Nutrition in Emergencies

Nutritional Assessment - Spotting Trouble Fast

• Objective: Rapidly detect acute malnutrition (wasting & oedema) in crisis-affected populations.
• Key Indicators (Children 6-59 months):
  • Mid-Upper Arm Circumference (MUAC):
    • SAM: < 11.5 cm (Red band)
    • MAM: 11.5 cm to < 12.5 cm (Yellow band)
  • Weight-for-Height/Length (WFH/L) Z-score:
    • SAM: < -3 SD
    • MAM: -3 SD to < -2 SD
  • Bilateral Pitting Oedema: Any presence signifies SAM.
• Screening: MUAC is primary for rapid community screening; WFH/L for individual assessment.
• Clinical Signs: Visible severe wasting, apathy, hair changes.

  ⭐ MUAC < 11.5 cm in children (6-59 months) is a direct, life-threatening indicator of Severe Acute Malnutrition (SAM).

SAM Management - Lifesaving Feeds

• Goal: Stabilize, prevent death, initiate recovery.
• Phased Feeding:
  • Phase 1 (Stabilization): F-75
    • Low protein, Na, osmolarity. 75 kcal & 0.9g protein /100ml.
    • Purpose: Metabolic correction, NOT rapid weight gain.
    • Dose: 100 kcal/kg/day (approx. 130 ml/kg/day); if edema, 100 ml/kg/day.
    • Small, frequent feeds (2-3 hourly).
    • ⚠️ Avoid refeeding syndrome.
  • Transition Criteria: Appetite returns, edema ↓.
  • Phase 2 (Rehabilitation): F-100 / RUTF
    • Higher energy & protein. F-100: 100 kcal & 2.9g protein /100ml.
    • Purpose: Rapid weight gain (catch-up growth).
    • Dose: 150-220 kcal/kg/day, 4-6 g protein/kg/day.
    • RUTF: Preferred for outpatient.

⭐ F-75 (Stabilization Phase): 75 kcal/100ml, 0.9g protein/100ml. Low osmolarity, prevents refeeding syndrome.

MAM & Micronutrients - Filling Nutrient Gaps

• Moderate Acute Malnutrition (MAM):
  • Criteria: MUAC 11.5 cm to <12.5 cm; WHZ -3 to <-2 SD.
• Management of MAM:
  • Targeted Supplementary Feeding Programs (TSFP).
  • Provide: Ready-to-Use Supplementary Foods (RUSF) e.g., Plumpy'Sup; or Fortified Blended Foods (FBF) like CSB++.
  • Duration: Usually 2-3 months.
• Critical Micronutrients:
  • Deficiencies common: Vitamin A, Iron, Zinc, Iodine, Vitamin C.
  • High-risk: Children <5 yrs, Pregnant & Lactating Women (PLW).
• Supplementation Strategies:
  • Vitamin A: 100,000 IU (6-11 months), 200,000 IU (12-59 months).
  • Iron-Folic Acid (IFA) for PLW, anemic children.
  • Multiple Micronutrient Powders (MNPs) for home food fortification.
  • Use of fortified staples and iodized salt.

⭐ High-dose Vitamin A supplementation is a crucial life-saving intervention in emergencies, significantly reducing measles-related mortality. ​

IYCF-E - Tiny Tummies, Big Needs

• IYCF-E (Infant and Young Child Feeding in Emergencies): Prioritizes protecting & supporting safe, appropriate feeding for infants & young children (0-23 months).
• Core Principles:
  • Promote & support exclusive breastfeeding for first 6 months.
  • Ensure timely, adequate, safe, and appropriate complementary feeding from 6 months onwards, alongside continued breastfeeding up to 2 years or beyond.
  • Minimize risks of artificial feeding; avoid untargeted distribution of breastmilk substitutes (BMS).
• Key Interventions:
  • Rapid assessment of IYCF practices.
  • Skilled counselling & support for mothers/caregivers.
  • Creating safe spaces for feeding (e.g., baby-friendly tents).
  • Management of Moderate Acute Malnutrition (MAM) & Severe Acute Malnutrition (SAM) in infants <6 months.

⭐ In emergencies, re-lactation support and wet-nursing (with screening) can be life-saving options for infants whose mothers are unavailable or unable to breastfeed.

• ⚠️ Avoid donations of infant formula, bottles, and teats unless specifically requested and managed by trained personnel to prevent undermining breastfeeding and increasing infection risks (e.g., diarrhea).

High‑Yield Points - ⚡ Biggest Takeaways

• MUAC screens acute malnutrition (children 6-59 months); < 11.5 cm is SAM.
• RUTF for community-based SAM management without complications.
• Vitamin A crucial in emergencies, especially measles outbreaks, to ↓ mortality.
• IYCF-E: Protect breastfeeding; control breast-milk substitute distribution.
• Sphere Standards: General food ration ~2100 kcal/person/day.
• Combat micronutrient deficiencies (Fe, Vit A, Iodine) via fortified foods/MNPs.
• Risk of Scurvy, Pellagra in prolonged emergencies with poor diet.