Supplementary Feeding Programme - Current Guidelines

Criteria for entry and exit to and from SFPs - from MSF guidelines

Foods used in SFPs - from CONCERN Worldwide guidelines

The diets are based predominantly on porridges, local foods and family diet. Most foods should provide energy intakes of 100-200 kcal/100 ml. The percentage energy from protein should be approximately 12-16% to allow for catch-up growth to occur.

Supplementary porridges

Supplementary porridges, made up to 150 - 200 kcal per 100 ml can be made up in the centres using blended cereals or milled staples with legumes or rice. Most blended cereals provide approximately 350-400 kcal per 100 g of dry product.

If available, mineral and vitamin mixes for supplementary feeding should be added to porridges which are not pre-fortified.

Milks

HEM (100 kcal and 2.9g protein per 100 ml) can be given in wet SFPs (see table opposite). Minerals and vitamins should be added to milks. To make up 1 litre use 900 mls of water.

Dry milk powders should not be distributed as a dry ration on their own; milk powder can be added to a pre-mix for distribution. See example below for composition of dry ration premix.

Local Foods and Family Diets

Emphasis should be placed on providing a supplementary diet based on locally available foods. If possible, vegetables purchased or grown locally should be included. A variety of recipes should be prepared with the community for wet feeding purposes. These recipes can be adapted to ensure they have adequate energy and protein content. Ease of use, accessibility and supply are important factors in selecting products for use in such recipes. Dry premix should be prepared using blended cereals that are available locally, examples given below.

High energy and protein biscuits

High energy and protein biscuits are suitable for use in SFPs. These biscuits increase the energy content of the supplementary diet significantly and are particularly useful in the beginning of the emergency operation.

Biscuits are a valuable commodity on the market and efforts should be made to prevent them being sold; they should be crushed or broken before being added to the dry ration premix.

Long-term dependence on high energy and protein biscuits should be avoided; biscuits are expensive and should not be given priority over locally available products. It is unlikely that families can afford these biscuits once food aid is no longer being provided. Every attempt should be made to use locally available foods.

Fruit

If available, fruit is a suitable supplement in a wet SFP and is a good source of vitamins. Children in therapeutic feeding programmes should have priority access to bananas.

When to Close Down Feeding Programmes

(MSF guidelines)

The decision to close down selective feeding programmes should only be made after a nutrition survey has clearly shown a significant decrease of global acute malnutrition in the population.

Prevalence of global acute malnutrition (-2 Z-scores W/H and /or oedema) among children under-five years old should be below 10%.

The following conditions should also be met:

• general food distributions are reliable and adequate,
• effective public health and disease control measures are in place,
• no seasonal deterioration of nutritional status is anticipated,
• mortality rate is low,
• the population is stable - no major influx is expected

Follow up nutrition surveys must be planned to detect any deterioration of the situation, even after closure of selective feeding programmes. this is especially important if the overall situation remains unstable.

Evaluation

(MSF Guidelines)
A brief overview of indicators often used for monthly reporting on SFPs is presented below: