The management of nutrition in major emergencies

The newly published WHO manual 'Management of nutrition in major emergencies'¹ replaces the 1978 edition, and reflects scientific and conceptual advances in understanding the prevention, causes and treatment of malnutrition in emergencies. It reflects the input of a wide range of individuals and agencies.

One of the major conceptual advances incorporated in the manual is that emergency management is viewed as a multisectoral venture; ministries and departments of local government need to plan and work together for emergency prevention, preparedness, response and rehabilitation. Safeguarding the nutritional status of the population also requires a holistic and proactive approach, which implies more than food distribution and health protection. Action is called for in the areas of environment, population, economic and human development, land and water management, production and trade, services, human rights, governance, empowerment and growth of civil society.

The book covers the concepts, principles, and precise measures needed to ensure adequate nutrition in both the relief phase and the subsequent rehabilitation and development phases.

There are seven chapters. The first, on meeting nutritional requirements, explains the importance of nutritional assessment as a fundamental tool for calculating food needs, monitoring the adequacy of food access and intake, and ensuring adequate procurements. The chapter also sets out recommendations for mean daily per capita intakes of energy and protein and for micronutrients and other specific nutrients. The major nutritional deficiencies are covered in chapter two, which includes detailed information on the signs, symptoms, prevention, and treatment of protein-energy malnutrition, iron-deficiency anaemia, vitamin A deficiency, iodine deficiency disorders, beriberi, pellagra, and scurvy. Chapter three describes the methodology for measuring malnutrition. Information includes target audiences for assessment, advice on body measurements and clinical indicators of malnutrition, and precise instructions for conducting rapid nutritional surveys, individual screening, and nutritional surveillance.

Chapter four provides a detailed guide to the planning, organisation, and delivery of general feeding programmes. Topics covered include basic requirements for suitable food commodities, principles of good organisation and co-ordination, and the composition of a general ration calculated to meet the populations' minimum requirements for energy, protein, fat, and micronutrients. Guidelines for selective feeding programmes are presented in chapter five, which covers both the supplementary feeding of vulnerable groups and the therapeutic feeding of individuals suffering from deficiency diseases.

In view of the close link between infectious diseases and malnutrition, chapter six offers advice on the organisation of services to ensure priority immunisations and to monitor and treat each of twelve infectious diseases commonly seen in developing countries. The book concludes with advice on the planning, administration, and logistics of emergency preparedness and response programmes, emphasising the need to detect vulnerability to nutritional deficiencies and monitor early warning indicators.

The essential purpose of this manual is to help build national capacities and human resource development within the country. Thus, the manual could be used as a framework for developing teaching modules and training programmes.

¹'Management of Nutrition in Major Emergencies' is available on request from Marketing and Dissemination, World Health Organisation, 1211 Geneva 27, Switzerland. The price of the book is Sw.fr. 72 (US $64.80), in developing countries Sw.fr. 50.40.

¹Management of Nutrition in Major Emergencies, Geneva, World Health Organisation (in collaboration with UNHCR, International Federation of Red Cross and Red Crescent Societies, and World Food Programme), 2000.