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Acute Malnutrition and Therapeutic Feeding: Think Again

June 10, 2012

Imagine a country where a humanitarian crisis strikes. If this country is extremely poor to begin with the first concern is the reduce death resulting from child acute malnutrition. To do so the international humanitarian community would more or less follow these steps:

i) conduct a nutritional assessment

ii) distribute food and target pregnant and breastfeeding mothers

iii) set up targeted therapeutic feeding programs for those children affected by acute malnutrition, as signaled by emaciation and swelling of the face.

In order to put in place the third intervention, therapeutic feeding centers are usually  set up in the areas most affected. This modus operandi is the accepted intervention to treat medical malnutrition. However, this presents challenges: these centers are difficult to set up and some people have a hard time accessing them. What comes out are late deliveries and low coverage. Given these pitfalls scholars and international organizations have thought about ways to move the locus of treatment away from specialized ad hoc medical centers into the communities affected by acute malnutrition. This approach is called community-based therapeutic feeding and it aims at giving to the community the capacity and responsibility to spot and treat with ready-to-use therapeutic feeding those cases without medical complications. In this way, the spectrum of service providers is widened, the detection is made more timely and more sustainable and patients load for doctor in health facilities is limited to those cases with medical complications.

Some sort of therapeutic feeding, be it facility or community-based, is therefore held as the single most effective intervention to treat acute malnutrition. But is this really the case? New research suggests that it is time to think again this paradigm.

The research asks what are the dietary patterns for children in normal time and what happen to them when adverse events (drought or war) occur. Take the example of the pastoralist communities in the Somali Region in Ethiopia. Knowing that milk plays an important role in the diets of these communities, researchers asked what is the use of this product within the household and how the access to milk affects the nutritional status of the child in the household. It turned out that community members hold the seasonal lack of animal products such as milk ( sporadically aggravated by extreme events such as droughts)  as a key factor behind child malnutrition. If the absence of animal milk is believed to drive child malnutrition then what happens when livestock is supported (either through supplementary feed or  vaccination and deworming medications at the outset of the dry season) so that the supply of milk is more stable? It turned out that milk consumption of children increased in the intervention areas and that the nutritional status of children consuming milk stabilized over the dry season as compared to children who were not consuming milk in the control areas. Equally important, costs associated with supporting livestock  were 45 – 75 percent less than intervention through therapeutic feeding.

The findings of the research points to the fact that our attention needs to shift from the emergency to what led to the emergency and how sign of crisis can be detected and deflated during period of normality. It poses new questions as well: if feeding centers are difficult to set up for the distribution of therapeutic foods what makes easier to distribute supplementary feeds or vaccines for cows and goats to a broad section of the communities affected?

In sum, therapeutic feeding fits into a modus operandi which focuses on treating the symptoms without thinking about the root causes. There is just no time to think about why acute malnutrition takes place in the first place. There is no time to ask what people and children eat in normal time and how these dietary patterns are likely to change under stress.  The attention span of the media and western public opinion, and therefore donors, lasts just as long as the peak of the crisis. For this reason, quick and short term fix are more in fashion. Needless to say, as this way of thinking persists the roots of the problems are not likely to change anytime soon.

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