Nutrition

Nutrition: The Pivotal Ingredient to Good Health

Nutrition is pivotal especially during a child’s first 1000 days, from conception until reaching the age of 2. Suboptimal nutrition during this window of opportunity deprives a child from reaching its full potential and can impair physical and cognitive development.

Increased nutrition-related morbidity and mortality, increased risk of developing non-communicable diseases later in life, as well as decreased IQ and school performance resulting in a lower national gross domestic product could all be attributed to malnutrition. In addition, malnutrition during childhood can have an effect on generations to come because malnourished adolescent girls might have a sub optimal nutrition status during pregnancy leading to low birthweight babies, who in their turn experience malnutrition during childhood. It is therefore important to break this intergenerational cycle of malnutrition with appropriate nutrition and food security interventions.

Nutrition in Emergencies
The number of people displaced by war, conflict or persecution has hit a record high with 65 million people displaced in 2016 of which more than half are from three countries: Somalia, Afghanistan and Syria, but emergencies are present in all parts of the world. In the majority of these emergencies people experience both long and short term challenges with dietary intake that can lead to malnutrition. Common forms of malnutrition in emergencies are acute malnutrition, micronutrient deficiencies and– if the emergency last for a longer period of time–the prevalence of stunting can also increase. Therefore, both treatment and prevention are important aspects of a nutrition response in emergencies.
The prevention of malnutrition is crucial in emergencies to decrease the risk of nutrition related morbidity and mortality. Prevention of malnutrition focuses mainly on infant and young child feeding practices (IYCF) such as early initiation of breastfeeding (within 1 hour after delivery), exclusive breastfeeding for the first 6 months and appropriate complementary feeding for children 6-23 months. Children who do not receive exclusive breastfeeding up to 6 months are 14% more likely to die than those who are exclusive breastfed and half of the diarrhea episode can be avoided by breastfeeding. IYCF activities can be implemented at a health facility through both individual and group counselling linked with Community-based management of acute malnutrition (CMAM) or at the community level through the Care Group model, mother-to-mother groups and the Men as Partners approach.

Alongside prevention, the treatment of acute malnutrition, in both its moderate acute and severe acute forms, is extremely important in emergencies where inadequate nutrition is an issue. AM provides nutrition services for acutely malnourished children aged 6-59 months as well as pregnant and lactating women (PLW), the most vulnerable groups in a population. Acutely malnourished children 6-59 months will receive ready-to-use supplementary or therapeutic foods (RUSF or RUTF) as well as routine medication such as antibiotics at outpatient facilities. Although the children will be treated at home, they will visit a health facility frequently during the course of the treatment to receive the therapeutic food commodities and to be continuously monitored. Children with acute malnutrition and medical complications, or those aged below 6 months, are admitted to inpatient facilities where they will receive specialized medical and nutrition treatment. Presently, worldwide almost 50 million children under 5 are acutely malnourished and the treatment of acute malnutrition is the most cost-effective nutrition intervention to prevent child mortality, demonstrating a potential to save between 720,000 to 917,000 lives per year.

Underlying both these activities are community mobilization and sensitization in order to create awareness among community residents about available nutrition services, monitor children and pregnant or nursing women and refer them to the nutrition services if necessary and to conduct defaulter tracing for those children that have defaulted in the CMAM program. Community sensitization also evolves around social behavior change which is tightly linked to IYCF, WASH, health and other technical areas. Integration with other sectors is thus crucial to achieve maximum impact when nutrition programs are part of emergencies interventions.

International Medical Corps partnership with Global Nutrition Cluster’s Rapid Response Team:
The Global Nutrition Cluster’s Rapid Response Team (RRT) is a partnership between Global Nutrition Cluster (GNC) and four NGO partners. The NGO partners are International Medical Corps-UK, ACF-USA, Save the Children-UK and World Vision Canada. The purpose of the RRT is to increases the capacity of Global Nutrition Cluster to support cluster coordination and information management, enabling timely coordinated response for emergencies. In 2012, the RRT mechanism was established and International Medical Corps-UK was the first partner to support a proposal for a Nutrition Cluster Coordinator (NCC)/RRT to the GNC. Since then International Medical Corps-UK has continued to partner with the GNC and has hosted one NCC/RRT that has been deployed to countries including Malawi, Turkey, Yemen, South Sudan, and Afghanistan, Bangladesh, and Iraq.

Our Response

International Medical Corps has a strong history of responding to nutrition needs in emergencies starting with the 1992 Somalia famine. International Medical Corps malnutrition treatment evolved from a strictly center-based approach in the 1990s to a community-based approach using the best practice approach of Community-based Management of Acute Malnutrition (CMAM) model to manage moderate and severe acute malnutrition.

The current goal of the nutrition team is to ensure that International Medical Corps’ programs contribute towards improved nutrition outcomes in development and emergency settings, through the following objectives:

• Ensure International Medical Corps is a leading “Nutrition First Responders”
• Improve nutrition programming quality
• Expand development nutrition programing
• Contribute to innovative programming and research
• Increase multi-sectorial integrated programming to improve nutrition outcomes

International Medical Corps is implementing nutrition interventions worldwide. Long-term development programs focus primarily on the prevention of all forms of malnutrition while also treating those who are already malnourished in countries such as Yemen, Ethiopia, Zimbabwe and Burundi.

We have also carried out emergency nutrition programs providing CMAM and IYCF services in a number of other countries including: Greece, Chad, Nepal, Sudan, South Sudan, Haiti, Nigeria, Mali, Afghanistan, Iraq, Turkey, DRC, Somalia and Ethiopia. All these interventions have been evidence-based, using either design findings from the global nutrition landscape or evidence generated from our own operational research to address the needs and capitalize on existing resources and national protocols. Our team also emphasizes evidence-based programming based on formative and operational research to highlight barriers and facilitate factors to behavior change, and measure the impact of approaches used to address nutrition challenges in communities around the world across countries and programs, including: Lebanon, Jordan, Nepal, Nigeria, Sierra Leone, Zimbabwe, and others.

International Medical Corps malnutrition programs focus on the period from conception through the 23rd month of a child’s life – the “1000-day window of opportunity” – as a critical opportunity for preventing stunting and physical and mental disabilities associated with malnutrition. We provide a combination of growth monitoring, nutrition education including individualized counseling and the use of micronutrient supplements through health facilities and as part of our ante and postnatal care, infant checkups and community outreach. Our nutrition education and counseling promotes healthy pregnancies and infant and young child feeding practices that include exclusive breastfeeding and appropriate introduction of complementary food to ensure healthy growth at the fetal stage, during infancy and early childhood.

To reinforce nutrition messages and create behavior change within the community, International Medical Corps works with local residents to develop peer support groups including the Care Group model, mother-to-mother groups, and the Men as Partners approach. Care Groups are led by local female volunteers trained by International Medical Corps that meet on a regular basis with mothers and their young children. The goals of these community-based behavior change interventions are to:

• Prevent malnutrition by disseminating nutrition, health, family planning and hygiene information
• Improve mother/child interaction through methods like infant stimulation
• Empower mothers and fathers, and their community to take responsibility for the growth and development of their children

Mother Care Groups improve behavior change, bring down costs per beneficiary, and build a sustainable community-level health promotion structure. Health and nutritional improvement cannot be ensured unless communities are aware of and utilize available health services. In addition, most of the decision-making regarding critical influential behaviors occurs in the home. Thus, International Medical Corps targets health facilities, community leaders, households and individuals to bring positive and lasting changes in attitudes, knowledge and behaviors.