ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

EDITO (by Amador Gomez)
Nutrition in ACF-S: taking actions against the differents faces of undernutrition
Infant undernutrition is one of the main mechanism for the transmission of poverty and inequality between generations, becoming a heavy mortgage on the future of the next generation.. Today’s undernourished are tomorrow’s poor. That is why undernutrition is not just a priority health problem; it is also a major barrier to development. Having a sustainable impact in undernutrition is not just a question of ready to use food or CMAM approach. Undernutrition is not simply acute. Stunting and carence of micronutrients are also very relevant in many contexts where ACF is working. In ACF-S we give priority to acute undernutrition in our operations, but at the same time, we are implementing and developing our nutritional approaches on differents contexts like seasonal hunger, emergency situations or chronic hunger. Most of the world’s acute hunger occurs during the annual hunger season. As an answer to this nutritional vulnerability gap, we are promoting the scale up of a basic intervention package against seasonal hunger which targets the prevention of children undernutrition. This seasonal anti-hunger intervention combines different approaches like cash based interventions to minimise the nutrition vulnerability and seasonal blanket feedings programmes to protect nutrition during the hunger gap. Other ACF-S nutritional interventions are oriented to impact in chronic undernutrition and micronutrients deficiencies like anaemia. Nutritional care practices are promoted through Hearth Model Programmes, complementary feeding practices, micronutrients supplementation and promotion of breastfeeding. Making progress in the fight against undernutrition and its positive effects on health and development is possible only if nutrition becomes a priority. ACF is working to Scale Up Nutrition at international level making part of initiaves as SUN (promoted by SCN). ACF has also developed a strategy on advocacy (AMAI) and some filed activities are already going on (e.g. Niger). All this approach integrate advocacy and capacity building components oriented to support the political commitment against undernutrition, achieve adequate coverage and the integration of nutrition interventions in the health policies and strategies at national level.
•Promotion of breastfeeding •Complementary feeding practices •Hearth model programmes •Handwashing & hygiene behaviour •Child Health Days •Vitamin A campaings •Deworming & parasite control •Anaemia & iron supplementation •Micronutrientes supplementation •Diarrhoea & Zinc supplementation •Seasonality and blanket feeding •Conditional cash transfer

Accompanied by a scale up of country political wlll and capacities

•Communtiy /clinic base management (outpatient/inpatient) •Integration into basic package of health services

© Amador Gómez. 2010

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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

CONTENTS
• • • • • • • • NEWS FROM THE HEADQUARTERS DID YOU KNOW...? QUESTIONS ASKED TO ZOOM ON A PROJECT RESEARCH AND TECHNICAL DEVELOPMENT WHAT HAPPENED? Publications, surveys, reports, meetings, fora… WHAT’S NEXT? Publications, surveys, reports, meetings, fora… WHAT CAN YOU FIND IN THE PREVIOUS & NEXT NEWSLETTERS? 2 3 4 5 7 9 10 12

This Newsletter was prepared in Madrid with the participation of all headquarters and missions. Thanks to all for your contributions.

NEWS FROM THE HEADQUARTERS
London
• Sandra Mutuma is the Senior Nutrition adviser at ACF-UK. Saul Guerrero (former Valid International) has joint ACF-Uk as responsible of monitoring and evaluation. David Doledec, and is still vacant. If you are interested to come and work in New York or would like to know more about this position, check out the following link:
http://www.actionagainsthunger.org/get-involved/jobs/hq/nutrition-advisor

Madrid
• Elisa Dominguez is the Head of Health and Nutrition Dpt. She is in charge of Central and South America, Middle East (Palestina, Syria) and Asia (Phylippines) and focal point for all surveys (SMART, KAP,…). • Marisa Sanchez is the Health, Nutrition and HIV technical adviser in Madrid. She is in charge of Western and Southern Africa. • Oscar Serrano is leaving the Health and Nutrition Coordinator for the emergency pool. Position in process of replacement. • Liselot Lemmens has started an internship of 4 months in September. She will be responsible of Nutrition Forum organisation (former CMN meeting) in Toledo end of October and to support Nut Dpt.

Paris
• Arrival of Anne Dominique Israel at the position of Senior Technical Advisor in Nutrition. Recruitment of a Nutrition advisor for Asian missions is now finalised.

▪ Departure of Rebecca Brown from the position of Senior
Technical advisor at the end of June: However, she will continue working with ACF as part-time position.

▪ Arrival of Ioana Kornett as Technical Director.
The different NUT technical advisors of ACF-France are then: Emergency response pool Starlène Barthelot (leaving soon) Asian missions Astrid de Brandebere (interim for 3 months-August-October) Emergency pools Olivia Freire following Sudan & Darfour, Chad, Central African Republic and North Caucasus (ofreire@actioncontrelafaim.org) Fabienne Rousseau following Burkina, Ethiopia, Liberia and Somalia (frousseau@actioncontrelafaim.org) Post-crisis pools Béatrice Mounier following Ivory Coast, Haiti, Zimbabwe, Afghanistan, Mongolia and Sierra Leone (csalpeteur@actioncontrelafaim.org)

Montreal
• Asmaa Ibnouzahir is nutritionist, expert & trainer on SMART.

New York
• Marie-Sophie Whitney is the senior nutrition advisor in charge of DRC, Uganda, Kenya, Southern Sudan, Pakistan and now also of Nigeria. msw@actionagainsthunger.org • A second nutrition advisor position has been open to replace

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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

DID YOU KNOW…
Closure of Angola mission (ACF Spain) The mission in Angola closed in the middle of July 2010 after more than 15 years of presence there. HIV International World Conference Amador Gomez, Marisa Sanchez and Cécile Salpeteur represented ACF at the 2010 HIV International World Conference that was held in Wien between the 17 and the 21
st th

FAMOS database development ACF-S is developing a database which should support the teams in the field in the daily management of data from nutrition centres. a This database was developed and by NOVATIVE, suitwerland foundation, before

implementation should be tested in the field. Test survey is expected to be implemented in Mauritania in OctoberNovember. Update of ENA for SMART surveys ACF-Ca has informed on the validated use of the last version

July. A study implemented on HIV patients in Donka

hospital in Guinea-Conakry was presented as poster. Exploratory mission in Mozambique An exploratory mission was set up by the Nut team in Swaziland in May 2010. A proposal to support a TFC at a hospital in Maputo has been prepared and it is under funding search. Response to crisis in Corredorr Seco (Guatemala), Niger and Mali Several emegency responses are currently ongoing: in Guatemala (Food security and Nutrition interventions), in Niger, a new base was opened (Gouré), in Mali, a blanket intervention with BP5 during the hunger gas has been implemented. Identification missions ongoing (AECID Convenio) Nutrition identification missions were implemented in Mali, Philippines and Peru through integrated approach (Nut-SA). HIV workshop in Paris An HIV workshop was held by ACF in the last week of June. Experiences from Haiti, Zimbabwe and Swaziland were exchanged. Contact: csalpeteur@actioncontrelafaim.org or msacnhez@achesp.org. Training on KAP surveys (Madrid) A training on KAP surveys was organised in Madrid HQ based on the new CARE manual: IYCF Practices: a step-bystep manual. CD is available for those interested. Contact: edominguez@achesp.org. ACF-S Nutrition policy ongoing Based on the ACF White paper, ACF-Spain is launching its Nutrition policy paper that will describe main strategis actually implemented in ACF-S missions.

of ENA (ENA-delta). Software can be dowloaded at www.nutrisurvey.net/ena_delta. Updates concern mortality component, a more developed plausibility checks including MUAC and a new component on Food Security based on the Household Economic Approach (HEA). More info on: http://www.nutrisurvey.de/ena_beta/food_security.htm Some pilot tests of this FS component are under study for upcoming SMART surveys in Guatemala and Filipinas.

Research study in Peru ACF-S is preparing a research in Peru in collaboration with University of Lima and University of Cadiz, under AECIF funds. Aim of this research is to compare efficacy, impact on growth development and cost/efficacy of differents products to prevent stunting and anemia. LNS vs a local product vs a fortified local product will be compared. The study will start by October and will take 2 years including preparation, distribution (12 months) and data collection and analysis. Technical Indicators Working Group In November, ACF-S will launch a working group on technical indicators in order to set up an ACF indicators database composed by “standards indicators” proposed by WHO, UNICEF or international institutions. Aim is to support field teams when writing proposals or implementing KAP surveys. People interested to participate in such working group can contact Elisa Dominguez at edominguez@achesp.org. Infant and Young Child Feeding Practices WHO manual indicators was launched in 2007

(http://www.emro.who.int/cah/pdf/IYCF-Indicators-2007.pdf). recently WHO published the manual to collect these indicators (http://whqlibdoc.who.int/publications/2010/9789241599290_ eng.pdf).

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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

QUESTIONS ASKED TO… Gilbert Manyoukou
Management of Nutrition programme at remote control

Questions & Answers

He is a nutritionniste with professional work experience for almost 20 years and in humanitarian organization since 1996. At the moment of the interview, he was acting as CMN in Mali since March 2009.

Q1. Which projects have been developed in Gao in 2009?

There was one nutrition project funded by ECHO in Gao and Ansongo. Another project on food and nutrition security funded by Government of Navarre, then, a third project was on HIV prevention in partnership with MDM and Nouveaux Horizons funded by the European Union. Finally, an emergency response was implemented during the hunger gap from September to December. Q2. What happened at the end of 2009 to start working on remote control? In November last year, security situation worsened: some cars were stolen and embassies released alerts on risk of kidnapping risk for Europeans. At the same time, an expatriate was kidnapped in Menaka. All these issues led to the evacuation of ACF international staff from Gao to Bamako. Q3. Hos the remote control-work was implemented? The evacuation was abrupt and neither local or expatriate workers were able to work in such way, on remote control. This made a fracture in the dynamic of projects monitoring. There was a very difficult time because we were in a fully process of nationalization of key positions and at the end of the emergency. For all of us, it was very difficult to support the national team in Gao from Bamako. In December, Gao's team came to Bamako for a meeting to discuss the management of projects and support activities that would be necessary for the team. Later on, in February, we had another meeting in a mid-point between Gao and Bamako, to discuss the situation of the teams that were in a state of important frustration and incapacity to plan activities along 2010. Q4. How do you maintain the quality of the projects? Are expats allowed to visit the area for track-monitoring? To maintain the quality we have relied on two aspects: ensuring a timetable of activities that is updated in a continuous basis and to maintain a very regular contact with teams in the field to support them. At the beginning, the team in Gao required high support from the coordination team in Bamako to meet their needs. Over time, a system of communication and responsibilities has been well defined and so many meetings are not needed anymore but based on specific issues to monitor or in specific needs.

We have been allowed recently to make short visits to Gao. Myself, I visited Gao last week for a training of the team on SMART surveys and Anne, the head of base, is currently there for a week time. Q5. This year 2010 is expected to be difficult for Sahel due to poor harvest last year. How is the situation Gao regarding vulnerability in food and nutrition security? The vulnerability on SAN is under a surveillance system since last year and we expect that this will be a tough year. The rains were not sufficient last year and several warnings were released by different actors in the field. Whereas analysis was not easy ACF decided to do a vulnerability survey in our areas of intervention to document the situation. The survey confirmed a worsening of the vulnerability in Ansongo. It was also decided to complete this study with a SMART survey which was performed in June. Q6. How the vulnerability study and the SMART surveys were carried out on remote control? What has been done to maintain quality and reliability of data without supervision of expatriate staff? The vulnerability study included both nomadic and agro-pastoral households in the area. The SMART survey only considered the agro pastoral zone to compare results with the ones from last year. To ensure the quality of the SMART survey, I moved to Gao for team training and we recruited an additional supervisor to assist the national responsible in the supervision. In addition, the project manager did the daily data entry for early detection of flags and monitoring was strengthened. Final results showed the same performance degree as in previous years under expat supervision. Q7. Which are the positive and negative points of working on remote control? Local staff feel more responsible and confident now, but is difficult to verify operational performance of activities. There have also been some delays in project execution.
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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

ZOOM ON A PROJECT
Another way to face hunger: the integrated approach in Peru
Bronwen Gillespie, Anthropologist Social Coordinator, ACF-Spain, Peru

Children in the rural Andes in Peru are not necessarily hungry; they are stunted from the double handicap of anaemia and chronic malnutrition. They may not be extremely thin, but they are noticeably short. This is the consequence of long periods exposed to a diet low in calories, protein and micronutrients. 32.8% of children under five are malnourished on 1 a national level, and in some rural communities the percentage reaches 72.7% . More than 265,000 children currently suffer from malnutrition and the concurrent negative effects on growth and development expressed in reduced motor skills, diminished ability to concentrate, reduced periods of attention, low motivation levels, and other irreversible 1 developmental problems . The situation is additionally complex given that it is in some sense invisible: mothers do not perceive of their children as ill; rather they are just small or quiet. The problem represents a threat to the development of the region as a whole in that it self perpetuating. Malnourished children, with less ability intellectual ability and continual health problems, strain the already overburdened education and health systems. Every person with malnutrition suffers from an average 10% 1 reduction in their potential earnings during the course of their lives , and these adults, in turn, face constraints in caring for their own children, becoming stuck in an intergenerational cycle of poverty and malnutrition. ACH is planning a four year integrated response to malnutrition in the Andean communities of Ayacucho, Peru with the aim of demonstrating sustained improvements in child health so that similar approaches can be initiated in other regions at risk. What are we “integrating” and why? Who will be involved in this integrated approach, and how will it be done? The multiple causes of malnutrition are interdependent and therefore should be addressed as such. The immediate causes of malnutrition are inadequate food intake and disease. These are fed by the underlying situation of household food security, psycho-social environment and care practices, and the level of services in public health, water and sanitation. There are many practical examples of the overlap of these factors: communities often need to improve irrigation systems before diversifying their production. Once food availability has improved, with the acquisition of livestock or poultry, for example, this does not automatically translate into consumption, as products may be sold or fed to “productive” household members rather than infants. Even if children are offered a more complete diet, poor sanitary facilities increase prevalence of diarrhoea which reduces their ability to absorb nutrients. Furthermore, habits that define the type of foods children are given, and when, where and how children are fed and cared for must be taken into account. Any intervention aiming to reduce malnutrition must simultaneously consider the role and responsibilities of family members and other caregivers and the cultural aspects of infant care as well as responding to more immediately obvious constraints.

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/// SUITE
Therefore, the technical components of food security, water and sanitation, local management, and nutrition are to be integrated as one action, with a cross-cutting emphasis on socio-cultural comprehension and awareness of gender roles, to promote cohesion in the fight against child malnutrition. The definition of problems, project planning, educational workshops and technical solutions will be carried out from an integrated perspective. Community members should not be involved in separate food security, health, or water mini-projects; rather the aim is for all actions to respond visibly and directly to improving childhood nutrition. From an operational point of view this is an interesting challenge and learning experience as professional training, program design and field work methods often unintentionally reinforce technical divisions, even when it is agreed that integration is a priority. All participants, from village level to government level, will have a role in a common process. The aim of this process is to fight malnutrition by articulating a relationship between people, their organizations, and their government, in order to help public services respond effectively to the problem. ACH and the local partners will foment active participation from local, district and provincial government representatives and corresponding technical services, from universities and networks already present in the area, from community-based organizations such as mothers’ groups, and from all family members, as without their awareness of the damage of malnutrition, little can be done to improve child-care decisions. ACH has been active in advocacy forums with the national government, spurring the adoption of country-wide goals in the fight against malnutrition. Peru already has legislation regarding the inclusion of human rights, 1 gender equality and intercultural perspective in healthcare . The challenge is to help health services strengthen their operations in predominantly rural districts, to ensure the quality and adequacy of care in these isolated areas, to adapt materials, advice and methods to the local context. Community vigilance systems will play an important role in assuring children show healthy growth, as government services cannot cover all attention due to the isolated conditions. This system will contribute to community ownership of the process, and is expected to be more affordable. ACH’s overarching goal is to test an integrated approach that government and local actors can manage to replicate in other regions at risk.

Success will depend on our capacity to understand the local socio-cultural context, concepts of well-being, and beliefs behind childcare practices, and integrate this within our strategies and communication tools. This will allow us to suggest solutions that are acceptable, sustainable and relevant. The intervention will work to understand and strengthen traditional food systems: The World Health Organization now recognizes that nutrition policy must refer to 1 alimentation, that is, to food, not to nutrients . Change will often be in the hands of mothers, and these mothers must be considered as equals, enabled in dialogue rather than as recipients of information, so that become able to reflect on nutrition issues for their children, drive the process, make decisions and motivate other women. The years of civil war and resulting migration and social dislocation, and a rapid transition into a global society has lead to the loss of traditional knowledge. At the same time, the experience of poverty, marginalization and discrimination, as well as illiteracy and domestic violence leaves women ill-positioned to have access to new information. Basic aspects of childcare are not natural for any of us; they are learned and depend on access to resources and a support system. “Feeding infants and young children is a complex challenge for all species, including our own, and now, when rapid social and cultural change has become the human condition, we no longer have the advantage of long-term cultural 1 evolution to guide our management of the process” . A look at urban industrialized societies makes this lesson clear: children in the UK and USA suffer from rising rates of obesity and governments have begun to legislate to reduce 1 children’s access to ‘food’ products deemed as dangerous for their health . This integrated public health approach in Peru may turn out to be relevant for other contexts around the world.

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BHAMI HISTORY : Exploring under-nutrition in my country, India
By Bhami Shah, Deputy Medico Nutrition Coordinator, ACF India Exploratory Mission Going from the beginning to the end of my first field visit in India as a new team member with ACF – India mission, I was unaware of the under nutrition issues faced within rural and tribal areas. My pre departure visualization was one of me entering remote villages with my colleagues, and after briefly surveying the problems, we would swiftly come up with ideas and solutions to better the life of villagers and improve upon the existing problem of child under nutrition. However, I did not understand the challenge of such a task and nor did I realize how crucial it was to finding solutions to overcome the problem. My pre imagination of child under nutrition was always the one that was linked with Africa, as most Indians in the field of nutrition have a myth that under nutrition is a problem of Africa and not of India. It was only after my visit, I realized that Madhya Pradesh (one of the 28 states in India, and second largest amongst them) reports equal number of malnourished children as in Chad and Ethiopia together. Being a nutritionist, my curriculum during my education years always focused on the green revolution and the hope of abundance it gave to millions of people in India. However, the bleak reality of under nutrition in India has been untouched by most of the people working in the fields of medicine and nutrition. For me under nutrition was always associated with the grades I- IV (weight-for-age), absolutely unaware of MUAC tapes being widely used around the world for active detection of under nourished children. Our professors always highlighted the importance of using Indian standards for detection purposes and international standards to be used as standbys for secondary reference or never to be used, with a notion that these standards might either distort or skew all the results due to differences in the growth pattern among the Indian and international population. Malnutrition during my studying years was generally linked to the per capita income and the associated poverty but not with the hygiene and sanitation and public health services. Most of the people in India working in the field of nutrition agree to the fact that the curriculum of both medical and nutrition colleges do not cover under nutrition issues in depth and many issues like prevention and treatment require more updated and organized technical knowledge. Though being an Indian urbanite, not only was my vision extremely unclear about rural life and the associated malnutrition in rural and tribal contexts, but what I imagined to be the proper way to conduct an assessment of under nutrition was also inaccurate. My first fascinating experience in the field was that of a village community meeting. At the beginning of the meetings most of the women who attended had their backs partially or fully turned to us, a lot of women were totally veiled. They completely distrusted us, rightfully so as a white person (my colleagues) had not been to their village in a generation. As the meeting went on they gradually began to open up, with most of them removing their veils and turning to face us. The women were giggling and whispering with each other throughout the meeting and very few answering questions which at times made it difficult for us understand the dynamics of the village life. The rest were too shy to speak, especially so since the men, alerted to our presence, had gathered in the backdrop to keep tabs over the proceedings. The meetings though had some communication difficulties; it gave us a very good insight in understanding the cycle of social determinants affecting life of the under nourished children amidst the villages we visited. A lot of factors were identified during the meeting as reasons for malnutrition, ranging from dangerous traditional practices during pregnancy and lactation to weak immunization coverage and poor transition to complementary foods – perpetuating the calorie protein gap. In most of these community meetings you could easily identify 3 - 4 children with SAM and what was surprising for me was that most of the women in the villages had an idea of what a under nourished child looked like. When inquired, they could easily point out on the child who was weak and fragile and would fit into the category of being under nourished. My visits into the villages were hosted by various NGO’s and it was quiet startling for me to see the way these NGO’s functioned. The supervisor of the NGO’s would walk around the villages with their community workers who had pre identified SAM children within the villages. These supervisors would further regulate these community workers to take these children to the Nutrition Rehabilitation Centre (NRC) irrespective of any communication with the family or the community worker. The NGO’s identified the villages and the problems, but very few NGO’s we visited would actually try to understand the complexity of the problem. They undertook the projects that kept the funds flowing (like all other NGO’s), but they failed to consult the affected villages. The projects weren’t collaborations with the people and the result was a lack of sustainability. The villages we visited had particularly high number of under nourished children and extremely low levels of admission in NRC.
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On communicating the reasons, we realized that these indigenous people were not comfortable to take their children to NRC as they had to live there alone, they had other children in the house to be looked after, they felt suffocated in the tiny room provide by NRC. They also complained of the toilets to be stinking as they were used to the fields and open spaces for sanitation purposes, they were scared of doctors in white coats as they resembled ghosts, they had transportation problems and other reasons which were most of the times not taken consideration by people in charge of reversing the problem. Another very important characteristic we noticed during our travel was that of the Indian social caste system. The Indian culture typically has a tendency of families and neighborhoods living together in particularly close relationships over generations, struggling to extort a living from the same limited area of land and water resource. Closely inspecting, some people grow fat and influential while others remain frail and dependent, fellow villagers are prone to conflicts, opposition, and even violence. Most villages of India include what villagers call "big fish," affluent, commanding people, fed and serviced through the labors of the struggling "small fish." This paradoxical behavior of the people seems to represent a general trend I noticed among most of the districts we visited in Madhya Pradesh where more than 50% people are pushed in the survival struggling to migrate in search of more income opportunities. Such paradoxical nature is also experienced in villages where village feuds were not uncommon and hostility towards these innocent villagers continue, where they are paid minimum wages for maximum output during the migration period. Villagers complained of their inability to look after children during the migratory work and a resultant high level of under nourished and sick children post migration period. The shock came to me when I inquired about the money they get back with them post the migration to which a fellow replied around Rs 20 – 30 for the whole migration trip. The migration pattern in Madhya Pradesh is out of necessity and the survival process, where the poorest of the poor migrate in need of 2 meals per day for themselves and their families. This trend of middle to upper class is extremely common in the Indian setting where Indians are incredibly kind to those in their social sphere, but when it comes to those of lower caste or lesser financial standing, they treat them very poorly. The various examples highlighted above present the current scenario of Indian villages where the situation is grave and requires urgent attention. Empowerment of local people to be participants in development of community can act as a good method to reverse the problem. According to me most families can practically pay for the quantity of food required to feed a young child which is nothing more than half a chapatti/half a banana and half bowl of dal with some vegetables. Food availability within the household is not the only grave factor causing malnutrition; it is also the lack of knowledge and opportunities about appropriate feeding practice which makes the difference. The denial of as little as 200 – 300 calories in a young child’s daily diet is what makes the differentiation between the normal growth of a child and the faltering that begins the fall towards sickness and loss. To end my journey here I would conclude by saying that, the days we spent visiting the villages during my field visit were enlightening, interacting with people of different cultures and traditions, being received by the inhabitants in the most welcoming way, some of them who had not seen an outsider enter before in the past years, the whole experience was absolutely surreal and unforgettable. Time and again, I remember my parents who are now city dwellers referring nostalgically to their “simple village life”, representing colorfully dressed village women gracefully carrying water pots on their heads. It’s only now after my visit I understand that village life is now no longer simple but it is indeed under severe threat where communities are struggling to pull themselves out of poverty and hunger. A lot of potential to overcome the problem of child malnutrition exists but it needs to be empowered and nourished which would help the villages get a step up to the ladder of alleviating under nutrition.

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Increasing ACF capacity and impact in preventing nutritional and humanitarian crises in areas affected by cyclical natural hazards and climate change – Project brief
Where undernutrition, natural hazards and climate change prevail (by Philippe Crahay, ACF-F) Maternal and child undernutrition is the underlying cause of 3.5 million deaths each year and 35% of the disease burden in children younger than 5 years (Black et al, 2008). The neglected crisis of undernutrition now receives more attention globally – as reflected by the Scaling Up Nutrition (SUN) initiative. Most of the countries where undernutrition prevails are located in disasters and climate change hotspots, e.g. in India, Bangladesh, Ethiopia, Pakistan and Sudan (the 5 worst countries in terms of GAM and disasters), but also in Indonesia, Niger, Somalia, Burkina Faso, Chad, Philippines, Kenya, Haiti, Central America, etc. – in others terms, the majority of ACF countries of intervention. The number of reported climate-related disasters (droughts, floods, cyclones) has more than doubled this decade compared to the nineties. Since the 1980s, the average number of people reported as affected by climate-related disasters has doubled, from 121 million to 243 million a year. According to Oxfam (2009), this number could rise up to 375 millions a year as soon as by 2015. Besides causing suffering and death, natural disasters cause many vulnerable communities and households to suffer serious setbacks, in terms of livelihood, water, food and nutrition security. When a population’s nutrition is poor before the hazard hits, the limited nutritional stores of young children are soon depleted, increasing their risk of severe malnutrition, disease, and death. Nutrition crises are amplified by the effects of the hazard on the underlying risk factors of undernutrition. Climate change magnifies disaster risk everywhere; it amplifies the risk of undernutrition through different pathways, related to food security and livelihoods, water, public health and care practices (ACF, 2010). Today, there are some solutions to better prepare vulnerable communities and reduce disaster risk and some negative impacts of climate change, through disaster risk management. So far, too little has been done in managing the growing impacts of natural disasters and climate change on nutrition and increasing the resilience of poor communities and households to natural disasters and climate change. Besides the nutrition sector remains largely disconnected from climate change-related agendas and field initiatives, whereas these are now reshaping humanitarian agendas and interventions. A tailored ACF project ACF is developing a project whose objective is to increase its capacity and impact in preventing nutritional and humanitarian crises in areas heavily affected by cyclical natural hazards and climate change. More specifically, this project aims to: Improve ACF analysis and conduct assessments in communities affected by undernutrition, cyclical natural hazards and climate change. Develop integrated nutrition-disaster risk management programming in these communities. Conduct trainings on nutrition-DRM programming and build ACF capacities. Share ACF knowledge and experiences in these fields to the nutrition and humanitarian communities. Advocate for a better integration of nutrition in key climate change agendas and initiatives, particularly through participation in the UNSCN Nutrition and Climate Change eGroup (see below). 3 case studies will be conducted, respectively in Ethiopia, Bangladesh and Guatemala. Project outputs will be delivered early 2011. For information, contact Philippe Crahay pcrahay@actioncontrelafaim.org UNSCN Nutrition and Climate Change eGroup The Nutrition and Climate change eGroup is an ad hoc online discussion forum, created with the aims of bringing a nutrition lens into climate change issues and increasing the participation of interested sectors to discuss how this can be done and what the priorities are. This eGroup also intends to identify opportunities for the nutrition agenda and weaknesses that hinder the participation of nutrition in such debates. It also intends to influence the agendas of the research community and the traditional nutrition donors. For more information, please see: http://www.unscn.org/en/nut-working/nutrition_and_climate_change/
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DRM –CCA-Undernutrition: Guatemala example
In Centro American countries, the social and environmental vulnerability is reflected in the frequency of extreme hydro meteorological events. As example, in Nicaragua there is a recurrence of droughts and floods (2008, 2009, 2010), rat pest (2007, 2008, 2009, 2010) and hurricanes (Ida and Tropical storms in 2009), that have caused extensive damages on the subsistence agriculture affecting livelihoods and resilience capacity of population, aggravating the food security and poverty situation, exacerbating the poor nutritional status of vulnerable population and subsistence farmers. In Guatemala , in the Jalapa, Chiquimula y El Progreso Departments, ACF is following the increases on undernutrition caseload caused mainly by a recurrent phenomena known as “seasonal hunger” that occurs every year between June and October. Last year, drought caused a 70% of harvest loss. This was a critical cause of increase of infant undernutrition. This year, heavy rains and flooding caused again important harvest damages and an increase on hygiene-related diseases (respiratory track infections, diarrhea and animal vectors transmitted diseases). All these factors combined contribute to increase the prevalence of acute undernutrition. Due to this situation ACF keeps on the commitment to eradicate Hunger and undernutrition strengthening food security, nutrition surveillance and support to the Minister of Health and Agriculture.

WHAT HAPPENED? Publications, reports, meetings, fora…
MM2 Forum in Geneva (Geneva, February 2010): A meeting regarding moderate malnutrition was organised by UNICEF and WHO in Geneva last February. Cécile salpeteur from ACF-F and Elisa Dominguez from ACF-S represented ACF in the meeting. Objective was to have a consultative meeting to write the new guidelines on moderate malnutrition. This guideline should be published by middle 2011. Nutrition Global Cluster (Geneva, July 2010): The annual meeting of the GNC was organized in Geneva last July. All ACF HQ were represented (except USA). Discussions regarding intervention in Haiti or several tools developed by GNC as the rapid assessment and the Harmioniused Training package were hold. Resume and background documents are available upon request at your Nut advisor level. World Congress on HIV (Viena, July 2010): ACF was present in this important Congress through a poster presented by Marisa Sanchez (ACF-S) regarding a study on nutrition in HIV patients carried out in Conakry (Guinea) in 2009. Workshop on Positive deviance experience (Bamako, August 2010): ACF office in Dakar organised this workshop to share experiences from West Africa ACF missions and discussed actions to follow. Documents available at ACF-Dakar office (Christophe Breyne [c.breyne@aahuk.org]. GNC meeting (NY, 21-22 Sept 2010): ACF-F and Ca were present. Objective was to define the next year cluster priorities and organisation. st 1000 days meeting: launching of the SUN roadmap on the 21 of sept with Hillary Clinton and Ban KI-Moon: ACF-F was invited World Public Health and Nutrition Congress (Oporto, 23-25 Sept 2010) : ACF-France and Spain will present some posters. ACF-UK will do an speech on scaling up nutrition initiative and road map (SUN). Launch on Research on NCA (Nutrition causal Analysis methodology) : with experts as Helen Young and Susan jasper (Tufts university), Yves martin Prevel (IRD) and Kate Ogden (WFP) led by Julien Chalimbaud (ACF). Contribution to writting a paper on MDGs (SCN)- Nutrition and the MDGs: accelerating progress towards 2015 : led by Sandra Mutuma at ACF-UK. Developpement of an international Working Working on CMAM : objective will be sharing information, tools, research, best practices (ongoing). Most information with Anne Dominique Israel (aisrael@actioncontrelafaim.fr).

WHAT’S NEXT? Publications, surveys, reports, meetings, fora…
ACF Nutrition Forum (Toledo, October 2010)- former CMN meeting: ACF-S is organising this Forum that will take th th place since the 25 until the 29 October in Toledo. External guests will be invited during 1 day to present strategies and interventions regarding new strategies on prevention and management of malnutrition. th ACF Nutrition Steering Committee (Madrid 21st, 22nd and 29 October 2010): The Responsibles of Nutrition Dpt at HQ level of different ACF HQ have been organised in such committee in order to share regular information, discuss about technical issues and strategies and fix guidance and collaboration on Nutrition technical issues at ACF network. This meeting will be organised prior to the Nutrition Forum to share annual action plans and organise collaboration between HQ in 2011. th ACF Nutrition meeting (Toledo, 29 October): Nutrition advisors from different HQ will meet in Toledo after the Nutrition Forum to evaluate the meeting, share information and discuss on technical issues. ACF CMAM integration into health system guideline: expected early 2011. CMAM Protocol updated: expected early 2011 Baby tent guideline: based on experience in Haiti.
© Action Contre la Faim International Network /// Newsletter N° /// September 2010 10 10

ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

INTERNET RESOURCES
. http://www.who.int/childgrowth/standards/technical_report/en/index.html WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass indexfor-age: Methods and development. Geneva: World Health Organization; 2006 . http://www.fantaproject.org/ Training Guide for Community-Based Management of Acute Malnutrition (CMAM) and Nutrition, Food Security and HIV: A Compendium of Promising Practices . http://www.ennonline.net Fields exchange; internation workshop on the integration of CMAM report; Infant feedding in emergency guidance and modules http://www.who.int/nutrition/topics/hivaids/en/index.html Here are all the documents of the recent HIV/AIDS meeting for West Africa held in Burkina Faso in November 2008 http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74 This is the website of the IASC Global Nutrition Cluster with in particular the 21 training modules in nutrition in emergencies (HTP). You can find information on the other Global clusters as well: Logistics, WASH, Health, Shelter, Protection etc. http://www.nutval.net/ Make sure the food rations distributed in ACFIN programs are balances by checking their nutritional value with NutVal 2, the software of WFP. http://www.nutrisurvey.de/index.html - the software & methodology of SMART nutrition surveys http://www.micronutrient.org/english/view.asp?x=1 Website of the INGO Micronutrient Initiative, with all information on micronutrients you need. http://www.thehnts.org The Health and Nutrition Tracking Service (HNTS) is a collaboration of non-governmental organizations (NGOs), United Nations (UN) agencies, and donors for the review, analysis and validation of critical health and nutrition data gathering methodologies and information in selected humanitarian emergencies. The website conatins information on nutrition indicators, tools and training. http://www.unscn.org/en/ SCN is the food and nutrition policy harmonization forum of the United Nations to promote cooperation among UN agencies and partner organizations in support efforts to end malnutrition. http://oneresponse.info/GlobalClusters/Nutrition/Pages/default.aspx Website of the GNC (Global Nutrition Cluster). The four focus areas for the Nutrition Cluster are strategic and are not meant to be exhaustive and include a) coordination, b) capacity building, c) emergency preparedness, assessment, monitoring, surveillance, and c)supply. http://www.coregroup.org/ Website on community health approaches including the HEARTH model (strategy using positive deviance). http://www.ibfan.org/ibfan-ibfan.html The International Baby Food Action Network, IBFAN, consists of public interest groups working around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and wellbeing of babies and young children, their mothers and their families through the protection, promotion and support of breastfeeding and optimal infant feeding practices. http://www.measuredhs.com/ website with information regarding demographic and health surveys (including nutrition) worldwide. http://www.childinfo.org/nutrition.html Monitoring of situation of children and women (nutrition) worldwide. ACF-IN The information and links contained Paris http://motherchildnutrition.org/news/index.html Workshop on HIV-AIDS, June 2010-within this site aim to address malnutrition in the global context, offering online access to the latest worldwide developments in its prevention and management. http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm Vacancies and situation in emergencies.

ACF-IN MEETINGS: SOME PICTURES
ACF Workshop on HIV-AIDS, Paris, July 2010

© Action Contre la Faim International Network /// Newsletter N° /// September 2010 10

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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

WHAT CAN YOU FIND IN THE PREVIOUS…
Issue
#1 #2

Sector
WASH FSL

Releasing date
September 2008 October 2008

HQ
Paris Madrid

Main articles Caracoli en medio de la sed cuando se esta rodeado de agua - ACF Colombia Groundwater quantification in coastal area - ACF France Fuel efficient stoves or not? – when we are able to follow up our own recommendations - ACF Uganda Can the environment absorb our activities? The “acadjas”, a pilot fish production project on Lake Tanganyika - ACF RDC Integrated Nutrition and Food Security Surveillance in Malawi - ACF Malawi Projects including the concept of value chain - ACF Paraguay

#3

Nutrition

January 2009

Paris

Nutrition communautaire et sécurité alimentaire au Niger, les défis de l’intégration - ACF Niger What is Research? – ACF France

#4 #5 #6

FSL WASH Nutrition

June 2009 July 2009 January 2010

New York Madrid New York

Direct cash after the Post Election Violence in Kenya - ACF Kenya Direct cash project in Lira, Uganda – ACF Uganda Sustainability factors for Water points in Liberia – ACF Liberia Light casing for rapid rehabilitation/construction open wells Integrated Nutrition and FSL activities in Southern Sudan – ACF Southern Sudan Projet de support nutritionnel et de sécurité alimentaire des Personnes Vivant avec le VIH - ACF RDC

#7

FSL

December 2009

Paris

Direct Cash transfer in Uganda: results and lessons learnt – ACF Uganda Partnership in program implementation: an experience of ACF in Barguna – ACF Bangladesh Changing general food distributions into cash based interventions, Cyclone Nargis experience – ACF Myanmar

#8

WASH

May 2010

New York

Hygiene promotion in emergencies: Capitalisation of ACF experiences in Nakuru and Molo IDP Camps, Kenya - ACF Kenya Groundwater research in Uganda - ACF Uganda

#9

FSL

July 2010

Madrid

Seed Fairs in Eastern DRC – ACF Congo The Sentinel Sites in Central America –ACF Central America CFW: Food Processing Activity for Women in Palestine – ACF Palestine Réponse au séisme en Haïti : spécificités d’une réponse d’urgence en milieu urbain – ACF Haïti

#10

Nut

September 2010

Madrid

Management at remote control in Gao – ACF Mali Integrated Approach –ACF Perú Bhami History – ACF India Climate change and malnutrition – ACF Int

… AND NEXT NEWSLETTERS?
Issue
#11

Sector
WASH

Releasing date
December 2010

HQ
Paris

If you want to contribute to the next NUT edition of Tech The News, that will be released in December 2010 and piloted by ACF-France, please contact :

Jean Lapègue – jlapegue@actioncontrelafaim.org

© Action Contre la Faim International Network /// Newsletter N° /// September 2010 10

12

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