|Bangladesh - relief ration|
|Bangladesh - relief ration||Julian Francis||06.10.98|
|Food relief in Bangladesh||Alain Mourey||06.10.98|
|Re: Bangladesh - relief ration||Beat Schürch||06.10.98|
|Bangladesh - relief ration -Reply||Janak Upadhyay||06.10.98|
|For Julian Francis||Katherine Hilderbrand||06.10.98|
|Bangladesh - relief ration||Michael Golden||06.10.98|
|Thanks to NGO Nutters||Julian Francis||19.10.98|
Date: Tue, 06 Oct 1998 12:41:33 +0100
From: Julian Francis <julianatbangla.net>
Subject: Ngonut: Bangladesh - relief ration
I am currently co-ordinating the flood relief/rehab programme in Bangladesh forthe International Federation of Red Cross and Red Crescent Societies (IFRCS).
While discussing what is an adequate maintenance diet we looked at one with 400 gms of wheat or rice per adult per day which with 60 gms pulses, 20 gms oil or fat, 30 gms fortified cereal blend, 15 gms sugar, 5 gms salt, covers 1,840-1,990kcals.
Given the prospect of severe food shortages here due to lack of purchasing power, some Bangladeshi relief workers are saying that adults should be able to get by on 1,200 kcals and children on 800. We are talking of a period of 3 to 4 months.
If you have any pertinent nutritional information which may be of assistance to me in co-ordination of this operation, I will be most grateful if you could very kindly let me know at this email address or <ifrcbdatbdmail.net>
Thank you very much
From: "Alain Mourey"<amoureyaticrc.org>
Date: Wed, 7 Oct 1998 09:34:42 +0100
Subject: Ngonut: Food relief in Bangladesh
As an introduction, let me say that quotations such as "adults may get by with 1200 kcal and children with 800 for 3 - 4 months" are not only absurd, they are criminal and deadly. Please do not listen to them. Let us keep in mind the paper by Cato Aall in "Disasters, Vol. 3, No 4, 1979" called "Disastrous international relief failure, a report on Burmese refugees in Bangladesh from May to December 1978". Though the food ration mostly consisted of cereals, it brought around 1300 kcal / p / day and mortality started to raise already after 3 months. UN officials at that time used such quotations in order not to increase the food ration, despite the advocacy made for it.
As for your problem : the ICRC in Somalia used an absolute minimum food ration of 1900 kcal / person / day. This allowed adults to stay alive though still malnourished, and young children to show some nutrition catch up. No distinction was made between children and adults because it is simply impossible and probably sociologically wrong to give different food rations to the differrent class of people within a community. Distributions should be carried out either to each and every person or on a family basis but anyway the ration should be the same for everybody, letting the people deal with family intradistribution.
There are today means of calculating energy requirements for refugees and displaced people and there are as well magic figures. I think it is widely agreed, according to the advocacy of John Seaman and John Rivers in the 1988 conference on Nutrition in times of disaster, that a food ration of 1900 kcal is an absolute minimum, allowing only for survival, provided that all the food received is eaten and not partly sold or exchanged. The figure for maintenance retained by the Sphere project is 2100 kcal. When I tried to find out where it comes from, I realised that a mistake had been done and it is actually 2170 kcal. Moreover this is for a population of quite a small size, men weighing 60 kg and women 52 Kg. This small size may actually fit with the characteristics of the people of bangladesh. This is easy to check on the spot.
Still more practically, before setting up your ration, you must be able to answer at least the following questions : - are the people completely dependent on relief food to meet their nutritional requirements?
- if yes, what are the other essential economic needs they have to meet, knowing that if not taken care of, relief food is going to be sold to have access to these needs ?
- if no, how much in term of calories can they get by themselves (roughly) ?
- what is the activity level of the people ?
- what is the present nutritional status ?
Then, you must know what you want to achieve with your assistance, or more dramatically what can you achieve if your means are limited.
Another aspect is the capacity of the ration to meet mineral and vitamin requirements. This is always an issue and damages can occur quite soon depending on the nutritional status of the people when you start feeding them. There are means now to easily complement a relief food ration with all vitamins and minerals needed.
I hope these indications are of some help to carry on your mission and I am very much sympathizing with the difficult task you face.
Good luck and best regards
A. Mourey, ICRC, nutrition unit.
Date: Tue, 06 Oct 1998 18:41:00 +0100
Subject: Re: Ngonut: Bangladesh - relief ration
The three main determinants of how much energy the rations should contain are:
1. the persons' actual nutritional status;
2. how much physical work they are expected to be able to do; and 3. how much food they are likely to be able to produce or otherwise obtain besides the rations you provide them with.
If these people are, on average, relatively light (short and thin) to begin with, if they are expected to do fairly heavy agricultural or other work, and if they cannot obtain any food from other sources, you can be quite certain that in 3 to 4 months they will, on a daily ration of 1200 kcal for adults and 800 kcal for children, lose weight (I would guess about 10% of their initial body weight) and/or be less physically active than expected, and be at a higher risk of suffering from infectious diseases (which may further contribute to the deterioration of their nutritional status).
What you were discussing (1840-1990 kcal / adult / day) looks like what one might still call a maintenance diet, while what some Bangladeshi relief workers propose (1200 kcal / adult and 800 kcal / child / day) is quite certainly not.
Rita Bahtia (Bhatiaatunhcr.ch) at UNHCR must often have to deal with this type of question in connection with rations for refugee populations and may be able to offer valuable additional advice.
Beat Schürch, Executive Secretary of IDECG
c/o Nestlé Foundation, P.O. Box 581
CH-1001 Lausanne, Switzerland
Date: Tue, 06 Oct 1998 18:36:14 +0100
From: Janak Upadhyay <UPADHYAYatunhcr.ch>
Subject: Ngonut: Bangladesh - relief ration -Reply
WFP/UNHCR have developed a guideline for food need estimation for refugees who are fully dependent on out side aid (attached document refers). If there is no other source of food proposed 1200 KCal for adult is very low. I hope attached guidelines will be of help to you.
(note added by MG - this is a critical document for all involved in relief planning - but it is as an attachment of 51 kb - in Word 6 format. It is not simple to cut and paste into this message as it contains tables - would those who can receive and read such a file contact either Janak at UNHCR or myself if they want copies of the attachment - for the others I am sure that UNHCR would send a hard copy if requested)
Date: Tue, 06 Oct 1998 18:37:31 +0100
From: "Katherine Hilderbrand" <khildatnutrition.itg.be>
Subject: Ngonut: For Julian Francis
Dear M. Francis,
In response to your atmail of this morning, there are a few comments I would like to make.
After years of discussions and lobbying, the UN relief agencies (HCR/WFP) finally decided last year that rations should never be (and definitely not planned to be) under 2.100 kcal/day/person.
Even with the first ration which you mention, people may not starve, but will definitely develop deficiency diseases unless they sell or exchange part of the food for other items containing essential vitamins and minerals.
As for the possibility of surviving on 1.200 kcal/day, I have serious doubts. The late John Rivers once said in an international conference that Jews in concentration camps received 1.500 kcal/day, ration which had been calculated to keep people just alive but totally apathetic and therefore easily controlled.
Active lobbying must be done on the situation you are facing and no agency should consider rations of less than 2.100 kcal/day.
If foods cannot be exchanged or sold, be prepared for epidemic breakouts of the typical micronutrient deficiencies.
Date: Tue, 06 Oct 1998 19:41:38 +0100
From: Michael Golden <refugeesatabdn.ac.uk>
Subject: Re: Ngonut: Bangladesh - relief ration
I agree absolutely with the other comments that have been made about the unacceptability of miserable rations. One further point - the ration should not be reduced for children - the ration is calculated as an average per-capita ration - adults will need more and children less. If you give the children less then you must also give the adults more - which creates a logistic nightmare at the point of distribution and makes food-basket monitoring almost impossible to interpret. Even breast-fed children should get their full ration.
We have run the ration suggested through "nutcalc" a free program, originating from the ACF Scientific Committee (Epicentre were commissioned to write it) - it has been developed precisely to help design and evaluate relief diets. The French version has fewer bugs than the English one - the ACF Scientific Committee did not have the funds to pay for the creation of an upgrade - however, a new program has been written by ORSTOM - perhaps someone from ORSTOM/Dominique Bounie could comment.
The ration is low in energy, retinol, vitamin C, riboflavin and potassium.
Also the contribution to most of the nutrients from the CSB is critical - there are different "varieties" and specifications for CSB manufactured in different places - the composition of the one available for use in Bangladesh would need to be assessed. No allowance has been made for availability or for antinutrients.
There is disagreement about the proportion of energy that should come from lipid in relief feeding - this is the reason for the low % of requirement given in the table below.
IFRCS proposed ration using wheat as the cereal, lentils as the pulse and CSB as the blended food.
ACF-NUTCALC Date: 05/10/98 Code: 40 Nom Ration: Bangladesh ngnu
Nom ration de reference : RATION EU PAR JOUR Type : Par jour Ration poids : 530
ALIMENTS COMPOSANT LA RATION
|WHEAT||grain entier||400 g||1236.0||46.8||8.0|
|LEN||Lentille,verte et brune,seche||60 g||178.2||14.6||1.1|
|SALT03||Sel de table fortifié en Iode||5 g||0.0||0.00||0.00|
; Total ; % par rapport la ration de reference ; Energie(Kcal) ; 1767.10 ; 88.35% Kcal ration/Ration reference ; Energie(Mj) ; 7394 ; ; Lipide (g) ; 30.92 15.7%; 47.57% Lipides ration/Ration reference ; Proteine (g) ; 66.78 15.1%; 119.25% Proteines ration/Ration reference ;
; N U T R I M E N T S ;
Vitamines Hydrosolubles Total proteines: 67g
Total lipides..: 31g Thiamine......2.30mg (255.6%)
Pyrodoxine..1.85mg (123.3%) Mineraux Vit B12.......:1.20ug ( 85.7%)
Vit C.......... 12mg ( 26.7%) Potassium....2298mg ( 74.1%) A.Panthotenic.6mg Magnesium..622.50mg (415.0%) Biotin..........:24ug Phosphore...1754mg (319.0%) Riboflavine...0.71mg ( 54.6%) Zinc.........: 14.03mg (147.7%) Niacine Total.26.90mg Iode...........172ug (132.5%) Niacine Poten.2.78mg Sodium......2072mg (360.3%) Niacine.......: 24.12mg Calcium..... 436mg ( 62.3%) A.Foliq Total.474ug (237.0%) Fer..........:5.31mg (148.9%) A.Foliq Libre. 0ug Cuivre...... 2.46mg (223.6%)
Score Proteique mg/g Vitamines Liposolubles Lysine....... 128mg B-Carotene......: 80ug Cysteine.... 96mg Retinol (A).....: 153ug Tryptophane167mg Retinol Equival.: 0ug Methionine.. 76mg Total Ret.Equiv.: 166ug ( 23.8%) Threonine... 148mg Vit D.........: 18.00ug (180.0%)
Vit E...........: 19 (465.0%)
(% Par rapport la ration de reference)
Prof. Michael H.N.Golden
Date: Mon, 19 Oct 1998 06:26:05 +0600 (GMT+0600)
From: Julian Francis <julianatbangla.net>
Subject: Thanks to NGO Nutters
I would like to thank you all very much for the assistance you gave me in very quick time. You may be interested to know that the following article has appeared in full in two dailies in Dhaka and provoked comment in the Editorials of three others. I look forward to more advice in the future.
Thank you once again
Disaster Preparedness Delegate, International Red Cross and Red Crescent Societies
AFTER THE FLOODS, HOW MUCH FOOD DO PEOPLE NEED, AND WHAT KIND?
by Julian Francis
A few days ago I wrote in these columns about the unsatisfactory amount of food available to the many thousands of people who have been seriously affected by the unprecedented floods this year, have little or no work, and little or no money with which to buy food. I have now done some research into the situation and received, via the magic of email, advice from many of the world's nutrition experts, some of whom are based in Dhaka.
The many administrative problems being encountered in the implementation of the VGF (Vulnerable Group Feeding) and other food-related schemes are, hopefully, being sorted out, but, as I pointed out in my earlier article, 16 kgs of grain per month per family is simply not enough from the nutritional point of view unless it is regarded as a supplementary amount only which, for most of the beneficiaries, it is not. In addition, it has to be remembered that if the grain provided is wheat, then about 10 percent of the weight is usually used as payment for the grinding of the grain into flour.
It is difficult to understand why, when although 30 kgs is provided per family per month under the Vulnerable Group Development (VGD) scheme, which is a long term arrangement, only 16 kgs has been allocated per family under the temporary VGF scheme related to the needs of individual families affected by the floods. With plentiful supplies of foodgrains in the country and on the way through the World Food Programme (WFP), it is bewildering as to why the figure of only 16 kgs per family per month is being used. It therefore follows that other organisations such as the Bangladesh Red Crescent Society and many NGOs are under considerable pressure to plug the food and nutrition gaps in the worst affected areas.
However, the main thing to realise is that most people who are currently short of food do not want to receive relief hand-outs. They want work, to be paid for in cash or grain, so it is imperative that all the bottlenecks to the implementation of these works are removed immediately.
While discussing the overall nutritional situation, it is important to take note of the other additional foodstuffs, such as pulses, vegetables, cooking oil etc., which are needed to make the diet into a nutritionally balanced one? These items can only be procured by selling some of the grain which, in turn, makes the situation even more precarious. Whichever way you look at it, the nutritional picture is quite bleak, but it is important, at these early stages of recovery after the disaster, to be as realistic as possible so that everyone can face up to the challenges that lie ahead and be better prepared.
While some relief workers with NGOs in Bangladesh have suggested that 1200 kcals should be enough for an adult per day, and 800 kcals for a child, international aid agencies such as WFP and UNHCR, after years of discussions and lobbying, finally agreed last year that the average calorific intake per capita per day should never be less than 2100 kcal/day. Nutrition experts also advise that calorific requirements should be worked out per capita and that there should not be a separate calculation for children as the family food basket is shared out according to need, manual workers needing and receiving more food than people in more sedentary situations.
Statistics, show that the actual average per capita intake in Bangladesh in normal times is 1800 kcal/day. It is therefore of further concern to note that in Bangladesh, the per capita availability of pulses, vegetables, oilseeds and fruits is not really satisfactory, and for many they are out of reach or not available. People with a rich indigenous knowledge know which roots and leaves of plants and trees which can be used in time of need and they use these to help ward off hunger and provide valuable vitamins and minerals. According to research available locally, daily per capita availability of pulses has gone down from 8 grams in 1973-74 to about 5.5 grams in 1994-95. The per capita availability of vegetables also dropped from 58 grams per day in 1969 to 36 grams in 1993. A similar picture is with oilseeds. (Source: Bangladesh Rural Reconstruction Association) It follows that aid organisations, in addition to giving high priority to the growing of nutritious quick-growing indigenous vegetable species, should be looking to provide protein/calorie supplements to enhance the food value of the VGF allocation of foodgrain, whether wheat or rice. Some international experts in the field of nutrition have suggested that if 1200 kcals/day only is available, weight losses of at least 10% should be expected over a 2-3 month period, while others have pointed out that this level of nutrition is totally unacceptable. Everyone should be encouraged to grow as many nutritious vegetables as possible, as soon as possible, to alleviate the overall nutritional situation.
Do we learn from mistakes ?
We have to ask if we learn from past experiences, and do we document them?
For instance, long ago, at the time of the Bihar Famine of 1966-67, when I worked with Oxfam, we were able to work closely with a small businessman in Sitapur in Uttar Pradesh, India, to manufacture a high protein food supplement derived largely from groundnut. It was a challenge to overcome the risk of the deadly bacteria, aflotoxin, which had often been encountered in the process of making groundnut by-products and thereby making it poisonous. The food supplement powder was used in the Bihar feeding schemes, mixed in with imported wheat flour, dal or other curry-like preparations. Supplies were used again in the 1971 Refugee Relief Camps in West Bengal, when organisations like Oxfam and Save the Children Fund-UK set up nutrition rehabilitation centres for the Under-5s. When the Sitapur factory was not able to supply enough, Oxfam discovered, to it's great surprise, that the Calcutta Municipal Corporation had a similar plant which was hardly used on a regular basis. Instead of ordering in expensive food supplements from abroad, Oxfam was able to galvanise the local facility into action and for many months purchased the entire production. After so many years have passed, it is a great concern to many of us that food supplements are still imported into Bangladesh, whereas there are a number of under-used local facilities making more appropriate food supplements from groundnuts and soybeans which are still easily available. These local industries have been in operation for a number of years with proven success, so it is difficult to understand why these products are not used and the local industries are not supported. Chira and gur are indigenous foodstuffs and used very effectively as emergency rations where dry food only can be distributed. For longer term feeding schemes, indigenous foodstuffs can surely be used as well.
I believe it to be most important that all the different kinds of nutritional rehabilitation feeding schemes currently being undertaken in Bangladesh are properly documented while still fresh in our minds so that lessons are indeed learnt from this disaster and people in need can be assisted in a better and more appropriate way in the future. It is not being suggested that more and more children's schemes are presently required, but if action is not taken on a large scale to grow more nutritious food, it might be.
The writer, Disaster Preparedness Delegate, International Federation of Red Cross and Red Crescent Societies (IFRCS), has worked in many relief and development situations in South Asia during the last 30 years.