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ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

EDITO (by Amador Gomez)


Nutrition in ACF-S: taking actions against the differents faces of undernutrition
Infant undernutrition is one of the main mechanism for the transmission of poverty and inequality between generations,
becoming a heavy mortgage on the future of the next generation.. Today’s undernourished are tomorrow’s poor. That is
why undernutrition is not just a priority health problem; it is also a major barrier to development.
Having a sustainable impact in undernutrition is not just a question of ready to use food or CMAM approach.
Undernutrition is not simply acute. Stunting and carence of micronutrients are also very relevant in many contexts where
ACF is working.
In ACF-S we give priority to acute undernutrition in our operations, but at the same time, we are implementing and
developing our nutritional approaches on differents contexts like seasonal hunger, emergency situations or chronic
hunger.
Most of the world’s acute hunger occurs during the annual hunger season. As an answer to this nutritional vulnerability
gap, we are promoting the scale up of a basic intervention package against seasonal hunger which targets the
prevention of children undernutrition. This seasonal anti-hunger intervention combines different approaches like cash
based interventions to minimise the nutrition vulnerability and seasonal blanket feedings programmes to protect nutrition
during the hunger gap.
Other ACF-S nutritional interventions are oriented to impact in chronic undernutrition and micronutrients deficiencies like
anaemia. Nutritional care practices are promoted through Hearth Model Programmes, complementary feeding practices,
micronutrients supplementation and promotion of breastfeeding.

Making progress in the fight against undernutrition and its positive effects on health and development is possible only if
nutrition becomes a priority. ACF is working to Scale Up Nutrition at international level making part of initiaves as SUN
(promoted by SCN). ACF has also developed a strategy on advocacy (AMAI) and some filed activities are already going
on (e.g. Niger).

All this approach integrate advocacy and capacity building components oriented to support the political commitment
against undernutrition, achieve adequate coverage and the integration of nutrition interventions in the health policies
and strategies at national level.
•Promotion of breastfeeding
•Complementary feeding practices
•Hearth model programmes
•Handwashing & hygiene behaviour

•Child Health Days


•Vitamin A campaings
•Deworming & parasite control
•Anaemia & iron supplementation
•Micronutrientes supplementation
•Diarrhoea & Zinc supplementation

•Seasonality and blanket feeding


•Conditional cash transfer

•Communtiy /clinic base


management (outpatient/inpatient)
Accompanied by a scale up •Integration into basic package of
of country political wlll health services
and capacities

© Amador Gómez. 2010


© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 1
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

CONTENTS
• NEWS FROM THE HEADQUARTERS 2
• DID YOU KNOW...? 3
• QUESTIONS ASKED TO 4
• ZOOM ON A PROJECT 5
• RESEARCH AND TECHNICAL DEVELOPMENT 7
• WHAT HAPPENED? Publications, surveys, reports, meetings, fora… 9
• WHAT’S NEXT? Publications, surveys, reports, meetings, fora… 10
• WHAT CAN YOU FIND IN THE PREVIOUS & NEXT NEWSLETTERS? 12

This Newsletter was prepared in Madrid with the participation of all headquarters and missions.
Thanks to all for your contributions.

NEWS FROM THE HEADQUARTERS


London David Doledec, and is still vacant. If you are interested to come
• Sandra Mutuma is the Senior Nutrition adviser at ACF-UK. and work in New York or would like to know more about this
Saul Guerrero (former Valid International) has joint ACF-Uk as position, check out the following link:
responsible of monitoring and evaluation. http://www.actionagainsthunger.org/get-involved/jobs/hq/nutrition-advisor

Madrid Paris
• Elisa Dominguez is the Head of Health and Nutrition Dpt. • Arrival of Anne Dominique Israel at the position of Senior
She is in charge of Central and South America, Middle East Technical Advisor in Nutrition. Recruitment of a Nutrition
(Palestina, Syria) and Asia (Phylippines) and focal point for all advisor for Asian missions is now finalised.
surveys (SMART, KAP,…). ▪ Departure of Rebecca Brown from the position of Senior
• Marisa Sanchez is the Health, Nutrition and HIV technical Technical advisor at the end of June: However, she will
adviser in Madrid. She is in charge of Western and Southern continue working with ACF as part-time position.
Africa. ▪ Arrival of Ioana Kornett as Technical Director.
• Oscar Serrano is leaving the Health and Nutrition Coordinator The different NUT technical advisors of ACF-France are then:
for the emergency pool. Position in process of replacement. Emergency response pool
• Liselot Lemmens has started an internship of 4 months in Starlène Barthelot (leaving soon)
September. She will be responsible of Nutrition Forum Asian missions
organisation (former CMN meeting) in Toledo end of October Astrid de Brandebere (interim for 3 months-August-October)
and to support Nut Dpt. Emergency pools
Olivia Freire following Sudan & Darfour, Chad, Central
Montreal African Republic and North Caucasus
• Asmaa Ibnouzahir is nutritionist, expert & trainer on SMART. (ofreire@actioncontrelafaim.org)
Fabienne Rousseau following Burkina, Ethiopia, Liberia
New York and Somalia
• Marie-Sophie Whitney is the senior nutrition advisor in charge (frousseau@actioncontrelafaim.org)
of DRC, Uganda, Kenya, Southern Sudan, Pakistan and now Post-crisis pools
also of Nigeria. msw@actionagainsthunger.org Béatrice Mounier following Ivory Coast, Haiti, Zimbabwe,
• A second nutrition advisor position has been open to replace Afghanistan, Mongolia and Sierra Leone
(csalpeteur@actioncontrelafaim.org)

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 2
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

DID YOU KNOW…


Closure of Angola mission (ACF Spain) FAMOS database development
The mission in Angola closed in the middle of July 2010 after ACF-S is developing a database which should support the
more than 15 years of presence there. teams in the field in the daily management of data from
nutrition centres. This database was developed by
HIV International World Conference NOVATIVE, a suitwerland foundation, and before
Amador Gomez, Marisa Sanchez and Cécile Salpeteur implementation should be tested in the field. Test survey is
represented ACF at the 2010 HIV International World expected to be implemented in Mauritania in October-
th
Conference that was held in Wien between the 17 and the November.
st
21 July. A study implemented on HIV patients in Donka
hospital in Guinea-Conakry was presented as poster. Update of ENA for SMART surveys
ACF-Ca has informed on the validated use of the last version
Exploratory mission in Mozambique of ENA (ENA-delta). Software can be dowloaded at
An exploratory mission was set up by the Nut team in www.nutrisurvey.net/ena_delta. Updates concern mortality
Swaziland in May 2010. A proposal to support a TFC at a component, a more developed plausibility checks including
hospital in Maputo has been prepared and it is under funding MUAC and a new component on Food Security based on the
search. Household Economic Approach (HEA). More info on:
http://www.nutrisurvey.de/ena_beta/food_security.htm
Response to crisis in Corredorr Seco (Guatemala), Niger Some pilot tests of this FS component are under study for
and Mali upcoming SMART surveys in Guatemala and Filipinas.
Several emegency responses are currently ongoing: in
Guatemala (Food security and Nutrition interventions), in Research study in Peru
Niger, a new base was opened (Gouré), in Mali, a blanket ACF-S is preparing a research in Peru in collaboration with
intervention with BP5 during the hunger gas has been University of Lima and University of Cadiz, under AECIF
implemented. funds. Aim of this research is to compare efficacy, impact on
growth development and cost/efficacy of differents products
to prevent stunting and anemia. LNS vs a local product vs a
Identification missions ongoing (AECID Convenio)
fortified local product will be compared. The study will start by
Nutrition identification missions were implemented in Mali,
October and will take 2 years including preparation,
Philippines and Peru through integrated approach (Nut-SA). distribution (12 months) and data collection and analysis.

Technical Indicators Working Group


HIV workshop in Paris
In November, ACF-S will launch a working group on technical
An HIV workshop was held by ACF in the last week of June.
indicators in order to set up an ACF indicators database
Experiences from Haiti, Zimbabwe and Swaziland were
composed by “standards indicators” proposed by WHO,
exchanged. Contact: csalpeteur@actioncontrelafaim.org or
UNICEF or international institutions. Aim is to support field
msacnhez@achesp.org.
teams when writing proposals or implementing KAP surveys.
People interested to participate in such working group can
Training on KAP surveys (Madrid)
contact Elisa Dominguez at edominguez@achesp.org.
A training on KAP surveys was organised in Madrid HQ
Infant and Young Child Feeding Practices
based on the new CARE manual: IYCF Practices: a step-by-
WHO manual indicators was launched in 2007
step manual. CD is available for those interested. Contact:
(http://www.emro.who.int/cah/pdf/IYCF-Indicators-2007.pdf).
edominguez@achesp.org.
recently WHO published the manual to collect these
indicators
ACF-S Nutrition policy ongoing
(http://whqlibdoc.who.int/publications/2010/9789241599290_
Based on the ACF White paper, ACF-Spain is launching its
eng.pdf).
Nutrition policy paper that will describe main strategis actually
implemented in ACF-S missions.
© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 3
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

QUESTIONS ASKED TO…


Gilbert Manyoukou
Management of Nutrition programme at remote control
He is a nutritionniste with professional
Questions work experience for almost 20 years
and in humanitarian organization

& Answers since 1996. At the moment of the


interview, he was acting as CMN in
Mali since March 2009.

Q1. Which projects have been developed in Gao in 2009? We have been allowed recently to make short visits
There was one nutrition project funded by ECHO in Gao and to Gao. Myself, I visited Gao last week for a training
Ansongo. Another project on food and nutrition security funded of the team on SMART surveys and Anne, the head
by Government of Navarre, then, a third project was on HIV of base, is currently there for a week time.
prevention in partnership with MDM and Nouveaux Horizons
funded by the European Union. Finally, an emergency Q5. This year 2010 is expected to be difficult for
response was implemented during the hunger gap from Sahel due to poor harvest last year. How is the
September to December. situation Gao regarding vulnerability in food and
nutrition security?
Q2. What happened at the end of 2009 to start working on The vulnerability on SAN is under a surveillance
remote control? In November last year, security situation system since last year and we expect that this will be
worsened: some cars were stolen and embassies released a tough year. The rains were not sufficient last year
alerts on risk of kidnapping risk for Europeans. At the same and several warnings were released by different
time, an expatriate was kidnapped in Menaka. All these issues actors in the field. Whereas analysis was not easy
led to the evacuation of ACF international staff from Gao to ACF decided to do a vulnerability survey in our areas
Bamako. of intervention to document the situation. The survey
confirmed a worsening of the vulnerability in
Q3. Hos the remote control-work was implemented? Ansongo. It was also decided to complete this study
The evacuation was abrupt and neither local or expatriate with a SMART survey which was performed in June.
workers were able to work in such way, on remote control. This
made a fracture in the dynamic of projects monitoring. There Q6. How the vulnerability study and the SMART
was a very difficult time because we were in a fully process of surveys were carried out on remote control?
nationalization of key positions and at the end of the What has been done to maintain quality and
emergency. For all of us, it was very difficult to support the reliability of data without supervision of
national team in Gao from Bamako. expatriate staff?
The vulnerability study included both nomadic and
In December, Gao's team came to Bamako for a meeting to agro-pastoral households in the area. The SMART
discuss the management of projects and support activities that survey only considered the agro pastoral zone to
would be necessary for the team. Later on, in February, we compare results with the ones from last year.
had another meeting in a mid-point between Gao and Bamako, To ensure the quality of the SMART survey, I moved
to discuss the situation of the teams that were in a state of to Gao for team training and we recruited an
important frustration and incapacity to plan activities along additional supervisor to assist the national
2010. responsible in the supervision. In addition, the
project manager did the daily data entry for early
Q4. How do you maintain the quality of the projects? Are detection of flags and monitoring was strengthened.
expats allowed to visit the area for track-monitoring? Final results showed the same performance degree
To maintain the quality we have relied on two aspects: as in previous years under expat supervision.
ensuring a timetable of activities that is updated in a
continuous basis and to maintain a very regular contact with Q7. Which are the positive and negative points of
teams in the field to support them. At the beginning, the team working on remote control?
in Gao required high support from the coordination team in Local staff feel more responsible and confident now,
Bamako to meet their needs. Over time, a system of but is difficult to verify operational performance of
communication and responsibilities has been well defined and activities. There have also been some delays in
so many meetings are not needed anymore but based on project execution.
specific issues to monitor or in specific needs.
© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 4
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

ZOOM ON A PROJECT
Another way to face hunger: the integrated approach in Peru
Bronwen Gillespie, Anthropologist
Social Coordinator, ACF-Spain, Peru

Children in the rural Andes in Peru are not necessarily hungry; they are stunted from the double handicap of anaemia
and chronic malnutrition. They may not be extremely thin, but they are noticeably short. This is the consequence of long
periods exposed to a diet low in calories, protein and micronutrients. 32.8% of children under five are malnourished on
1
a national level, and in some rural communities the percentage reaches 72.7% . More than 265,000 children currently
suffer from malnutrition and the concurrent negative effects on growth and development expressed in reduced motor
skills, diminished ability to concentrate, reduced periods of attention, low motivation levels, and other irreversible
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developmental problems .

The situation is additionally complex given that it is in some sense invisible: mothers do not perceive of their children as
ill; rather they are just small or quiet. The problem represents a threat to the development of the region as a whole in
that it self perpetuating. Malnourished children, with less ability intellectual ability and continual health problems, strain
the already overburdened education and health systems. Every person with malnutrition suffers from an average 10%
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reduction in their potential earnings during the course of their lives , and these adults, in turn, face constraints in caring
for their own children, becoming stuck in an intergenerational cycle of poverty and malnutrition.

ACH is planning a four year integrated response to malnutrition in the Andean communities of Ayacucho, Peru with the
aim of demonstrating sustained improvements in child health so that similar approaches can be initiated in other regions
at risk. What are we “integrating” and why? Who will be involved in this integrated approach, and how will it be done?

The multiple causes of malnutrition are interdependent and therefore should be addressed as such. The
immediate causes of malnutrition are inadequate food intake and disease. These are fed by the underlying situation of
household food security, psycho-social environment and care practices, and the level of services in public health, water
and sanitation. There are many practical examples of the overlap of these factors: communities often need to improve
irrigation systems before diversifying their production. Once food availability has improved, with the acquisition of
livestock or poultry, for example, this does not automatically translate into consumption, as products may be sold or fed
to “productive” household members rather than infants. Even if children are offered a more complete diet, poor sanitary
facilities increase prevalence of diarrhoea which reduces their ability to absorb nutrients. Furthermore, habits that define
the type of foods children are given, and when, where and how children are fed and cared for must be taken into
account. Any intervention aiming to reduce malnutrition must simultaneously consider the role and responsibilities of
family members and other caregivers and the cultural aspects of infant care as well as responding to more immediately
obvious constraints.

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 5
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

/// SUITE
Therefore, the technical components of food security, water and sanitation, local management, and nutrition
are to be integrated as one action, with a cross-cutting emphasis on socio-cultural comprehension and
awareness of gender roles, to promote cohesion in the fight against child malnutrition. The definition of
problems, project planning, educational workshops and technical solutions will be carried out from an integrated
perspective. Community members should not be involved in separate food security, health, or water mini-projects;
rather the aim is for all actions to respond visibly and directly to improving childhood nutrition. From an operational point
of view this is an interesting challenge and learning experience as professional training, program design and field work
methods often unintentionally reinforce technical divisions, even when it is agreed that integration is a priority.

All participants, from village level to government level, will have a role in a common process. The aim of this
process is to fight malnutrition by articulating a relationship between people, their organizations, and their government,
in order to help public services respond effectively to the problem. ACH and the local partners will foment active
participation from local, district and provincial government representatives and corresponding technical services, from
universities and networks already present in the area, from community-based organizations such as mothers’ groups,
and from all family members, as without their awareness of the damage of malnutrition, little can be done to improve
child-care decisions. ACH has been active in advocacy forums with the national government, spurring the adoption of
country-wide goals in the fight against malnutrition. Peru already has legislation regarding the inclusion of human rights,
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gender equality and intercultural perspective in healthcare . The challenge is to help health services strengthen their
operations in predominantly rural districts, to ensure the quality and adequacy of care in these isolated areas, to adapt
materials, advice and methods to the local context. Community vigilance systems will play an important role in assuring
children show healthy growth, as government services cannot cover all attention due to the isolated conditions. This
system will contribute to community ownership of the process, and is expected to be more affordable. ACH’s
overarching goal is to test an integrated approach that government and local actors can manage to replicate in other
regions at risk.

Success will depend on our capacity to understand the local socio-cultural context, concepts of well-being, and
beliefs behind childcare practices, and integrate this within our strategies and communication tools. This will
allow us to suggest solutions that are acceptable, sustainable and relevant. The intervention will work to understand and
strengthen traditional food systems: The World Health Organization now recognizes that nutrition policy must refer to
1
alimentation, that is, to food, not to nutrients . Change will often be in the hands of mothers, and these mothers must be
considered as equals, enabled in dialogue rather than as recipients of information, so that become able to reflect on
nutrition issues for their children, drive the process, make decisions and motivate other women. The years of civil war
and resulting migration and social dislocation, and a rapid transition into a global society has lead to the loss of
traditional knowledge. At the same time, the experience of poverty, marginalization and discrimination, as well as
illiteracy and domestic violence leaves women ill-positioned to have access to new information. Basic aspects of
childcare are not natural for any of us; they are learned and depend on access to resources and a support system.
“Feeding infants and young children is a complex challenge for all species, including our own, and now, when rapid
social and cultural change has become the human condition, we no longer have the advantage of long-term cultural
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evolution to guide our management of the process” . A look at urban industrialized societies makes this lesson clear:
children in the UK and USA suffer from rising rates of obesity and governments have begun to legislate to reduce
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children’s access to ‘food’ products deemed as dangerous for their health . This integrated public health approach in
Peru may turn out to be relevant for other contexts around the world.

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 6
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

BHAMI HISTORY : Exploring under-nutrition in my


country, India
By Bhami Shah, Deputy Medico Nutrition Coordinator, ACF India Exploratory Mission

Going from the beginning to the end of my first field visit in India as a new team member with ACF – India
mission, I was unaware of the under nutrition issues faced within rural and tribal areas. My pre departure
visualization was one of me entering remote villages with my colleagues, and after briefly surveying the
problems, we would swiftly come up with ideas and solutions to better the life of villagers and improve upon the
existing problem of child under nutrition. However, I did not understand the challenge of such a task and nor did
I realize how crucial it was to finding solutions to overcome the problem. My pre imagination of child under
nutrition was always the one that was linked with Africa, as most Indians in the field of nutrition have a myth that
under nutrition is a problem of Africa and not of India. It was only after my visit, I realized that Madhya Pradesh
(one of the 28 states in India, and second largest amongst them) reports equal number of malnourished children
as in Chad and Ethiopia together. Being a nutritionist, my curriculum during my education years always focused
on the green revolution and the hope of abundance it gave to millions of people in India. However, the bleak
reality of under nutrition in India has been untouched by most of the people working in the fields of medicine and
nutrition.

For me under nutrition was always associated with the grades I- IV (weight-for-age), absolutely unaware
of MUAC tapes being widely used around the world for active detection of under nourished children. Our
professors always highlighted the importance of using Indian standards for detection purposes and international
standards to be used as standbys for secondary reference or never to be used, with a notion that these
standards might either distort or skew all the results due to differences in the growth pattern among the Indian
and international population. Malnutrition during my studying years was generally linked to the per capita
income and the associated poverty but not with the hygiene and sanitation and public health services. Most of
the people in India working in the field of nutrition agree to the fact that the curriculum of both medical and
nutrition colleges do not cover under nutrition issues in depth and many issues like prevention and treatment
require more updated and organized technical knowledge.

Though being an Indian urbanite, not only was my vision extremely unclear about rural life and the
associated malnutrition in rural and tribal contexts, but what I imagined to be the proper way to conduct an
assessment of under nutrition was also inaccurate. My first fascinating experience in the field was that of a
village community meeting. At the beginning of the meetings most of the women who attended had their backs
partially or fully turned to us, a lot of women were totally veiled. They completely distrusted us, rightfully so as a
white person (my colleagues) had not been to their village in a generation. As the meeting went on they
gradually began to open up, with most of them removing their veils and turning to face us. The women were
giggling and whispering with each other throughout the meeting and very few answering questions which at
times made it difficult for us understand the dynamics of the village life. The rest were too shy to speak,
especially so since the men, alerted to our presence, had gathered in the backdrop to keep tabs over the
proceedings. The meetings though had some communication difficulties; it gave us a very good insight in
understanding the cycle of social determinants affecting life of the under nourished children amidst the villages
we visited. A lot of factors were identified during the meeting as reasons for malnutrition, ranging from
dangerous traditional practices during pregnancy and lactation to weak immunization coverage and poor
transition to complementary foods – perpetuating the calorie protein gap. In most of these community meetings
you could easily identify 3 - 4 children with SAM and what was surprising for me was that most of the women in
the villages had an idea of what a under nourished child looked like. When inquired, they could easily point out
on the child who was weak and fragile and would fit into the category of being under nourished.

My visits into the villages were hosted by various NGO’s and it was quiet startling for me to see the way
these NGO’s functioned. The supervisor of the NGO’s would walk around the villages with their community
workers who had pre identified SAM children within the villages. These supervisors would further regulate these
community workers to take these children to the Nutrition Rehabilitation Centre (NRC) irrespective of any
communication with the family or the community worker. The NGO’s identified the villages and the problems,
but very few NGO’s we visited would actually try to understand the complexity of the problem. They undertook
the projects that kept the funds flowing (like all other NGO’s), but they failed to consult the affected villages. The
projects weren’t collaborations with the people and the result was a lack of sustainability. The villages we visited
had particularly high number of under nourished children and extremely low levels of admission in NRC.

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On communicating the reasons, we realized that these indigenous people were not comfortable to take their
children to NRC as they had to live there alone, they had other children in the house to be looked after, they felt
suffocated in the tiny room provide by NRC. They also complained of the toilets to be stinking as they were used to the
fields and open spaces for sanitation purposes, they were scared of doctors in white coats as they resembled ghosts,
they had transportation problems and other reasons which were most of the times not taken consideration by people
in charge of reversing the problem.

Another very important characteristic we noticed during our travel was that of the Indian social caste system.
The Indian culture typically has a tendency of families and neighborhoods living together in particularly close
relationships over generations, struggling to extort a living from the same limited area of land and water resource.
Closely inspecting, some people grow fat and influential while others remain frail and dependent, fellow villagers are
prone to conflicts, opposition, and even violence. Most villages of India include what villagers call "big fish," affluent,
commanding people, fed and serviced through the labors of the struggling "small fish." This paradoxical behavior of
the people seems to represent a general trend I noticed among most of the districts we visited in Madhya Pradesh
where more than 50% people are pushed in the survival struggling to migrate in search of more income opportunities.
Such paradoxical nature is also experienced in villages where village feuds were not uncommon and hostility towards
these innocent villagers continue, where they are paid minimum wages for maximum output during the migration
period. Villagers complained of their inability to look after children during the migratory work and a resultant high level
of under nourished and sick children post migration period.

The shock came to me when I inquired about the money they get back with them post the migration to which
a fellow replied around Rs 20 – 30 for the whole migration trip. The migration pattern in Madhya Pradesh is out of
necessity and the survival process, where the poorest of the poor migrate in need of 2 meals per day for themselves
and their families. This trend of middle to upper class is extremely common in the Indian setting where Indians are
incredibly kind to those in their social sphere, but when it comes to those of lower caste or lesser financial standing,
they treat them very poorly.

The various examples highlighted above present the current scenario of Indian villages where the situation is
grave and requires urgent attention. Empowerment of local people to be participants in development of community
can act as a good method to reverse the problem. According to me most families can practically pay for the quantity of
food required to feed a young child which is nothing more than half a chapatti/half a banana and half bowl of dal with
some vegetables. Food availability within the household is not the only grave factor causing malnutrition; it is also the
lack of knowledge and opportunities about appropriate feeding practice which makes the difference. The denial of as
little as 200 – 300 calories in a young child’s daily diet is what makes the differentiation between the normal growth of
a child and the faltering that begins the fall towards sickness and loss.

To end my journey here I would conclude by saying that, the days we spent visiting the villages during my
field visit were enlightening, interacting with people of different cultures and traditions, being received by the
inhabitants in the most welcoming way, some of them who had not seen an outsider enter before in the past years, the
whole experience was absolutely surreal and unforgettable. Time and again, I remember my parents who are now city
dwellers referring nostalgically to their “simple village life”, representing colorfully dressed village women gracefully
carrying water pots on their heads. It’s only now after my visit I understand that village life is now no longer simple but
it is indeed under severe threat where communities are struggling to pull themselves out of poverty and hunger. A lot
of potential to overcome the problem of child malnutrition exists but it needs to be empowered and nourished which
would help the villages get a step up to the ladder of alleviating under nutrition.

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 8
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

Increasing ACF capacity and impact in preventing nutritional and


humanitarian crises in areas affected by cyclical natural hazards and
climate change – Project brief
Where undernutrition, natural hazards and climate change prevail (by Philippe Crahay, ACF-F)

Maternal and child undernutrition is the underlying cause of 3.5 million deaths each year and 35% of the disease
burden in children younger than 5 years (Black et al, 2008). The neglected crisis of undernutrition now receives more
attention globally – as reflected by the Scaling Up Nutrition (SUN) initiative. Most of the countries where
undernutrition prevails are located in disasters and climate change hotspots, e.g. in India, Bangladesh, Ethiopia,
Pakistan and Sudan (the 5 worst countries in terms of GAM and disasters), but also in Indonesia, Niger, Somalia,
Burkina Faso, Chad, Philippines, Kenya, Haiti, Central America, etc. – in others terms, the majority of ACF countries
of intervention.

The number of reported climate-related disasters (droughts, floods, cyclones) has more than doubled this decade
compared to the nineties. Since the 1980s, the average number of people reported as affected by climate-related
disasters has doubled, from 121 million to 243 million a year. According to Oxfam (2009), this number could rise up
to 375 millions a year as soon as by 2015. Besides causing suffering and death, natural disasters cause many
vulnerable communities and households to suffer serious setbacks, in terms of livelihood, water, food and nutrition
security. When a population’s nutrition is poor before the hazard hits, the limited nutritional stores of young children
are soon depleted, increasing their risk of severe malnutrition, disease, and death. Nutrition crises are amplified by
the effects of the hazard on the underlying risk factors of undernutrition. Climate change magnifies disaster risk
everywhere; it amplifies the risk of undernutrition through different pathways, related to food security and livelihoods,
water, public health and care practices (ACF, 2010). Today, there are some solutions to better prepare vulnerable
communities and reduce disaster risk and some negative impacts of climate change, through disaster risk
management.

So far, too little has been done in managing the growing impacts of natural disasters and climate change on nutrition
and increasing the resilience of poor communities and households to natural disasters and climate change. Besides
the nutrition sector remains largely disconnected from climate change-related agendas and field initiatives, whereas
these are now reshaping humanitarian agendas and interventions.

A tailored ACF project


ACF is developing a project whose objective is to increase its capacity and impact in preventing nutritional and
humanitarian crises in areas heavily affected by cyclical natural hazards and climate change. More specifically, this
project aims to:

Improve ACF analysis and conduct assessments in communities affected by undernutrition, cyclical natural
hazards and climate change.
Develop integrated nutrition-disaster risk management programming in these communities.
Conduct trainings on nutrition-DRM programming and build ACF capacities.
Share ACF knowledge and experiences in these fields to the nutrition and humanitarian communities.
Advocate for a better integration of nutrition in key climate change agendas and initiatives, particularly through
participation in the UNSCN Nutrition and Climate Change eGroup (see below).

3 case studies will be conducted, respectively in Ethiopia, Bangladesh and Guatemala. Project outputs will be
delivered early 2011. For information, contact Philippe Crahay pcrahay@actioncontrelafaim.org

UNSCN Nutrition and Climate Change eGroup


The Nutrition and Climate change eGroup is an ad hoc online discussion forum, created with the aims of bringing a
nutrition lens into climate change issues and increasing the participation of interested sectors to discuss how this can
be done and what the priorities are. This eGroup also intends to identify opportunities for the nutrition agenda and
weaknesses that hinder the participation of nutrition in such debates. It also intends to influence the agendas of the
research community and the traditional nutrition donors.
For more information, please see: http://www.unscn.org/en/nut-working/nutrition_and_climate_change/
© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 9
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

DRM –CCA-Undernutrition: Guatemala example


In Centro American countries, the social and environmental vulnerability is reflected in the frequency of extreme hydro
meteorological events. As example, in Nicaragua there is a recurrence of droughts and floods (2008, 2009, 2010), rat pest (2007,
2008, 2009, 2010) and hurricanes (Ida and Tropical storms in 2009), that have caused extensive damages on the subsistence
agriculture affecting livelihoods and resilience capacity of population, aggravating the food security and poverty situation,
exacerbating the poor nutritional status of vulnerable population and subsistence farmers.

In Guatemala , in the Jalapa, Chiquimula y El Progreso Departments, ACF is following the increases on undernutrition caseload
caused mainly by a recurrent phenomena known as “seasonal hunger” that occurs every year between June and October. Last
year, drought caused a 70% of harvest loss. This was a critical cause of increase of infant undernutrition. This year, heavy rains
and flooding caused again important harvest damages and an increase on hygiene-related diseases (respiratory track infections,
diarrhea and animal vectors transmitted diseases). All these factors combined contribute to increase the prevalence of acute
undernutrition.

Due to this situation ACF keeps on the commitment to eradicate Hunger and undernutrition strengthening food security, nutrition
surveillance and support to the Minister of Health and Agriculture.

WHAT HAPPENED? Publications, reports, meetings, fora…


MM2 Forum in Geneva (Geneva, February 2010): A meeting regarding moderate malnutrition was organised by
UNICEF and WHO in Geneva last February. Cécile salpeteur from ACF-F and Elisa Dominguez from ACF-S
represented ACF in the meeting. Objective was to have a consultative meeting to write the new guidelines on moderate
malnutrition. This guideline should be published by middle 2011.
Nutrition Global Cluster (Geneva, July 2010): The annual meeting of the GNC was organized in Geneva last July. All
ACF HQ were represented (except USA). Discussions regarding intervention in Haiti or several tools developed by GNC
as the rapid assessment and the Harmioniused Training package were hold. Resume and background documents are
available upon request at your Nut advisor level.
World Congress on HIV (Viena, July 2010): ACF was present in this important Congress through a poster presented
by Marisa Sanchez (ACF-S) regarding a study on nutrition in HIV patients carried out in Conakry (Guinea) in 2009.
Workshop on Positive deviance experience (Bamako, August 2010): ACF office in Dakar organised this workshop to
share experiences from West Africa ACF missions and discussed actions to follow. Documents available at ACF-Dakar
office (Christophe Breyne [c.breyne@aahuk.org].
GNC meeting (NY, 21-22 Sept 2010): ACF-F and Ca were present. Objective was to define the next year cluster
priorities and organisation.
st
1000 days meeting: launching of the SUN roadmap on the 21 of sept with Hillary Clinton and Ban KI-Moon:
ACF-F was invited
World Public Health and Nutrition Congress (Oporto, 23-25 Sept 2010) : ACF-France and Spain will present some
posters. ACF-UK will do an speech on scaling up nutrition initiative and road map (SUN).
Launch on Research on NCA (Nutrition causal Analysis methodology) : with experts as Helen Young and Susan
jasper (Tufts university), Yves martin Prevel (IRD) and Kate Ogden (WFP) led by Julien Chalimbaud (ACF).
Contribution to writting a paper on MDGs (SCN)- Nutrition and the MDGs: accelerating progress towards 2015 :
led by Sandra Mutuma at ACF-UK.
Developpement of an international Working Working on CMAM : objective will be sharing information, tools,
research, best practices (ongoing). Most information with Anne Dominique Israel (aisrael@actioncontrelafaim.fr).

WHAT’S NEXT?
Publications, surveys, reports, meetings, fora…
ACF Nutrition Forum (Toledo, October 2010)- former CMN meeting: ACF-S is organising this Forum that will take
th th
place since the 25 until the 29 October in Toledo. External guests will be invited during 1 day to present strategies
and interventions regarding new strategies on prevention and management of malnutrition.
th
ACF Nutrition Steering Committee (Madrid 21st, 22nd and 29 October 2010): The Responsibles of Nutrition Dpt
at HQ level of different ACF HQ have been organised in such committee in order to share regular information, discuss
about technical issues and strategies and fix guidance and collaboration on Nutrition technical issues at ACF network.
This meeting will be organised prior to the Nutrition Forum to share annual action plans and organise collaboration
between HQ in 2011.
th
ACF Nutrition meeting (Toledo, 29 October): Nutrition advisors from different HQ will meet in Toledo after the
Nutrition Forum to evaluate the meeting, share information and discuss on technical issues.
ACF CMAM integration into health system guideline: expected early 2011.
CMAM Protocol updated: expected early 2011
Baby tent guideline: based on experience in Haiti.
© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 10
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

INTERNET RESOURCES
. http://www.who.int/childgrowth/standards/technical_report/en/index.html WHO Multicentre Growth Reference Study Group:
WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-
for-age: Methods and development. Geneva: World Health Organization; 2006
. http://www.fantaproject.org/ Training Guide for Community-Based Management of Acute Malnutrition (CMAM) and Nutrition,
Food Security and HIV: A Compendium of Promising Practices
. http://www.ennonline.net Fields exchange; internation workshop on the integration of CMAM report; Infant feedding in
emergency guidance and modules
http://www.who.int/nutrition/topics/hivaids/en/index.html Here are all the documents of the recent HIV/AIDS meeting for West
Africa held in Burkina Faso in November 2008
http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74 This is the website of the IASC Global Nutrition
Cluster with in particular the 21 training modules in nutrition in emergencies (HTP). You can find information on the other Global
clusters as well: Logistics, WASH, Health, Shelter, Protection etc.
http://www.nutval.net/ Make sure the food rations distributed in ACFIN programs are balances by checking their nutritional value
with NutVal 2, the software of WFP.
http://www.nutrisurvey.de/index.html - the software & methodology of SMART nutrition surveys
http://www.micronutrient.org/english/view.asp?x=1 Website of the INGO Micronutrient Initiative, with all information on
micronutrients you need.
http://www.thehnts.org The Health and Nutrition Tracking Service (HNTS) is a collaboration of non-governmental organizations
(NGOs), United Nations (UN) agencies, and donors for the review, analysis and validation of critical health and nutrition data
gathering methodologies and information in selected humanitarian emergencies. The website conatins information on nutrition
indicators, tools and training.
http://www.unscn.org/en/ SCN is the food and nutrition policy harmonization forum of the United Nations to promote cooperation
among UN agencies and partner organizations in support efforts to end malnutrition.
http://oneresponse.info/GlobalClusters/Nutrition/Pages/default.aspx Website of the GNC (Global Nutrition Cluster). The four
focus areas for the Nutrition Cluster are strategic and are not meant to be exhaustive and include a) coordination, b) capacity
building, c) emergency preparedness, assessment, monitoring, surveillance, and c)supply.
http://www.coregroup.org/ Website on community health approaches including the HEARTH model (strategy using positive
deviance).
http://www.ibfan.org/ibfan-ibfan.html The International Baby Food Action Network, IBFAN, consists of public interest groups
working around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and well-
being of babies and young children, their mothers and their families through the protection, promotion and support of
breastfeeding and optimal infant feeding practices.
http://www.measuredhs.com/ website with information regarding demographic and health surveys (including nutrition) worldwide.
http://www.childinfo.org/nutrition.html Monitoring of situation of children and women (nutrition) worldwide.
ACF-IN Workshop
http://motherchildnutrition.org/news/index.html on HIV-AIDS,
The information and linksJune 2010-within
contained Paristhis site aim to address malnutrition in
the global context, offering online access to the latest worldwide developments in its prevention and management.
http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm Vacancies and situation in emergencies.

ACF-IN MEETINGS: SOME PICTURES


ACF Workshop on HIV-AIDS, Paris, July 2010

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 11
ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

WHAT CAN YOU FIND IN THE PREVIOUS…


Issue Sector Releasing date HQ Main articles

#1 WASH September 2008 Paris  Caracoli en medio de la sed cuando se esta rodeado de agua - ACF Colombia
 Groundwater quantification in coastal area - ACF France
#2 FSL October 2008 Madrid  Fuel efficient stoves or not? – when we are able to follow up our own
recommendations - ACF Uganda
 Can the environment absorb our activities? The “acadjas”, a pilot fish
production project on Lake Tanganyika - ACF RDC
 Integrated Nutrition and Food Security Surveillance in Malawi - ACF Malawi
 Projects including the concept of value chain - ACF Paraguay
#3 Nutrition January 2009 Paris  Nutrition communautaire et sécurité alimentaire au Niger, les défis de
l’intégration - ACF Niger
 What is Research? – ACF France
#4 FSL June 2009 New York  Direct cash after the Post Election Violence in Kenya - ACF Kenya
 Direct cash project in Lira, Uganda – ACF Uganda
#5 WASH July 2009 Madrid  Sustainability factors for Water points in Liberia – ACF Liberia
 Light casing for rapid rehabilitation/construction open wells
#6 Nutrition January 2010 New York  Integrated Nutrition and FSL activities in Southern Sudan – ACF
Southern Sudan
 Projet de support nutritionnel et de sécurité alimentaire des Personnes
Vivant avec le VIH - ACF RDC
#7 FSL December 2009 Paris  Direct Cash transfer in Uganda: results and lessons learnt – ACF
Uganda
 Partnership in program implementation: an experience of ACF in
Barguna – ACF Bangladesh
 Changing general food distributions into cash based interventions,
Cyclone Nargis experience – ACF Myanmar
#8 WASH May 2010 New York  Hygiene promotion in emergencies: Capitalisation of ACF experiences in
Nakuru and Molo IDP Camps, Kenya - ACF Kenya
 Groundwater research in Uganda - ACF Uganda
#9 FSL July 2010 Madrid  Seed Fairs in Eastern DRC – ACF Congo
 The Sentinel Sites in Central America –ACF Central America
 CFW: Food Processing Activity for Women in Palestine – ACF Palestine
 Réponse au séisme en Haïti : spécificités d’une réponse d’urgence en
milieu urbain – ACF Haïti
#10 Nut September 2010 Madrid  Management at remote control in Gao – ACF Mali
 Integrated Approach –ACF Perú
 Bhami History – ACF India
 Climate change and malnutrition – ACF Int

… AND NEXT NEWSLETTERS?

Issue Sector Releasing date HQ If you want to contribute to the next NUT edition of Tech
The News, that will be released in December 2010 and
#11 WASH December 2010 Paris
piloted by ACF-France, please contact :

Jean Lapègue – jlapegue@actioncontrelafaim.org

© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 12

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