General nutrition support standard 1: all groups
The nutritional needs of the population are met.
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Key indicators (to be read in conjunction with the guidance notes)
There is access to a range of foods - staple (cereal or tuber), pulses (or animal products) and fat sources - that meet nutritional requirements (see guidance note 1).
There is access to vitamin A-, C- and iron-rich or fortified foods or appropriate supplements (see guidance notes 2, 3, 5 and 6).
There is access to iodised salt for the majority (>90%) of households (see guidance notes 2, 3 and 6).
There is access to additional sources of niacin (e.g. pulses, nuts, dried fish) if the staple is maize or sorghum (see guidance notes 2-3).
There is access to additional sources of thiamine (e.g. pulses, nuts, eggs) if the staple is polished rice (see guidance notes 2-3).
There is access to adequate sources of riboflavin where people are dependent on a very limited diet (see guidance notes 2-3).
Levels of moderate and severe malnutrition are stable at, or declining to, acceptable levels (see guidance note 4).
There are no cases of scurvy, pellagra, beri-beri or riboflavin deficiency (see guidance note 5).
Rates of xerophthalmia and iodine deficiency disorders are not of public health significance (see guidance note 6).
Guidance notes
1. Nutritional requirements: the following estimates for average population requirements should be used, with the figures adjusted for each population as described in Appendix 7.
- 2,100 kcals per person per day
- 10-12% of total energy provided by protein
- 17% of total energy provided by fat
- adequate micronutrient intake through fresh or fortified foods.
It should be noted that these are the requirements for food aid provision only if the population is entirely dependent on food aid to meet its nutritional requirements. In situations where people can meet some of their nutritional needs themselves, food aid provision should be adjusted accordingly, based on the assessment. For planning food rations, see Food aid planning standard 1.
2. Preventing micronutrient diseases: if these indicators are met, then deterioration of the micronutrient status of the population should be prevented, provided adequate public health measures are in place to prevent diseases such as measles, malaria and parasitic infection (see Control of communicable diseases standards). Possible options for the prevention of micronutrient deficiencies include food security measures to promote access to nutritious foods (see Food security standards 2-3); improving the nutritional quality of the ration through fortification or inclusion of blended foods or locally purchased commodities to provide nutrients otherwise missing; and/or medicinal supplementation. Micronutrient losses which can occur during transport, storage, processing and cooking should be taken into account. Exceptionally, where nutrient-rich foods are available locally, increasing the quantity of food in any general ration to allow more food exchanges may be considered, but cost-effectiveness and impact on markets must be taken into account.
3. Monitoring access to micronutrients: the indicators measure the quality of the diet but do not quantify nutrient availability. Measuring the quantity of nutrient intake would impose unrealistic requirements for information collection. Indicators can be measured using information from various sources gathered by different techniques. These might include monitoring food availability and use at the household level; assessing food prices and food availability on the markets; assessing the nutrient content of any distributed food; examining food aid distribution plans and records; assessing any contribution of wild foods; and conducting food security assessments. Household-level analysis will not determine individual access to food. Intra-household food allocation may not always be equitable and vulnerable groups may be particularly affected, but this is not practical to measure. Distribution mechanisms (see Food aid management standard 3), the choice of food aid commodities and discussion with the affected population could contribute to improved intra-household allocation.
4. Interpreting levels of malnutrition: trends in malnutrition might be indicated by health centre records, repeat anthropometric surveys, nutritional surveillance, screening or reports from the community. It may be expensive to set up systems to monitor malnutrition rates over large areas or long periods of time, and technical expertise is required. The relative cost of such a system should be judged against the scale of resourcing. A combination of complementary information systems, e.g. both surveillance and intermittent surveys, may be the most effective use of resources. Wherever possible, local institutions and communities should participate in monitoring activities, interpretation of findings and the planning of any response. Determining whether levels of malnutrition are acceptable requires analysis of the situation in the light of the reference population, morbidity and mortality rates (see Health systems and infrastructure standard 1, guidance note 3), seasonal fluctuations, pre-emergency levels of malnutrition and the underlying causes of malnutrition.
5. Epidemic micronutrient deficiencies: four micronutrient deficiencies - scurvy (vitamin C), pellagra (niacin), beri-beri (thiamine) and riboflavin - have been highlighted, as these are the most commonly observed deficiencies to result from inadequate access to micronutrients in food aid-dependent populations and are usually avoidable in a disaster situation. If individuals with any of these deficiencies present at health centres, for example, it is likely to be as a result of restricted access to certain types of food and probably indicative of a population-wide problem. As such, deficiencies should be tackled by population-wide interventions as well as individual treatment (see Correction of malnutrition standard 3). In any context where there is clear evidence that these micronutrient deficiencies are an endemic problem, their levels should be reduced at least to pre-disaster levels.
6. Endemic micronutrient deficiencies: tackling micronutrient deficiencies within the initial phase of a disaster is complicated by difficulties in identifying them. The exceptions are xerophthalmia (vitamin A) and goitre (iodine) for which clear 'field-friendly' identification criteria are available. These deficiencies can also be tackled by population-level interventions, e.g. high-dose vitamin A supplementation for children and post-partum women, salt iodisation and public awareness campaigns. See Appendix 6 for definitions of their public health significance.
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