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Meeting the challenges of micronutrient deficiencies in emergency-affected populations

Published online by Cambridge University Press:  27 March 2009

Z. Weise Prinzo*
Affiliation:
Department of Nutrition for Health and Development, World Health Organization, 1211 Geneva 27, Switzerland
B. de Benoist
Affiliation:
Department of Nutrition for Health and Development, World Health Organization, 1211 Geneva 27, Switzerland
*
*Dr Zita Weise Prinzo, fax +41 22 7914156, email weiseprinzoz@who.ch
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Abstract

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Micronutrient deficiencies occur frequently in refugee and displaced populations. These deficiency diseases include, in addition to the most common Fe and vitamin A deficiencies, scurvy (vitamin C deficiency), pellagra (niacin and/or tryptophan deficiency) and beriberi (thiamin deficiency), which are not seen frequently in non-emergency-affected populations. The main causes of the outbreaks have been inadequate food rations given to populations dependent on food aid. There is no universal solution to the problem of micronutrient deficiencies, and not all interventions to prevent the deficiency diseases are feasible in every emergency setting. The preferred way of preventing these micronutrient deficiencies would be by securing dietary diversification through the provision of vegetables, fruit and pulses, which may not be a feasible strategy, especially in the initial phase of a relief operation. The one basic emergency strategy has been to include a fortified blended cereal in the ration of all food-aid-dependent populations (United Nations High Commissioner for Refugees/World Food Programme, 1997). In situations where the emergency-affected population has access to markets, recommendations have been to increase the general ration to encourage the sale and/or barter of a portion of the ration in exchange for locally-available fruit and vegetables (World Health Organization, 1999a, b, 2000). Promotion of home gardens as well as promotion of local trading are recommended longer-term options aiming at the self-sufficiency of emergency-affected households. The provision of fortified blended foods in the general ration has successfully prevented and controlled micronutrient deficiencies in various emergency settings. However, the strategy of relying only on fortified blended foods to prevent micronutrient deficiencies should be reviewed in the light of recurring evidence that provision of adequate supplies of these foods is often problematic. Donor policies on the bartering or exchange of food aid should also be clarified. Furthermore, the establishment of micronutrient surveillance systems, including standardized micronutrient deficiency diagnostic criteria, are vital for the control of micronutrient deficiency diseases.

Type
International and Public Health Nutrition Group Symposium on ‘Achieving a balanced diet in the developing world: strategies to meet micronutrient needs’
Copyright
Copyright © The Nutrition Society 2002

References

Applied Nutrition Programme (1995) Report on a Workshop on the Improvement of the Nutrition of Refugees and Displaced People in Africa, Machakos, Kenya, 57 12 1994. Nairobi, Kenya: University of Nairobi.Google Scholar
Berry-Koch, A Moench, R, Hakewill, P & Dualeh, M (1990) Alleviation of nutritional deficiency diseases in refugees. Food and Nutrition Bulletin 12, 106112.CrossRefGoogle Scholar
Brin, M (1963) Thiamine deficiency and erythrocyte metabolism. American Journal of Clinical-Nutrition 12, 107116.Google ScholarPubMed
Centers for Disease Control (1989 a) Nutritional status of Somali refugees in eastern Ethiopia, 09 1988-05 1989. Morbidity and Mortality Weekly Report 38, 455456.Google Scholar
Centers for Disease Control (1989 b) Nutrition and health status of displaced persons-Sudan, 1988–1989. Morbidity and Mortality Weekly Report 38, 848855.Google Scholar
Centers for Disease Control (1991) Outbreak of pellagra among Mozambican refugees - Malawi, 1990. Morbidity and Mortality Weekly Report 40, 209214.Google Scholar
Combs, GF Jr (1992) The Vitamins: Fundamental Aspects in Nutrition and Health. San Diego, CA: Academic Press.Google Scholar
Desenclos, JC, Berry, AM Padt, R Farah, B Segala, C & Nabil, AM (1989) Epidemiological patterns of scurvy among Ethiopian refugees. Bulletin of the WorldHealth Organization 67, 309316.Google ScholarPubMed
Dijkhuizen, P (1998) Funding to test out camp level milling and fortification equipment. Field Exchange. Special Focus: Micronutrients. Emergency Nutrition Network, issue 5, p. 13. Dublin: Emergency Nutrition Network.Google Scholar
Dijkhuizen, P (2000) Processed complementary foods in the WFP. Food and Nutrition Bulletin 21, 6264.CrossRefGoogle Scholar
Hansch, S (1992) Diet and ration use in Central American refugee camps. Journal of Refugee Studies 5, 300312.CrossRefGoogle Scholar
Magan, AM, Warsame, M, Ali-Salad, A-K & Toole, MJ (1983) An outbreak of scurvy in Somali refugee camps. Disasters 7, 9497.CrossRefGoogle Scholar
Mardel, S, Hailey, PC, Mahmutovic, A, Broom, J, Golden, MHN, Franklin, M & Mills, CF (1995) Micronutrient status of the besieged residents of Sarajevo: May 1993. European Journal of Clinical Nutrition 49, Suppl. 2, 546561.Google ScholarPubMed
Mears, C & Young, H (1998) Acceptability and Use of Cereal-based Foods in Refugee Camps-Case Studies from Nepal, Ethiopia and Tanzania. Oxfam Working Paper. London: Oxfam.CrossRefGoogle Scholar
Medecins sans Frontieres/Epicentre (1992) Study of the food habits of breast-feeding women among the Karen refugee population in the Mae Sod region, Thailand 1992. Medical News 1, 4.Google Scholar
Moren, A & Le Moult, D (1990) Pellagra cases in Mozambican refugees (letter). Lancet 335, 14031404.CrossRefGoogle Scholar
Stevens, D Araru, P & Dragudi, B (2001) Outbreak of micronutrient deficiency diseases: did we respond appropriately? Field Exchange. Emergency Nutrition Network, issue 12, pp. 1517. Dublin: Emergency Nutrition Network.Google Scholar
The FANta Project (1999) Enhancing the Nutritional Quality of Relief Diets. Washington, DC: The FANTa Project, AED.Google Scholar
Toole, MJ (1992) Micronutrient deficiencies in refugees. Lancet 339, 12141216.CrossRefGoogle ScholarPubMed
Toole, MJ Nieburg, P & Waldman, RJ (1988) The association between inadequate rations, undernutrition prevalence, and mortality in refugee camps: case studies of refugee populations in eastern Thailand, 1979–1980, and eastern Sudan, 1984–1985. Journal of Tropical Pediatrics 34, 218224.CrossRefGoogle ScholarPubMed
United Nations High Commissioner for Refugees/World Food Programme (1997) Guidelines for Estimating Food and Nutritional Needs in Emergencies. Geneva: UNHCR (available on request).Google Scholar
Upadhyay, J (1998) Persistent micronutrient problems among refugees in Nepal. Field Exchange. Special Focus: Micronutrients. Emergency Nutrition Network, issue 5, pp. 45. Dublin: Emergency Nutrition Network.Google Scholar
World Health Organization (1999 a) Scurvy and its Prevention and Control in Major Emergencies. World Health Organization Publication. WHO/NHD/99.11. Geneva: WHO.Google Scholar
World Health Organization (1999 b) Thiamin Deficiency and its Prevention and Control in Major Emergencies. World Health Organization Publication. WHO/NHD/99.13. Geneva: WHO.Google Scholar
World Health Organization (2000) Pellagra and its Prevention and Control in Major Emergencies. World Health Organization Publication. WHO/NHD/99.12. Geneva: WHO.Google Scholar