Transcript Διαφάνεια 1

Global burden of acute malnutrition
and the latest innovations in the field
From the classical approach to the latest innovations in
the field: Community-based Theurapetic Care (CTC)
Eleni kakalou, MD
MSc International Health-Health Crises Management
5th Medical Department, Evangelismos General Hospital
FOOD IS NOT ENOUGH
Without essential nutrients millions of children will die
“Eating millet porridge every day is the equivalent of living
off bread and water.
With luck, toddlers here might have milk once or twice a
week. Young children are
so susceptible to malnutrition because what they eat lacks
essential vitamins and
minerals to help them grow, remain strong and fight off
infections.”
200 million malnourished children
20 million severely malnourished children
50% of deaths attributable to malnutrition for <5yrs
Dr. Susan Shepherd, MSF Medical Coordinator for the nutritional programme in Maradi, Niger
Causes of death in children under 5 years
Source: WHO, based on C.J.L. Murray and A.D. Lopez, The
Global Burden of Disease, Harvard University Press,
Cambridge (USA), 1996; and D.L. Pelletier, E.A. Frongillo and
J.P. Habicht, ‘Epidemiological evidence for a potentiating
effect of malnutrition on child mortality’, in American Journalof Public Health,
1993:83.
The vicious cycle
Latin America and the Caribbean
Sub-Saharan Africa
Equitable growth
The success story
CTC-Pilot project
2000, Ethiopia :
• TFC prohibition lead to out-patient
treatment
• Clinical outcome and effectiveness equal
or better
Collins and Sadler, 2002
CTC-development
• 2001 Darfur, Sudan: 25,000 pts treated
• 2002 Valid International, Concern
FANTA/AED: formalization and 3yr
research
• 2004-5: Maradi, Niger: MSF treated
60,000 pts with outcome that surpassed
the classical approach
CTC principles
• Maximum coverage and access
• Timeliness
• Appropriate care
Ready–to-Use Therapeutic Food (RUTF)
• Late 1990’s by researcher Andre Briend and Nutriset a
private company making (nutritional products for
humanitarian relief)
• RUTF is an energy-dense mineral/vitamin-enriched food,
specifically designed to treat severe acute malnutrition
(Briend et al.,1999)
• Equivalent in formulation F100, WHO recommenede
treatment of malnutrition (WHO, 1999/a)
• RUTF promotes a faster rate of recovery from severe
acute malnutrition than standard F100 (Diop et al., 2003)
New classification of malnutrition
Collins and Yates, 2003
Screening and Admission by MUAC
(CTC manual, Valid, 2006)
Decision chart for SPF programmes
Community mobilization
(CTC manual, Valid, 2006)
Admissions, exits and total number in
OTP in Malawi, 2002-3
(CTC manual, Valid, 2006)
Health impact of malnutrition
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Physical growth
Morbidity and mortality (Infection etc)
Mental capacity
Child bearing potential
Chronic heart disease
Diabetes
Hypertension
Stunting and mental capacity
Malnutrition as a disease
Malnutrition: from one to generation to
the next
Maradi, Niger 2005
• MSF treated over 60,000 severely
malnourished
children using RUTF
• 38,000 severely malnourished children
were treated
• Cure rate > 90%
• 4 hospitals and 17 emergency outpatient
feeding centres
Field Exchange. Emergency Nutrition Network. Scaling up the treatment of
acute childhood malnutrition in Niger. Issue 28; July 2006
Scaling up to moderately malnourished
children, 2006
• 65,000 malnourished children treated
• 11 Out-patient treating centers
• 92,5% acute moderate malnutrition in OTP
(recovery rate 95.5%)
• 7,5% acute severe malnutrition in SC (recovery
rates 81.3%)
• Gain weight 5.8g/Kg/day vs 3g/Kg/day
• Defaulter’s rate 3.4%
1. Field Exchange. Emergency Nutrition Network. Management of moderate acute
malnutrition with RUTF in Niger. Issue 31; September 2007
2. A Retrospective Study of Emergency Supplementary Feeding Programmes. Dr.
Carlos Navarro-Colarado. June 2007. ENN and SC UK. Available at http://www.
ennonline.net/research
A mother’s experience
“I prefer to come here once a week rather than staying
in a treatment centre, because I have to take care of the
fields and my other children – I have three other children
at home.”
“I have no-one to look after my other kids, my oldest girl
is only 10 years old, I have no-one to help me. Without
this place I wouldn’t have sought help, even if my child
was very sick, because I can’t leave my other children
alone for weeks.”
Mothers of children receiving therapeutic RUF outpatient
care in Magari, Niger
Funding
• At a current cost of €3 per kilo, total product cost would
amount to €750 million to treat the 20 million children
that WHO estimates have severe acute malnutrition.
• However, considering that raw materials account for at
least 50% of locally produced product and that the most
significant cost is powdered milk, the future cost will be
higher
Rising price of milk
Cost for SAM
• MSF estimate based on RUTF needed to treat
all cases of Severe Acute Malnutrition (258,000
tons for 20 million children at an average of 12.9
kilos per child
• Price per treatment: 38.7 euros, Jan 2008
Case study 2:
Collaboration in Darfur, 2004
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During the emergency in Darfur in 2004, six different NGOs implemented
the various components of the CTC programme in El Geneina
TFC interventions were run by MSF-France and MSFSwitzerland; medical
care was provided through clinics operated by MSF-Switzerland and Medair
OTC was provided by Concern, Tearfund and SC-US and outreach by
Medair, Concern and MSF-Switzerland
Collaboration between the NGOs for coherent protocols and referral was
facilitated by Valid and United Nations International Children’s Emergency
Fund (UNICEF)
This cooperation resulted in the decongestion of inpatient care and the
more efficient use of resources. It enhanced case-finding, case follow-up
and hygiene promotion
Case fatality rates for severely malnourished individuals fell and programme
coverage increased dramatically
Source: (Walsh and Faroug, 2004)