Selective Feeding Programme Evaluation in Nyapara, Bangladesh.

Summary of Internal MSF Holland Evaluation.

Nyapara refugee camp in Bangladesh houses Rohinga refugees from Myanmar who arrived in 1992. The refugees have a male-dominated society and the camps have been described as 'closed', heavily politicised and with entrenched power structures. A survey implemented by UNHCR in July 1996 found rates of wasting of 15%. The reasons for this high prevalence of wasting were thought to be that a lot of the general ration was diverted and sold on the market by men to meet needs or the needs of camp leaders as other sources of income were very limited. Other reasons were social collapse resulting in lack of advice and support for young mothers who often had many children to care for and the fact that the dry take home supplementary feeding ration was often shared with other children. The take home ration was also considered as an additional source of income. All this prompted agencies to change from take home supplementary feeding to on-site feeding. The change from take home to on-site feeding was implemented by MSF and OXFAM in March 1997. The target of the SFP was to meet the full nutritional requirement of the child. Thus, for every child admitted the general ration was reduced by an equivalent amount for his or her household. A survey conducted in February 1998 found 11.5% wasting with 0.7% severe wasting and 9.9% angular stomatitis in the camp.

In February 1998 MSF Holland evaluated their selective feeding programmes in Nyapara, Bangladesh. Their main findings with regard to the unusual supplementary feeding programme were as follows:

When the programme switched over to on-site feeding there was no change in attendance rate. The average weight gains and length of stay on the programme was described as satisfactory. Overall performance of the SFP was also satisfactory. The evaluation concluded that the diet was satisfactory but that addition of CMV would be a major improvement.

Poor growth (20% of children stayed for more than 60 days) was said to be mainly due to healthy children just not reaching discharge criteria. It was therefore suggested that it might be a good idea to introduce an additional exit strategy so that children are discharged after more than two weeks at 85% weight for height or after more than two months at greater than 80% weight for height providing they are followed up by outreach workers for one month after discharge.

Finally, the evaluation cautioned that the introduction of an on-site supplementary feeding programme which provided a full ration for the beneficiary was very unusual and that while successful in this context, the type of approach should generally be avoided as it is not cost-effective and also takes feeding responsibility away from the family.

For further information contact: Saskia Van der Kam, Medecins Sans Frontieres, P.O. Box 10014, 1001 EA Amsterdam. Email: sak@amsterdam.msf.org