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

contents31220265••••••••••••15•••••••••1922•24•2Field ArticlesEnset – The ‘False Banana’as Food SecurityPotential of Using QBmix toPrevent MicronutrientDeficiencies in EmergenciesVulnerability Mapping inUrban AfghanistanInfant Feeding Alternativesfor HIV Positive Mothers inKenyaResearchAdequacy of ReplacementMilks for Infants of HIV-Infected MothersGrass Pea Consumption andNeurolathyrismRefugee Participation inCamp Health ServicesStarvation and FutureCardiovascular DiseaseEffect of Displacement onGrowth of Children in NigeriaInvesting in Nutrition toReduce PovertyDietary Assessment of CampRefugeesImpact of Dietary ZincSupplementation on PEMCarbon Dioxide Production inAcutely Ill MalnourishedChildrenHIV/AIDS and HumanitarianActionNutritional Status of HIV+Pre-School Children inSouth AfricaTaking forward research onadult malnutritionNews & ViewsCourse on Saving Lives andLivelihoodsWHO/TALC materials on theManagement of SevereMalnutritionNutrition in emergenciesworking group, SCN 2004New Measuring Scoops forF75 Therapeutic MilkECOWAS Nutrition Forum onNutrition and HIVEquity in Donor AidAllocation to IraqTraining in Public Health inEmergenciesUpdate from Food Security,Livelihoods & HIV/AIDSWorking GroupFAO/WHO Meeting Warn ofContaminated Infant FormulaLettersEvaluationLessons From SCUKEvaluation in DRCAgency ProfileNutriset29 People in aidFrom the EditorThe more cynical amongst us in the emergencynutrition sector may sometimes be heard complainingthat there is nothing new in this professionand that we just keep re-inventing the wheel - ‘theproblems are the same, as are the solutions.’However, a cursory glance over this issue of FieldExchange gives lie to any such claim. There areplenty of new developments. For example, the pilotingof a newly developed product called QBmix (amicronutrient rich condiment) by MSF amongstIDPs in Angola to help combat the endemic pellagraproblem that has plagued this population for anumber of years (see field article by EvelynDepoortere). The study shows that QBmix mayoffer a cheaper, and logistically simpler, alternativeto fortified CSB, as a means of preventing furtheroutbreaks. There is also a field article in this issueabout an indigenous crop grown in south andsouthwest Ethiopia - ‘Enset’ (or false banana) andbeing promoted by the development agency SelfHelp International The crop appears to have manypotential uses which have a positive impact on foodsecurity. According to the author, there may bepotential for promoting this local drought resistantcrop in other food insecure areas of Ethiopia and fordisseminating knowledge widely about its potentialfor reducing food insecurity. This issue alsocarries a summary of a study concerning theconsumption of green peas in drought prone areasof Ethiopia. Consumption of this wild food, especiallyin drought periods, is associated with neurolathyrism(a neurodegenerative condition).However, the study shows that incidence is reducedwhen the affected population simultaneouslyconsumes food aid in the form of cereal. Thefindings support the case for targeting food aid inthese vulnerable areas, not just to the poorest, butalso to those likely to increase their consumption ofthis legume.There are also research findings reported in thisissue, which, although not entirely new, add to analready considerable body of knowledge. Forexample, a study of the longer term impact of thesiege and resulting famine in Leningrad during thesecond world war shows that the legacy of starvationis not just limited to growth impairment, butalso future cardio-vascular health. There is also astudy on ration adequacy amongst Thai refugees.This shows, yet again, how poor ration quality forfood aid dependent refugees is directly responsiblefor the high levels of stunting and micronutrientdeficiencies which have existed amongst this populationfor a number of years The inadequacy of themicronutrient content of home prepared replacementmilks as a breastmilk substitute – an ongoingconcern of many in infant feeding circles - is highlightedin one summarised research piece byRollins et al in South Africa. In this setting, infantformula is considered an appropriate and viableoption for feeding infants of HIV positive mothers.However, a field article by Tom Oguta and his teamin Kenya finds that home-adapted animal milksmay be the preferred breastmilk substitute, andonly available option, for carers of infants whosemothers are HIV positive. While current internationalguidelines recommend fortification of homeprepared milk with micronutrients, in practice,these are often not locally available.Take any sample of Field Exchange and it isapparent that there is a continuous steam of importantinformation and ideas provided by new researchand pilot interventions, which should, at leasttheoretically, help inform better practice.Unfortunately, much of this information neverfinds its way into the published literature. In spiteof what cynics may say, there is still much we don’tknow. Where we have good quality research thereis often a need to collate disparate research findingsinto a sufficient body of coherent evidence to makea case and advocate for change. Emergency rationadequacy for refugees and findings like those fromthe Thai refugee study are obvious examples whereit appears that we have not reached a critical massof evidence to effect change.As editor of Field Exchange it is becoming increasinglydifficult to leave out articles and research onHIV related issues. This issue of Field Exchangecarries a field article on infant feeding practicesamongst HIV positive mothers in Kenya, asummary of a review of the impact of HIV on crisesand humanitarian work, and research on predisposingfactors to malnutrition amongst HIV positivechildren in eastern Cape, South Africa. There is alsoa report on the AAH/Oxfam co-chaired meeting ofthe HIV, food security and livelihoods workinggroup.The multifaceted interface between HIV andnutrition is becoming increasingly recognised andreflected in HIV/nutrition programming, especiallywhere the HIV pandemic is most pronounced,e.g. southern and Eastern Africa. There is agrowing trend towards using food aid in much ofthis HIV programming. The use of food aid is beingincreasingly advocated, especially following emergencyprogrammes under protracted relief andrehabilitation arrangements (PRROs). Food is thereforebeing incorporated into Prevention of Motherto Child Transmission programmes (PMTCT),Home Based Care (HBC), TB treatment (DOT),Orphan and Vulnerable Children programmes(OVC) and Neighbourhood Child Protectionprogrammes (NCP). There appear to be multipleroles for food aid in these programmes with avariety of objectives proffered, e.g. nutritional, foodsecurity, incentive to comply with treatment, incentivesfor volunteers, protection, etc. However, thereis often a lack of clarity over exit criteria, how foodaid will be integrated with other packages and littlethought or attention as to how these programmeswill be monitored and evaluated. While there maybe a rationale for food aid in many of theseprogrammes, there is the very real danger that foodmay be used uncritically with little attention givento impact. Furthermore, in some cases it may bethat food aid actually has a negative impact, e.g.undermines the volunteer ethos.There is a long history of uncritical and ultimatelyineffective use of food aid in longer term nutritionprogramming, e.g. supplementary feeding.Some critics of current developments are alreadyimplying that use of food aid in HIV programmingmay be an attempt to introduce development foodaid (which has dwindled over the past three decades)by the back door. It is essential, therefore, thatthis relatively new area of programming is introducedcautiously and based on pilot studies. Wheresuccessful, interventions can be rolled out, providingmonitoring and evaluation mechanisms are inplace. There can be no excuse for failing to applylessons from the past regarding the use of food aidin longer term nutrition interventions to this newera of HIV/AIDS and nutrition programming.Finally, we enclose in this issue the first ENNSpecial Supplement. This supplement, and subsequentones that are planned, are meant to collatecutting edge field experiences in rapidly developingsubject areas. A letter written by one of theauthors in this issue of Field Exchange (AnnaTaylor), highlights why targeting is such an importantsubject and where clarity is urgently needed.The next ENN Special Supplement will be onCommunity Based Therapeutic Feeding programmes.We hope you enjoy this issue of Field Exchange.Jeremy ShohamAny contributions, ideas or topics for future issuesof Field Exchange? Contact the editorial team onemail: marie@ennonline.net