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News
En-net update,
March-May 2012
By Tamsin Walters, en-net moderator
Thirty-six questions were posted on en-net in the three months
March to May inclusive, eliciting 176 replies. In addition 25 job vacancies
were posted.
Recent discussions have included: Mid Upper Arm Circumference
(MUAC) changes in pregnancy and ongoing research into what are the
most appropriate thresholds to use for pregnant and lactating mothers
in programmes to treat acute malnutrition and how they correlate
with adverse outcomes, dilemmas of whether to use weight-forheight
or MUAC to diagnose acute malnutrition and the potential
biases of the two measures in different population groups, the challenges
inherent in attempting causal analyses of acute malnutrition,
and considerations of how to continue to promote breastfeeding in
community-based management of acute malnutrition (CMAM)
programmes.
An interesting discussion arose from a situation in Somalia where
reports came in of mothers “starving” their children in order to benefit
from nutritional treatment and a protection ration being provided
alongside programmes to treat acute malnutrition. This is not an unfamiliar
scenario and has been reported in several countries, with
greater or less emphasis, in many programmes implemented in crisis
situations. The Nutrition Cluster in Somalia is trying to gather further
evidence to establish how significant and widespread the problem is.
Meanwhile, performance monitoring data from one programme in
Somalia has shown an increase in relapses in the last three months
from 8% to 17%, which could be linked to the same issue. Suggestions
and solutions were sought on how to address this situation.
Discussants advised enhancing community mobilisation and counselling
for both mothers and fathers, as well as engaging other
influential community leaders. Contributors cited successful examples
of both individual counselling as well as group discussions in
programmes in Uganda, South Sudan, Ethiopia, Niger, Haiti and
Bangladesh.
Despite these examples of successful approaches to address the
immediate issues, it was agreed that ‘starving’ of children was most
likely symptomatic of a much greater underlying problem of food
insecurity. “These are usually decisions made under conditions of real
stress which aid workers, agencies, donors and planners have never
personally faced and often to not consider” 1 .
A situation where people are taking such desperate measures to
access basic commodities suggests a large unmet need in terms of
general rations and basic household food needs. It is a survival strategy
for the family.
Excerpts from a letter from Nelson Mandela on World Food Day,
September 2004, was quoted to bring home the real issues people are
facing and the decisions they are making in such situations:
"Hunger is an aberration of the civilized world... Families are torn asunder
by the question of who will eat. As global citizens, we must free children
from the nightmare of poverty and abuse and deprivation. We must
protect parents from the horrifying dilemma of choosing who will live. 2 "
The discussion concluded with a consensus that mothers should
never be shamed or punished in nutrition programmes, but efforts
should be made to understand and help them. Mothers do not harm
their children unthinkingly; they are facing desperate life and death
decisions for their families. Our work is to try to understand and
respect the reality of their day to day lives and adjust our programmes
accordingly to meet their needs.
To view the full discussion, go to
http://www.en-net.org.uk/question/717.aspx
To join any discussion on en-net, share your experience or post a
question, visit www.en-net.org.uk
Contributions from Fortune Maduma, Martha N, Peris Mwaura, Yara
Sfeir, Chantal Autotte Bouchard, Mark Myatt, Leo Anesu Matunga, Alex
Mokori, Michael Golden, Nikki Blackwell and others.
MAMI-2 research
prioritization
– call for collaborators
In January 2010, the report of ‘The Management of Acute Malnutrition in
Infants aged