Nutrition Considerations in Disaster Management PDF Print E-mail
FNRI DIGEST
Written by Rodolfo F. Florentino, M.D., Ph.D. and Marietta M. Bumanglag, BSFN   

INTRODUCTION

The Philippines is one of the most disaster-prone areas in the world, having shares of calamities causing considerable loss of lives and destruction to property. Situated within the Typhoon Belt Area", "Circum-Pacific Seis-mic Belt" and "Ring of Fire", the country is vulnerable to a wide spectrum of disasters. Some disasters are predictable and preventable, while the adverse impact of those which cannot can be mitigated.

Disaster relief is an indispensable service to the injured, the sick, the homeless and the distressed. Food then becomes an even more important necessity in times of disaster. Thus, emergency feeding is a major component of disaster relief.

Emergency feeding should not only satisfy hunger and cravings but also consider nutritional needs. Otherwise, malnutrition will remain uncontrolled or will eventually ensue, with its consequences on morbidity and even mortality.

Emergency feeding aims to satisfy the needs of victims to sustain life and maintain good health. It also provides relief to the condition of casualties, boosts the morale of displaced people and enables emergency workers to perform their tasks.

The Mount Pinatubo Experience

Experience learned and insights gained in the Mt. Pinatubo eruption and its aftermath could serve us well in dealing with future disasters. On June 12, 1991, Mt. Pinatubo spewed ash and pyroclastic materials, triggering lahar flows when it rains, which until today cause havoc to life and property. Had it not been for the early warning of volcanologists on the impending eruption and the timely evacuation of inhabitants through the concerted efforts of the National Disaster Coordinating Council (NDCC), concerned government officials, community leaders, civic organizations and the citizens themselves, a tragedy of greater magnitude could have resulted.

Safety evacuation of inhabitants did not end the relief services. After the disaster, the Department of Health (DOH) realized that while they are closely monitoring the health status of evacuees, not much is known of their nutritional condition and whether the nutritional needs of victims are fully served.

Thus, the Food and Nutrition Research Institute (FNRI), in cooperation with the Field Epidemiology Training Program of the DOH, spearheaded the nutritional assessment of children below five years old and their families in selected evacuation centers in Pampanga, Tarlac and Zambales including the cities of Angeles and Olongapo (Villavieja, et al., 1991). These evacuation centers were selected based on total population, resident status and health conditions of evacuees.

The survey aimed to determine the nutritional status of the most vulnerable groups and provide directions on appropriate interventions to control and prevent malnutrition. The survey covered 1,289 children five years old and below including their families, half of whom are Aetas while the other half are non-Aetas. Children were measured for weight and height or recumbent length.

Mothers or guardians were interviewed to determine the one-day food intake of children using the 24-hour recall technique. The interviews also sought information on family food supply and dietary practices.

The anthropometric survey results showed an extremely high proportion of malnutrition among children as manifested by various indicators. Fifty percent were moderately and severely underweight-for-age, 43.8% were stunted and 30.8% were wasted.

Severe chronic malnutrition was evidently rampant. About 15 of every 100 children were both wasted and stunted. Malnutrition was worst among children aged six months to two years old. There was gross inadequacy in the children's food and nutrient intake. Intake of energy and all the major nutrients except protein was grossly deficient, especially among the Aetas.

The influence of food rationing was evident in the diet of children at various age levels. Food available to the families on a per capita basis was only less than half a kilo, 65% of which, or 300 grams, was rice. The rest was made up of root crops, dried and canned fish (usually sardines), processed meat, milk, dried beans and vegetables. These foods came either through ration or donation, or in the case of non-Aetas, purchased or self-acquired. Rations reaching the children were grossly inadequate for their nutritional needs.

Major Nutritional Considerations

While we cannot prevent disasters such as the Mt. Pinatubo explosion, much can be done to alleviate the condition of disaster victims by paying attention to their nutritional needs, particularly the children, pregnant and lactating women and the elderly. Proper planning and management of emergency feeding are vital components of disaster management. Food and nutritional management may vary according to the kind of disaster and length of time during which food supplies are needed.

There are three phases in emergency feeding reflecting the stages of the situation. These are the early, intermediate and extended emergency periods. Nutritional objectives, priority nutrients, and the food sources differ according to the period of emergency (Donato, et al., 1983).

Early Emergency lasts for just a few hours to one or two days immediately following a disaster. People are hungry but not starving. The period is characterized by stress, anxiety or even shock. The objective is providing victims with something to eat and drink, provide them comfort, improve morale and to help counteract shock. All victims are targeted, with special consideration to the infants, preschoolers, pregnant and nursing mothers, the sick and wounded. At least four cups of safe water per person must be provided. Simple, easy-to-serve quick energy foods high in calories derived from carbohydrates sustain bodily processes.

Examples:

    * plain water/milk and rootcrops/tubers

    * tea/coffee/cocoa/salabat(ginger tea) and cereals/cereal products

    * coconut water/softdrinks and sweets/ spreads

Intermediate Emergency is the transition period from initial onset of disaster to rehabilitation, which may last from several days to weeks. Conditions are still far from normal but the initial shock is over. The objective is to provide food and water within nutritional limits for temporary maintenance. Special consideration should again be given to the vulnerable groups. Priority care is also due to the sick and injured, as well as the rescue workers who need energy replenishment. Water, calories, protein, thiamin and salt are the priority nutrients. Foods may be in the form of ready-to-eat, packed or canned, served with or without heating.

Examples:

    plain water and cereals/cereal products

    beverage and sweets/ spreads

    soups and canned/ cured/dried fish or meat

    juices/milk and dried beans/milk products/ high-protein formulations

Extended Emergency is the period where the worst is over. The objective is to sustain life and maintain normal health. If rations are provided for more than a month, diet should be aimed at reaching and maintaining the recommended dietary allowances for calories, proteins, vitamins and minerals by serving more varied and hearty meals capped with fruits and vegetables. External food supplies, domestic or imported, may continue to be utilized, while increasing selfreliance and veering away from total dependence on external help. It should be noted that imported foods are not popularly consumed. It is best to use foreign donated foods in formulating local recipes for victims. The energy-giving, body-building, and regulating foods are convenient guides in planning adequate meals. Hot meals, soups, one-dish meals with cereals, fruits, and beverages served at a regular meal pattern may be given. Fortified or enriched local or donated foods or even pharmaceutical preparations may be served to ensure supply of micronutrients.

Management of Feeding Operations

Proper management of feeding operations is imperative in maximizing limited resources and ensuring efficiency. Mass feeding starts with ready-to-eat type foods, progressing to cooked meals as the kitchen becomes more organized and facilities more complete. Cooked meals are given in evacuation centers during the first days of a major disaster. These are gradually replaced by dry rations. The latter, however, requires that people cook their own food. This encourages self-sufficiency in food preparation and distribution does not have to take place daily.

Emergency mass feeding can be carried-out by Mobile Feeding in a mobile canteen or kitchen, but this is applicable when there are available and passable roads. Mass feeding may also be carried out in feeding centers located in any vacant building, school or health center with adequate space and ventilation. It may be necessary to pool available resources. The victims themselves may be asked to assist in preparing, serving foods and to bring their own utensils.

Supplemental feeding may be resorted to when mass feeding is inadequate to vulnerable groups. It is intended to prevent and treat malnutrition by providing additional foods that are high in energy and protein but low in bulk to compensate for specific deficiencies in the food otherwise available to them. For example, supplementary feeding may be given to the moderately and severely underweight infants and pre-schoolers, as well as to pregnant and lactating women among the victims.

Conscious of the need for disaster preparedness, the FNRI has been developing food technologies that may be used for emergency or supplementary feeding. These technologies have been particularly designed to provide nutrient-rich food to vulnerable groups and can lend themselves well for disaster feeding (Catalogue of FNRI Technologies, 1988). Examples are cereal-legume instant baby foods prepared simply by adding hot water; precooked weaning food; nutrient blends and soup bases in powder form used to supplement thin soups; protein-rich noodles; high-fiber fruit juices; and high-protein toppings for one-dish meals, among many others.

The FNRI is developing a food bar that can serve as a complete meal in times of emergency feeding.

Water and Food Safety

Of primary importance in emergency feeding is the provision of safe food and water. Food and water can easily be contaminated and become the source of food and water-borne diseases during disasters. Adequate and safe drinking water must be available and accessible to all victims and relief workers. The minimum water need for drinking may be calculated at one liter per person a day, three or more liters during hot climate or 15-20 liters per person a day for drinking and hand washing.

Infants and young children who critically need water require more in proportion to their weight than adults do. It is also essential for lactating mothers for adequate milk production and for fluid restoration of the sick during vomiting, diarrhea and fever. If safety of drinking water is uncertain, it is required that domestic water disinfection and protection be instituted. Bringing water to a rolling boil for 5-20 minutes is the most common way of disinfecting drinking water. Other disinfectants are chlorine compounds, iodine and potassium permanganate. It is very important that disinfected water be stored, transported and distributed in clean, covered and non-corrosive containers to avert recontamination and assure safe use.

Similarly, food sanitation must be ensured. Food can become degraded or contaminated due to exposure to elements. Extra care is needed in all aspects of food management, from purchasing (or acceptance of delivered donated foods) to storage, preparation and cooking and service to lessen, if not eliminate the risk of contamination. Food handlers play a very important role in this regard.

CONCLUSION

The provision of adequate and safe food ration in terms of quality and quantity, or giving full consideration to the nutritional needs of disaster victims can do much to preserve life, maintain morale and relieve the condition of casualties.

In addition, this will further motivate emergency workers in their job and heal psychological scars of people made destitute due to disasters.

Finally, proper planning, coordination, management and mobilization of resources, together with constant monitoring of the nutritional condition of victims particularly the children and disaster preparedness are key ingredients of a successful emergency feeding operation.

 

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  Updated  November 2014
 
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