Nutrition in Emergencies

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http://airsoftgun.co.id/files/nutrition_in_emergencies.pptx

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There are different types of vulnerability to malnutrition:

  • Physiological vulnerability refers to those with increased nutrient losses and those with reduced appetite (see below)
  • Geographical vulnerability, which reflects their harsh or difficult living environment which may be exacerbated by distance, creating problems of access or availability of foods e.g. desert or mountain communities living in extremes of temperature.
  • Political and economic vulnerability, which reflects the community status, lack of representation or isolation
  • Internally Displaced People (IDPs) or refugees may temporarily or permanently be unable to access services or support, increasing their vulnerability
  • Those who were vulnerable prior to the emergency due to food insecurity, poverty, gender, race, religion, land rights etc

Physiological Vulnerability
Individuals with increased nutrient requirements such as Children 0-24 months; Pregnant and lactating women; People with infectious illness;
Individuals with reduced appetite or metabolic disturbances: Older people; People with chronic illness, including people living with HIV-AIDS (PLWHA)/ TB / Cancer; Mentally ill and/or suffering from depression and anxiety

Socio-political vulnerability: Women and girls; Orphans; IDPs and Refugees; Lower social classes (indigenous tribes, untouchables); Stigmatized groups (prostitutes, survivors of Ebola, HIV-affected populations, mentally ill); Those easily overpowered (physically disabled, mentally ill, older populations, sick, adolescent girls)

0-6 months
Infants under six months are a unique group due to their feeding needs, physiological and development needs, which makes them at a much higher risk of morbidity and mortality compared to older children. Exclusive breastfeeding is recommended from birth to 6 months followed by the introduction of appropriate complementary food at 6 months along with continued breastfeeding up to 24 months of age.

6-24 Months
A child has food, health and care needs that must all be fulfilled if he or she is to grow well. Most growth faltering occurs between the ages of 6 and 24 months, when the child is no longer protected by exclusive breastfeeding. At this time the child is more exposed to infection through contaminated food or water and is dependent on the mother or caregiver for frequent complementary feeding. Unfortunately, even a child adequately nourished from 24 months of age onwards is unlikely to recover growth ‘lost’ in the first two years as a result of malnutrition. The consequences of malnutrition on this young age group are the most serious.

Pregnant and Lactating women
There are increased nutrient needs during pregnancy to ensure adequate foetal growth and to build up the body in preparation for breastfeeding. Inadequate food intake during pregnancy can increase the risk of delivering a low birth weight baby. When mothers are breastfeeding they require extra energy, which they can get from the reserves they have built up during pregnancy and from eating extra food after birth. This way they can ensure the quality of breast milk for optimal growth of their infant.
Women and girls are more likely to be malnourished than men in most societies due to their reproductive role (often with little or no time for nutritional replenishment between pregnancies), in addition to their lower socioeconomic status, and their lack of education. Social and cultural views about foods and caring practices further exacerbate this. Around half of all pregnant women are anaemic and 100 million women in developing countries are underweight. This reduces their productivity and makes them vulnerable to illness and premature death. If they are stunted there are higher risks of complications during childbirth, and each week up to 10,000 women die from treatable complications related to pregnancy and childbirth. Infants without a mother are significantly more likely to become malnourished and die.

People living with chronic illness such as HIV/AIDS and tuberculosis
Malnutrition and HIV/ AIDS and/or tuberculosis can lead to: Weight loss, especially loss of muscle tissue and body fat, Vitamin and mineral deficiencies, Reduced immune function and competence, Increased susceptibility to secondary infections AND Increased nutritional needs because of reduced food intake and increased loss of nutrients leading to rapid disease progression

People already infected with HIV/ AIDS and TB are at greater risk of physically deteriorating in an emergency because of a number of factors. These include reduced food intake due to appetite loss or difficulties in eating; poor absorption of nutrients due to diarrhoea; parasites or damage to intestinal cells; changes in metabolism; acute or chronic infections and illness and a break in supply of medications for management of disease and symptoms. There is evidence to show that the energy requirements of people living with HIV and AIDS increase according to the stage of the infection. Micronutrients are particularly important in preserving immune system functions and promoting survival. Malnutrition and HIV affect the body in similar ways. Both conditions affect the capacity of the immune system to fight infection and keep the body healthy.

Older people and people living with disability
Adults with reduced appetites due to illness, psychosocial stress, age or disability often face a range of nutritional risks that can be further exacerbated by an emergency. Loss of appetite and difficulties in eating may also be common in patients suffering from motor-neurone problems. This may lead to an inadequate energy and micronutrient intake at a time when the body needs it most. Difficulties in chewing and swallowing mean less food is eaten. Reduced mobility affects access to food and to sunlight (important for maintaining a healthy level of vitamin D status). Disabled individuals may be at particular risk of being separated from immediate family members (and usual care givers) in a disaster and it may not be easy for them to find foods they can easily eat.

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