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Widya Rahmawati MKP Nutrition in Emergency Nutritional Dept, Faculty of Medicine, University of Brawijaya 2013
Nutritional Emergency? “…suatu kondisi dimana populasi mengalami pengurangan
akses terhadap makanan sehingga meningkatkan resiko/ancaman kesakitan dan kematian…” “When a population has reduced access to food, associated
with actual or threatened increases in morbidity and mortality” (The John Hopkis University & IFRC Public Health for Emergencies, 1999).
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Dalam keadaan emergency, apa yang terjadi? No fuel, no water
Fuel and water available
Adverse condition
Fuel available, no water
No fuel, water available Corazon V. Barba, 2007
Emergency condition Ketidakmampuan sebagian besar populasi untuk mempertahankan keseimbangan antara: kebutuhan
What they able to eat
Kekurangan gizi tidak hanya disebabkan oleh kekurangan makanan pada satu waktu. Ketidakcukupan intake dalam waktu panjang juga menyebabkan kekurangan gizi.
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Emergency indicators Indicators
Emergency Levels
Mortality rate
> 2 per 10.000 per day
Nutritional status of children
> 10% less than 80% w/h
Food
< 2.000 kcal/person/day
Water quantity
< 10 L /person/day
Water quality
> 25% of people with diarrhea
Site space
< 30 m2/person (not include garden space)
Shelter space
<3,5 m2/person
Nurul Muslihah, 2010
Prinsip Respon dalam Emergency “Tindakan segera dan tepat untuk menyelamatkan nyawa, menjamin perlindungan dan pengembalian kehidupan yang layak bagi korban bencana”
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Type of Emergency Situation Natural Disaster
Terisolir
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Human Induced Tidak Terisolir 2
Technological
Emergency
Food Insecurity
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Malnutrition outbreaks
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Non Disaster
Kinds of Disaster, by source Natural
Human Induced
Technological
Earthquakes Floods Typhoons Tsunamis Volcanic eruptions Landslides
Fires Chemical explosions Wars Plane crash due to Structural economic technical failures adjustments Other forms of political and economic instability
Corazon V. Barba, 2007
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Type of Emergency, by time Short-term
Medium-term
Long-term
1. earthquakes, volcanic eruptions, floods, tsunamis, fires 2. stoppage of food supply may only be necessary for a few hours or weeks
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may arise without any warning extended only to a limited area
crop failure due to drought relief food has to be provided until the next harvest (6 mos1 yr) there might be some warning period generally covers a large area but not necessarily the whole of a country
disruption of food supplies by war for one or more years warnings may be or may not be available problem is usually a national one, involving the whole country
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Corazon V. Barba, 2007
Stages of Emergency Periods Early Emergency Period
Intermediate Emergency Period
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The transition period • from the onset of a disaster to • rehabilitation Situations are still far from normal but the initial shock is over Provision of food is part of the relief package
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Immediate period • following the disaster May last for 1-2 days or even a few hours • Characterized by anxiety and stress and sometimes, • shock Food supply is cut-off No productive work available
Extended Emergency Period The period after the worst is over Rehabilitation begin as the near-normal conditions set in
Corazon V. Barba, 2007
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Operation in Emergency Response • Commodity services & Education • Population estimation & register • Site selection, planning & shelter • Commodity distribution • Health • Food & Nutrition • Water • Environment sanitation • Supplies and Transport Nurul Muslihah, 2010
Makanan merupakan hal utama dalam respon emergency
Berbagai program dilakukan untuk menangani masalah gizi dalam emergency
Program makanan secara langsung: - general food distribution, - supplementary feeding program - therapeutic feeding program - micronutrient fortification
Secara tidak langsung dengan menyelesaikan akar masalahnya
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Pentingnya mengatasi masalah gizi pada emergency • moderate malnutrition raises mortality in emergencies,
• acute malnutrition is a strong predictor of excess mortality among young children
• micronutrient deficiencies contribute to disease-mediated mortality in emergencies
FEEDING PROGRAM
Mengurangi kekurangan gizi
Mengurangi kematian akibat kekurangan gizi
Food & Nutrition in Emergency “Setiap orang memiliki hak yang sama untuk mendapatkan standart kehidupan yang layak untuk kesehatan dan kesejahteraannya untuk dirinya dan keluarganya, termasuk makanan...”
“Everyone has the right to a standard of living adequate for the health & well-being of himself and his family, including food…” (Universal Declaration of Human Right/UDHR, article 25-1)
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Bantuan Makanan untuk keadaan emergency Dalam keadaan emergency, diharapkan semua orang tetap
memiliki akses terhadap makanan yang cukup dan aman Bantuan makanan, diharapkan dapat: Memenuhi seluruh kebutuhan gizi untuk semua populasi
(quantity, quality & safety) Memenuhi kebutuhan minimum energy, protein & lemak untuk bertahan hidup dalam aktivitas ringan Gizi seimbang Beraneka ragam, diterima cara budaya, sesuai untuk konsumsi manusia, dan sesuai untuk seluruh sub group dalam populasi
Feeding Program Strategy Type of Feeding Program
Selective feeding program
General food distribution
Supplementary feeding program (SFP)
Blanket SFP
Micronutrient intervention
Therapeutic feeding program (TFP)
Targeted SFP
Mathys et al, 2000)
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Nutritional support for Emergency situation General nutrition support: distribution of a basket of food commodities to crisis-affected populations. Correcting malnutrition: selective feeding interventions for vulnerable groups • targeted supplementary feeding - to prevent moderately severely malnourished, for vulnerable group • blanket supplementary feeding - to prevent malnutrition and related mortality, for subpopulations • therapeutic feeding - treatment of severe malnutrition with nutrient + medical intervention.
Micronutrient interventions: fortified foods or local fortification to meet people’s needs or address outbreaks of micronutrient deficiency.
Mason F, et al, 2003, A Review of the Advances and Challenges in
Nutrition in Conflicts and Crises over the Last 20 Years, Washington DC: FANTA (www.fantaproject.org) Young, H., A. Borrel, et al. (2004). "Public nutrition in complex emergencies." The Lancet 365(1909): 1899. (download.thelancet.com) Salama, P., P. Spiegel, et al. (2004). "Lessons learned from complex emergencies over the past decade." Lancet 364: 1801-13. (download.thelancet.com) Nutrition In Emergencies: WFP Experiences And Challenges (www.wfp.org sites/default/files/Nutrition) The Code and infant feeding in emergencies worldbreastfeedingweek.net wbw2009 images icdc_%20focus_english
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Hoping you enjoy this class…
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