Issue 22 Editorial

The more cynical amongst us in the emergency nutrition sector may sometimes be heard complaining that there is nothing new in this profession and that we just keep re-inventing the wheel - 'the problems are the same, as are the solutions.' However, a cursory glance over this issue of Field Exchange gives lie to any such claim. There are plenty of new developments. For example, the piloting of a newly developed product called QBmix (a micronutrient rich condiment) by MSF amongst IDPs in Angola to help combat the endemic pellagra problem that has plagued this population for a number of years (see field article by Evelyn Depoortere). The study shows that QBmix may offer a cheaper, and logistically simpler, alternative to fortified CSB, as a means of preventing further outbreaks. There is also a field article in this issue about an indigenous crop grown in south and southwest Ethiopia - 'Enset' (or false banana) and being promoted by the development agency Self Help International The crop appears to have many potential uses which have a positive impact on food security. According to the author, there may be potential for promoting this local drought resistant crop in other food insecure areas of Ethiopia and for disseminating knowledge widely about its potential for reducing food insecurity. This issue also carries a summary of a study concerning the consumption of green peas in drought prone areas of Ethiopia. Consumption of this wild food, especially in drought periods, is associated with neurolathyrism (a neurodegenerative condition). However, the study shows that incidence is reduced when the affected population simultaneously consumes food aid in the form of cereal. The findings support the case for targeting food aid in these vulnerable areas, not just to the poorest, but also to those likely to increase their consumption of this legume.

There are also research findings reported in this issue, which, although not entirely new, add to an already considerable body of knowledge. For example, a study of the longer term impact of the siege and resulting famine in Leningrad during the second world war shows that the legacy of starvation is not just limited to growth impairment, but also future cardio-vascular health. There is also a study on ration adequacy amongst Thai refugees. This shows, yet again, how poor ration quality for food aid dependent refugees is directly responsible for the high levels of stunting and micronutrient deficiencies which have existed amongst this population for a number of years The inadequacy of the micronutrient content of home prepared replacement milks as a breastmilk substitute - an ongoing concern of many in infant feeding circles - is highlighted in one summarised research piece by Rollins et al in South Africa. In this setting, infant formula is considered an appropriate and viable option for feeding infants of HIV positive mothers. However, a field article by Tom Oguta and his team in Kenya finds that home-adapted animal milks may be the preferred breastmilk substitute, and only available option, for carers of infants whose mothers are HIV positive. While current international guidelines recommend fortification of home prepared milk with micronutrients, in practice, these are often not locally available.

Take any sample of Field Exchange and it is apparent that there is a continuous steam of important information and ideas provided by new research and pilot interventions, which should, at least theoretically, help inform better practice. Unfortunately, much of this information never finds its way into the published literature. In spite of what cynics may say, there is still much we don't know. Where we have good quality research there is often a need to collate disparate research findings into a sufficient body of coherent evidence to make a case and advocate for change. Emergency ration adequacy for refugees and findings like those from the Thai refugee study are obvious examples where it appears that we have not reached a critical mass of evidence to effect change.

As editor of Field Exchange it is becoming increasingly difficult to leave out articles and research on HIV related issues. This issue of Field Exchange carries a field article on infant feeding practices amongst HIV positive mothers in Kenya, a summary of a review of the impact of HIV on crises and humanitarian work, and research on predisposing factors to malnutrition amongst HIV positive children in eastern Cape, South Africa. There is also a report on the AAH/Oxfam co-chaired meeting of the HIV, food security and livelihoods working group.

The multifaceted interface between HIV and nutrition is becoming increasingly recognised and reflected in HIV/nutrition programming, especially where the HIV pandemic is most pronounced, e.g. southern and Eastern Africa. There is a growing trend towards using food aid in much of this HIV programming. The use of food aid is being increasingly advocated, especially following emergency programmes under protracted relief and rehabilitation arrangements (PRROs). Food is therefore being incorporated into Prevention of Mother to Child Transmission programmes (PMTCT), Home Based Care (HBC), TB treatment (DOT), Orphan and Vulnerable Children programmes (OVC) and Neighbourhood Child Protection programmes (NCP). There appear to be multiple roles for food aid in these programmes with a variety of objectives proffered, e.g. nutritional, food security, incentive to comply with treatment, incentives for volunteers, protection, etc. However, there is often a lack of clarity over exit criteria, how food aid will be integrated with other packages and little thought or attention as to how these programmes will be monitored and evaluated. While there may be a rationale for food aid in many of these programmes, there is the very real danger that food may be used uncritically with little attention given to impact. Furthermore, in some cases it may be that food aid actually has a negative impact, e.g. undermines the volunteer ethos.

There is a long history of uncritical and ultimately ineffective use of food aid in longer term nutrition programming, e.g. supplementary feeding. Some critics of current developments are already implying that use of food aid in HIV programming may be an attempt to introduce development food aid (which has dwindled over the past three decades) by the back door. It is essential, therefore, that this relatively new area of programming is introduced cautiously and based on pilot studies. Where successful, interventions can be rolled out, providing monitoring and evaluation mechanisms are in place. There can be no excuse for failing to apply lessons from the past regarding the use of food aid in longer term nutrition interventions to this new era of HIV/AIDS and nutrition programming.

Finally, we enclose in this issue the first ENN Special Supplement. This supplement, and subsequent ones that are planned, are meant to collate cutting edge field experiences in rapidly developing subject areas. A letter written by one of the authors in this issue of Field Exchange (Anna Taylor), highlights why targeting is such an important subject and where clarity is urgently needed. The next ENN Special Supplement will be on Community Based Therapeutic Feeding programmes.

We hope you enjoy this issue of Field Exchange.

Jeremy Shoham

Any contributions, ideas or topics for future issues of Field Exchange? Contact the editorial team on email: marie@ennonline.net