Alimentaçãoe nutrição no campo dos refugiados.pptx

Alimentação e Nutrição no campo de refugiados é muito importante para a saúde e sobrevivencia dos mesmos, e para isso é necessário uma alimentação baseada em diverentes nutrientes e teor calorico, pois estão suscetiveis a diversas doenças e diversos problemas de desnutrição.

1. U niversídade Católica de Moçambique Departamento de Medicina-FCS  Food and Nutrition Security 4 o ano Setembro/2024 Akú Júnior Macuácua Médico GP Mestrando Medicina Tropical [email protected]

2. The ten (10) top priorities  Initial assessment Measles immunization Water and sanitation Food and nutrition Shelter and site planning Health care in the emergency phase Control of communicable diseases and epidemics Public health surveillance Human resources and training Coordination

3. Malnutrition is a global issue that affects billions. The term malnutrition refers to both undernutrition and overnutrition . Traditionally, undernutrition is prevalent in developing countries and obesity is an epidemic in developed countries. Recently, obesity has been increasing in developing countries, In the following sections, undernutrition and malnutrition are used interchangeably. Introduction

4. There are 925 million undernourished people in the world today:  one in seven people do not get enough food to be healthy and lead an active life . Malnutrition accounts for 11% of the global burden of disease . Each year it kills 3.5 million children under 5ys ; Malnutrition is implicated in about 40% of the 11 million deaths of children under 5 in developing countries; Lack of immediate and exclusive breastfeeding in infancy causes an additional 1.5 million of deaths. Quick facts and figures

5. Countries may lose 2-3% of their Gross Domestic Product (GDP) as a result of iron, iodine, and zinc deficiencies . Without addressing malnutrition , the world community might not be able to achieve the Sustainable Development Goals (SDGS), especially those related to health, hunger, and poverty Cont…

6. Some frameworks of analysis for approaching food and nutrition security A multileveled approach : from global food budgets to the nutritional status of the individual. Systems analysis : complex interaction of multiple influences on food and nutrition. Hazard and vulnerability : shocks and trends in availability, supply and access that alter the risk of a nutritional crisis or emphases more on changes in vulnerability in terms of socio-economic well-being and loss of biological resilience.

7. May, J. (1954)

8. Multileveled Food and nutrition security Availability of food Access to food Use of food at family level Use of food at individual level Nutritional status

9. Food Security – Macro Issues

10. Food Security - Indicators Category Indicator Food production Supply indicators Meteorology Rainfall Agriculture Crop production Socio-economic Demand indicators Economic Market prices Social Coping strategies Health and nutrition Outcome indicators Nutrition Anthropometry Health Morbidity

11. Causes of malnutrition – the UNICEF framework

12. Poor Household Food Security Low crop production Lack of alternative sources of income Lack of village level research and extension systems Fear of dispossession of land Lack of money Lack of village level technology and disseminating systems Lack of appropriately trained research and extension workers Lack of land tenure security Lack of credit at village level Poor village access roads

13. Nutrition – Infectious Disease Link

14. Nutrition in the life cycle

15. Deaths associated with undernutrition 60% Source: EIP/ WHO.Caulfield LE, Black RE .Year 2000 Major causes of death among children, all over the world

16. Trends in mortality in under 5ys

17. Nutritional Deficiencies - WHO categorization Protein-energy malnutrition Iodine deficiency Vitamin A deficiency Anaemias Other nutritional disorders relating to lack of vitamins and micronutrients

18. Nutrients - summary Vitamins - A (carrots), D, E, K, C (oranges) and Group B Minerals - Iron (greens), Calcium (cabbage), Iodine (fish and other sea food) Protein - for growth and extra energy Carbohydrate - wheat, rice, maize, potatoes ... - for energy Fats - energy intake in high concentrations that if in excess is stored as body fat

19. Sphere – Nutritional Requirements (2004) 20

20. Vitamins Fat soluble; A – carrots, spinach, egg yolk, cheese, liver, tomatoes, apricots Function: normal development of bones and teeth and aids night vision Deficiencies: poor growth, xerophthalmia (night blindness) D – oily fish, egg yolk, butter, uv -rays of sunlight Function: assists absorption and metabolism of phosphorous and calcium – Deficiencies: rickets in children, osteomalacia (demineralisation and softening of bones), osteoporosis (loss of bone density through bodies absorption of calcium and phosphorus from the bone). E – wheat germ, egg yolk, green vegetables Function: controls oxidation in body tissues Deficiencies: unclear but use of vitamin E to aid healing process of tissue. K – green vegetables Function: anti- hemorrhagic and essential for production of prothrombin which helps to clot the blood Deficiencies: delayed clotting time and liver damage.

21. Vitamins- B Water soluble : B1 (Thiamine), B2 (Riboflavin) and B3 (Niacin or nicotinic acid) (together the B complex): wholemeal flour and bread, brewers yeast, milk, eggs, liver, fish, vegetables, cereals Function: B1 anti- neuritic , anti-beriberi, anti-pellagra, health of nervous system – B2 and B3 steady and continuous release of energy from carbohydrates Deficiencies: B1 beriberi, neuritis, poor growth in children – B2 and B3 fissures at corner of mouth and tongue inflammation, corneal opacities, pellagra (dermatitis, diarrhoea and dementia). B6 ( Pyridoxene ) – Source is as other B complexes Function: protein metabolism Deficiencies: nervousness and insomnia.

22. Vitamins B12 – other B complexes , liver, kidneys Function: red blood cell formation Deficiencies: serious anaemia. Folic Acid – green vegetables, liver Function: assists in production of red blood cells Deficiencies: causes premature babies. C (ascorbic acid) – fresh fruit, green leaf vegetables, potatoes, turnips Function: formation of bones and connective tissue, teeth and red blood cells Deficiencies: sore mouth and gums, capillary bleeding, scurvy, delayed wound healing.

23. Minerals and Trace Elements Calcium – milk and dairy products, green leafy vegetables Function: necessary for bone formation and teeth, blood clotting Deficiencies: bone diseases, ostomalacia, rickets, tooth decay and tetany (muscular spasms). Iodine – sea food, iodised salt Function: synthesis of thyroid hormone (thyroxin), essential for metabolism and circulation Deficiencies: goitre, cretinism (underdeveloped physically and mentally). Iron – red meat (and liver and kidney), egg yolk, whole grains, dark green vegetables, raisins, treacle, molasses Function: formation of haemoglobin Deficiency: anaemia, fatigue. (greater need during pregnancy)

24. cont … Magnesium – whole grains, milk, legumes, nuts. Function: influences enzymes (essential for carbohydrate and protein metabolism) Deficiencies: unlikely but mainly in cases of chronic malabsorption. Potassium (K) – Fruit, vegetables, meat, wholegrains. Function: principle intercellular electrolyte that influences muscle contraction Deficiencies: rare but very serious is it happens. Sodium – salt, meat, milk, vegetables. Function: important for regulating water balance Deficiency : weakness, abdominal cramps, faintness. Zinc – oysters, eggs, wholegrain. Function: wound healing, sexual and physical development Deficiency: fatigue, retarded growth and sexual maturity.

25. Oral Rehydration Salts For treatment of dehydration due to diarrhoea . Isotonic solution – restores equilibrium of bodies systems where energy, vitamins and trace elements have been rapidly lost. UNICEF sachet contains; Glucose anhydrous – 20.0g Sodium chloride – 3.5g Trisodium citrate dihydrate – 2.9g Potassium chloride – 1.5g Dissolved in one litre of drinking water. Infants to take over 24 hr period. Children to take over and 8 to 24 hr period. Adults to take freely as required.

26. There are 26 million refugees globally: 80% facing food insecurity irrespective of location.  The vulnerable group, including Women (pregnancy and girls) Children (<5y) LGBTQIA2S+ Elderly Persons with disabilities  Malnutrition is frequent in refugee populations and is an important contributory cause of death.  Protein-energy malnutrition (PEM) Source : Nisbet, C.; Lestrat, K.E.; Vatanparast, H.. Food Security Interventions among Refugees around the Globe: A Scoping Review. Nutrients 2022, 14 , 522. https://doi.org/10.3390/nu14030522 Food and nutrition

27. Two main factors explain why the risk of malnutrition is higher in a population  1. The sudden and massive reduction in :  Food availability due to a real lack of food or an inadequate distribution of rations Food accessibility No means of buying food or inequities in the food distribution 2. The impaired health environment: Higher exposure to communicable disease Lower standard of health services Lack water Poor hygiene

28.  A first quick evaluation : Global idea of the situation  Second stage by quantified data collection : Prevalence of malnutrition Food availability and accessibility Nutritional survey Monitor the basic food ration by regular Food and nutrition

29.  THE NUTRITIONAL STATUS OF THE REFUGEE POPULATION The prevalence of acute malnutrition in children under 5 years  How to measure malnutrition: Weight-for-height index (W/H) Which is recommended as the most reliable indicator in emergencies because it: Reflects the current situation and Sensitive to rapid change +  Bilateral oedema in children Indicates severe malnutrition, irrespective of their W/H  Measure of the mid-upper arm circumference (MUAC)  It is not a reliable indicator because the risk of measurement error is high

30. Implementation of the nutritional survey The survey is performed on a representative sample of children : Aged between six months and five years, Use the W/H index (interpreted by Z-scores)

31. Measuring nutritional status Key malnutrition indicators

32. THE ROLE OF THE HEALTH AGENCIES The agencies will decide with which kind of nutritional intervention they want to be involved. They usually carry out selective feeding programmes for acutely malnourished children (and possibly for other vulnerable groups). It is their responsibility to monitor the regularity and adequacy of food rations. They generally leave general food distributions to organizations with more specific experience and capacity (either temporarily or over a longer period)

33. OBJECTIVES OF FOOD INTERVENTION PROGRAMMES  The general objectives : Are to meet the basic food needs of all refugees and to decrease the mortality and morbidity resulting from malnutrition The operational objectives are: To ensure a minimum average food ration of 2,100 Kcal/person/day containing an adequate nutrient content. To reduce the prevalence of malnutrition and mortality from malnutrition by the treatment of acutely malnourished individuals and the prevention of malnutrition in other groups at risk.

34. Nutrition interventions to build nutritional resilience: developmental emphasis Assessment – extent, cause, who affected Indirect interventions – sanitation, water, income, diversification of agriculture, entitlement interventions … Part indirect intervention – food for work, cash for work Fortification of food stuffs – micronutrient supplementation Encouragement of breast-feeding and good weaning practices Nutrition education Production of blended foods Available nutritional rehabilitation units (NRUs) … for supplementary feeding programmes and monitoring purposes.

35. Nutrition interventions to provide for rapid nutritional recovery: emergency/disaster emphasis Emergency food distribution: General rations - To ensure minimum calorie requirement, protein, vitamins and minerals. Cereals, oil and beans. - Fuel and cooking utensils may also be needed. - If so food aid can be dry rations. - Wet rations and collective food preparation (on mass) have to be used in some instances.

36. Selective feeding programmes  The objective is to: Reduce the prevalence of malnutrition and mortality among the groups at risk Provide extra food for the malnourished and at-risk groups The programme must actively identify those who are eligible for the selective feeding programmes, using criteria described in this chapter.

37.  Supplementary feeding programmes (SFP) targeted SFP blanket SFP Therapeutic feeding programmes (TFP) hospital and feeding centres community-based Types of selective feeding programmes are contemplated

38. Nutrition interventions to provide for rapid nutritional recovery: emergency/disaster emphasis Emergency food distribution: Supplementary foods - usually processed and high caloric and protein value (i.e. corn-soya milk) to rehabilitate malnourished people - and/or where general ration does not provide a balanced diet, - and/or where there are special needs of selected groups such as under-fives, pregnant and breast-feeding women, the elderly, and the sick.

39. Nutrition interventions to provide for rapid nutritional recovery: emergency/disaster emphasis Emergency food distribution: Therapeutic feeding - for severely malnourished people (i.e. <70% WFH/L with or without kwashiorkor. - typically frequent doses of high-energy milk. - patients also likely to have other health problems, including anaemia and vitamin deficiency diseases. - can be expensive and labour intensive.

40. Overall intervention guideline MSF (1997) Refugee Health, an approach to emergency situations , Macmillan, p.86.

41. Akú Júnior Macuácua Médico GP Mestrando Medicina Tropical [email protected] Thank you