Malnourished Children

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Hundreds of thousands of badly malnourished children with limited access to hospital care, could be
given life-saving treatment at home with a locally-made peanut butter based food
Malnutrition kills at least an estimated 1 million children each year -- an average of one child every 30
seconds.
Worldwide, an estimated 20 million children under the age of five suffer from acute malnutrition, most of
them in south Asia and sub-Saharan Africa, according to the agencies which called for more community-
based treatment. The high-energy food, a paste-like composition of peanuts, milk, sugar and vegetable
oil, costs as little as $3 per kg when produced locally. It requires no refrigeration or added water.
When implemented on a large scale, and properly combined with hospital treatment for children with
complications, community-based management of severe acute malnutrition could prevent the deaths of
hundreds of thousands of children each year," the U.N. aid agencies said.
Many poor families do not have access to hospitals where malnourished children traditionally receive
special milk-based diets, the agencies said.
But community health workers or volunteers can easily identify the children suffering from severe acute
malnutrition by measuring mid-upper arm circumference.
It is urgent that this approach, along with preventive action, be added to the list of cost-effective
interventions being used to improve nutrition and reduce mortality," said WHO director-general Margaret
Chan.
The foods are not water-based, meaning that bacteria cannot grow in them, and they can be used in
areas where good hygiene is lacking, according to the statement.
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Severe malnutrition is a major cause of child morbidity and mortality in developing

countries especially sub-Saharan Africa. The hospital case fatality rate of severely
malnourished children in developing countries ranges from 20 to 30%. In Uganda the
prevalence of malnutrition remains high: among children below 5 years, 39% are
stunted, 4% are wasted and 23% are under weight. For the rehabilitation of severely
malnourished children, the World Health Organization recommends a liquid milk-based
diet, formula 100 (F100) which contains 100 kilocalories per 100 milliliters. F100 is
prepared by mixing dried skimmed milk, oil, sugar and mineral vitamin mix. It provides
100 kilocalories of energy and contains 2.9 grams of protein per 100 milliliters. In
Uganda the rehabilitation of severely malnourished children is based on High Energy
Milk (HEM) which is reconstituted cows¶ milk with nutritional composition similar to
F100.
Recently a semi-solid ready- to- use therapeutic food (RUTF) whose nutrition
composition is similar to F100 or HEM has been designed. It is prepared by mixing full
cream powder, icing sugar, ground nut paste, vegetable oil and mineral vitamin mix.
RUTF contains 545 kilocalories per 100 grams of which 10% are protein calories and
59% lipid calories. This preparation can be eaten without adding water hence reducing
the risk of bacterial contamination and it can be used at home with minimum
supervision. RUTF has energy density of more than 5 times that of milk-based feeds.
Hitherto the efficacy of RUTF in the rehabilitation of severely malnourished children in
Uganda has not been studied. The purpose of this study is to determine whether giving
daily RUTF in the rehabilitation of severely malnourished children results in a higher
weight gain than giving HEM.
Hypothesis: Giving 5 meals of RUTF daily in the rehabilitation of severely malnourished

children will result in a higher mean weight gain (>10g/kg/day) than giving 5 meals of
HEM daily.
The researchers calculated the minimum sample size of 64 patients in each group for
90% power and 95% confidence. In the calculation the researchers assumed that the
mean weight gain in the control (HEM) group would be 10.1 g/kg/day with standard
deviation of 4.4g according to results of a study by Diop in Senegal; and assumed that
the mean weight gain in the RUTF group would be 12.63g/kg/day (25.05% effect size)
World Hunger Facts 2009

World Hunger Education Service
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conflict as a cause of hunger and poverty. At the end of 2005, the global number of refugees was at
its lowest level in almost a quarter of a century. Despite some large-scale repatriation movements, the
last three years have witnessed a significant increase in refugee numbers, due primarily to the violence
taking place in Iraq and Somalia. By the end of 2008, the total number of refugees under UNHCR¶s
mandate exceeded 10 million. The number of conflict-induced internally displaced persons (IDPs)
reached some 26 million worldwide at the end of the year . Providing exact figures on the number of
stateless people is extremely difficult But, important, (relatively) visible though it is, and anguishing for
those involved conflict is less important as poverty (and its causes) as a cause of hunger. (Using the
statistics above 1.02 billion people suffer from chronic hunger while 36 million people are displaced
[UNHCR 2008])
Hunger is also a cause of poverty. By causing poor health, low levels of energy, and even mental
impairment, hunger can lead to even greater poverty by reducing people's ability to work and learn.
climate change Climate change is increasingly viewed as a current and future cause of hunger and
poverty. Increasing drought, flooding, and changing climatic patterns requiring a shift in crops and farming
practices that may not be easily accomplished are three key issues. See the Hunger Notes special
report: Hunger, the environment, and climate change for further information, especially articles in the
section: Climate change, global warming and the effect on poor people such asGlobal warming causes
300,000 deaths a year, study says and Could food shortages bring down civilization?
Progress in reducing the number of hungry people. The target set at the 1996 World Food Summit
was to halve the number of undernourished people by 2015 from their number in 1990-92. (FAO uses
three year averages in its calculation of undernourished people.) The (estimated) number of
undernourished people in developing countries was 824 million in 1990-92. In 2009, the number had
climbed to 1.02 billion people. The WFS goal is a global goal adopted by the nations of the world; the
present outcome indicates how marginal the efforts were in face of the real need.
So, overall, the world is not making progress toward the world food summit goal, although there has
been progress in Asia, and in Latin America and the Caribbean.
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Stratergies
Project aid includes food aid provided on a grant basis. It is used to support specific
and defined activities to promote economic and social development, usually in the
form of maternal and child health, food-for-work, and school feeding projects. It is
distributed through differentiated market channels.
These include the use of food as wages (i.e.., in-kind payment) to develop
infrastructure and assets, as an incentive to resettle new lands and adopt new
agricultural practices, and as inputs to spur agricultural development at a low cost to
the government in terms of foreign exchange and budgetary support (for example,
dairy or oilseed development projects). These measures all have ÷ ÷nutritional
consequences, which may be positive or negative. They are mediated by the general
process of economic development. They can and should be measured primarily and
observed in the long term, after the active distribution of food in the community has
ceased.
These include that (a) it is feasible to identify those at greatest nutritional risk in the
community and subsequently encourage their regular participation; (b) through the
provision of food commodities, along with efforts involving moral suasion, household
nutrient availability can be increased significantly; and (c) the perception of needs
within the household can be altered to encourage a new allocation of food
commodities among family members.
Empirical evidence also indicates that a 1 per cent increase in income will lead to an
increase in calorie consumption of up to 0.7 per cent for the poorest of the poor.
This figure tends toward 0.3 to 0.5 per cent for the more typical indigent household.
Recent research has shown that income elasticities of demand for calories among
the poorest of the poor households is 0.3 in Brazil (1), 0.61 in India, 0.67 in
Bangladesh (2), 0.74 in Indonesia (3), and 0.71 in Sri Lanka 14). Similar figures for
households near the poverty line (although not the poorest) show markedly lower
elasticities of 0.35 in Bangladesh, 0.37 in Indonesia, 0.44 in India, and 0.43 in Sri
Lanka. There is little doubt that the participants in food aid projects are poor and at
risk. However, participation is less likely by the poorest, who are most inaccessible
and hardest to reach because of where they live, time constraints, lack of education,
and so forth. Thus, it is assumed that the realistic calorie elasticity figure is between
0.3 and 0.5.
Severe logistical problems were identified in Malawi, a site chosen by the WFP for an
in-depth evaluation (8). The response was first to resolve logistical problems,
thereafter, procedures to determine impact would be developed and instituted. The
evaluation team separated the development of a process-oriented management
information system to improve project performance from impact evaluation
activities. Similar recommendations have been made to WFP by others who argue
that "ongoing management and operational evaluations" should no longer fall within
the domain of the Evaluation Service, who should focus on "providing information
important to policy formation and project design" (9). This is the wrong approach.
Instead, impact indicators should be incorporated into routine data collection
procedures that are part of the management process from the outset. This will have
numerous advantages. It will create an opportunity to collect baseline information
that will prove vital to further evaluation efforts. Similarly, a well-developed
management information system will provide secondary data that can subsequently
be used to evaluate projects (10-12). And most important, the development of a
goal-oriented management system, in which impact data are key elements, is the
best source of positive feedback on project performance, and serves as a powerful
motivating force for the field staff.
http://www.unu.edu/Unupress/food/8F063e/8F063E01.html

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http://74.125.153.132/search?q=cache:4vy-
oFhAttYJ:ochaonline.un.org/OchaLinkClick.aspx%3Flink%3Docha%26docId%3D1095102+distribution+ch
annels+undertaking+to+provide+food+for+malnourished+children&cd=8&hl=en&ct=clnk&gl=in
Under-nutrition is widespread among young children in poor countries. In many

countries one of the programmatic responses has been distribution of supplementary
food to under-nourished children and, often, their families. Traditionally, children under
five years have been identified based on low weight-for-age or other anthropometric
indicators, and those below a certain cut-off have received supplements. Typically this
results in supplementation of many children in the 3-5 year age range, since they are
most likely to display cumulative deficits in height and weight, and thus fall below the
chosen cut-off.
However, there has been increasing evidence that the most effective period to ensure
benefit from supplementary food is when children are 6 to 24 months of age. This is the
period of highest growth velocity among humans and thus a period when most growth
faltering occurs.
Based on this evidence, the current study aims to assess the effectiveness and cost-
effectiveness of a preventive approach that targets children under 24 months as
compared to the traditional ³curative´ approach that targets malnourished (and usually
older) children under the age of 5 years.
The comparison is made in the programmatic context of a US Title II food aid

distribution program implemented by an international non-governmental organization in
rural Haiti. This programmatic context is common in many countries that receive
assistance from the United States Agency for International Development and other
donors. The study has also involved development of new nutrition education materials
and tools, aimed at enabling caregivers to prevent malnutrition. In addition, a range of
program operational issues will be studied in order to yield results useful to other
implementers of similar interventions.
Comparison: Comparisons will be made at the level of the program site, with service
delivery points randomized either to target food supplements as in the past, based on
the child¶s nutritional status, or to target preventively based on age. Pregnant women
and lactating women with infants under 6 months of age will receive supplements under
both targeting models. Effectiveness will be assessed based on two cross-sectional
surveys, at baseline and two years after full implementation of the program.
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Malnourished Children

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Severe malnutrition is a major cause of child morbidity and mortality in developing

Hypothesis: Giving 5 meals of RUTF daily in the rehabilitation of severely malnourished

World Hunger Facts 2009

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Under-nutrition is widespread among young children in poor countries. In many

The comparison is made in the programmatic context of a US Title II food aid

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Malnourished Children

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Malnourished Children

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