RAPID HEALTH ASSESSMENT PROTOCOLS FOR EMERGENCIES
( By WHO - OMS, 1999 )

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8-Implementing the selective feeding programme

Even if the overall food needs of a population are adequately met, inequities in the distribution system, disease, and other social factors may cause high degrees of malnutrition in certain vulnerable groups. Vulnerable groups may be targeted to receive a food supplement to upgrade their diet to a level that responds to their increased needs. Those that are already acutely malnourished must receive medical and nutritional attention to rehabilitate them to a healthy state. Table 7 can be used to help interpret the seriousness of the situation (it is intended as a guide, not as a set of rules).

Table 7 Deciding on nutritional needs





















Finding


Action required


Food availability at household level below 2100 kcal (8.79 MJ)


Unsatisfactory situation


Improve general rations until local food availability and access can be made adequate.



Malnutrition ratea 15% or over

or
10-14% with aggravating factorsb


Serious situation


General rations (unless situation limited to vulnerable groups), plus:



- supplementary feeding generalized for all members of vulnerable groups (especially children, and pregnant and lactating women);







- therapeutic feeding programme for severely malnourished individuals.




Malnutrition ratea 10-14%

or
5-9% plus aggravating factorsb


Risky situation


No general rations, but:



- supplementary feeding targeted to individuals identified as malnourished in vulnerable groups;

- therapeutic feeding programme for severely malnourished individuals

Malnutrition ratea under 10% with no aggravating factors


Acceptable situation


No need for population interventions.

Attention to malnourished individuals through regular community services.


Notes

The above are only general indications. The best way to ensure that the nutritional needs of young children and other vulnerable groups are met is on a case-by-case basis, taking account of the particular local (including sociocultural) circumstances.

a Malnutrition rate: proportion of child population (aged six months to three or five years) who are below median -2 SD or 80% of reference value of weight-for-height.

b Aggravating factors:





- general food ration below the country-specific mean energy requirement;
- crude death rate >1 per 10 000 per day;
- epidemic of measles or whooping cough;
- high prevalence of respiratory or diarrhoeal diseases.
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