/
ccording to the World Health Organization(WHO), deficiencies in iron, ccording to the World Health Organization(WHO), deficiencies in iron,

ccording to the World Health Organization(WHO), deficiencies in iron, - PDF document

test
test . @test
Follow
393 views
Uploaded On 2015-07-24

ccording to the World Health Organization(WHO), deficiencies in iron, - PPT Presentation

mineral premix provided by UNICEF thisproject has overcome many of the difficultiescommon in countries emerging from conflict toprovide monthly fortified maize rations to115000 beneficiaries In Za ID: 91616

mineral pre-mix provided UNICEF

Share:

Link:

Embed:

Download Presentation from below link

Download Pdf The PPT/PDF document "ccording to the World Health Organizatio..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

ccording to the World Health Organization(WHO), deficiencies in iron, vitamin A anddeath through disease in developing countries.Most people affected by micronutrient deficienciesdo not show overt clinical symptoms nor are theythemselves necessarily aware of the deficiency, aphenomenon called Ôhidden hungerÕ. Yet hiddenhunger makes people susceptible to infectiousdiseases, impairs their physical and mentaldevelopment, reduces their labour productivity andThere is a close relationship between malnutrition,which is often linked to lack of food, andspecific micronutrient deficiency diseases thatin micronutrients. Iron deficiency, for example,is one of the most widely prevalent micronutrientdeficiencies in the world, afof all pregnant women and young children indeveloping countries. A lack of vitamin A is notonly the leading cause of child blindness acrossdeveloping countries, it also affects childrenÕsimmune systems and is directly responsible formore than ten million deaths each year. Thedeficiencies often exceeds two percent of gross mineral pre-mix provided by UNICEF, thisproject has overcome many of the difficultiescommon in countries emerging from conflict toprovide monthly fortified maize rations to115,000 beneficiaries. In Zambia, iron deficiency was a seriousproblem among camp-restricted refugees. WFPand its partners imported, installed and trainedworkers in the use of two Containerized Millingand Fortification Units (MFUs), halved iron-deficiency anaemia and reduced vitamin Adeficiency among camp residents. In addition,WFP dramatically reduced waiting times forrefugees who used to have their whole grainmaize rations milled at small local facilitieswith insufficient milling capacity. The context and scale of each of the three case-studies described in this paper was different,but the lessons learned are comparable. Allprojects were succesful in their own right, but alsorequired a considerable amount of staff time andsupervision as well as external technical expertise,WFP operational context. In order to expand andsustain the provision of fortified cereal flour toWFP beneficiaries and beyond, getting the privatemilling sector as well as governments on boardwould be crucial. Where this is not possible, suchas in very isolated, difficult to reach locations,strong, specialized partners are a prerequisite, butthese are few in number. Alternatively, in suchcontexts or in situations where the need isurgent and cannot be met through local flourfortification in the short term, other approachesto improve the diet, such as the use ofmultimicronutrient formulations, packed forindividual or household use, may be more World Food Programme WFP World Food Programme WFP and prevalence of micronutrient diseases inmicronutrient deficiencies through flourfortification should be a priority, especially as thecosts involved are low and the impact on thehealth of Afghans would be enormous.WFP has distributed flour Ð milled and fortifiedelsewhere Ð through its food assistance projectfor Internally Displaced People (IDPs) inAfghanistan for many years.Aware that flour fortification could help toaddress many of the micronutrient deficienciesamong the broader Afghan population, WFPbegan to investigate the possibility of launchinga micronutrient fortification programme in In November 2002, a comprehensive report wasissued on ÔFlour Fortification Issues inAfghanistanÕ, which assessed the capacity ofboth small- and large-scale flour mills in Kabuland Mazar and advocated that flour fortificationcould, and should, be pursued on both levels inAfghanistan. Based on examples of flourfortification in Tajikistan where the situationwas very similar to Afghanistan, the reportproposed some potential fortification strategiesas well as their likely costs.Following these initial recommendations, aconsultant from MI with substantial experiencewith small maize mills in southern Africa andlarge wheat mills in Pakistan, investigated theBased on this work, it was proposed that flourfortification should commence in small-scalechakki mills as soon as possible. The mills,whether water or generator run, were regardedas suitable for manual fortification, i.e. addingthe micronutrients (vitamins A, B1, B2, Niacin,Folate and the mineral Iron) by hand to thewheat grain while it is being milled and soproducing fortified flour. Discussions were alsowhom agreed to proceed with flour fortification.Meanwhile, WFP asked MI to suggest ways ofensuring the long-term success and sustainabilityof flour fortification in Afghanistan, since WFPcannot guarantee funding for such a lengthyproject. For this reason, MI India undertook asocial marketing study on flour fortification. Theresulting report ÔThe Softer Side of NationRebuilding: Promoting Fortified foods inAfghanistan - A Social Marketing ApproachÕ,argued that millers would need strategic supportto help them create effective brand names in orderto promote this new product. Furthermore, it wasawareness among the population about the benefitsof fortified flour would have to be undertaken bythe MoPH, with the support of WFP.On the basis of these reports andrecommendations, the MoPH and WFP started asmall-scale wheat flour fortification project inKabul in March 2004. This pilot project wasdesigned to be part of a broader fortificationstrategy developed by the MoPH. The small-scale flour fortification project wasfunded by the Canadian InternationalDevelopment Agency (CIDA) under the FoodPlus programme and funding for premix was World Food Programme significant impact that fortification has onreducing micronutrient deficiencies. Despite the various constraints andmanaged to produce over 1,250 tons of fortifiedflour. Based on data on flour consumption inAfghanistan (500g per person per day; FAO,2002) almost 4,000 people received locallyproduced fortified flour for 24 months.A baseline survey was conducted prior to thestart of the flour fortification programme in thearea. The survey was based on a random sampleof 1000 women and 1000 children to assess theprevalence of anaemia and the iron levels inchildren under five and women aged 15-49.Furthermore, information on flour purchases,data on the dietary patterns of adults anddeficiencies were also collected.The pilot project in Badakhshan began in June2004 in 10 mills around the town of Faizabad,each with a daily capacity of 1 ton. An NGO,FOCUS, was contracted to dilute the premixand monitor the project on behalf of WFP andthe MoPH. The project ran successfully for afew months but was suspended in September WFP from adding a vitamin and mineral premix to whole wheat grains to the endproduct, a packet of fortified flour. vitamins or minerals. Their men take the wheat for milling and they made no decisions regarding whether to fortify their wheat flour or not; however, after informing them about flour fortification and the benefits of vitamins and minerals, the women became interested and they committed themselves to fortifying their flour if they got the chance.4.CoverageCommunity leaders were concerned that the programme did not have wide coverage, especially in those districts which become isolated in winter and among those people who buy flour from the market and/or bread from the bakeries. It was suggested that the UN should also consider mass fortification of all locally produced and imported flour.Peaks and gaps in flour production at small availability of wheat grain both at market and household level. The calculation for premix was based on the maximum capacity production per day (200kg-750kg) and as a result some of this expensive commodity was not immediately utilized and expired.Before introducing a programme, a participatory approach should be considered different target groups such as authorities, the private sector.After the fortification programme ended inBadakshan, an appraisal mission evaluated thefortification programmes. The mission foundsufficient evidence to conclude that fortificationwill have a significant impact on health indices inaddition, the mission agreed that flourfortification is both a practical and feasiblesolution to the micronutrient deficiencies of theAfghan population, particularly as bread is thestaple food of most families, whether rich or poor. However, the mission concluded that small-scalefortification is not the most effective means ofintroducing, and certainly not of expanding, flourfortification in Afghanistan, as this approachrequires intensive and sustained interaction withmany producers, while overall output is limited.At the same time, large-scale mills are becomingoperational in Afghanistan, providing a more cost-efficient channel for the delivery ofmicronutrients to the population at large.Considering these recommendations, WFPAfghanistan formulated a new plan to expandinto large-scale flour fortification by workingcities (Kabul, Mazar, Kunduz and Hirat). Future plans: large-scale When the small-scale fortification projectbegan, no large mills were functioning in thecountry. Since then, several large-scale millswith modern technology have begun operatingWorld Food Programme WFP lagued by almost three decades of war,Angola has required external food assistancefor many years. Once pronounced to be the worstcountry in the world in which to be a child, closeto half of AngolaÕs children aged under five, some45 percent, have already had their growth stuntedby malnutrition and related diseases. Until just two years ago, the town of Kuito in Bieprovince was home to more than 100,000 IDPs,many of whom were almost entirely dependenton food aid for survival. The original residents ofKuito also found it difficult to cultivate their ownfood, with the front lines of the conflict nearby,fields littered with landmines and the townbesieged for long periods. In 1999, the NGO MŽdecines Sans Frontires(MSF) diagnosed the first case of pellagra, adisease caused by a deficiency in the micronutrientniacin, in Kuito. Pellagra is generally a rareemergencies in countries such as Malawi,Mozambique and Zimbabwe, all places where dietsare monotonous and dominated by maize, which islow in niacin. Its symptoms are dermatitis,diarrhoea, dementia and sometimes death. In the following six months, 898 cases werediagnosed, and by 2002, more than 3,800 casesof pellagra had been registered. The growing pellagra outbreak prompted MSFand other organizations to distribute Vitamin Bcomplex supplements for women. WFP began todistribute dried fish and in mid-2000 it beganproviding corn-soya blend (CSB) to therapeuticfeeding centers and school feeding programmes,and to IDPs in 2001, in an effort to boost theintake of niacin and other essentialmicronutrients among its beneficiaries. Unfortunately, these responses were insufficientto stem the outbreak. MSF reported thatcompliance with the Vitamin B supplementswas low, and WFPÕs CSB rations were notavailable to the broader population. Since thebasic diet of people in Bie was still limitedmostly to maize, the cases of pellagra continuedto grow. Professor Mike Golden, an expert in nutrition inemergency situations, recommended that WFPfortify and mill maize upon arrival at the port ofWorld Food Programme WFP proper government channels at each provincial level.¥A comprehensive advocacy and communication strategy, essential to the long-term sustainability of the programme, activity is being sought. ANGOLA - a monthly monitoring system whereby samples of the fortified flour are tested at a laboratory to ensure the correct levels of vitamins and minerals have -a dialogue with MI and the Government of Angola to incorporate fortification at the national level. This includes establishingregulations and standards for fortificationother government officers. The fact that this plant is now functioning smoothly has demonstrated WFPÕs capacity in this area, building confidence in the ability of similar health and nutrition interventions to succeed in difficult or transition environments. The few initial problems in dealing with the private sector in a post-conflict maintenance practices, employee health and safety requirements, were outweighed by the private sectorÕs drive for efficiency and profit. WFPÕs large demand enabled it to negotiate good prices and as other companies enter the market it should become even more competitive and sustainable in the long term. The collaboration between UNICEF and WFP worked well, with UNICEF supplying the vitamins and WFP supplying the On the basis of this positive experience, the two agencies have expanded their work together to include education, water and sanitation projects. WHO also provided assistance with deworming activities. Donations of maize or cash with which to buy maize are not always predictable. WFPÕs reliance on voluntary donations, plus changes in the Government of AngolaÕs policy towards genetically modified foods meant that it was not always possible to guarantee a regular supply of maize to be fortified and Fortification of maize meal should be given priority in allocation of resources, given its vital role in preventing that fortified maize meal in Angola lasts anaverage of six weeks to three months on theshelf, meaning that it needs to be procured,milled, transported, distributed and consumedattention from logistics, operations, andimplementing partners to reduce unnecessaryOptions for preservatives and improved packaging should be explored. 3. Operating conditionsIn a post-conflict situation, many factorsoutside WFPÕs control impact on its ability todeliver: limited implementing andcommercial partners (includingdamaged infrastructure; poor energy supply; World Food Programme WFP support from CARE-Canada, had beencontracted by WFP and UNHCR to distributefood in this camp which was established in 2000for Angolan refugees. To support the projectÕsactivities in Zambia, a National Task Force wasalso set up that included representatives fromUNHCR, WFP, the Government of Zambia,CARE-Zambia, and two other NGOs, AfricanHumanitarian Aid (AHA) and ChristianOutreach Relief and Development (CORD). Two containerized MFUs were commissioned inAugust 2003 and have been in operationNangweshi Camp is located in Shangombodistrict in the Western Province of Zambia. Themain camp was established early in 2000 for15,000 Angolan refugees. In 2002, an extensioncamp was established to accommodate an influxof new refugees. The nearest town, Senanga, isabout 45 km awayVehicle access to the camp is difficult and involvescrossing the Zambezi by pontoon and drivingthrough sandy soils. Access is particularly difficultduring the rains and is dependent upon unreliablewater transport from Senanga to the camp.At the end of October 2003, there wereapproximately 26,500 refugees living in bothnationals lived within a 10 km radius of thecamp. Approximately 20 percent of the campÕspopulation was under 5 years of age and 40 percent between 5 and 17.WFP provides food as well as funds to and to AHA for supplementary feedingactivities. It also supports groups engaged inwarehouses and food distribution centers. In July 2003, an anthropometric andmicronutrient survey was conductedOverall, the anthropometric results for childrenunder five indicated a relatively satisfactoryoverall nutrition status, but anaemia in under-fives and vitamin A deficiency amongadolescents were cause for concern.WFP has supplied maize grain to the campsince it was established and maintains the grainsupply. Maize is the main commodity providedWithin the camp, food rations, including wholemaize, were distributed every 15 days to refugeehouseholds. On the days of food distribution,one member of each family queued for their World Food Programme WFP 2 The total population of Shangombo district according to the Zambian 2000 census was 82,353 and the town of Senanga had a population of 110,063.3 The survey was conducted by the Institute of Child Health, London, in collaboration with: the Tropical Disease Research Centre, Zambia; AHA; UNHCR;and CARE-Canada. Subjects were selected using systematic sampling based on house and population data supplied by UNHCR and CARE4 The Food Basket supplied by WFP was calculated using NutVal 2004 to provide on a per capita basis approximately 2154 kcal, 69 g of protein, 39 g fatand those micronutrients naturally present in the commodities supplied. Oil is generally fortified with vitamin A but this cannot always be guaranteed.Rations were composed of: maize grain - 450 g; beans - 120 g; vegetable oil - 20 g; and salt - 10 g. In addition, high energy protein supplements anddried skim milk are provided for use in supplementary and therapeutic feeding activities. The first year of operationsA milling coordinator was appointed by CARE-Zambia to be responsible for the overallmanagement of the MFUs along with two MFUsupervisors to oversee the day-to-day operationof machinery and staff. In addition, a millmechanic would be responsible for repairingThe supervisors were initially reticent to operatecomplexity compared with the simple hammermills with which they were familiar. However,within one day of training they were operatingthe units without assistance. Each MFU now hasone supervisor and 6 staff (men and women)who can control the milling and fortificationBoth MFUs have been operating for 6 hours perday for 26 days per month to meet the campÕsrequirement for fortified grain and no accidentshave been reported since the start of operations. 1. Food distribution and consumer Food rations continue to be distributed twicea month. However, with the introduction ofthe MFUÕs ration sizes were reduced. Therehave not been any problems linked to thereduction in the weight of rations as:refugees were probably losing anequalwhen they took their whole maize to thehammer mills to be ground; andrefugees no longer have to queue tohave their grain milled. The time saved has been much appreciatedby the refugees and has resulted in people,especially women and girls, having morefamily tasks or to attend school or courses. seven hammer mills operating in the campemployed over 40 people. With theintroduction of the two MFUs the totalnumber of people employed to supervise and4 Zambian nationals). These individuals haveacquired new and more sophisticated skillsand knowledge through on-the-job training inthe assembly of the plant, its operations,hygiene, first-aid and safety education. In various discussions during an evaluationimplementing partners reported a considerableimprovement in health and nutritional statusparticular, women and children were said to bestronger and less frequently ill, pregnancyoutcomes improved, and there were alsoreports of very specific improvements of, forexample, poor sight in pregnant women. Infact, the community sensitization may alsohave created some unrealistically highexpectations as refugees were now wondering:Òwhy should children still be getting sick?Óand Òwhy do old people not see well?Ó Results of the nutrition follow-up survey showsthat the introduction of fortified maize was required the implementing partners in the campto take on new roles and responsibilities. Thepartners have shown that integrating such anew initiative within normal day-to-day campmanagement is feasible and that in doing sothe partners acquire new managerial andtechnical skills. Refugees have been involvedas workers in the milling operations and have,Zambia, adapted well and with pride toworking with more sophisticated and complexequipment than they were used to. Getting both the government and the leadershipof the refugee community actively involved atan early stage helped pave the way for a smoothtransition from distribution of whole maizegrains to a fortified maizemeal through, forinstance, agreements on fortification levels andrefugee employment as well as solicitingcommunity support. Given the involvement of refugees in the millingand fortification of their own maize, propercommunity sensitization was particularlyimportant. The sensitization activities carriedout by AHA and CORD aimed at removinguncertainties with respect to the addition ofunknown substances to their food, were veryeffective, resulting in the refugee communitybeing very supportive towards the newarrangement. At the time of the evaluation, perceptions ofpositive outcomes were noted among therefugees, especially in terms of health of womencamp staff reported significant saving of timeby refugees as they no longer had to queue tohave their grain milled. Results of the nutrition surveys do indeed showthat the introduction of fortified maize wasassociated with improvements in theunder five was halved, while vitamin Adeficiency in adolescents decreasedsignificantly. There was also a significantdecrease in chronic malnutrition in under-fivesApart from the cooperative attitude of thebeneficiaries, the success of the Nangweshi on-site milling and fortification project islargely due to the efforts of the many actorsinvolved both nationally and internationally whohave worked closely together to take the idea ofa mobile, containerized mill and fortificationunit and turn it into a working pilot project inless than three years. In particular, the projecthas provided the country office in Zambia withthe experience and motivation to embark on anew, similar initiative: as the refugees from theNangweshi camp are currently being repatriatedto Angola, the milling and fortificationequipment will be redeployed in a camp forCongolese refugees in Northern Zambia, whereit will be used for the milling and fortificationof locally procured cassava. 7 Full details are given in a separate report ÔEvaluation of the nutritional impact of on-site milling and fortification in Nangweshi Refugee Camp, ZambiaÕ POLICY, STRATEGY & PROGRAMME SUPPORT DIVISIONNUTRITION SERVICEVia C. G. Viola, 68/70 - 00148 Rome, Italywww.wfp.org Layout images: from left to right, Imagebank; WFP/C. Hughes; Imagebank; WFP/M. Huggins; WFP/T. HaskellPrinted: November 2006