SELECTIVE FEDING

PROGRAMMES

SESSION 20

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SELECTIVE FEDING PROGRAMME

• There are two mechanisms through which

food may be provided
– General Food Distribution
– Selective Feeding Programmes

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 SELECTIVE FEEDING
PROGRAMMES
• The GFR, in pracctice, rarely provides sufficient
food to allow for catch-up weight gain for those
already malnourished
• SPFs are therefore a “safety net” for those whose
families cannot cope and are not sustained by the
general ration
• SFP do not usually reduce the prevalence of
moderate malnutrition
• The main objective is to reduce the prevalence of
severe malnutrition and mortality.
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 SELECTIVE FEEDING
PROGRAMMES
There are two forms of selective feeding
programmes:
• Supplementary Feeding
• Therapeutic Feeding Programmes

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SUPPLEMENTARY FEEDING
PROGRAMMES
Supplementary feeding programmes (SFPs)
• Provide nutritious food in addition to the
general ration
• Supplementary Feeding Programmes (SFPs)
• They aim to rehabilitate malnourished
persons or to prevent a deterioration of
nutritional status
• SFPs are short-term measures and should
not be seen as a means of compensating for 5
an inadequate general food ration.
SUPPLEMENTARY FEEDING
PROGRAMMES
Target Population
• Children <5 years, Pregnant women, Lactating
women up to six months, those suffering from
chronic wasting illnesses.
SFPs comprise two different types:
• Targeted SFPs: the aim is to prevent the
moderately malnourished becoming severely
malnourished and to rehabilitate them.

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 Supplementary Feeding
Programmes
• Blanket feeding programmes: Aim is to
prevent widespread malnutrition and to
reduce excess mortality among those at-risk
by providing a food/micronutrient
supplement for all members of the group
• Supplementary food can be distributed
– On-site feeding
– Take home or dry ration

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SUPPLEMENTARY FEEDING
PROGRAMMES
Take-home rations:
• Require less resources
• Carries less risk of cross-infection
• Takes less time to establish
• Less time consuming for mother to attend
• Responsibility for feeding within the family
• Particularly appropriate for dispersed populations
who have had to travel long distances on a daily
basis
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SUPPLEMENTARY FEEDING
PROGRAMMES
On-site feeding me be justified:
• Food supply in the household is limited
• Firewood and cooking utensils are in short
supply
• Security situation is poor and beneficiaries
are at-risk when returning home carrying
weekly supplies of food
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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES
Objective
• Rehabilitate moderately malnourished persons
• Prevent the moderately malnourished from
becoming severely malnourished
• Reduce mortality and morbidity risk in children
under 5 years
• Provide a food supplement to selected pregnant and
nursing mothers and other individuals at-risk
• Provide follow-up to referrals from Therapeutic
Feeding Programmes
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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES
When to start
• Malnutrition prevalence of 10-14% global
acute malnutrition among children
• Many malnourished individuals due to poor
food security and high rates of disease and
prevalence of 5-9% global acute
malnutrition in the presence of aggravating
factors

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 TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES

• Moderately malnourished children under five

years of age
 Between 70% and 80% if the median weight for
height OR
 Between –3 and –2 Z weight-for-height
 Malnourished individuals (based on weight-for-
height, BM1, MUAC) or clinical signs:
• Older children 5-10 year
• Adolescents
• Adults and the elderly persons
• Medical referrals
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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES

Criteria for admission cont.

• Referrals from TFC
• Selected pregnant women and nursing
mothers until 6 months, using MUAC <22
cm

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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES
Criteria for discharge:
• Children who have maintained at least 85%
of medium weight-for-height for a period of
two weeks (wet SFP) or one month (dry
SFP)
• Individuals older than 5 years who have
attained a stable and satisfactory nutritional
status and who are free from disease

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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES
When to close?
• When all the following criteria are safisfied
• General food distribution is adequate (meeting
planned nutritional requirement)
• Prevalence of acute malnutrition is below 10%
without aggravating factors
• Control measures for infectious diseases are
effective
• Deterioration in nutritional situation is not
anticipated
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TARGETED SUPPLEMENTARY FEEDING
PROGRAMMES

Criteria for closing cont.

• In cases where the prevalence of acute
malnutrition is below 5% (in the presence
of aggravating factors) but the absolute
number of malnourished children may still
be considerable, the closure of TSFPs may
not be appropriate

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BLANKET SUPPLEMENTARY
FEEDING PROGRAMMES
Objective:
• Aimed primarily to prevent deterioration in
the nutritional status of the population, but
also reduce the prevalence of acute
malnutrition in children under five years
thereby reducing mortality and morbidity

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BLANKET SUPPLEMENTARY
FEEDING PROGRAMMES
• No need when there is an adequate general
ratio
• Necessary when nutritional needs are not
met by the general ration or other ways

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BLANKET SUPPLEMENTARY
FEEDING PROGRAMMES
When to set up Blanket SFPs:
• At the onset of an emergency when the GFR
distribution systems are not adequately in place
• Problems in delivering/distributing the GFR
• Prevalence of 10-14% acute malnutrition in
presence of aggravating factors
• To provide micronutrient-rich food to the target
population in times of deficiency outbreaks

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BLANKET SUPPLEMENTARY
FEEDING PROGRAMMES
Criteria for admission
• All children younger than 5 or 3 years using the
height as a cut-off point (5 years=110 cm, 3
years=90cm)
• Pregnant women from the time of confirmed
pregnancy, and nursing mothers until maximum 6
months after delivery
• Other at-risk groups (for instance sick and elderly
persons)

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BLANKET SUPPLEMENTARY
FEEDING PROGRAMMES
When to close
• General food distribution is adequate and is
meeting planned minimum nutritional
requirements
• Prevalence of acute malnutrition is below 15%
without aggravating factors
• Prevalence of acute malnutrition is below 10% in
presence of aggravating factors
• Disease control measures are effective

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 FOOD COMMODITIES USED
IN SFPs
1. The size and the type of daily food supplement will
depend on the adequacy of GFR, the malnutrition
rate and the feeding programme modalities
2. Food must be energy-dense and rich in
micronutrients, culturally appropriate, easily
digestible and palatable eg Corn Soya Blend (CSB),
Unimix, Famix
3. In situations when cooking may not be feasible,
ready to eat items, such as high-energy biscuits or
locally made snacks, can be used.

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 FOOD COMMODITIES USED
IN SFPs
4. Energy-dense foods that contain at least 100 kcal
per 100 g with at least 30% of the energy coming
from fat. Unimix, Famix, CSB have a fat content
of only 6% and thus about 10g of oil should be
added to 100 g blended food during preparation,
and be distributed as a dry pre-mix or cooked
porridge
5. No use of fresh milk or milk powder in a take-
home ration because it discourages breastfeeding
and the danger bacterial contamination. Mix
powdered milk with cereal flour and suga
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 FOOD COMMODITIES USES
IN SFPs
6. On-site feeding or wet ration should
provide from 500 to 700 kcals of energy
per person per day, including 15 to 25 g or
protein
7. Take-home or dry ration should provide
from 1,000 to 1,200 kcal per person per
day and 35 to 45 protein

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 MONITORING AND
EVALUATION OF SFPs
Done through:
• Nutrition surveys
• Growth monitoring
• Regular collection of feeding centre
statisistics

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 MONITORING AND
EVALUATION OF SFPs
• Indicators:
• Recovery rate acceptable >70% alarming
<50%
• Death rate acceptable <3 per month,
alarming >10
• Defaulting <15%, alarming >30%

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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
Objective:
• To provide treatment to severely
malnourished individuals to reduce the risk
of excess mortality and morbidity
• It consists of intensive medical and
nutritional treatment

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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
When to start?
• When the number of severely malnourished
individuals cannot be treated adequately in
other facilities
• The availability of trained staff is a
prerequisite for establishing TFPs.

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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
• Criteria for admission
• Children younger than 5 years of age (or less than
110 cm in height) who are severely malnourished
(weight-for-height less than –3z scores or less than
70% of the median and/or with oedema)
• Severely malnourished children older than 5 years,
adolescents and adults. Use of BM1<16
• Low birth weight (LBW) babies
• Orphans younger than one year (only when
traditional care practices are inadequate)
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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
Criteria for admission cont.
• Mother of children younger than one year with
breastfeeding failure
• Criteria for discharge:
Refer a child to SFP when he/she:
• Maintains a weight-for-height>=75% of the
reference of >=-2.5 score for two consecutive
weeks
• Shows a good appetite and is free of illness
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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
When to close:
• Number of patients in decreasing (for e.g.
drops below 20)
• Adequate medical and nutritional treatment
in either a clinic or a hospital is available

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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
Nutritional Rehabilitation
• Phase 1: Acute Phase (Intensive Care)
• 24-hour in-patient care
• Control of infection and dehydration
• Control of hypoglycaemia and hypthermia
• Frequent feeds with TM (10-12 times/day)
• Only milk-based diets given
• Diet contains 75 kcal/100ml and is called F75
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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
• Phase 2: Rehabilitation Phase
– Providing at least 6 meals per day to regain weight
– Medical care continues
– Mothers trained to care for the children at home
– Diet (F100) is designed to for rapid catch-up in weight
– Cereal-based porridge, made of blended (fortified), oil
and sugar is given
– High-energy biscuits and gradual introduction to family
diet

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 THERAPEUTIC FEEDING
PROGRAMMES (TFPs)
• Monitoring and Evaluation
• Recovery Rate, acceptable 75%, alarming <50%
• Death rate; acceptable <10, alarming >15
• Defaulter; acceptable <15, alarming >25
• Weight gain (g/kg/day); acceptable >=8,
alarming<8
• Coverage; >50-70%; alarming <40%
• Mean length of stay; <3-4 wks; >6 wks
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