Scoop situation - Field Exchange - Emergency Nutrition Network

ContentsField Articles2 Nutrition coordination in Zimbabwe:Achievements and Challenges12 Treatment of severe malnutrition inTanzania – a problem with ‘scoops’• PostscriptResponse on F-75 and use of measuringscoops21 Socio-Cultural Determinants of FoodSharing in Southern Sudan26 Wet nursing for refugee orphans inBangladesh• PostscriptUNHCR Comment29 Evaluation of Relactation by theSupplemental Suckling TechniqueResearch4 Review of targeting methods in HIVprogrammes5 An investigation of anthropometric trainingby NGOs6 Mortality and nutrition surveys by NGOs7 Famine in North Korea: Markets, Aid andReform8 Market analysis and humanitarian action inNiger8 Livestock Feeding Support as DroughtResponse9 Assessing micronutrient deficiencies inemergencies10 Triggers, Early Warning and Response inFFP Assistance11 WHO growth reference for children andadolescentsNews14 Regional workshop on IFE in Bali 200814 The Humanitarian Response Index15 New Red Cross Guidelines for CashTransfer Programming15 IASC Guidance on Mental Health andPsychosocial Support in emergencies15 Health and Nutrition evaluation guidelines15 FAO Livelihoods Assessment and Analysise-learning course16 WHO Technical Consultation and Updateon HIV and Infant Feeding16 Launch of The Lancet’s Series on Maternaland Child Undernutrition16 Sphere Project celebrates 10th anniversary17 Nutriset and Valid Nutrition sign licenceagreement17 WHO/UNICEF Joint Statement on OptimalIodine Nutrition17 Revival of ‘New & Noteworthy in Nutrition’18 Joint Statement on micronutrientdeficiencies in emergencies18 Reporting Skills and Professional WritingHandbook19 Report on WFP Training Workshop in Sudan19 Changes in eligibility for specialised food forHIV positive adults20 Workshop on the Integration ofCommunity-based Management of AcuteMalnutrition (CMAM)25 ENN led Management of Acute Malnutritionin Infants (MAMI) ProjectEvaluation23 WFP Targeted Supplementary Feeding inEthiopia25 Real time evaluation of Pakistan FloodResponseAgency Profile27 Department of Nutrition for Health andDevelopment (NHD), World HealthOrganisation33 People in AidFrom the EditorThe devil is in the detailIn this edition of Field Exchange we have anumber of field articles that address verydetailed programming issues.A field article by ACF deals with theexperience of implementing thesupplementary sucking technique (SST) forthe many infants under six monthspresenting at therapeutic feeding units inKabul, Afghanistan. Although the techniqueappears to lead to good outcomes whencorrectly applied, there were many instanceswhere the SST was not well implemented.For example, many infants were consideredcured when still mixed feeding and evenwhere infants were discharged on breastmilkalone, mothers often reverted to mixedfeeding at home. Unit staff found the admissioncriteria vague and difficult to apply, andwere also confused by the treatment protocolsand discharge criteria. Many of theinfants presented with breastfeeding difficultiesbut were not severely malnourished. Theauthor’s frank evaluation of their programminghas led them to question whether theadmission criteria used in the Kabul contextwere the best ones and whether the risks ofmanaging young infants, who need skilledsupport but may not specifically need to bein these intensive care centres, outweighsthe benefits.Another field article by Yara Sfeir of UNHCR,describes the challenges of feeding a smallnumber of infant orphans amongst Rohingarefugees in a camp in Bangladesh. Befittingthe local context, it was decided to locatewet nurses for these infants. However,locating wet nurses was not straightforward,even though there were only five orphans.Eventually, wet nurses were found in thewider community, i.e. not just amongstrelatives. Even then, a number of practicalproblems emerged, for example onehusband didn’t want his wife to breastfeedanother person’s child while one wet-nursefound it difficult to come to the centre tofeed eight times a day as she lived somedistance from there. There were alsosecurity issues about attending the centre atcertain times. All these challenges wereeventually met through ‘creative’ adaptationand according to the author, were well worththe effort.An article by Chloe Angood fromSouthampton University describes theproblems of using scoops provided withNutriset F75/F100 therapeutic milk formula.Through her work in a paediatric ward inTanzania where mortality rates amongstseverely malnourished children were veryhigh, she observed a number of difficulties inusing the Nutriset scoops. These includedover-feeding children, nurses finding it difficultto calculate the correct recipe for differentfeed volumes, miscounting of scoops andthe difficulty of making up individual feedsfor each child. A number of practicalrecommendations are made by the author toaddress these problems. Nutriset havewritten a post-script addressing some ofthese issues.These articles remind us that although wemay think our programme approaches andimplementation tools are the right ones,reality on the ground may, at times, causeus to re-assess how we do things.Approaches cannot just be devised andimplemented from ‘on-high’. We need to holdthe old mantra about ‘bottoms-up’programming at the forefront of ourthinking. In other words, not only is thedevil in the detail, but so is the answer.We also have our usual ‘bigger picture’material in this issue of Field Exchange.There is a particularly interesting field articleabout nutrition sector coordination in thecurrent Zimbabwe crisis, written by DianneStevens from UNICEF Zimbabwe. The articledescribes how UNICEF and partners havegradually plugged the coordination vacuumin Zimbabwe through establishing a NutritionTechnical Consultative Group (NTCG) thatnominally focuses on consultation and bestpractice, but in effect has become acoordination mechanism that is accepted bygovernment. Achievements of the NTCG todate, especially given the challengingprogramming environment, are considerable.These include greatly expanding reliable datato inform programming and mappingactivities in the nutrition, water and healthsector thereby strengthening inter-sectoralcoordination.We know from recent history how importantit is to get humanitarian co-ordination rightand what happens when we don’t.Coordination is essential for strategicplanning, gathering data and managinginformation, mobilising resources, ensuringaccountability, having a clear division oflabour and providing leadership. The work ofthe IASC global cluster (see Field Exchangeissue 31 news section) is making strikingheadway in strengthening country levelcoordination across a range of sectorsincluding nutrition. As highlighted by DianneStevens, while the cluster approach has notyet been officially activated in Zimbabwe,the approach has been collectively endorsedat a Workshop on Humanitarian Reform inJune 2007, and endorsed by the IASCCountry Team.This issue of Field Exchange also contains awide range of research, evaluation and newspieces. Research topics include summaries ofpapers on the development of the WHOgrowth reference for school-aged childrenand adolescents, and on livelihoods-baseddrought responses in pastoralist areas ofEthiopia. There are also summaries of areal-time evaluation of the response to thePakistan floods in 2007 and of a retrospectiveevaluation of the targeted supplementaryfeeding component of WFPs protracted reliefand rehabilitation programme (PRRO) inEthiopia from 2005 onwards.We hope you enjoy this issue of FieldExchange and, as always, please feel free towrite in with contributions and opinions.Jeremy ShohamEditorAny contributions, ideas or topics for futureissues of Field Exchange? Contact theeditorial team on email: office@ennonline.net1