Drought resistant 'banana' - Field Exchange - Emergency Nutrition ...

Field ArticleMSF/Epicentre, Angola, 2003dependent population, 60 100g/person/day ofCSB are needed compared to 1.5g ofQBmix/person/day. Thus for the equivalentmicronutrient supply for 1000 people for 30days, 40-66 times the weight of CSB is neededcompared to QBmix. CSB needs to be transportedby ship, which takes about 3 weeks to arrivein Luanda and 2-3 weeks for custom clearance.For QBmix, transport can be by plane (and thereforequicker) or ship.Storage conditions for CSB andQBmix are similar, both needingdry conditions. CSB comes in plasticbags of 25 kg, while QBmixcomes in aluminium sachets of210g (70 sachets in 1 carton box).QBmix must be stored below 30Centigrade. The shelf life for CSB isbetween 6-18 months but vitamincontent declines over time. Shelflife for QBmix is at least 12 months,during which time the micronutrientcontent remains stable.As required quantities of CSBare much greater, there is a timeelement involved in setting upappropriate distribution systems,whereas sachets of QBmix can begiven out quickly. However, givenits unfamiliarity, it does take timeto explain why and how to useQBmix. For beneficiaries, it isobviously easier to take home afew sachets compared to a 9-15 kgbag.DiscussionNearly all QBmix recipientsfound it easy to use, liked the tasteand smell and would like to havemore of it available in the future.Moreover, they would be ready tobuy the product on the market if itwere available. The majority ofsachets were empty and manypeople spontaneously asked toreceive more. Also, experience has shown thatpeople in sub-saharan African like salty tastes,e.g. QBmix has been used to prepare meals in aprison in the Ivory coast after an outbreak ofberiberi and was well accepted.Compared to CSB, the volume and weightneeded is considerably less for QBmix, leadingto lower international and national transportcosts. However, CSB also provides calories(380kcals per 100g) and people are familiar withit. In contrast, QBmix has few calories andpeople are unfamiliar with it, so resources areMSF/Epicentre, Angola, 2003needed to explain the role and use of theproduct.The results of this study cannot be generalisedor extrapolated to other situations. Forexample, in Afghanistan, mothers in a therapeuticfeeding centre did not like an earlier versionof the product. A standardised questionnaire haslimitations, e.g. it may not capture all the informationavailable from respondents.Furthermore, recipients were in a position ofDistribution of QBmixdependence on food aid so they may have notfelt free to say what they really thought. Theymay have been afraid of being excluded fromfood distribution and felt that if they said whatwas expected, this would ensure they receivedthe product again.In the pellagra group, interviews were notnecessarily conducted with those who preparedthe meal. It was the patient who received theQBmix who was interviewed, so that the informationwas second hand.Strategies for the futureIn Angola, the need for QBmix has becomeless relevant, as fortified maize is scheduled fordistribution and the situation is increasinglystable, with more people having access to adiversified diet. In other situations where MSFintervenes, QBmix and/or other products nowon the market such as Topnutri-Fam , a nutrientconcentrate that comes in the form of powder,may be more appropriate, and clear operationalindications have now been defined. Even thoughthese products are not the solution,they do provide one possible tool toprevent micronutrient deficiencieswhere there are no other sources ofvitamins or minerals.In large-scale emergencies, whenthe general ration programme iserratic, or unbalanced in terms ofmicronutrients, ready-to-use micronutrientsupplementation productsshould systematically be distributedto vulnerable populations. This typeof supplement can also be used inother situations. For example, forhospitalised patients, patients in TBor HIV treatment programmes, or ina prison setting, where the productcould be systematically added toprepared meals 2 or 3 times perweek. Although medical humanitarianagencies may not be directlyinvolved in the distribution of generalfood rations, they do have a rolein ensuring people have an adequatesupply of micronutrients. Activitiesfor such agencies could, therefore,involve lobbying for the use of thisform of micronutrient supplementationwith those agencies resourcingand/or implementing nutritionalinterventions, and social marketingin order to promote and explain theuse of this type of product.When introducing this type of newproduct onto the market, clear andadapted information should be given to thetarget population. For example, specifically forQBmix, key information to give at the time ofdistribution should include the following practicalmessages:• the mix contains vitamins and mineralsessential for health• use one screw top per person• use every day if possible, but 2-3 times perweek is sufficient• salt can be added if desired• the mix should be added to the meal aftercooking.In order that the recipient population fullycomprehend the role and significance of aproduct like QBmix, ‘reference’ persons from thecommunity should be appointed who can bereferred to at all times.In conclusion, new products are now availableon the market, which should facilitate theprevention of micronutrient deficiencies in foodaid-dependent populations in emergencies. Aidagencies should be aware of the existence ofthese products and be ready to use them whenindicated.For further information, contact: EvelynDepoortere, Epicentre, p/a MSF-Belgium,Dupréstraat 94, 1090 Brussels, Belgium. Email :evelyn.depoortere@brussels.msf.orgExplaining the use of QBmix5Produced by DANature Foods/Compact AS, Norway.14