of both feet of the child for 3 seconds; observe for an indent which indicates severe acute malnutrition
  • All infants <6months need to be assessed for forms of nutrition received
20
Q

What groups are vulnerable to the anthropometric assessments?

A
  • Extremes of age
  • Gender: women? Pregnancy/breastfeeding and cultural practices
  • Comorbidities – HIV/AIDS, TB, immunocompromise
  • NB Note that none of these groups per se necessarily constitutes an at risk group rather the interplay between these and other drivers e.g.:
  • Existing or developed social practices
  • Accompanied or alone/extended families
  • Pre-existing cultural inequalities
21
Q

What are the logistics when it comes to food? (PART 1)

A
  • WHO suggests that an individual should take 2100 kcal (8.8 MJ) per day
  • <1500 kcal; - mortality rises in stressed populations
  • Higher total kcal for CMR>1/10,000 or exposure/Lower if population has access to additional resources
  • Sources: local food best
  • Consider local economy – support and avoid undermining
  • Dried imported food may be necessary
  • Special needs for sick and vulnerable ie targeted supplements
22
Q

What are the logistics when it comes to food? (PART 2)

A
  • Coordination between NGOs and other actors
  • Appropriate supply chain
  • Security around distribution and storage sites
  • Extra capacity to cover damage, theft and corrupt practice
  • Record strategy eg ration cards – depends on needs assessment
23
Q

List the red flags that require immediate action

A
  • Crude mortality - >1/10 000/day
  • Mortality in children <5yrs - >4/10 000/day
  • <1500 kcals/day in adults
  • <100 kcal/kg/day in infants & small children
  • Reduced MUAC in 10% children <5yrs
  • Reduced z score
  • Wasting >15 % of normal body weight
24
Q

State the differences between protein V energy malnutrition VD

A
  • Acute (thinner), chronic (stunted) and acute on chronic malnutrition
  • Kwashiorkor: protein-energy malnutrition with oedema - Little muscle loss, Predominantly protein deficiency
  • Marasmus: thin with no oedema - Muscle wasting, Global deficiencies
25
Q

Describe the different types of micronutrient deficiencies

A
  • Vitamin A – Xerophthalmia, Bitot’s spots and corneal softness, night blindness
  • Vitamin B1 (thiamine) – Beriberi with CNS and CVS disruption
  • Vitamin B3 (niacin) – Pellagra with dermatitis, diarrhoea, dementia
  • Vitamin C - Scurvy
  • Iron - anaemia
  • Iodine - goitre
  • Zinc – supplement with ORS for diarrhoea
26
Q

Describe malnutrition and measles immunisations

A
  • Increased susceptibility with a 20% mortality rate
  • Immunisation should be targeted at those aged 9 months and 15 years
  • Needs to be administered within 10 days of camp set up – do not delay for formal immunization schedule
  • Ensure cold chain, storage, equipment and human resources for administration
  • Vitamin A should also be administered (Vit A + imms delivers 85% protection)
  • Vaccination can also reduce disease severity in those already affected
27
Q

What are selective feeding programs?

A
  • Treatment for children and other groups with acute malnutrition
  • Therapeutic feeding centres (TFCs) are resource intensive
  • Admissions for treating severely malnourished – criteria context dependent
  • Patients often apathetic and hypothermic despite tropical temperatures