Scoop situation - Field Exchange - Emergency Nutrition Network

More documents

Recommendations

Info

Training in ActionC Angood, Tanzania, 2007leads to considerable wastage. With a limitedcountry supply of F75 and F100 sachets available,this system is unsustainable.To avoid wastage, nurses prefer to make uponly the volume of feed required on the wardevery 3 hours. In the absence of dietary weighingscales, scoops are a practical way of measuringthe right amount of F75/ F100 powder tomake up feeds. Nutriset provides a packet ofsmall red scoops inside each box of F75 andF100 to help with exactly this problem. Thesescoops measure approximately 4g of F100/ F75powder. The instructions that come with thescoops instruct users to add 20ml water to onescoop of F75 and 18ml water to one scoop ofF100. This is potentially a very helpful solutionfor nurses. However, in practice, the use ofthese scoops throws up problems.Problems with the Nutriset ‘red scoop’The following problems were observed in theapplication of these instructions in Tanzania:1. Children are commonly overfed F75. Thefinal volume of ‘made up’ F75 or F100 isnot stated. Nurses commonly assume thatthe final volume is the same as the volumeof water added (e.g. 20ml when makingF75, when, in fact, the final volume is 20%higher, i.e. 24ml). If a child is prescribed100ml F75, nurses using this system willcommonly feed the child 120ml. This putsthe child at risk of fluid overload.2. Nurses find it difficult to calculate thenumber of scoops to use for different feedvolumes. For example, if a child requires80ml of F75, the nurse must divide 80ml by24ml to find the number of scoops ofpowder to use. The answer is 3.3, whichmust be rounded to 4 scoops. The nursemust then calculate how much water toadd by multiplying 4 by 20ml (which is80ml water). The maths skills of the nursesencountered were generally quite low andall found this calculation to be verycomplex. Calculations were frequentlywrong, leading to risk of either fluid overload (if too much F75 is given) or hypoglycaemia (if too little F75 is given). To avoidthis calculation, a table is needed showingthe volume of water to add to 1, 2 3 scoopsetc., and the final volume of reconstitutedF75 or F100. But Nutriset does not indicatethis final volume per scoop, and so thetable is difficult to create.3. Miscounting of scoops: When making upfeeds, it is very easy to miscount thenumber of scoops when the numberrequired is above 5. This happens whenfeed volumes are in excess of 100ml, whichis very common. This means that it is alltoo easy to reconstitute feeds incorrectly.4. Difficulties of making up feed for severalchildren: The red scoop is too small whenthere are more than 10 severely malnourishedchildren, all feeding 2 or 3 hourly.Larger quantities need to be prepared whichrequires a larger scoop. The big challengewith this method is finding an accuratemeasure of one quarter/one half of a sachet.Possible solution to the problem of‘scoops’A meeting of the partners was held in October2007, including representatives from MuhimbiliNational Hospital, Morogoro RegionalHospital, Amana District Hospital, TFNC,WHO Tanzania, Muhimbili National Hospital,the IMTF and University of Southampton. Theabove issue of scoops was discussed. It is verydifficult to source ready-made, calibratedscoops in Tanzania. Much research was doneduring the 6 months and no satisfactory solutionwas found. The possibility of sourcing ormaking better scoops in Tanzania was consideredby the partners, but quickly dismissed dueto technical and resource constraints. Instead itwas felt by the group that Nutriset shouldconsider adapting the existing red scoop tosomething more useful that could have internationalapplicability. Specifically, the groupwould like to request the following fromNutriset:PostscriptResponse on F-75 and use ofmeasuring scoops By Mamane Zeilani, NutrisetMamane Zeilani is Director for International Development and Nutritional Strategies at Nutriset, includingproduct Research and Development Before joining the team in August 2006, he implemented and oversawemergency nutrition and food security programmes in west and southern Africa (Malawi, Burundi,Eritrea, Zimbabwe, Niger), and Asia (DPRK, Afghanistan and Tajikistan) for several international NGOs.Since 1986, Nutriset has been very involved inseeking practical solutions for the developmentof quality nutritional products. These productsare today widely used by humanitarian actorsin the developing countries. Among them aretwo formulae utilised in the dietetic treatmentof severe malnutrition, mostly in children agedunder 5 years of age. These therapeutic milks,named F-75 and F-100, are used for the initialtreatment (or stabilisation phase) and for nutritionalrehabilitation of severely acutelymalnourished children, under medical supervisionand according to internationally recognisedguidelines and protocols .From large scale to individual solutions(using scoops)The F-100 formula was designed in 1993 and F-75 in 1994. They were first used in large emergencies.As is the case for the majority of productsdeveloped by Nutriset, packaging andinstructions were initially created to reflect thesituation on the ground. The need of the internationalcommunity was to rapidly treathundreds of children in any given therapeuticfeeding centre (TFC). Thus, at the request ofnon-governmental organisations (NGOs), eachsachet contained the quantity of milk powderrequired to make up 2.4 litres of formula. Thiswas considered to be the most pragmatic solution.The sachet had to be manufactured in sucha way so as to withstand tough transport andstorage conditions. The quantity of F-75 and F-100 added to 2 litres of boiled water is 410g and456g, respectively. NGOs did not request anymeasuring instrument for smaller quantities.With the progressive and extensive implementationof the WHO manual for the managementof severe malnutrition , Nutriset adaptedits supply in terms of products and packaging.Smaller size TFCs were set up in countriesfacing nutrition emergencies. However, the lackof refrigeration facility and the resultingwastage of therapeutic milk then became a seriousissue. To satisfy a special request from oneof its partner working in such a context (treatingsmall number of children at any one time ina TFC), Nutriset developed red measuringscoops. This enabled field workers, and particularlylocal staff, to easily measure the exactquantity of milk powder needed to preparesmall quantities of F-75, as well as F-100. Thesered scoops are also used to make up ReSoMal(Rehydration Solution for the SeverelyMalnourished).Ongoing research and developmentThese red scoops are currently packed in everybox of F-75 therapeutic milk manufactured byNutriset in Malaunay, France. Further technicalsolutions, including the development of smallersachets, have been sought and are reachingfinal technical validation stages. Moreover,sachets that contain the equivalent of either aquarter or a half of the original F-75 sachet havesuccessfully passed the final validation processin 2006.As can be seen, Nutriset is constantly seeking todevelop products and related packaging solu-13
Field Articlea) Much clearer instructions that avoid confusionand miscalculations and that explainhow much water to add to each red scoopand the resulting volume of feed.Instructions could include a chart of precalculationsfor 1, 2, 3 scoops, etc.b) A scoop that accurately measures onequarter of a sachet (perhaps a blue scoopfor F100 sachets and an orange scoop forF75 sachets to co-ordinate with respectivebox and sachet colours) with clear instructionsthat explain how many scoops to use,how much water to add and the resultingvolume of feed (instructions should detailhow to make one quarter and one half of asachet).For more information, contact:Chloe Angood, Institute of Human Nutrition,University of Southampton,email:c.angood@soton.ac.ukFeed preparation instructions on thewall in one hospital before the training– these are copied from the NutrisetinstructionsThe reorganised feeding stationwith new, clear instructions,after the trainingC Angood, Tanzania, 2007Regionalworkshop onIFE in Bali 2008A three day strategy workshop/one day trainingon Infant and Young Child Feeding inEmergencies (IFE) is scheduled to be held inBali, Indonesia on 10-13th March, 2008. Thisworkshop is being organised under theauspices of the Inter Agency StandingCommittee (IASC) Global Nutrition Cluster 1that is led by UNICEF. Within the cluster, themain organiser is the IFE Core Group 2 , incooperation with UNICEF East Asia andPacific Regional Office, UNICEF South AsiaRegional Office and the Ministry of Health,Indonesia. The Emergency Nutrition Network(ENN) as co-ordinator and representative 3 ofthe IFE Core Group is co-facilitating this workshop.The workshop is funded by the GlobalNutrition Cluster and by contributions and inkindsupport of IFE Core Group members.This strategy workshop on IFE has been identifiedas a key step to help improve coordination,policy guidance, implementation andresponse capacity in the region. The focus ofthe workshop is on emergency preparednessand improving the early response to protectand support IFE. Indonesia was chosen as thehosting country in order to learn from theirIFE experiences in the recent tsunami andearthquake responses.The workshop will bring together participantsfrom a mixture of key government, UN,donor, international and local NGO representativesfrom 16 countries – Afghanistan,Bangladesh, Cambodia, China, India,Indonesia, Maldives, Myanmar, Nepal,Pakistan, Papua New Guinea, Philippines, SriNewsLanka, Thailand, Timor-Leste and Viet Nam.The objectives of the meeting are to:• Increase awareness of the importance of IFEin the region, including orientation on relevantpolicy, guidance and key issues in IFE• Identify key constraints to providing earlysupport and protection for appropriateinfant feeding practices in emergencies, and• Identify strategic directions and practicalsteps to address these at country andregional levels.Further information and an agenda are availableon the ENN website and from the keymeeting contact (below). A summary of themeeting report and of experiences shared atthe workshop will feature in future issues ofField Exchange.For further information, contact:Ali Maclaine, tel (UK): +44 (0)20 8989 5735fax: +44(0) 1865 324997email: alimaclaine@btinternet.comor Marie McGrath, ENN,email: marie@ennonline.netThe Operational Guidance on Infant and YoungChild Feeding in Emergencies (v2.1, Feb 2007) isnow available in Bahasa (Indonesia), Japanese andChinese, online at http://www.ennonline.net/ife1http://www.humanitarianreform.org/2The IFE Core Group is an inter-agency collaboration thatcomprises UNICEF, UNHCR, WFP, WHO, EmergencyNutrition Network (ENN), Action Contre la Faim and CAREUSA. It is co-ordinated by the ENN.3The ENN/IFE Core Group is a member of the UNICEF-ledIASC Global Nutrition Cluster on behalf of the IFE CoreGroup and highlights IFE issues in global cluster activities.tions best adapted to the context of humanitariannutrition interventions. Having readChloe Angood’s article in this issue of FieldExchange it is clear that further work needsto be done in order to facilitate the use of F-75 and F-100 therapeutic milk by nutritionistsin the field. Nutriset would like toacknowledge the great value of the workdone by this research group.Nutriset would like to invite organisationsand individuals that train and/ormanage therapeutic feeding programmeswithin health structures in the developingworld to contact us, as we would be verypleased to explore new means of improvement.Nutriset will welcome solutions toimprove packaging of F-75 and F-100, aswell as its other products for the treatment/preventionof malnutrition. Our teamwill work to clarify instructions accompanyingred scoops to enable everyone tocomprehend the quantities of scoopsneeded per quantity of water to make upthe different volumes of feed.For more information, contact:Mamane Zeilani, Nutriset,email:mzeilani@nutriset.fr ornutriset@nutriset.frThe Humanitarian Response IndexSummary of published news 1A recent news piece in the Lancet covered thelaunch by Kofi Annan, former UN SecretaryGeneral, of an index that ranks 23 countries inthe Organisation for Economic Co-operation(OECD) according to their effectiveness inhumanitarian donorship. The HumanitarianResponse Index aims to make donors moreaccountable by ranking them according to 57indicators that reflect the principles and goodpractices that govern humanitarian action.The Indicators are focused around fivethemes – responding to humanitarian needs,integrating relief and development, workingwith humanitarian partners, implementinginternational guiding principles, and promotinglearning and accountability. The outcomesare based on hard data and the views of varioushumanitarian agencies working on theground in eight countries.According to the index, Sweden is the mosteffective donor and Greece is the least effective.The wide-ranging indicators also high-light where donors could ‘do a lot better’. Forexample, the UK is ranked ninth andalthough it scores well in the amount ofmoney given and its speedy response tohumanitarian crises, it is let down by having apoor human rights record.The authors conclude that this new index is auseful “report card on donor activity” but itwill only be truly effective if it inspires donorsto improve their humanitarian donorshiprecord. Individual citizens, civil society, nongovernmentalorganisations, and politiciansshould use this new tool to hold their governmentsto account.For more on the Humanitarian ResponseIndex, visit the website of DevelopmentAssistance Research Associates (DARA) whohave devised the index,http://www.daraint.org/1The Humanitarian Response Index. The Lancet - Vol.370, Issue 9603, 8 December 2007, Page 1880. Registerfor access to full text at http://www.thelancet.com14
Page 1 and 2: January 2008 Issue 32ISSN 1743-5080
Page 3 and 4: Field ArticleA health centrein Zimb
Page 6: ResearchMUAC measurement in MalawiA
Page 9 and 10: Women and children,in the village o
Page 12 and 13: ResearchWHO growth reference forchi
Page 16 and 17: NewsNew Red CrossGuidelines forCash
Page 18 and 19: NewsNutriset and ValidNutrition sig
Page 20 and 21: NewsWFP/T Loro, Sudan, 2007 WFP/T L
Page 22 and 23: Field ArticleSocio-CulturalDetermin
Page 24 and 25: Field Articletices such as buro) ar
Page 26 and 27: EvaluationReal timeevaluation ofPak
Page 28 and 29: PostscriptUNHCR CommentAnn Burton,
Page 30 and 31: Field ArticleEvaluation ofRelactati
Page 32 and 33: Field ArticleAdmission weights rang
Page 34 and 35: Sphere Project, 2006Sphere Project,
Page 36: Emergency Nutrition Network (ENN)32

Scoop situation - Field Exchange - Emergency Nutrition Network

Create successful ePaper yourself

Delete template?

Save as template?