Rapid Nutrition - News

[Marieta Reeks]

Thedistinct metabolic and immune system changes caused by the two diets were observed despite the diversity of the participants, which shows that dietary changes consistently affect widespread and interconnected pathways in the body. More study is needed to examine how these nutritional interventions affect specific components of the immune system. According to the authors, the results of this study demonstrate that the immune system responds surprisingly rapidly to nutritional interventions. The authors suggest that it may be possible to tailor diets to prevent disease or complement disease treatments, such as by slowing processes associated with cancer or neurodegenerative disorders.

The NIDDK conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see the NIDDK website.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

MSF calls on the warring parties to ensure the protection of civilians, health care structures, and staff so that vital assistance can be effectively provided for the tens of thousands of people whose lives are at risk before it is too late. MSF estimates that 370 trucks carrying 20 tons of food each will need to be delivered every month, and with the rainy season fast approaching and potentially impacting roads, action must be taken urgently.

In January, MSF conducted a rapid nutrition and mortality assessment of 400 households in Zamzam camp and found alarming numbers of children dying from malnutrition. We then carried out mass screenings of more than 46,000 children in March and April, and found that a staggering 30 percent were suffering from acute malnutrition, including 8 percent with severe cases.

Similar figures were found among the more than 16,000 pregnant and breastfeeding women who were screened: 33 percent were acutely malnourished, and 10 percent of them had severe acute malnutrition. These figures are double the emergency threshold of 15 percent, indicating that there is a massive, life-threatening emergency in Zamzam camp.

In Zamzam camp, there is an acute disaster on a catastrophic scale. The situation is critical and the level of suffering is immense, but despite this being known for nearly three months, nowhere near enough has been done to help those who are struggling to survive.

MSF has already scaled up our response by opening a second health clinic, enrolling over 11,000 children in our nutrition program and opening a 35-bed field hospital to treat the most critical cases. Currently, there are 23 patients receiving inpatient treatment, including 12 who are suffering from severe acute malnutrition and four who are being treated for suspected measles.

MSF is planning to start a measles vaccination campaign and expand activities to provide support for pregnant women. However, this is not enough to meet the needs. There is no other health care available in the camp and this urgently needs to be addressed.

Even before the start of the war in Sudan, people in the camp received very little support. Food rations were far below international standards, access to clean water was insufficient, and there were only two other health clinics in the vast camp before MSF opened its first one in 2022.

Everyone in Zamzam camp needs support, but the recent arrivals are especially vulnerable. With the violence escalating in North Darfur once again, additional people are becoming displaced, meaning there may soon be even more competition for the already very limited resources in the camp

The only way to prevent the situation from deteriorating further is to provide people with reliable food distributions and sufficient rations. This urgent aid must be delivered swiftly: With the rainy season approaching, and no tarmac on the roads, it will become difficult for aid trucks to reach Zamzam. Despite being aware of the severity of the situation, and famine alerts coming from UN agencies themselves, the UN is not doing enough to prevent the malnutrition crisis in Zamzam from falling further into catastrophe.

What we know: An understanding of nutritional determinants and causal pathways is critical for designing contextualised and targeted programmes that address undernutrition in all its forms. Current assessment approaches are useful but may be time and resource intensive.

What this adds: As part of its broader work to support innovative solutions to respond to moderate wasting in children under five, the MWI, in partnership with Action Against Hunger, piloted a rapid nutrition determinants assessment (NDA) approach in Nepal. This article describes the development of this qualitative approach and challenges, opportunities, and lessons learned through the experience.

The Rapid NDA methodology was developed by Action Against Hunger and further contextualised in situ by the Action Against Hunger Nepal and MWI teams. The methodology aimed to fill specific information gaps, be quick to implement, be accomplished by a small team, and include a community validation exercise. Considering these specific needs, a qualitative approach was considered most appropriate.

The specific objectives of the assessment were to identify key determinants of undernutrition among the study population and to understand how determinants of wasting interact with each other, so as to determine which causal pathways are likely to explain most cases of wasting. The MWI in Nepal was specifically interested in moderate wasting. However, as communities could not differentiate causes of wasting and stunting, or the associated severity, the respondents were not asked to limit their responses to moderate wasting. Therefore, general undernutrition was considered in this setting.

The assessment was designed to be quick and easy to implement. Therefore, the number of community consultations was reduced from that required by a Link NCA (table 1) while trying to maintain the scope of thematic areas covered for it to remain relevant for the multi-sectoral analysis of nutrition determinants. The Action Against Hunger research team was comprised of one supervisor and two research assistants. The team was further supported by a community mobiliser, with technical support provided by the MWI/Action Against Hunger team both in country and remotely. The team spent a maximum of six days in each location, which included three and a half days for data collection, one day for data synthesis and analysis, and one day for community validation (table 2). Government stakeholders were involved in the assessment preparation and as respondents during data collection.

In each location, the research team conducted 10 or 11 semi-structured interviews and nine focus group discussions. Focus group discussions were with community leaders, traditional healers, health staff, representatives of local organisations, and the carers of children aged under five years.

Interview guides covering the main determinant categories of undernutrition were developed for the semi-structured interviews and focus group discussions. These categories were: health and nutrition, mental health and care practices, food security and livelihoods, WASH, and gender. The interview guides were organised by sector but included questions for each determinant within that sector. Therefore, the team had the flexibility to ask questions according to feedback from the community. A variety of visual aids were used with the objective of assisting respondents to consider various determinants of undernutrition in the study area and to categorise them in terms of importance. Seasonal and historical calendars were used to identify temporal variations in determinants and their effect on child outcomes (figure 1).

Qualitative data was recorded manually in a notebook and reproduced electronically at the end of each data collection period in a sampled location, usually at the end of each day. The data was compiled in an Excel spreadsheet organised according to the five determinant categories to allow for an efficient analysis. Synthesis sheets (figure 2) allowed all determinants to be tracked to see the frequency with which they were raised throughout the sessions. All views were analysed using qualitative content analysis methods, whereby raw data was condensed into categories or themes and coded based on valid inference and interpretation.

For each location, the teams developed pathways based on how the community explained their experiences of the key nutrition determinants. These pathways were then confirmed with the community during the validation process.

The findings produced from the Rapid NDA include a weighted matrix of nutrition determinants and a series of pathways describing how the community experiences those determinants through to illness and/or wasting. The assessment produced municipality-specific determinants and pathways. However, the scope of this article does not cover these details. Instead, it presents generalised findings to provide an example of the type of information produced.

The importance of the determinants to undernutrition are weighted twice: once through the focus group discussions and key informant interviews, and then again through the community validation. This two-stage process is important for providing a full picture of how the determinants are related to each other and to child nutrition outcomes. Figure 3 shows an example findings framework from Sunil Smriti Rural Municipality, Rolpa district. Here, while focus group discussions and key informant interview respondents rated low access to quality diet within the fourth level of importance for undernutrition, the community validation process rated it as top priority. Even when sufficient income is available for food purchases, nutritious foods are not always available in the local market and/or not prioritised for purchase. This clarifies the importance of this determinant when seeking to address the local wasting burden.

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