Issue 09 Editorial

Dear Readers,

Field Exchange 9 comes to you from our new offices. Visitors to the ENN will now find us at Unit 2.5, Enterprise Centre, Trinity College, Pearse Street, Dublin 2, Ireland. Contact details can be found at the back of the newsletter.

Often mistakenly assumed to be breastfed and therefore healthy, under 6 month old infants have to date been overlooked in terms of assessment and treatment of malnutrition. Infants of this age group have generally been excluded from nutrition surveys and guidelines generally do not include their treatment in Therapeutic Feeding Centres (TFCs). Clearly, this is not acceptable given that this group often represent a significant proportion of those admitted to therapeutic feeding centres during emergencies. Claudine Prudhon from ACF writes about the experience of undertaking anthropometric assessment of infants in Kabul, and highlights the difficulties encountered in their assessment. Mike Golden adds a post-script, which provides additional context to Claudine's article and gives reasons why this type of survey, is of value. His piece also reports on a similar survey undertaken in Liberia using the example to show the level of inaccuracy introduced by 'rounding up' measurements to a specific decimal point, and the biases introduced when a height of 65cm is assumed as a cut-off for 6 month olds. Both these articles provide new data, analysis and thinking and we would urge readers to take up Golden's suggestion to carry out and share any assessment of this age group so that guidelines and policies governing treatment of this age group are better informed.

On the same subject in our research section Mary Corbett shares the findings of her MSc thesis in Nutrition in which she assessed the effectiveness of rehabilitating malnourished infants while maintaining or improving the mother's milk supply. Mary describes how in the management of infants under 6 months excellent weight gains were achieved and infants were discharged exclusively breastfeeding. Mary also passes on some treatment tips she picked up during the course of this work.

One of the biggest difficulties faced by all in the emergency food and nutrition sector, is the dearth of emergency based research. Some of the most profound advances in understanding of food emergencies and optimal response have come out of a handful of research studies carried out in the 'teeth' of emergencies. De Waals work in northern Darfur on the nature of famine in the mid-eighties, and Collins work on adult malnutrition in Somalia (1992-3) spring to mind.

Emergencies do not provide the most suitable environments for conducting rigorous research, but is that a reason not to attempt some form of study? Marie Mc Grath says no, and describes her attempts to undertake research into infant feeding during the Kosovo crisis. Marie describes how a combination of bad timing, (the refugees were moving back home from Albania and Macedonia) and the operational demands on agency staff made it very difficult to adhere to normal research protocols. The author extracts a number of 'constructive' lessons about conducting research during emergencies.

Perhaps a little unusually for a food and nutrition publication we carry an article written by an MSF team about assessing post traumatic stress disorders (PTSD) in populations affected by violence in Freetown, Sierra Leone. The authors remind us that one of the underlying causes of malnutrition is poor care and make an explicit link between the effects of trauma and the ability of those affected to care for dependants (and themselves) with resulting adverse consequences for nutrition and food security. As an important determinant of the social and care environment the authors believe that nutritionists and other health workers should recognise traumatisation in the communities in which they work and advocate for remedial intervention where appropriate. The article describes the assessment approach and demonstrates how widespread and severe the traumatic experience has been in this waraffected city. The results of the MSF survey on prevalence of PTDS in Freetown following conflict are mind-boggling. Seven percent had suffered amputations while over half those surveyed had witnessed torture. A third had seen attempted amputations. Using western measurement standards 99% had experienced trauma with nearly half experiencing symptoms of PTSD. Start to extrapolate these figures to populations in Africa that have recently suffered civil conflict and the numbers of those psychologically damaged become imponderable. Wars in the last decade affecting Angola, Burundi, Liberia, Rwanda, DRC, Sudan, Somalia, Mozambique have been every bit as brutal as that in Sierra Leone. PTDS manifests itself in many ways. There are the physical symptoms that can be measured like headaches and non-specific physical malaise that make people seek medical help. Values and morals also become undermined. Horrific events no longer seem so horrific. In short, war brutalises and the brutalisation that occurs in war pays no heed to creed or colour and sows the seeds for future conflict.

On a separate topic we recognise that over the years World Food Programme has attracted its fair share of criticism from other agencies. These criticisms have usually revolved around the fact that food has either been provided too late, in insufficient quantities or has been of the wrong type. At the same time most agencies involved in the food and nutrition sector are, at some point, dependent on WFP for food. A few agencies have tried to go it alone in terms of food procurement and logistics but their experiences have not generally been happy ones. The fact is: WFP move huge quantities of food around year in and year out for emergency and development purposes and often do so at very short notice. On many occasions they do a great job. However, the successes rarely make headlines while news of failures seem to fast-track around the aid community. Yet WFP appear to make little effort to explain or publicise the constraints under which they have to operate. Basically, WFP act as brokers for a myriad of donor governments who pledge and commit food aid and financial resources for a variety of ever changing reasons. WFP therefore often find that they have at least one hand tied behind their back. They either can't get hold of sufficient food quickly enough or they lack the cash to move the food around. The WFP evaluation of the Hurricane Mitch emergency food aid response summarised in this issue, provides some insight into the kind of problems the agency has to grapple with even when food is readily available.

Without committing ourselves to dates or editions we are hoping to run two special focus editions of Field Exchange at some point in the future on 'adolescent and adult malnutrition' and 'therapeutic feeding programmes in emergencies'. Please forward any submissions on either of these topics to us here at the ENN.

Editors,

Fiona O'Reilly
Jeremy Shoham