Pir Mehr Ali Shah

Arid Agriculture University, Rawalpindi

Office of the controller of Examinations
Mid Exam / Spring 2021 (Paper Duration 12 hours)
To be filled by Teacher

Course No.: HND-504 Course Title: Nutritional in Emergency

Total Marks: 12 Date of Exam: 03-05-2021
Degree: BSc (Hons) HND Semester: 6th Section: A (Morning/Evening)
Marks
Q. No. 1 2 3 4 5 6 7 8 9 10 Obtained/
TotalMarks
Marks
Obtaine
d
Total Marks in Words:
Name of the teacher:
Who taught the course: Signature of teacher / Examiner:

To be filled by Student

Registration No.: 18-ARID-6131 Name: MUHAMMAD MEHRBAN

Answer the following questions.

Q.No.1. Write a detail note on how to calculate food requirements based on access to foods
and give your insights about monitoring mechanisms to access the adequacy of the RATION?
As health professional do you agree with role of Government during COVID-19. Please
explain with justifications
Answer:
PART A:
CALCULATION OF FOOD REQUIREMENTS BASED ON ACCESS TO FOODS
Food Requirements
 At the beginning of emergencies such as refugee tides, floods and hurricanes, people usually
have no food other than the food provided by the relief program. In these types of situations,
it is usually appropriate to estimate the food needs of humanitarian assistance based on the
adjusted population energy needs (i.e., provide the full ration calculated using the adjusted
plan).
 Generally, the proportion of energy demand that the population can provide is estimated to be
the closest to 25% (i.e., 25%, 50%, 75%).
 For example, if the energy requirement of a given population has been calculated to be 2,100
kcal, and the assessment determines that the population is capable of providing 25% of its
 daily energy requirement (approximately 500 kcal), then food aid should be calculated as
providing 1, 600 kcal.
Basic Principles
 When an emergency occurs, it is crucial to ensure that the affected population has sufficient
basic food rations. The availability of such rations will reduce the need for other expensive
and cumbersome food interventions.
 Personal energy requirements are mainly determined by BMR, which is estimated for
different groups of people based on age, gender, weight, female reproductive age,
physiological state (ice pregnancy or breastfeeding) and physical activity level (PAL).
 The total energy demand of the population is based on the addition of the proportions of all
age groups in the population to determine its total energy demand. The demographic profile
can be obtained through census data or surveys of refugee/internally displaced persons (IDP)
populations.
 When the population is completely dependent on food aid, the external food supply must meet
at least its minimum needs.
 Food rations should be used to supplement any food that the affected population can obtain by
themselves through activities such as agricultural production, trade, labor, and small
businesses. It is necessary to understand the various mechanisms that people use to obtain
food and be able to better estimate food and nutritional needs.

1. NEED FOR AN INITIAL REFERENCE VALUE FOR EMERGENCY FEEDING

 Therefore, in the first phase of the emergency, the estimated average energy demand per
capita i2,100 kcal, which will be used to expedite the decision to start providing food
immediately. Once some demographic and food security information is collected, the
calculation of the amount of food aid needed should be adjusted accordingly.
 If it is obvious from the beginning of the emergency that the food demand is different from
the initial reference value of 2100 kcal, you can flexibly use a more appropriate figure to plan
the food demand; for example, in the case of maintaining food or income access.

2. ADJUSTMENT OF INITIAL REFERENCE VALUE

 When no other food is available and only the number of people affected is known, the initial
reference value of 2100 kcal applies in the early stages of an emergency. When demographic
information is collected and the extent to which people obtain food from other sources is
known, the initial reference value of 2100 kcal must be adjusted to reflect the actual energy,
protein and micronutrient needs to be met through external food aid.
Factors to consider when establishing ration levels
i. Demographic characteristics (age and gender composition)
 The composition of the beneficiary population affects nutritional needs. For example, a
population consisting only of women and children will require approximately 6% less energy than
the considered standard population (a country).

ii. Activity level:

The FAO/WHO/UNU report published in 1985 gave PAL values for different levels of activity.
The current quantitative level of 2100 kcal is based on a mild PAL of 1.55 x BMR for men and
1.56 x BMR for women. This level will maintain the health and nutritional status of individuals
engaged in light industry. When the workload exceeds the light level, an increase in rations
should be considered. In this regard, attention should be paid to the workload by sex.

iii. Environmental temperature:

The current practice is to use the average temperature of 20ºC as the reference temperature, and
add 100 calories for every 5 degrees below 20ºC.

iv. Health, nutrition and physiological condition:

Before assistance is provided, the affected population may have suffered tremendous nutritional
pressure and severe chronic food shortages. Other risk factors include micronutrient deficiencies
that are widespread in the place of origin, or widespread epidemics that threaten the population.
These risk factors may require adjustments to ration levels.

v. Household food security:

The need for external food assistance depends on the level of access to local food. In turn, this is
affected by the local food supply on the one hand (for example, on the market or from its own
production). It must be assessed to what extent this input of the population is sustainable or
reflects the erosion of the assets originally owned by the population.

3. CHOOSING COMMODITIES:
Taking into account the initial planning figure (2,100 kcal), foods that meet the basic energy,
protein, fat and micronutrient requirements of the affected people must be selected first.
Acceptable rations should also consider local eating habits. It also includes optimizing and
adjusting rations based on the amount of food people get.

4. FACTORS AFFECTING FOOD PROCESSING, PREPARATION AND USE

When setting food rations for emergencies, other important issues that directly affect the ability to
meet people's nutritional needs should be considered. Specifically:
 Local food habits and cultural acceptance
 Milling requirements
 Fuel for food preparation
  Non-food items needed for food preparation

5. MANAGEMENT OF FOOD-RELATED ISSUES

 Temporary substitution of food items
 Packaging of food-aid products
 Exchange and trade of rations
 Quality control

PART B
MONITORING MECHANISM TO ACCESS THE ADEQUACY OF RATION
Monitoring Mechanism
Merely estimating the population’s food needs and planning rations are not enough to ensure that
needs are met in emergency situations. So, we recommend that:
 First, a monitoring system must be established to ensure that any shortcomings in rationing
are detected in a timely manner.
 Second, a strategy should be formulated to outline actions to deal with food shortages or
insufficient rations.
 Third, the timing of access to food may vary greatly, and opportunities for obtaining food
through the population’s own means in different situations are also very different.

I. MONITORING MECHANISM TO ASSESS ADEQUACY OF RATION

The monitoring of general food distribution plans is usually carried out at four different levels:
 Food pipeline and supply - at the resource level, pledges, shipments, deliveries to the camp,
available inventory in the warehouse. This is achieved through reports and record checks (for
example, waybills, logs, etc.).
 Food-distribution process - Monitor the actual organization of the distribution system:
frequency, distribution location, availability of registration cards and ration cards, food basket
monitoring.
 Community level - Monitor the use, sale and exchange of food and its impact on the
prevalence of protein energy malnutrition and micronutrient deficiencies. Link with the health
monitoring system to assess all the causes of malnutrition.
 Household level - determine extent to which an individual obtains, prepares and consumes
food; infant feeding methods; and women's views on the quality and value of food

II. MONITORING TOOLS:

No single monitoring tool can meet all information requirements in all situations. The choice of
specific tools to be used in a given situation will depend on the goals of the emergency intervention,
 available resources and local conditions. Information collected through monitoring should be used
continuously for review.
 Food Basket Monitoring (FBM)
 Qualitative methodologies (rapid assessments)
 Household surveys (quantitative)
 Anthropometric and micronutrient- deficiency disease surveys
 Household Food (Economy Assessments)
 Food and Livelihood (Security Assessment)

III. FOLLOW-UP TO MONITORING

In emergency situations, there may be many constraints that limit the possibility of providing
adequate rations in quantity and quality. Therefore, it is essential that in the event of shortages,
appropriate corrective measures should be taken to prevent any adverse consequences in the target
population. In any case, the public should be informed of expected or actual shortages.

PART C
ROLE OF GOVERNMENT DURING COVID-19

 The Pakistani government has taken unprecedented measures to deal with the impact of the
COVID-19 crisis. The Pakistani government has taken preventive measures against COVID-
19.
 Pakistan has implemented a policy of lockdown, staying at home, isolation from society and
providing quality hospital care for the people.
 From the very beginning, the government understood the severity of the COVID-19 pandemic
and immediately took severe action. The government cancelled all international flights and
tried to minimize large gatherings.
 These early preventive measures minimized the peak of the pandemic and the number of
cases in the country. State officials deal with the coronavirus pandemic by taking timely and
vigilant precautions to ensure the safety of citizens.
STEPS REQUIRED TO BE TAKEN BY GOVERNMENT
 In developing countries like Pakistan, disease outbreaks have greatly challenged the medical
system. Lack of basic sanitation facilities, inadequate sanitation policies, weak governance
and the public’s indifference to general protection measures has further aggravated the
situation. It needs to show a disciplined, clear, practical, rapid, comprehensive, rational and
collective response.
 This can be achieved by testing a large number of individuals and then isolating these cases
after COVID-19 positive test results, introducing PPE, enhancing healthcare capabilities, and
taking administrative measures to ensure better safety for healthcare professionals. In
 addition, providing medical staff with resources in the best possible way can help them cope
with this epidemic.
 The primary and secondary healthcare systems also need to be repaired because they will
relieve the pressure on the tertiary healthcare system. If the main problems in the management
system are resolved, it will have a profound impact.
All provincial authorities and government officials must ensure better safety for health care
professionals, conduct awareness campaigns, and eliminate fear of citizens.
 The hospital staff must be provided with maximum protection at all costs.
 The government must take a responsible approach to educate the public and ensure that its
information must show the fact that there is no guarantee that the number of people in
Pakistan will still be lower than in the West.
 After obtaining a positive test result for COVID-19, quarantine and social distancing must be
actively implemented. People should be advised to cover their faces with mask.
 The shaky public health sector must get funding and the priority it deserves.

Other General Guidelines

Local governments should take health and social measures to stop the spread of the virus by ensuring
the equal participation of all members of society. In this regard, the World Health Organization
(2020c) recommends a media-based campaign to spread awareness among the public.
 We suggest that the following recommendations allowed by official agencies and existing
literature are reasonable and ethical starting points for the country to take steps to reduce this
virus. The government should establish a psychological hotline to provide psychological
assistance to serving doctors and other medical personnel. In addition, hospital staff should be
provided with adequate personal protective equipment to protect them from infection
 During the current pandemic, medical staff should be adequately trained to select appropriate
protective equipment. They may have multiple options, but they find it difficult to choose the
right option.
 Health care professionals should be provided with basic equipment, including N95 and
surgical masks, face shields, and space for later disposal of the equipment.
 Governments should reconsider the health system, because public lanterns may also be a
potential source of virus transmission. Only a well-managed health system can limit the
spread of the virus, especially in developing countries, where governments must reformulate
their waste management plans.

Q.No.2. Please find out the reasons, what are the research gaps and priorities in nutrition?
Please justify emergency situation arising due to earthquake and lock down due to
PANDEMIC along with their impacts on health and nutrition. Please discuss the utilization of
local reserves for tackling nutrition emergency.
Answer:
PART A:
Please find out the reasons, what are the research gaps and priorities in nutrition?
The knowledge (academic, research), technology and capacity gaps are needed to be filled in
the field of nutrition are given below:

1. Education of the Dietitians

 The nutritionists need to be trained for the future. Although registered dietitians are
experts in the field of food and nutrition services and interventions, nutrition is only
one of many problems that the service target or patient will encounter. Need for
extensive training and exposure to many problems faced by the people.
 The dietitians need to have an understanding of relevant social and health professions
so that they can operate effectively in medical teams and systems that serve the
elderly. The more work should be done to educate future nutritionists about aging,
and pointed out that other health professions also offer many undergraduate and
graduate courses on aging.

2. The Nutrition Services for the people:

 The integration of food and nutrition care and services in all environments, including
communities, outpatient clinics, rehabilitation, assisted living and nursing
homesElderly people in need of nutrition services should set goals through a well-
designed screening plan.
 There is a need to develop and implement interventions that target the different
cultures, geographic locations and characteristics of older people in these
environments. Patient-oriented services should be coached by dietitians or healthcare
professionals are likely to be accepted by the elderly. It is also suggested conducting
research on how to educate people to make informed health-related decisions, such as
choosing nutrition services as a way for patients to directly benefit.

3. Refining Outcomes Measures

 Another research gap discovered is that the outcome indicators of interventions have
been improved to prove their cost-effectiveness and improved quality of life.
 One of the main goals of the Administration on Aging (AoA) is to keep people at
home for as long as possible instead of going to nursing homes. However, the
evaluations of the AoA program were small and did not address Congress’s main
interest-will interventions prevent people from institutionalizing and reducing health
 care costs? In addition, if the current assessments linking these plans to Medicare and
Medicaid results show ineffectiveness and do not result in a reduction in health care
expenditures, it must be determined why they were unsuccessful, so improvements
can be made.
 It also emphasized that more data on the cost-effectiveness of OAA nutrition
programs is needed. In this year, about 40% of the elderly participated in the family
meal plan. Many of these homeless people should be identified through a nutritional
assessment in the hospital, and that lunch should be provided more than five times a
week. For people who meet food and other service needs through programs, it is
necessary to record the savings that Medicare and Medicaid save.

4. The Use of Fortified Foods and Dietary Supplements

 It is necessary to conduct basic and translational research on the development,
evaluation and proper use of fortified foods and dietary supplements to maintain and
improve health of the people.
 The first is the further characterization of dietary supplement use behavior, including
describing the effect of nursing staff's advice.
 It is also necessary to characterize the diversity of beliefs (such as alternative
medicine) and behavioral, cultural, and social factors that may influence and
confound dietary supplement data. Women's Health Program and Ginkgo Memory
Evaluation Research, Nevertheless, there is still a need to evaluate the use of dietary
supplements and the method of collecting dietary supplement data.
Another remaining research gap includes preclinical and clinical research.
 Better distinguish which people may need dietary supplements,
 Assess the safety and effectiveness of supplements,
 Capture daily dietary intake and total daily nutritional intake,
 Assess the drug-nutrient interaction, and

5. Nutrient Requirements
 It is identified another research gap, which is methods that need to be improved,
including biomarkers, analytical methods, dietary assessment tools, and systematic
reviews. Although progress has been made in the verification of biomarkers used in
national surveys, it’s also reported on major developments in the field of analytical
methods. But there is a need to determine the best way to incorporate formal methods
of weighing the power of interpretation into policy and clinical practice.
  The nutrient requirements study as a priority research blank and explained that some
current dietary reference intakes (DRI) are "obviously wrong." For example, the
estimated average requirements (EARs) of vitamin E (and possibly vitamin A) are too
high; continuous research and improved biomarkers are needed to obtain a more
realistic and accurate EAR. In addition, there is evidence that the recommended
dietary allowance (RDA) for vitamin B12 may be too low; the elderly may need up to
6 micrograms per day. As the discussion of protein requirements emphasized, the
need for macronutrients must be further studied.
6. Communication and the Education
 The development of nutrition science, another area of development is the exchange
with caregivers and educational materials, which are suitable for the needs of the
people. For example, information on how USDA’s “MyPlate” would be helpful. In
addition, best practices need to be effectively communicated to implement these
recommendations for patients and their families. As patients spread throughout the
healthcare system from the community to the hospital, the information can be very
confusing, so using a common language will help.
 There is a need to expand ties with the most vulnerable in the ageing population.
Using existing connections and resources to increase awareness of existing programs
and services will is helpful.

7. Obesity and Related Disorders

Another research area identified is the prevention and treatment of obesity and obesity-
related diseases (including sarcopenia). The increase in population in conflict with the
obesity epidemic, and pointed out that failure to solve the obesity problem of the people
may even erode the life expectancy of the past century.

8. Food Insecurity and Healthy Aging

 When talking speech on food insecurity for the elderly, the basic food needs of the
elderly must be met, and pointed out that if people cannot obtain, afford or prepare the
food they need, Nutritional interventions will not work.
 The impact of the current economic downturn on the food insecurity of the elderly,
worried that they might be ignored due to concerns about children, and suggested
researching ways to prioritize the needs of many people. The research on food deserts
is very important, focusing on policy changes that communities can make to increase
food supply and access. The role of community gardens, local products and food
banks in increasing the food supply in the food desert
9. Funding Opportunity
The research theme of this funding is "translational research" to help the people maintain the
health and independence of the community. The purpose of this funding is to transfer the
evaluation of documented evidence-based interventions from a rigorous research
environment to a community environment, thereby forming a true partnership. The two
requirements listed in the announcement are:
 The connection between the university and the organization in the community that
cooperates with the people
 Cost-effectiveness as one of the criteria. Nutrition is one of many criteria that can be
evaluated.

10. Other Academic, Research, Technology And Capacity Gaps

Marketing research is another major gap discovered. There should be more focus group
discussions with people to determine which foods appeal to them and identify other issues of
concern. It is also suggested solving marketing problems, because people consumers lack
trust. How people are sensory appreciation of food and plate appeal can change the way they
eat.
 The impact of microorganisms on human metabolism and disease is a relatively new
area of research.
 There is often a lack of knowledge of the interface between practitioners and patients.
Forums such as this provide opportunities for researchers to understand how to adapt
their research to issues that best meet the needs of practitioners and ultimately
patients.

PART B:
Please justify emergency situation arising due to earthquake and lock down due to
PANDEMIC along with their impacts on health and nutrition.

 Sudden natural and technological disasters have directly or indirectly brought huge
health burdens to people, and indirectly burdened the ability of health service
departments to meet basic health care needs. The relationship between infectious
diseases and disasters deserves special attention. Disasters have many changing
definitions. The basic common element of these definitions is that disasters are
unusual public health events that overwhelm the response capacity of affected
communities.
  Since the beginning of the COVID-19 pandemic, access to fresh food has been
restricted, people are spending more and more time indoors, and physical activity has
also been restricted. However, more time at home may lead to some positive habits,
including increased cooking.

EMERGENCY SITUATION ARISING DUE TO EARTHQUAKE ALONG WITH

THEIR IMPACTS ON HEALTH AND NUTRITION:
In the past five centuries, earthquakes have killed 5 million people, 20 times the number of
deaths caused by volcanic eruptions. Within seconds or minutes, a large number of injuries
(most of which are not life-threatening) require immediate medical services from medical
institutions, and these medical institutions are usually not prepared, damaged or completely
destroyed, just like in an earthquake. In 2003, Bam, Iran. The earthquake killed 26,271
people. After the earthquake, the entire medical infrastructure of the city was destroyed. Long
before the first foreign mobile hospitals arrived, all the wounds were airlifted to 13 provinces
in Iran.

1. Immediate health effects

 Trauma-related casualties caused by building collapse.
 The secondary effects of the earthquake (drowning and bodily injuries related to the
tsunami, injuries from landslides, burns from fires and smoke inhalation) and trauma-
related deaths and injuries.

2. Medium-term effects on health

 Secondary infection of untreated wounds.
 Due to the interruption of obstetric and neonatal services, the morbidity and risk of
complications related to pregnancy, childbirth, and newborns increase.
 The potential risk of infectious diseases, especially in overcrowded areas.
 Due to the interruption of treatment, the incidence of chronic diseases and the risk of
complications are increased.

3. The Impact of Earthquake on the Health System:

 Damage to health facilities and transportation infrastructure, which in turn interrupts
service delivery, leads to a decrease in the access and function of health services at all
levels.
  There is a lack of medical staff who may not be able to reach medical institutions that
are still in operation, or whose homes and families may be directly affected by the
earthquake.
4. Disaster Mitigation and Earthquake Prevention:
 Strengthen the risk management system for health emergencies.
 By improving the quality of the built environment, and through better land use
control, including building adjustments, to limit the risk of earthquakes.
 Ensure that sanitation facilities are capable of responding to disasters, and can
maintain the functions of sanitation facilities after an earthquake occurs, with
appropriate training of personnel, and be able to cope with growing and changing
sanitation needs.
5. Impact on infectious Diseases:
 Disasters related to natural events may affect the spread of pre-existing infectious
diseases. However, the imminent risk of a major outbreak after a natural disaster has
been exaggerated.
 Among the factors mentioned incorrectly were the bodies of the victims, many of
which were buried under rubble. Dead bodies from primarily healthy people do not
pose a risk of increased disease incidence.

6. Damage to Health Faculties and Hospitals:

 In the 1985 Central Mexico earthquake, 5,829 hospital beds were destroyed or
evacuated. The earthquake in El Salvador (2001) resulted in the loss of 2,000 hospital
beds, which accounted for 40% of the country’s hospital capacity.
 The control of infectious diseases and other public health programs suffers from the
loss of laboratory support and hospital diagnostic capabilities.

EMERGENCY SITUATION ARISING DUE TO LOCK DOWN DUE TO PANDEMIC

ALONG WITH THEIR IMPACTS ON HEALTH AND NUTRITION
There is clear evidence that epidemics such as COVID-19 have adversely affected the
livelihoods of individuals, families and communities. Some of the impacts of COVID – 19
lockdowns are listed below:

1. Impact on Basic Health Care Services:

 The COVID-19 pandemic will have an impact on multiple levels. At the health
system level, the outpatient department (OPD) is closed and the focus is only on
emergency or COVID-19 cases. We may see a shortage of essential medicines due to
 the disruption of the overall supply chain. While health care providers are diverted to
help respond to this pandemic, they are also at high risk of contracting the disease.
 Due to social distancing and imposed blockades, the role of community health
workers has been weakened. Coupled with the transfer of financial resources to
COVID-19 response measures, this will take funding away from basic health,
immunization and reproductive health programs and reduce the chances of patients
who rely on free or subsidized care from getting treatment.

2. Impact on Immunization Services:

 Immunization services have been interrupted due to the COVID-19 outbreak. Not
only in Pakistan, but also in vaccine-producing countries, continued blockades and
flight restrictions will create some gaps in basic vaccine stocks and cause
immunization services to be interrupted.
 At present, due to the blockade, the spread of COVID-19 in the community and
vaccinators are unable to use basic personal protective equipment. Immunization
services are only provided from fixed locations and extension services have been
stopped.

3. Impact on Maternal and Reproductive Health Services:

 The COVID-19 outbreak and subsequent lockdown limited women’s access to life-
saving maternal and reproductive health services.
 The impact of COVID-19 on reproduction and newborn health care will be on
multiple levels. E.g.,
 At the health system level, due to the disruption of the entire supply chain, we may
see a shortage of drugs, such as contraceptives, antiretroviral drugs for HIV/AIDS,
and antibiotics for the treatment of sexually transmitted infections.

4. Impact on Food Security:

 The COVID-19 pandemic has evolved into a global crisis that has affected the
livelihoods and food security of millions of people in Pakistan. If urgent measures are
not taken to maintain the life of the food chain and protect food consumption, the
pandemic will have a major impact on everyone, especially the poorest and most
vulnerable.
 A longer lock-down period will also reduce the purchasing power of smallholders for
daily food, the input of kharif planting and the purchasing power of livestock feed,
which will adversely affect smallholders.
5. Impact on Nutrition Service:
 It should also be pointed out that in Pakistan, the national prevalence rate of stunting
is 40.2%, and the prevalence rate of severe stunting is 19.6%.
 Boys (40.9% and 20.2%, respectively) are higher than girls (39.4% and 19.1%). The
prevalence is slightly higher in rural areas (18.6%) than in urban areas (16.2%).
 Vitamin A, vitamin D and zinc deficiencies in children under five are estimated to be
51.5%, 62.7% and 18.6%, respectively. More than half of Pakistani children (53.7%)
and adolescent girls (56.6%) suffer from anemia. Obesity is becoming a serious health
hazard among young children and adolescents, increasing from 5% in 2011 to 9.5% in
2018.

6. Impact on Education Sector:

 The COVID-19 pandemic has also affected the continuity of education and learning,
and all public and private sector educational institutions across Pakistan were
immediately closed. Some educational facilities have also been designated as isolation
and quarantine centers. In addition, the closure of educational institutions due to
COVID-19 directly affected 42 million students from preschool, elementary school to
high school and degree university.

7. Impact on Labor Migration:

Pakistan is one of the major labor exporting countries in the world, with nearly 11 million
Pakistanis working in different countries. The ban on international travel and restricted
inter-city travel have had an impact on labor migration during the lockdown period.

PART C:
Please discuss the utilization of local reserves for tackling nutrition emergency.
OVERVIEW:
All food systems will continue to be affected by disasters and extreme weather events.
Triggered by the recent global food crisis and concerns about climate change, governments in
some countries have been working hard to develop more robust and resilient food systems.
For many governments, one of the oldest options is to reserve emergency food reserves for
food security and disaster preparedness purposes. After the 2007-2008 and 2011 world food
price crises, the governments of some Asian countries have been maintaining emergency
food reserves to ensure greater supply and price stability. Disasters and extreme weather
events help the government justify emergency food reserves.
INTRODUCTION:-
The issue of Emergency Food Reserve (EFR) or Emergency Food Stock (EFS) is inherently
contradictory. On the positive side, many governments have used this approach as a policy
option to achieve goals such as food security, disaster preparedness, and famine warning
systems. Recent examples can be found in the Middle East and North Africa and South Asia,
East Asia and Southeast Asia. On the downside, large-scale EFR/EFS may not be efficient
because they distort food prices and markets, and therefore, are subject to the constraints of
the World Trade Organization (WTO) regulations
 EFR can be used as a means to reduce disaster risk (including adaptation to climate
change), and aims to understand why Asian governments have re-adopted emergency
food reserves as a national policy, with a focus on Indonesia, the Philippines and
Malaysia.
EFR or EFS
 Establishing emergency food reserves or emergency food stockpiles can be defined as
the process of holding back a certain amount of a food commodity from the current
production/procurement year for use in the future, anticipating shocks from droughts
and other climate-related calamities.
 This policy anticipates future uncertainties in the market as well as on farms. Because
future climate is very likely to be more uncertain, it is often difficult to specify the
most optimal food stock quantity to be held at government warehouses. As a result,
governments are often trapped in either risk-averse or risk-taking behavior.
Under global climate change scenarios, food security faces risks and turbulence
 Under global climate change scenarios, food security faces risks and turbulence. The
expected increase in extreme weather has led to anticipated actions by the
government, including new initiatives to promote the adoption of EFR policies.
Affected by recent disasters and climate change issues, governments in some
countries have been trying to develop stronger and more resilient food systems.
 For many countries in Asia, this means the re-adoption of EFR. Unfortunately, we
believe that this is not well understood in climate change adaptation research and
contemporary disaster research.

Food Security Reserve Agreement

 The Association of Southeast Asian Nations (ASEAN) first initiated the "Food
Security Reserve Agreement" in 1979 to meet emergency needs (ASEAN 1979).
Policy makers have realized that the region is vulnerable to natural disasters and the
possibility of food shortages. But the association took 30 years, until shortly after the
 2007-2008 world food crisis, plus three other East Asian countries (China, Japan,
South Korea), established ASEAN Plus three emergency rice reserves Area.
 (APTERR), as a mechanism to resolve potential food shortages in the region based on
climate and market uncertainty. The final formal agreement was signed in Jakarta in
October 2011 (APTERR 2017).

AFSIS
 The Association of Southeast Asian Nations has also established the ASEAN Food
Security Information System (AFSIS), which serves as a central information
repository for five commodities (rice, corn, soybeans, sugar and cassava).
 AFSIS not only monitors and analyzes the production, import, export, inventory,
price, food security ratio and self-sufficiency rate of these commodities, but also
provides data on the losses suffered by each member country due to floods and
droughts.

Emergency/Humanitarian Food Stocks

 These stocks are used to protect food access in the event of food shortages in
emergencies, especially for vulnerable groups. In any type of emergency that the
government deems necessary, or as part of a larger post-disaster safety net, such food
stocks will be released. Reserving reserves for emergencies and/or unforeseen
disasters is another aspect that makes food reserves particularly attractive.
 In order to ensure that food and nutrition supplies at the municipal and household
levels are guaranteed, the Japanese government has stipulated to reserve two weeks of
rations.

Food security and price stability stocks

 This kind of food inventory has an inherent welfare goal because it can act as a buffer.
Food security stocks are used to ensure food supply and price stability. The
government usually uses this stock to control domestic supply and the domestic price
of food. The theoretical basis for this stock is that the government buys food from
farmers and/or the market at a cheap price, and releases the stock when the market
price exceeds the acceptable level of affordability. The concept is based on a formal
definition of food security.
 In 1996, the World Food Summit adopted the concept of stability in the definition of
food security, which included “always” to be combined with the three aspects of food
 security-tangible food supply, economic and tangible food acquisition and utilization
(in nutrition Aspect) food.

Safety Net Food Stock

The safety net inventory is aimed at low-income groups in society. These grain stocks are
usually sold at high subsidized prices. For food security purposes, such food reserves are
sometimes maintained and stored together with the reserves.
 However, unlike stocks used for food security, safety net stocks target specific groups
or beneficiaries classified by government and based on established poverty lines, as
seen in countries such as India and Indonesia. Generally, such stocks are designed to
improve food supply and access to people suffering from chronic food insecurity.

International/multilateral food stockpiles: regional grain stocks

The most cited regional grain reserve mechanism; perhaps the most famous example is the
ASEAN plus Three Rapid Rice Reserve (APTERR).
 The reserve is composed of 10 member states of ASEAN and China, Japan and South
Korea, and aims to help the region stabilize the supply of rice (the main food crop in
the region) in emergency situations. In 2014, APTERR disposed of 787,000 tons of
rice.
 Other examples of regional food reserves include the Food Bank of the South Asian
Association for Regional Cooperation (SAARC) and the Regional Humanitarian Food
Reserve of the Economic Community of West African States (ECOWAS).

Q.No.3. What is the relation between food security and obesity? Discuss in detail nutrition
situation of Pakistan and give suggestion how we can make nutrition as best discipline?
Name a latest complex emergency that has resulted in a nutrition emergency followed by an
international response?

Answer:
PART A:
RELATION OF OBESITY AND FOOD SECURITY:

OBESITY:

Obesity is a complex disease that involves too much body fat. Obesity is not just a cosmetic issue.
This is a medical problem that increases your risk of other diseases and health problems, such as
heart disease, diabetes, high blood pressure and certain cancers.
FOOD SECURITY:

Food security means that all people can physically, socially and economically obtain sufficient, safe
and nutritious food to meet their food preferences and dietary needs at any time. Active and healthy
life.

OBESITY AND FOOD SECURITY:

 Food security means that food is available for all people with amount of nutrients that their
body requires, therefore the chance of becoming obese in the people of that area is low.
Therefore, the food security and obesity are indirectly linked. While the chance of becoming
obese with food insecurity is higher.
 Obesity is a separate issue and may be affected by the following factors. Many factors,
including diet, activity level, and Income level, access to food, genetics, lifestyle Choice and
culture 9. In contrast, especially, it is mentioned in GFSI that food security is national Issues
related to structural issues, Such as corruption, infrastructure and food supply. How difficult
is this to track the range, Structural issues affect personal issues
 This study describes the relationship between food security status and body weight and
dietary intake, and suggests that ethnicity may lead to differences in food insecurity through
cultural norms and community support.

PART B

Discuss in detail nutrition situation of Pakistan and give suggestion how we can make
nutrition as best discipline?

Nutrition situation of Pakistan:

 Pakistan is "on track" to meet two targets for Maternal, Infant and Young Child Nutrition
(MIYCN). No progress has been made in achieving the goal of reducing anemia among
women of reproductive age, since 52.1% of women between the ages of 15 and 49 are
affected.
 Meanwhile, there are insufficient data to assess the progress Pakistan has made towards
achieving the goal of low birth weight, nor are there adequate prevalence data. Pakistan is
"on track" towards the goal of exclusive breastfeeding, with 47.5% of infants aged 0-5
months exclusively breastfed. Pakistan has made some progress towards meeting the
stunting target, but 37.6% of children under 5 years of age are still affected, which is higher
than the average for the Asia region (21, 8%).
 In Pakistan, the nutritional status of children under the age of five is extremely poor.
Pakistan has also made some progress towards meeting the wasting target, but 7.1% of
 children under 5 years of age are still affected, lower than the average for the Asia region
(9.1%). The prevalence of overweight children under 5 is 2.5% and Pakistan is "on track" to
prevent the number from rising.
 Anthropometric deficits are systematically higher in rural areas, probably due to low
socioeconomic status and very poor access to basic health services.
 According to the national food consumption surveys carried out in Pakistan, the average
daily energy intake per capita covered the daily needs in the periods 1984-85 and 1987-88.
In the Pakistani diet, cereals remain the main staple food and provide 62% of total energy.

Suggestion how we can make nutrition as best discipline?

Nutrition refers to a healthy and balanced diet. Food and drinks can provide the energy and
nutrients needed for health. Health is more than just the absence of disease. This is a positive
quality that emphasizes physical, social, intellectual, emotional and mental health. Providing the
best nutrition for all nutrients of all types and quantities is the cornerstone of good health and
the frontier of prevention.

Making nutrition a Best Discipline:

According to my opinion, the right to full nutrition and the right of the child to reach his or her full
potential. In this way, nutrition interventions will also have a positive impact on the survival and
development of children, with a focus on the critical first years of life.

People can easily spread health and nutrition awareness in Pakistan in the following ways:

 Holding seminars
 Meetings
 Poster showing malnutrition
 Dispatch of steering groups in rural areas of Pakistan
 Outreach programs in schools and colleges
 Using media
 Start a program that deals with personal nutrition and health

Some health awareness and nutrition tips/methods are:

 Awareness and promotion of Public Health Systems, preventive medicine and emergency
care in rural areas
 It is committed to integrating innovative science-based solutions and partnerships to
improve the ability to achieve three related goals:
 Protect Rural Public Health by preventing outbreaks of new diseases; and
 protecting ecosystems by promoting conservation
  unlocking the potential of preventive health care in traditional communities
 Through biosphere-centric activities, food and nutritional safety and sustainable resources
reduce the spread of infections and diseases without freeing us from the comfort of habits.
 The ecology, art, and technology restore toxins in the landscape. We need local clean food
and resources for all living things in the environment.
 Ways to raise awareness and coverage of alternative natural health resources
 To promote awareness of Environmental Health
 Supporting traditional midwifery and the greater health care needs of young women and
girls
 To promote the link between vegetable gardens, healthy eating, nutrition and health
 Links between existing public health systems and community health care.

On individual basis:

Here are some little ways that can nutrition a best discipline.

Keeping calorie counts:

Keep your daily calorie intake to a reasonable amount. Find out how many calories you need for
your age, gender, activity level, and your personal weight goals. To help determine your calorie
and nutrient needs.

Portion sizes:

Keep food portion sizes to a reasonable and recommended amount. Controlling "Portion
distortion" is important.

Adding fruits and veges:

Try to eat more of these foods: vegetables, fruits, whole grains, lean proteins, and some low-fat
dairy products. Fruits, vegetables (and grains) offer important vitamins, minerals, and
phytochemicals. They also contain fiber to help with digestion and prevent constipation.
Research shows that a diet rich in fruits and vegetables can help lower cholesterol and blood
sugar and prevent heart disease.

Adding whole grains in diet:

Try to make at least half (or preferably all) of your daily grains whole. Foods made from whole
grains are an important source of energy and fiber. Learn to read food labels so you can identify
which grains are truly whole.

Selecting leaner proteins:

 Select leaner protein sources and try to use more plant-based protein in your meals and recipes.
Protein foods include animal sources (meat, poultry, seafood, eggs, and dairy products) and
plant sources (beans, peas, soy products, nuts, seeds).

Decreasing the intake of less healthy foods:

Cut down on less healthy foods. These are foods high in saturated and solid (trans) fats and
added sugars and salt, such as cookies, ice cream, candy, sweetened beverages, and fatty meats
such as bacon and hot dogs. These foods generally provide a lot of calories and minimal
nutritional benefit, if any. Take them as occasional treats, but not every day.

Reducing sodium intake:

Reduce your sodium (salt intake). Cut back on canned, packaged, and frozen processed foods. If
you are buying these items, use the Nutrition Facts label to choose low sodium versions of foods.
Restaurant foods high in sodium are also another important source of salt added to the diet.

Taking less sugary drinks:

Rethink your drink. Drink more water and other sugar-free drinks instead of sugary drinks and
other high-calorie drinks. Sodas, sweetened juices, energy and sports drinks are a major source
of added sugar and calories.

Conclusion:

In conclusion, according to my opinion, all of these steps are important for making the nutrition
a best discipline.

PART C

Name a latest complex emergency that has resulted in a nutrition emergency followed by
an international response?

 The latest emergency that resulted in nutrition emergency followed by international

response is COVID-19 PANDEMIC.
 The COVID-19 pandemic, also known as the coronavirus pandemic, is the 2019 global
coronavirus disease (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2).
 The virus was first discovered in Wuhan, China in December 2019. The World Health
Organization announced the COVID-19 public health emergency of international concern on
January 30, 2020, and subsequently announced a pandemic on March 11, 2020. As of May 3,
 2021, there have been more than 152 million confirmed cases, of which more than 3.2 cases
of COVID-19 have caused 1 million deaths, making it one of the deadliest epidemics in
history.

COVID-19 IN PAKISTAN:

 The COVID-19 pandemic has affected approximately 210 countries, with more than 67
million confirmed cases and more than 1.5 million deaths worldwide, including Pakistan.
Taking into account the population density, medical and health care capacity, existing
poverty and environmental factors, there are more than 420,000 infected people and more
than 8,300 people died. The spread of the coronavirus in the community quickly occurred in
Pakistan.
 This article analyzes the short-term and long-term impact of the COVID-19 peak on
Pakistan’s socio-economic and environmental aspects. It is estimated that by the 2021 fiscal
year, there will be about 10% of the economic loss, that is, 1.1 trillion Pakistani rupees. The
government has conducted a comprehensive analysis of certain pandemic barriers (such as
lockdowns, social distancing, and travel restrictions) to determine how they affect the
livelihoods of nearly 7.15 million workers. Therefore, the poverty rate is expected to rise by
33.7%.

THE IMPACT OF COVID-19 ON PEOPLES’S LIVELIHOODS, HEALTH AND FOOD SYSTEM

 The COVID-19 pandemic has caused huge loss of life on a global scale and posed
unprecedented challenges to public health, food systems and the world of work. The
economic and social damage caused by the pandemic is devastating: tens of millions of
people are at risk of falling into extreme poverty, and the number of undernourished people
(currently estimated at nearly 690 million) may increase to 132 million by the end of the
year. Of the year.
 Of the 3.3 billion global labor force, nearly half are at risk of losing their livelihoods. Workers
in the informal economy are particularly vulnerable because most people lack social
protection and access to quality medical care, and lose opportunities for productive assets.
Without the means to make money during the lockdown, many people will not be able to
support themselves and their families. For most people, no income means no food, or at
best, less food and less nutritious food.
 The pandemic has affected the entire food system and exposed its vulnerability. Border
closures, trade restrictions and restrictive measures have been preventing farmers from
entering the market, including buying inputs and selling products, and preventing
 agricultural workers from harvesting crops, thereby disrupting domestic and international
food supply chains and reducing access to healthy, safe and diverse diets Opportunity.
 While feeding the world, millions of paid and self-employed agricultural workers often face
high levels of working poverty, malnutrition and poor health, lack of safety and labor
protection, and other types of abuse.

THE END….!