Nutrition in Disease Prevention Training

The professional short course will major on emergency nutrition response in complex emergencies. The implications of an emergency nutrition approach for assessment and analysis, policy development, program design and implementation will be examined. This will provide an understanding of the causes and nutritional outcomes of humanitarian crises and complex emergencies (malnutrition, morbidity and mortality). The course has a field-oriented focus based on a wide range of recent and past food and nutrition crises ranging from Darfur to the Syrian crisis. The course reviews international response strategies, nutrition programs and relevant policies; and incorporates relevant applied research. The course provides the opportunity for participatory approach drawing upon the actual work experience of the delegates and applying a range of up-to-date case-study materials based on current humanitarian crisis.

Target Audience.

The course is aimed at staff of UN agencies, NGOs and national ministries of health in countries that are regularly affected by emergencies. Health workers, nutritionists, doctors, nurses as well as programme managers are encouraged to apply.

You do not need any formal academic qualifications for entry as we value experience. You will be taught by practitioners from a wide range of backgrounds including international NGOs, teaching and research institutes, all of whom have substantial expertise within the sector.

    Pedagogy

ü  Video with a brief introduction and relevance of the topic

• Presentation with the basic elements of the unit
• Document with a detailed description of the topic
• List of references and additional resources
• Practical field case studies of discussions.

Main  Training Modules

An Introduction to malnutrition in emergencies

An overview of the different types of malnutrition and their public health significance in emergencies. Physiological vulnerability in relation to the inter-generational cycle of malnutrition will be covered. An overview of classification of nutrients in the diet, including the concept of Type I and Type II nutrients. The roles and responsibilities of different international agencies for addressing malnutrition will be introduced. 

Objectives:

• Analyze the main types of malnutrition and understand their public health significance in general and in emergency contexts.
• Describe how malnutrition affects individuals throughout the life cycle, and how malnutrition can impact future generations. Discuss the implications of this for who is most vulnerable in emergencies.
• Determine the causes of malnutrition based on a conceptual framework, which differentiates between the immediate, underlying, and basic causes of malnutrition.

Politics and Terminology: Food crisis, health crises or political crises?

The role of food and nutrition in the process, dynamics and outcomes of emergencies will be addressed. A brief overview of Sen’s entitlement theory of famine and some subsequent modifications will be discussed. An introduction to the concept of Public Nutrition, focusing on the project cycle and application of the conceptual framework of the causes of malnutrition and its relevance in emergencies will also be reviewed.

Objectives

• Analyze the issues in defining and declaring famine
• Understand the basis of Sen’s entitlement theory and subsequent modifications, 
including the role and importance of coping strategies, war and civil unrest
• Recognize the main causes of excess mortality in emergencies.
• Assess how famine theories have influenced response strategies; food first approaches 
versus public health responses, versus more combined strategies.

Meaning and measurement of malnutrition (Part l); Individual anthropometric status and associated risks.

• An overview of measurement of individual nutritional status will be briefly discussed. The calculation of nutritional indices and reference values and the classification of malnutrition will be addressed. The operational implications of the new WHO growth standards will be reviewed, as well as the recent work on MUAC. The relationship between severity of malnutrition and risk of mortality in emergencies will be briefly reviewed.
• Objectives:
• Identify the different uses of individual nutritional status (growth monitoring, screening, program admission and discharge criteria and for population based nutrition surveys)
• Calculate an individual’s nutritional status using the weight-for-height index, by comparing their body measurements to international reference values.
• Understand the implications of the new WHO growth standards and their use in emergencies.
• Comprehend the relationship between individual nutritional status and mortality risk.

Meaning and measurement of malnutrition (Part ll); Anthropometric surveys including analysis, interpretation and use for decision-making; Early warning and nutrition surveillance systems.

The session will provide an introduction to sampling and survey design, statistical analysis and interpretation, with an emphasis on reviewing survey validity and reliability rather than operational planning to undertake surveys. The meaning and interpretation of survey findings for complex emergencies will be discussed. Nutritional risk and vulnerability will be addressed in relation to findings and broader factors.

Objectives:

• Describe with the stages of planning, designing, analyzing, interpreting and reporting on a standardized nutrition survey.
• Apply nutritional benchmarks used to interpret anthropometric data in relation to the selective feeding decision-making frameworks.
• Apply survey results and draw conclusions about the nutritional situation that will serve as an adequate basis for decision-making and planning a strategic response.

Community Management of Acute Malnutrition

An overview of the management of severe acute malnutrition, phases of treatment, management of associated medical complications and nutritional and medical protocols will be discussed. Policies and guidelines will be reviewed. The design and organization of program including centralized versus community-based treatment approaches will be described. Monitoring at individual and program will be discussed.

Objectives:

• Compare CMAM to other models for treating acute malnutrition
• Comprehend the differences between supplementary and therapeutic feeding and their
• Examine the protocols of treatment and management of severe malnutrition specifically in 
relation to admission criteria, systematic medical treatment of underlying complication, monitoring

Addressing micronutrient deficiencies

The risks for micronutrient deficiencies in emergencies and the challenges for their assessment will be addressed. Strategies for prevention and control of micronutrient deficiency diseases will be discussed. These will include: Vitamin A supplementation, fortification of foods locally, regionally and internationally (salt, cereals, blended food, oil) and improving the quality of the general ration program and promoting access to sources of micronutrient rich food.

Objectives:

• Understand the increased risks for micronutrient deficiency diseases (MDDs) associated with crisis-affected populations
• Become familiar with the different types of MDDs that are common in emergencies, specifically scurvy pellagra and beri-beri
• Be familiar with the broad range of responses and strategies for addressing MDDs including supplementation, fortification, food-based approaches and public health responses.

Infant and Young Child Feeding in Emergencies

The importance of breastfeeding and appropriate complementary feeding in refugee and other emergency situations will be given. Appropriate strategies for protecting, supporting and promoting breast-feeding among emergency affected populations, including policy development and co-ordination will be discussed. An overview of the key factors for consideration in providing nutritional support for people living with HIV/AIDS will also be discussed.

Objectives:

• Analyze the relationship between infant feeding, disease, mortality and the emergency context
• Analyze challenges for promoting and supporting breastfeeding and the increased risks of artificial feeding associated with emergencies
• Describe practical strategies for supporting women to breastfeeding and understand how safe artificial feeding can be promoted and supported.
• Explain current policies on infant feeding in the context of HIV/AIDs affected populations. 
 

Emergency; mechanisms, modalities and planning rations (DEBATE)

Review of the importance and evolution of emergency food aid programming and summary of current key UN and donor policies. Overview of food distribution modalities (GFD, SFPs, FFW, School Feeding, VGFs), their objectives & target groups. Policies and procedures for planning general rations, including an overview of key food groups in the diet and related food commodities in the food basket. The calculation of a population’s minimum average nutritional requirement, making adjustments, planning an appropriate food basket (acceptable, palatable, hygienic, fuel efficient). Introduce recommended daily requirements and calculation of nutritional composition of foods.

Objectives:

• Compare different types of modalities for food distribution related to nutritional objectives.
• Assess and their relative roles and responsibilities of UN agencies, donors, and NGOs in 
relation to food aid
• Analyze the nutritional requirements of an adequate ration, the different options for 
commodities, and be able to review the nutritional adequacy of a general ration for a given
• Synthesize alternatives to general food distribution
• Debate the continuation of food aid as a means of humanitarian support

Nutrition outcomes through Agriculture, food security, livelihoods, cash programming

Objectives:

• Argue the role of food security and agriculture interventions in promoting nutrition
• Assess the effects of combined agriculture and nutrition education on child growth
• Compare current activities involving food security, nutrition and agriculture interventions 
 

Nutrition and Public Health in Emergencies

Public health emergencies including outbreaks and sanitation crises require nutrition components. Prevention, treatment and control of communicable diseases including measles, water and sanitation, diarrhea, reproductive health will be discussed, particularly in relation to their impact on preventing and controlling deterioration in nutritional status.

Objectives:

• Analyze the role of nutrition as part of a public health response in emergencies.
• Examine nutrition response in the context of the Ebola response
• Examine nutrition response in recent cholera outbreaks

Targeting- principles, procedures and protection

Review of the general approaches to food distribution and targeting, including practical constraints and challenges and how they are addressed. Review of standard practices for monitoring food distribution and targeting, with case-examples. A consideration of how distribution and targeting practice either upholds humanitarian principles and protection, or alternatively undermines them and implications for nutrition.

Objectives:

• Analyze the purpose of targeting (efficiency, effectiveness)
• Explain how targeting and distribution influence protection.
• Compare modalities for targeting and management of food distribution

Way forward After the Training

Participants will develop a work plan through the help of facilitators that stipulates application of skills acquired in improving their organizations. ASPM will monitor implementation progress after the training.

Training Evaluation:

Participants will undertake a simple exercise before the training and after the training in-order to monitor knowledge gained through the training.