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Food Security Unit –PLG Feb 2004
Presentation by : Dr Roohullah Shabon
Emergency Health & Nutrition Specialist
Save the Children,Emergency and Protection Unit,
Washington DC
SC Emergency Health & Nutrition Program in Ethiopia
Tens of thousands of people are estimated to have died from the food crisis in Ethiopia and over 13 million are still dependent on food aid for survival.
SC Emergency Health & Nutrition Program in Ethiopia
Save the Children-US Emergency Health and Nutrition Program (EHNP) aims at developing its activities in an integrated approach including health and nutrition. All program activities are undertaken with the goal of both immediate humanitarian relief and long term sustainable development.
Activities: Together with Government and other agencies.
Early Warnings System Collected, compile and analysis nutrition surveillance and
food security data. Revise and standardize early warning indicators and
parameters Conduct one-week rapid assessment of early warning
system.
Rapid Assessments Conducted 13 Rapid Assessments and participated in two
Consolidated Appeals. Development of “Rapid Health, Nutrition and Food
Security Assessment Tools” , Rapid Assessments guideline and train the staff.
Cont. Activities: Together with Government and other agencies.
Nutrition Surveys Development of nutrition survey guidelines, training
of the staff and technical and/or financial support provided to 17 Nutrition Surveys
Sub granting of Funds Funding has been provided to a total of 9
NGOs and 3 government agencies
Cont. Activities: Together with Government and other agencies.
Rapid Nutrition Response Programs At present running 6 TFCs, 1 NRU, 4 SFPs and 2 OTPs (Outpatient Therapeutic
Programme). A total of 4 CTC programs has been established by the EHNP in Arbegona, Aroresa, Bensa and Hulla woredas.
Admitted a total of 3,307 patients, of which 78.04% were cured. From March up to October 2003 , there were 725 severely malnourished
children in treatment. Handed over 5 TFCs; four to the government and two to local NGOs.
Health Unit and W/S UnitsThe Units will strengthen the EHNP Project Units’ health promotion efforts and build the local capacity of the regional/zonal MOH in terms of therapeutic/supplementary feeding management, health & nutritional surveillance, health and sanitation education and malaria control.
Therapeutic Feeding Centre
The objective of TFC is to reduce morbidity & mortality associated with severe malnutrition & restore health promptly in a population of affected areas.As soon as the numbers of severely malnourished cases are more than the capacity of the health facility, specific structure like Nutrition Rehabilitation Unit (NRU) is set up within the health facilities. When this is not possible as in emergency situations, TFC should be started.
The decision to open TFC is based on:
Result of Nut. Survey and Rapid Assessment. The prevalence of Severe Acute Malnutrition (SAM)
in a random survey among children under five years old is more than 3%.
The prevalence of Global Acute Malnutrition (GAM) is more than 10%.
Under-five mortality rate is more than 2/10000 per day.
The absolute number of severely malnourished is over 20 cases
Closure of TFC
Decrease in TFC admissions over 2 consecutive months, and average number of patients for the last two consecutive weeks (14 days) less than 20 inpatients in TFC
Under five mortality rate < 2/10000 per day
Prevalence of Severe Acute Malnutrition (SAM) < 3%
Prevalence of Global Acute Malnutrition (GAM) < 10 %
STAFFING PATTERN of TFC
Nutritionist Nutrition workers Health workers Logisticians Cooks, cleaners, guards Outreach workers Health educators/social workers
Community-based Therapeutic Care (CTC)
Start with supplementary feeding from Sudan, Ethiopia and Malawi, CTC is the best means to quickly respond to an emergency situation where there are high or increasing levels of severe malnutrition.
The CTC concept aim to integrate emergency nutrition with long-term programs by establishing structure that can be re-activated in future emergencies.
The main principles of CTC are
Coverage Access Timeliness Sectoral integration Capacity building
CTC has the following elements:
Therapeutic Feeding Centre (known as a Stabilisation Centre (SC) in our program):
The TFC will be only for severely malnourished children who are not well enough to be treated at the OTP site. They will be treated as inpatients until their condition is stable enough for them to be discharged home (normally 5-10 days). Some children will not respond to treatment at the TFC and will need to be referred to hospital.
Supplementary Feeding Programmed (SFP): This is made up of a two-weekly dry ration of Famix
or CSB, health education and very basic medical care in collaboration with existing health facilities
CTC has the following elements continue:
Outpatient Therapeutic Programme (OTP): There will be an OTP at every SFP distribution site. This is where the majority of severely malnourished children will be assessed and treated.
Outreach work. The community element of the CTC program must be strong in order to mobilize mothers/caretaker to bring their child to the SFP/OTP for screening.
Management Phases of CTC:
Stabilisation phase This is the initial phase of
treatment of severe malnutrition with complications as inpatient in stabilisation centre (previous TFC): life-threatening problems
are identified and treated specific deficiencies are
corrected metabolic abnormalities
are reversed feeding begins
Stabilisation phase
Target group: Children with
severe malnutrition with complications
Treatment According to WHO
protocols for the initial phase of the treatment of severe malnutrition with complications
Outpatient Therapeutic Programme (OTP)
2 groups of admissions: Direct OTP Indirect OTP
Direct to OTP People with severe
malnutrition with no complications
Admitted directly into OTP with no stabilisation phase
Indirect to OTP People who previously has
severe malnutrition with complications admitted into OTP after discharge from Stabilisation Centres
OTP treatment
RUTF (Ready Use Therapeutic Feeding) every week or two weeks
Systematic medication Direct OTP
Amoxicillin Vitamin A, Folic
Acid Mebendazole Anti-malarial Vaccination
Supplementary Feeding Programme (SFP)
Dry take home supplementary ration
Basic health care De-worming
Vit A
Measles
Consultation and appropriate referral if
necessary
Admission criteria same as WHO
Advantage of CTC
CTC programs bring treatment out of the center and to the peripheral areas. Thus greatly increasing coverage.
CTC programs are not meant to replace TFCs but to complement and integrate them into a larger, more accessible, and holistic program that allows better follow-up of patients.
Contin. Advantage of CTC
Integrates with food security programmes Shared trainings, workers Demonstration gardens Promotion of crops for local RUTF
Includes local production of RUTF where appropriate
Wide range of linkages to key social structures, key individuals
Mother to mother techniques for education and increasing participation
3. What is the difference of CTC & TFC
TFC 24 care centre based Food targeted to the child Use F100 and F75 Close/continuous follow-
up Quick weight gain More widely understood &
accepted High cost Cross infection Decrease household
economy-mothers away 20 days
Good for patients with complication dehydration and septicaemia.
What is the difference of CTC & TFC
CTC Stay in the household and
community based Empowering the family Mother to mother support
with PDI approach Use Ready to Use Therapeutic
Food (RUTF) Treating malnutrition where it
occurs More Coverage Community awareness and
participation lead to address food insecurity
Evolvement from emergency to development and vice versa
Study/Sphere:85% (75) Cure,4.1(10) Death,4,7(15) Default
Challenges to the CTC approaches :
Logistics-distance, weather, etc making outreach somewhat difficult
Lack of capacity and understanding in the government makes sustainability & exist strategy shaky
Resource intensive operation and need functional health centres system
CTC being new approach acceptability by partners is questioned