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

Carbon Dioxide Production in Acutely Ill Malnourished ChildrenSummary of published paper 1ResearchArecent study set out to test the hypothesisthat the rate of carbon dioxideproduction is less in marasmic childrenwith acute infection whencompared to well-nourished children, but greaterwhen compared to uninfected marasmic children.The study took place at Queen ElizabethCentral hospital, in Blantyre, Malawi. Using astable isotope tracer dilution method, rates ofcarbon dioxide production were measured inchildren aged 12-60 months while receivingfeeding. Results from 56 children were compared,28 with marasmus and acute infection, 16with marasmus, and 12 well nourished withacute infection. Those with acute infection hadmalaria, pneumonia or sepsis.Well nourished children with acute infectionproduced more carbon dioxide than marasmicchildren. However, the rate of carbon dioxideproduction in marasmic children with acuteinfection was not greater than in uninfected children.The observed rate of carbon dioxideproduction was greater than that which could beproduced from the dietary intake alone.The study concluded that marasmic childrendo not increase energy expenditure in responseto acute infection, as well nourished children do.The data suggest that children with proteinenergymalnutrition and acute infection expendless energy, largely due to a lower body temperatureand the absence of fever. Although notraising body temperature in response to acuteinfection conserves scarce nutrients, it also determinesthat the immunological benefits of feverare not realised. Fever activates cellular immunity,stimulates the acute phase response, enhancesiron sequestration and is associated withbetter survival. The clearance of the malariaparasite is also accelerated by fever.Dietary energy intake in the 44 marasmic childrenstudied was 350 kj/kg/day (84 kcal/kg/d),the level recommended for malnourished childrenfrom experience in treating malnourishedchildren in Jamaica. The data from the rate ofcarbon dioxide production suggests that tomatch energy expenditure, intake should havebeen increased by 25% to about 440 kj/kg/day(105 kcal/kg.d), when the thermic effect of foodis considered. Current standard recommendationsare that during the initial phase of treatment,severely malnourished children shouldreceive 336-420 kj/kg/day (80-100 kcal/kg/d).Further research is needed to determine whetherincreased dietary energy improves the responseto acute infection, and whether these childrenmight be better served by increasing their dietaryintake.1Manary, M et al (2004). Carbon dioxide production duringacute infection in malnourished Malawian children.European Journal of Clinical Nutrition, vol 58, pp 116-120HIV/AIDS andHumanitarianActionSummary ofpublished report 1The Humanitarian Policy Group (HPG)have just published a report whichexamines the implications of HIV/AIDSfor understanding crisis and the role ofhumanitarian aid. It focuses on the humanitarianresponse in southern Africa in 2002 and 2003.In reviewing the literature, the report sets outhow the disease has clear negative impacts onfood security at household level and that theseimpacts are complex, wide-ranging and genderspecific.In particular, it highlights that:• HIV/AIDS is one of many factors contributingto underlying vulnerability• HIV/AIDS creates particular types of vulnerabilities,through affecting predominantlyprime-age adults, clustering in households, isgender specific, and through interacting withmalnutrition• HIV/AIDS undermines the ways in whichpeople have traditionally coped with famine• HIV/AIDS may increase mortality infamines, as people with AIDS will be lessableto cope with reduced food intake andadditional disease burdens• Issues associated with crisis may add to therisks of transmission of HIV/AIDS andcontribute to the spread of the epidemic.However, it is also argued that original researchis limited, tending to focus on agricultureand there is little information about the scale ofthe impact of HIV/AIDS on food security atnational and regional levels. The report stressesthe importance of understanding how theimpact of HIV/AIDS interacts with otherfactors, such as drought and conflict, to createacute humanitarian crises. All these factors mustbe considered when providing humanitarianrelief in the context of a HIV/AIDS epidemic.The process whereby HIV/AIDS negativelyinfluences outcomes in an emergency has beendescribed as ‘new variant famine’.The report asserts that the argument thatHIV/AIDS significantly contributed to thesouthern Africa crisis came about gradually, butmay have been over-emphasised and that otherequally or more important factors risked beingneglected. There has been concern on the part ofcertain donors and NGOs about how HIV/AIDSis being used to justify a need for continuedhumanitarian aid in some countries, and therehas been scepticism about the underlying empiricalevidence of the links between HIV/AIDSand food insecurity. The level of current datameans that the scale and severity of HIV/AIDS’contribution to both acute and chronic food insecurityis simply unknown.Considering the numbers affected and dyingwith HIV/AIDS in sub-Saharan Africa, theauthors consider HIV/AIDS a humanitarianproblem and a long-term crisis, which requiresboth a humanitarian response to suffering and along-term perspective. They raise a number ofchallenges in responding to this situation:i) Considering HIV/AIDS as a health crisis inits own right, in terms of massive andincreasing levels of mortality and morbidityover a period of decades, requires a longtermresponse encompassing prevention,care,treatment and mitigation.ii) Increasing underlying vulnerability,HIV/AIDS adds to the impact of othershocks, triggering acute crises more easilyand complicating recovery.iii) HIV/AIDS, as one of many contributoryfactors to long-term and chronic foodinsecurity, poverty and destitution, adds tothe existing need for safety nets and longtermwelfare, as part of the overall responseto poverty.The report author acknowledges that theseare not new challenges and there is a danger of‘AIDS exceptionalism’, privileging AIDS overother diseases in health systems or focusingunduly on the impact of AIDS in food securityprogrammes. It is further argued that the overallresponse to HIV/AIDS needs to take place overdecades, and requires a rethinking of relief1A transcript of the meeting and the published reportHIV/AIDS and humanitarian action. Paul Harvey,Humanitarian Policy Group, HPG Report 16, April 2004 areavailable online at http://www.odi.org.uk/hpgmodalities, development modalities and of thelinks and interaction between humanitarian aidand development actors. The report finds arange of practical questions and challengesaround programming of humanitarian aid in thecontext of an HIV/AIDS epidemic (see box).Programming challenges in the contextof HIV/AIDS• Incorporate analysis of HIV/AIDS andlivelihoods impact into early warningsystems and assessments• Emerging types of vulnerability due toHIV/AIDS should be considered inassessment (e.g. widows, elderly,orphans) and targeting (e.g. urbanand peri-urban areas)• Targeting and the delivery of aid mustbe sensitive to the possibility of AIDSrelatedstigma and discrimination• The HIV/AIDS epidemic reinforces theexisting need for humanitarianprogrammes to be gender-sensitive• Emergency interventions must aim toensure that they do not increasepeoples susceptibility to infection withHIV/AIDS• Food aid in the context of HIV/AIDSshould review ration sizes and types offood, and assess delivery and distributionmechanisms in the light ofHIV/AIDS related vulnerabilities, suchas illness, reduced labour and increasedcaring burdens• Labour intensive public works programmesshould consider the needs oflabour constrained households, theelderly and the chronically ill• HIV/AIDS reinforces the need forhealth issues to be considered as partof a humanitarian response• Support to agricultural production(including seed distribution) shouldrecognise adaptations that people aremaking in response to HIV/AIDSThe author reiterates that humanitarian reliefshould remain focused on saving lives and alleviatingsuffering in response to acute crises.However, in the context of a HIV/AIDS epidemic,HIV/AIDS issues need to be ‘mainstreamed’by aid agencies, both internally in terms of trainingand organisational policies, and externallyin terms of how humanitarian aid programmesare structured and delivered.9