AracelisArchuleta

AmandaAlonzo
WhineyGalindo
AlexMercado
TheodoreMitchell

GrantTitle:RHopeAddressingNutritionalRiskandStuntinginSyrianRefugeeChildren
ExecutiveSummary:
ThethreeyearRHopeAandBprogramisaresearchprogramthataimstoeliminatestunting
andencouragethedevelopmentalgrowthofchildrenfrominfancyto11yearsofageinSyrian
refugeesfleeingtoBulgaria.Thefirstphaseoftheprojectaimsto:
Providingpostnatalsupplementationtobreastfeedingmothers
Supplementingcaloricneedsviaalipidbasednutrientsupplement(LNS)
Educationalclasseswillbeprovidedforparentsandguardiansaroundbasicnutritionwithan
emphasisoncomplementaryfoodsavailablegeographicallytoensureadequateproteinintake.
Thisinformationwillbeaimedtobridgeculturalandknowledgegapsthrougheducationinorder
toallowourtargetpopulationtobefamiliarwiththeirnewlocation.Thepropersafetyprotocols
forpreparation,handlingandstorageofallfoodproductssuppliedwillalsobeprovidedinorder
tomeetthepracticalandpersonalneedsofourtargetpopulation.
Theprogressoftheprogramwillbemeasuredbytakingourtargetgroupsanthropometric
measurementsandbiochemicaltestsofferedatvaryingschedulesoverthethreeyearspan.To
ensurefollowupparticipation,thefamilieswillbeprovidedaprepaidandroidphoneandasolar

poweredcharger.ServicewillbeprovidedaslongastheRHopeapplicationisaccessedviathe
prepaidandroidphoneandinformationupdatedmonthly.

TargetGroup
ThetargetedgroupwillfocusonSyrianrefugeechildrenfrominfancyto11yearsofagewith
visibleandclinicalsignsofstuntinginVoennaCamp,Bulgaria.Allocatedresourceswillmeet
theneedsof1,5002,000childrenforbothtargetgroups.RHopeBwillfocusonprovidinglipid
basednutrientsupplementationforchildrenfrominfancyto5yearsofageandtheirfamily.

Specificaimsandbackground
RHopeisaprogramthataimstoaidinreducingtheriskofstuntingamongstmigrantchildren
andthecomplicationsassociatedwithmalnutrition.Syrianrefugeechildrenandtheirfamilies
havelimitedresourcesonthemoveandlackaccesstothenutrientsnecessaryforlife.RHope
wantstoprovidelipidbasednutrientsupplementationtochildrenfrominfancyto11yearsofage
ineffortstoreverseandpreventfurtherstuntingbyprovidingenergydense,highfatandnutrient
densesupplements.BytargetingstuntingcausedbymalnutritionRHopecanbetterstriveto
decreaseprevalenceandincidenceofdiseasesassociatedwithmalnutritionandstunting.By
providingLNSsupplementationwewillaimtohelpchildrensphysical,mentalandemotional
growth.

TheobjectivesRHopeaimstoachievearethefollowing

 By2019,theincidenceofstuntingrelatedtomalnutritionwillbereducedamongstSyrian
refugeemigrantchildrenfrominfancyto11yearsofageby40%.

By2018,65%ofparents/guardiansoftargetgroupchildrenwillbeabletoidentifythree
waystodeterminewhenfoodhasperishedbysmell,tasteandappearanceofpackaging.

In2016RHopewillprovidelipidbasednutrientsupplementationto95%ofSyrian
refugeechildrenwithmoderatetoseveresignsofmalnutritionduringthefirstmonthof
assessment.

In2016RHopewillprovidecellphonesandsolarpanelchargerstoparentsoftarget
grouptohelpmonitorprogressthroughmigrationwithinthefirst3monthsofproject
implementationtobeusedtheremainderofprogram.
Intervention
Inordertotreatstuntingandmalnutritioninourtargetpopulationweproposetheuseofalipid
basednutrientsupplement(LNS).TheLNSwillbemadefromingredientssimilartothecultural
dietarycompositionofthetargetpopulation.Aformulabasedonchickpeas,eggplant,andolives
inadditiontowholegrainricewasselected.Thisistoensurethedigestibilityandsuitabilityof
thesupplementtooptimalgrowthanddevelopmentofthetargetpopulation.TheLNSwillbe
providedinadditiontodriedeasytomakefoodproductslikebeans,rice,driedfruits,seeds&
nuts,powderedmilk,curedmeats,andreusablewaterbottleswithfiltrationunits.Bottledwater

willbeprovidedatallencounters.Enoughresourceswillbeprovidedfortheentirefamilygroup
toconsumethreemealswith15002200kcalpermealbasedonneed.
ThemacroandmicronutrientcompositionoftheLNSisasfollowsper100g
NutrientAmountFat39.6gProtein27.9gFiber11.8gVitaminC49.8mgVitaminA176
IUVitaminB60.43gFolate124.5gCalcium142.8gIron4.3gZinc3.2g.510kcalfrom
proteinandfat.Inadditiontoessentialfattyacidsandtraceminerals.Inadditiontothefoods
beingprovidedtothefamiliesthereshouldbemorethanenoughkcaltomeetenergyneedsfor
familygroups.
Parentsandguardiansoftargetgroupchildrenwillbeprovidededucationandtrainingto
identifyfoodthathasexpiredbasedonsight,smell,conditionofpackaging.Educationwillalso
beprovidedforfoodsafetyintermsofpreparation,packagingandstorage.Followuplessons
andupdateswillbeprovidedviadailyupdatestoapredownloadedappontheandroidphone
beingprovidedtoallparticipantsover9yearsoldinadditiontoparentsandguardiansofthose
underandover9yearsofage.
Thisassessmentwillfocusoncompilingmeasurementsanddatathatwillallowustoeasily
monitortheprogressofeachparticipantandtheoverallsuccessoftheprogram.Thefollowing
datawillbeinitiallycollectedandassessedyearone.

First,dietarytechnicianwillassistinmeasuringthechildparticipantsheight(cm)andweight
(kg)measurementsusingadigitalscaleandsupinelength(cm)usingmeasurementtape.These
measurementswerethenusedtocalculateeachBMIandzscoreforheight/lengthforage(HAZ)

,weightforage(WAZ),andclassifiedusingWHOlevelsofseverity(mildz<1,moderatez<2,
severez<3).

Midupperarmcircumferences(MUAC)measuredatthemidpointoftherightarm,head,chest,
andwaistcircumferenceswerealsorecordedusinganonstretchinsertiontape.Thefinaldata
wastakenbyDRassistantsandrecordedinElectronicdatabases.

Abaselineenrollmentinterviewatwhichparticipants,childrenandparents,willbeasked
questionsbasedoffaninequestionFoodAccessSurveyTool(FAST)andcompleteaFood
FrequencyQuestionnaire(FFQ).Thiswillassesstheparentaleducationandoccupation,initial
knowledgeofnutrition,andperceptionsofhouseholdfoodsecurity.Furthermore,theFFQwill
allowustoanalyzetheinitialconsumptionsofparticularnutrientswewillbefurtherassessing
andsupplementing.TheseinterviewswillbeconductedbytheDietaryTechniciansatthe
campsitesandallanswerswillberecordedinanElectronicDatabase.
ExpectedOutcomes
BiochemicalMeasures:
CompleteBloodCountwithlipidpanelanddifferential
Proteinthroughurine(2xayear)
AnthropometricMeasures:
MUAC(midupperarmcircumference)
Waistcircumference
Height

Weight
Budget
Wearerequesting$25,000,000dollarsforourthreeyearinterventionplan.10millionwillbe
allottedforyearoneandwillincludethefollowingforinitialscreeningssupplements,34month
biochemical/anthropometricassessments,monthlyeducationandtrackingviatech:
$375,000forbasicnutritioneducationforparents/guardiansincludingmacro/micronutrient
needs,foodsafety,culturalfamiliarityclasses.
$3,250,000forthelipidbasednutrientsupplementsaswellaspre/postnatalsupplements.
$1,000,000forphoneserviceswhichwillprovideaprepaidandroidphoneforevery
participant(orparticipant'sparentifunder9yearsofage)formonitoringprogressand
communication.Thisalsoincludestechsupportforthesystemaswellasasolarpoweredbattery
charger.
$2,800,000forsalary:2RDs,15DTRs,15CNAs,3RNs,2MDs.
$1,200,000formedicalsuppliesandtransportation.
1,375,000foremergenciesormiscellaneousexpenses.

Year1ExpenditureCategory

Budget

PhoneService/Techsupport

$1,000,000

Salary

$2,800,000

Food/Supplement

$3,250,000

MedicalSupplies/Transportation
Education

$1,200,000
$375,000

Misc./Emergency

$1,375,000

TOTAL=$10,000,000

Foryear2,ourbudgetestimatesrequire$8,250,000tocontinueprovidingresourcesand
educationaswellasmonthlybodyweightmeasurementsandquarterly
anthropometric/Biochemicalmeasures.Wewillalsocontinuemonitoringprogressandtracking
viatech(androidphoneandapplications).
ExpenditureCategory
Salary

$2,500,000

Food/Supplement

$3,000,000

MedicalSupplies/Transportation

$1,000,000

Education
Misc./Emergency
TOTAL=$8,250,000

Budget

$375,000
$1,375,000

Foryear3,weneedatotalof$6,750,000.Thiswillpayfortheongoingexpensesofsalaries,
supplements,andmonitoringaswellasnewevaluationssuchasourfollowupanalysisto
measureimprovements.

ExpenditureCategory

Budget

Salary

$2,000,000

Food/Supplement

$2,500,000

Screening/FollowUp

$1,750,000

Misc.

$500,000

TOTAL=$6,750,000

ProposedTimeline

ProgramStartDateMay19,2016
June19th,2016MonthlyAnthropometricAssessments
beginwithmonthlysupplychecksOctober2016,4monthBiometricassessmentbegins
April2017ProgramEvaluationStaffTrainingMay2017FullPhysicalExamsProgram
UpdatesApril2018ProgramEvaluationandStaffTrainingMay2018FullPhysicalsand
ProgramUpdatesApril2019ProgramEvaluationParticipantCallInMay2019Program
EndsandParticipantsPreparedforandprovidedwithfollowupprotocols

MonitoringandEvaluationsmethods

Differentmethodswillbeusedtomonitorandevaluateourprogram.Onebeinga
biannuallybiochemicaltestwerewewillmeasuretheCBCandlipidpanel.Wewillbetaking
urinesamplesfromtherefugeestomeasuretheirproteinlevelsandourtargetgroup
anthropometricmeasurements(ht.wt.andMUAC)willbetakenbimonthly.Onemajor
techniqueformonitoringdifferentcomponentsofourprogramiswiththeuseofprepaidandroid
phoneandasolarpoweredchargerthereforewillrequiretechsupport,whichwillaidusin
organizingourdatabase.
Withtheuseofphones,wewillbeabletomonitorwhatthefamiliesareeatingona
weeklybasis.Byusingtechnologywewillhaveaccesstoourdatabasesystemwherewewill
maintainarecordofallthemeasurements.Wewillbemonitoringanychangethathasoccurred
inthemeasurementsthatwillbetaken.Bymonitoringourgroupwewillbeabletoseethe
progressoradelayofourassessedactions.Itwillalsoprovideinformationonthemigrans
formingadatabase.Thisdatabasewillinformusonwhetherornotthemigrantshave
participatedineatingadequatelyoriftheyhaveupdatedtheiranthropometrics.Ourgoalistoget
ourtargetgroupwithinnormallimitsusingtheWHOchartsforourtargetgroup.Forour
evaluation,wewillbegivingourtargetgroupfoodaccesssurveywerewewillaskspecific
questionsthataskwhattheyhavebeeneatingandhowtheyhavebeenallocatingresourcesnot
providedbytheprogram.Byevaluatingourtargetgroupthroughoutthefirstyearwewillbeable
torecognizetheeffectivenessofourprogram.
Inorderforthemigrantstocontinuereceivingouraidandmoresuppliestheywillneed
tocometothecampsandshowtheirphoneandcode,whichisonewaytoensureusthattheydo
notsellthephonesgiventothem.


Sustainability
Aftertheperiodoffundingends,theprogramwillbesustainedthroughfundingbyphone
providerstoallowtheparticipantstokeepthephoneswithouthavingtopayfortheservicefor5
years.Phonecompanieswillbeinclinedtodothisasitwillaccountfortaxrideoffandan
opportunitytoexpandtheirservices.Helpfulphonenumberstodifferenttypesofcommunity
organizationsandserviceswillbeuploadedintotheirphonesfortheirownconvenienceandto
usewhennecessary.Thiswillallowforawaytokeepincontactwithfamilies,butevenmoreso
ofawayforfamiliestokeepincontactwithpeopleandorganizationswhocouldprovide
healthy,safeandsecurefoodsupply.After5years,wehopethatmigrantswillhavedeveloped
theskillstoremainselfsufficientandtheirchildrenwillbeoldenoughtodeveloptheirown
selfsufficiency.

Longtermfollowup
RHopeplanstokeeptheprovidedcellphonesactivefor5yearsaslongastheyaremaintaining
cooperationbyparticipatinginthebimonthlysurveys.Byhavingthiscommunicationweare
hopingthatitwillbetterhelpusestablishtheefficiencyofourprogram,aswellasdetermine
furtherneedsandresourcesformigrantsthroughouttheirtransition.Byworkingwithmultiple
organizationspromotinghealthandnutritionthroughoutthepopularmigratorycountries,we
hopetobeabletoreferthetargetgrouptohealthclinicstocheckcurrenthealthstatus.