Priority Health interventions which
impact Nutrition in Emergencies
Module 15
Learning objectives
• Understand how nutrition and health status is related to
extreme poverty and vulnerability, how these are exacerbated
by natural hazards
• Be aware of the interventions required from other sectors to
ensure optimal health and nutritional status in an emergency
• Understand the importance of planning for host populations
as well as emergency affected populations
• Understand the importance of coordination between health
and nutrition programme staff and how to better coordinate
and/or integrate health and nutrition interventions
• Understand how to plan for high impact nutrition and health
interventions.
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Globally >35% of under-five deaths are
attributable to undernutrition
Malaria
1%
Measles 1%
Pneumonia
15%
Diarrhoea 19%
Injuries, 3%
HIV/AIDS 1%
Causes of Neonatal Deaths
>35%
attributable
to
undernutrition
Other, 19%
Other – 7%
Tetanus – 1%
Diarrhoea – 1%
Sepsis – 17%
Neonatal 42%
Asphyxia – 23%
Congenital – 12%
Preterm – 38%
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Framework of the causes of maternal and child under nutrition and
its short-term consequences
Source: Lancet series on
Maternal and Child
Undernutrition 2008 –
adapted from Conceptual
framework for analysing the
causes of malnutrition, UNICEF,
1997
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Reproductive Health and Undernutrition
• Poor intra-uterine growth, low birth weight and
subsequent suboptimal child growth and
development are consequences of:
– Poor maternal health
– Inadequate diet (quantity & quality) before and during
pregnancy
– Lack of micronutrient supplementation
– Multiple pregnancies, especially in quick succession
• Early childbirth (<18 years) & older mothers (>35
years) are risk factors for both mother and child
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Consequences of Maternal Undernutrition
Maternal consequences
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Child consequences
Increased risk of maternal
death
Increased infections
Anaemia
Compromised immune
functions
Lethargy and weakness
Lower productivity
Lactational failure
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Increased risk of foetal and
neonatal deaths
Intrauterine growth retardation
Low birth weight
Pre-term birth
Compromised immune functions
Birth defects
Cretinism and reduced IQ
Source: UNICEF, 2006
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Major causes of morbidity and mortality in
emergencies
• Major causes of excess morbidity and mortality in
emergencies are: acute respiratory infections, diarrhoeal
diseases, malaria (where prevalent), measles and
undernutrition
• Meningococcal meningitis and typhoid may cause large
scale epidemics in emergencies
• Tuberculosis is also often critical in long term emergencies
• Poor reproductive health, gender based violence (GBV) and
its consequences, including HIV, are also a major concern
• Trauma/injury, mental health and psychosocial issues also
contribute to excess morbidity and mortality in
emergencies.
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Child and Maternal Health in Emergencies
• Emergencies exacerbate the severity and magnitude of
childhood diseases.
• Children under-5 have the highest mortality rates in
refugee populations
– In 1991 at the Turkey - Iraq border 63% of deaths of Kurdish
refugees were in children
– In 1992 during the famine in Somalia over 74% of <5 years died
in IDP camps
– Among Rwandan and Burundian refugees in DRC in 1996, 54%
of all deaths were among children < 5
• Maternal health may also be negatively affected by a poor
health environment, while maternal nutrition may be very
seriously affected by inadequate quality and quantity of
food.
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Mental Health in Emergencies
• Mental health and psychosocial issues in emergencies
include:
– Pre-existing social problems (e.g. extreme poverty,
discrimination against or marginalisation of particular groups)
– Emergency-induced social problems (e.g. family separation,
disruption of social networks and/or community structures)
– Humanitarian-induced social problems (e.g. undermining
community structures or traditional support mechanisms)
– Pre-existing psychological problems (e.g. mental disorders,
alcohol abuse)
– Emergency-induced psychological problems (e.g. grief,
depression, anxiety including post traumatic stress disorder)
– Humanitarian aid related problems (e.g. anxiety due to lack of
information about food distribution )
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Health of the Elderly in Emergencies
• The health and nutritional status of the
elderly population is also affected in
emergencies by issues such as:
– loss, grief and depression, exhaustion and poor
diet, exacerbating poverty, and chronic disease
– Lack of access to appropriate medical
treatment
– Inadequate and inappropriate diet
– Inability to cook
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Health programming in emergencies and links to
Nutrition
• Health system should:
– Provide equitable optimal access to health care
– Ensure minimum level of care (quantity and quality)
– Include components of health promotion from early
stages involving communities (both males and
females)
– Consider needs for outreach activities (mobile clinics,
particularly in case of outbreaks)
– Integrate community participation and potential
outreach community staff in planning, management,
implementation , M&E of services.
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Health programming in emergencies and links to
Nutrition
• Essential health services
– Communicable diseases: their control requires a
systematic approach and cooperation from various
sectors (WASH, Food, Nutrition, Health, Shelter)
– Malaria or tuberculosis are also diseases that have
impact on nutrition and require multi-sector
preventative measures
– For all diseases, standards for case fatality rates are
determined and should be maintained.
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Case fatality rates
Disease
Case fatality rate (CFR)
Cholera
1% or lower
Shigella dysentery
1% or lower
Typhoid
1% or lower
Meningococcal meningitis
Varies between 5-15%
Malaria
<5% in severely ill malaria patients
Measles
<5% *
*CFR as high as 21% have been reported in some conflict
settings
•If CFRs exceed these levels an immediate evaluation of
control measures should be undertaken and corrective steps
taken to ensure CFRs are reduced to and maintained at
acceptable levels
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Health programming in emergencies and links to
Nutrition
• Child health is divided into:
– Care of newborns (care at birth, early initiation of
breastfeeding, health and immunization after birth,
education and support for mothers)
– Care of children (in line with WHO IMCI guidelines)
which include:
– Assess nutrition and immunisation status and potential
feeding problems at the outpatient health facility level
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Health programming in emergencies and links to
Nutrition
• Establishment of child-focused
health interventions which
address the major causes of
excess morbidity and mortality
• Where measles vaccination
coverage is <90% or is
unknown:
– Mass measles vaccination
campaign should be conducted
for children 6 months to 15
years
– Vit. A should be administered
to children 6-59 months
– A system should be set up to
ensure that any newcomers to
the area are vaccinated
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Health programming in emergencies and links to Nutrition
• Diarrhoeal diseases are a major cause of morbidity and
mortality in emergency situations
– often accounting for over 40% of deaths in an acute phase of an
emergency
– with 80% of these deaths occurring among children under 2 years of age
• Prevention of outbreaks of Cholera and Shigella dysentery are of
particular concern in emergencies
– they are highly infectious diseases
– if poorly managed can result in extremely high case fatality rates
• Risk factors for diarrhoea include overcrowding, inadequate
quantity and quality of water, poor personal hygiene, poor
washing facilities, poor sanitation, poor cooking facilities and
lack of soap
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Health programming in emergencies and links to
Nutrition
• Diarrhoea control interventions in emergencies include:
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provision of adequate quantities of safe drinking water
provision of facilities for safe disposal of human excreta
provision of adequate storage for cooked and uncooked food
appropriate cooking utensils and fuel for cooking
provision of soap for handwashing
promotion of optimal breastfeeding practices
provision of information on all of the above activities for
prevention
• Prompt diagnosis and appropriate treatment according to
protocols and guidelines is essential to reduce and prevent
excess mortality in emergencies.
•
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Health programming in emergencies and links to
Nutrition
• Sexual and reproductive health should encompass:
– A Minimum Initial Services Package (MISP),
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Prevent, and manage the consequences of sexual violence
Support mothers breastfeed
Reduce the transmission of HIV
Prevent maternal and newborn morbidity and mortality
Begin planning for comprehensive RH services.
– Then
• Adolescent Reproductive Health
• Family Planning
• Maternal and Newborn Care including postpartum vitamin A
supplementation
• Gender Based Violence (protection and care)
• STI Care
• HIV Care.
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Health programming in emergencies and
links to Nutrition
• Recommended intervention pyramid for mental health
Examples:
Mental health care by mental health
specialists
Specialized
services
Basic mental health care by PHC
doctors. Basic emotional and
practical support by community
workers
Focused non
specialized
support
Strengthening
community and family
support
Activating social networks communal
traditional supports
Supportive age-friendly spaces
Advocacy for basic services that are
safe, socially appropriate and that
protect dignity
Social considerations in basic
services and security
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Key messages
• Emergencies exacerbate severity and magnitude of childhood
diseases and mortality rates are highest in children under five
• The health and nutritional status of pregnant women
significantly impact the health, well-being and nutritional status
of their infants
• The child is more likely to be born premature, with LBW and
more vulnerable to illness and undernutrition if the mother is
sick and undernourished or has multiparity
• Humanitarian crises, increase vulnerability to HIV and negatively
affect the lives of those people living with HIV
• The role of operational health agencies in emergencies is to
provide essential services that effectively reduce health risks.
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Key messages
• Establishment of good quality control of communicable
diseases interventions has significant impact on health
and nutritional status of an emergency-affected
population
• Implementation of key priority reproductive health
interventions has a positive affect on the health, wellbeing and nutritional status of both infants and mothers
• Provision of quality basic child health care at first line
health facilities, supported by promotion of key infant
and young child feeding and care practices will have a
positive impact on the health and nutritional status of
young children.
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