Complementary food working meeting

20.04.2015

Participants

• NCC, Anna Ziolkovska • Akhmetov foundation, Olga Yudina • CDC, Oleg Bilukha• People in Need, Natalia Tserkevich • UNICEF, Mutribjon Bahruddinov • WFP RO, DouraMichele • WFP, Nguyen Deborah

Caseload estimation

Estimation of population in need: children 6-23 mo

Population U2 0-6 mo 6-11 mo

12-23 mo

100% 1.99% 0.44% 0.52% 1.03%NGCAs of Donetska and Luganska Oblast

3,200,000

63,680

14,080

16,640

32,960

All IDPs in Ukraine (official data as of 17 April), including:

1,200,000

23,880

5,280

6,240

12,360

IDPs in Donetska Oblasts

450,000 8,955

1,980

2,340

4,635

IDPs in Luganska Oblasts

162,000 3,224

713

842

1,669

IDPs in Kharkiv Oblasts

162,000 3,224

713

842

1,669

IDPs in Zaporizhzhska Oblasts

87,000 1,731

383

452

896

IDPs in Dniprpetrovska Oblasts

73,000 1,453

321

380

752

Target groups

• 1st priority NGCAs: 90%: 45,000 children 6-23 months (15,100+29,900)

• 2nd priority IDPs: 90% : 13,000 children 6-23 months (4388+8612)

Energy requirements

• 650 kcal/day for children 6-11 months:– 50% (325kcal) – complementary food basket– 50% (325kcal) – breast-milk (diapers) or 2kg infant

formula/month• 900 kcal/day for children 12-24 months old:– 50% (450 kcal) – complementary food basket– 50% (450kcal) – breast-milk or family food

Monthly baby basket composition 6-11 months

Items g, totalSemolina 1000Fortified cereals 1000Baby meat puree 400Baby vegetable puree 1200Baby fruit puree 1200Total 4800

About 300 UAH/basket

Notes: 6-11 mo basket

• 1st priority• OK for macro- and micronutrient content• MNPs instead of fortified cereals to reduce the

cost – UNICEF to explore

Monthly baby basket composition 12-23 months

About 250 UAH/basket

Items g, totalSemolina 1000Buckwheat 1000Oats 800Rice 1000Meat puree 800Vegetable puree 600Fruit puree 600Total 5800

Notes: 12-23 mo basket

• 2nd priority• MNPs is needed – UNICEF to explore• If funding in limited possible only MNPs

distribution• Leaflet on how to adapt general food ration to

children 12-23 moths – WFP to explore

Current baby basketsTranslation:

Baby basket (0-12 months)

1. Infant formula - 0.70kg2. Baby cereals - 0.50 kg3. Baby vegetable puree – 2kg4. Baby fruit puree- 2kg 5. Pampers - 506. Semolina – 1,00kg

Baby basket (12-35 months)

7. Baby cereals - 0.75 kg8. Baby vegetable puree – 2kg9. Baby fruit puree- 2kg 10. Semolina – 2,00kg11. Oats – 0,80 kg

Suggestions for revision of current baby baskets (Akhmetov foundation, 0-11 mo)

• As blanket distribution of infant formula is prohibited by international standards and infants aged 0-6 months do not require anything but breast milk, the complementary food distribution should start from the age of 6 months. In addition no infant formula should be distributed to population without prior individual assessment of needs of each child. Only targeted distribution of infant formula to non-BF children is suggested.

• Some of the cereals (1kg) in the baby basket should be fortified as this is the only feasible way at this point to ensure that children receive necessary micronutrients. The cereals should be in assortment – both with milk and no-milk content due to different preferences of mothers and from variety of cereals as they provide different numbers of microelements.

• According to physiological requirements of children 6-11 months in order to provide animal protein there is a need to introduce meat purees (at least 400g a month to baby baskets).

• In order to decrease price, number of fruit and vegetable purees can be reduced to 1.2 kg each taking to consideration that they will have access to fortified cereals.

Suggestions for revision of current baby baskets (Akhmetov foundation, 12-36 mo)

• From the age of 24 months child is fully capable of eating family food, therefore Nutrition Sub-Cluster will only target with baby food distribution children up to age of 23 months (until the second birthday).

• Introduce a variety of cereals as they provide different micronutrients.• As this basket content is low in important micronutrient provision of

Multiple Micronutrient Powders for children 6-23 months will fulfil the requirement. This option is to be further explored.

• Increase quantity of meat puree to 800g at least due to growing need of children in animal protein

• In order to decrease price of basket and considering access of children to family food, number of fruit and vegetable purees can be reduced to 600 g each.

13

UNICEF standard MNP (15 minerals and

vitamins)

Nutrient levels based on WHO RNI and RDAs for children 6- 24 mo.

14

UNICEF MNPs3 US cents/sachetShelf life 2 years1g/sachet (very light)1 box = 30 sachets

Advantages: Delivery Concept• Easy to use and high acceptability among families and children;

focus on ages 6 – 24 months

• A food-based rather than a medical approach

• Does not require literacy

• Does not conflict with breast-feeding practices

• Used to promote the timely introduction of complementary foods at 6 months of age and proper weaning practices

• Can be used for other ages throughout the life cycle

• Light weight, easy to store and transport

• Inexpensive and low tech to manufacture.15

16

Experience from Haiti• MNPs added to Supplementary Feeding

Programme– MNPs distribution (30 sachets/60 days) alongside food

distribution– Recommended dose: 1 sachet/day– Education• Pamphlets in ration• Mothers’ groups• Instructions at distribution

– At 2 and 9 mo after the start of the intervention children receiving BOTH WSB and MNP had significantly lower prevalence of anemia

Menon et al. Journal of Nutrition. Jan 07.

Issues and constraints to MNP use/scale-up

• Product registration- Food or pharmaceutical

• Composition • Packaging• Production capacity• Does sharing occur?• Need more operational

experience• Need programme guidance• Need quality documentation

of scale-up experiences

17

Funding required (9.3 mln) for 6 months

NGCAs, 6-11 months

3.7 mln(2.0 mln CF +1.7 mln BMS/diapers)

NGCAs, 12-23 months

3.5 mln

IDPs, 6-11 months

1.1 mlnIDPs, 12-23 months

1 mln