Food security - food transfers standard 1: General nutrition requirements
Ensure the nutritional needs of the disaster-affected population, including those most at risk, are met.
Key actions (to be read in conjunction with the guidance notes)
Use levels of access to adequate quantity and quality of food to determine if the situation is stable or is likely to decline (see guidance notes 1, 4–5).
Design food transfers on the basis of the standard initial planning requirements for energy, protein, fat and micronutrients, adjusted as necessary to the local situation (see key indicators, guidance note 2 and Appendix 6: Nutritional requirements).
Ensure the population’s access to appropriate nutritious foods and nutritional support is protected, promoted and supported (see guidance notes 3–8).
Ensure children aged 6–24 months have access to nutritious, energy-dense complementary foods and pregnant and breastfeeding women have access to additional nutritional support (see guidance note 2).
Ensure households with chronically ill members, including PLHIV, and members with specific impairments or vulnerabilities have access to appropriate nutritious food and adequate nutritional support (see guidance notes 6–8).
Key indicators (to be read in conjunction with the guidance notes)
There is adequate access to a range of foods, including a staple (cereal or tuber), pulses (or animal products) and fat sources, that together meet nutritional requirements (see guidance notes 2–3, 5).
There is adequate access to iodised salt for the majority (>90 per cent) of households (see guidance notes 2–4 and Appendix 6: Nutritional requirements).
There is adequate access to additional sources of niacin (e.g. pulses, nuts, dried fish) if the staple is maize or sorghum (see guidance notes 2–3 and Appendices 5: Measures of the public health significance of micronutrient deficiencies and 6: Nutritional requirements).
There is adequate access to additional sources of thiamine (e.g. pulses, nuts, eggs) if the staple is polished rice (see guidance notes 2–3).
There is adequate access to adequate sources of riboflavin where people are dependent on a very limited diet (see guidance notes 2–3).
There are no cases of scurvy, pellagra, beriberi or riboflavin deficiency (see Guidance note 5 and Appendix 5: Measures of the public health significance of micronutrient deficiencies).
The prevalence of Vitamin A deficiency, iron deficiency anaemia and iodine deficiency disorders are not of public health significance (see guidance note 5 and Appendix 5: Measures of the public health significance of micronutrient deficiencies).
- Interpreting access to food: Access to food can be measured by analytical tools such as the food consumption score or dietary diversity tools. Approaches that consider a number of variables including food security, access to markets, livelihoods, health and nutrition may be appropriate to determine if the situation is stable or declining and if food interventions are necessary (see Food security and nutrition assessment standard 1).
- Nutritional requirements and ration planning: The following estimates for a population’s minimum requirements should be used for planning general rations, with the figures adjusted for each population as described in Appendix 6: Nutritional requirements:
- 2,100 kcals/person/day by fat
- 10 per cent of total energy provided by proteinby fat
- 17 per cent of total energy provided by fat
- adequate micronutrient intake.
If a ration is designed to provide all the energy content of the diet, then it must contain adequate amounts of all nutrients. If a ration is intended to provide only part of the energy requirement of the diet, then it can be designed using one of two approaches. If the nutrient content of the other foods available to the population is unknown, the ration should be designed to provide a balanced nutrient content that is proportional to the energy content of the ration. If the nutrient content of the other foods available to the population is known, the ration may be designed to complement these foods by filling nutrient gaps. The average planning figures for general rations take into account the additional needs of pregnant and breastfeeding women. Adequate and acceptable food for young children should be included in the general ration, such as fortified blended food (see Infant and young child feeding standard 2). Equity should be ensured so that similar food rations are provided to similarly affected populations and population sub-groups. Planners should be aware that different ration scales in adjacent communities may cause tension. Ingestion of excessive amounts of micronutrients can be harmful and ration planning needs to consider this especially if several different fortified food products are to be included.
- Preventing acute malnutrition and micronutrient deficiencies: If the key food indicators are met, then deterioration of the nutrition status of the general population should be prevented, provided adequate public health measures are also in place to prevent diseases such as measles, malaria and parasitic infection (see Essential health services - control of communicable diseases standard 1 and standard 2). Ensuring the adequate nutrient content of food aid rations may be challenging in situations where there are limited food types available. Options for improving the nutritional quality of the ration include fortification of staple commodities, inclusion of fortified blended foods, inclusion of locally purchased commodities to provide missing nutrients and/or use of food supplementation products such as lipid-based, nutrient-dense, ready-to-use foods or multiple micronutrient tablets or powders. These products may be targeted at vulnerable individuals such as children aged 6–24 or 6–59 months or pregnant and breastfeeding women. Exceptionally, where nutrient-rich foods are available locally, increasing the quantity of food in a general ration to allow more food exchanges may be considered, but cost-effectiveness and impact on markets must be taken into account. Other options that may also be considered for the prevention of micronutrient deficiencies include food security measures to promote access to nutritious foods (see Food security and nutrition assessment standard 1 and Food security–livelihoods standards 1 and standards 2). Micronutrient losses, which can occur during transport, storage, processing and cooking, and the bioavailability of the different chemical forms of the vitamins and minerals should be taken into account.
Monitoring utilisation of food rations: The key indicators address access to food but do not quantify food utilisation or nutrient bioavailability. Direct measurement of nutrient intake would impose unrealistic requirements for information collection. However, utilisation may be estimated indirectly using information from various sources. These sources might include monitoring food availability and use at the household level, assessing food prices and food availability in local markets, examining food aid distribution plans and records, assessing any contribution of wild foods and conducting food security assessments. Food allocation within households may not always be equitable and vulnerable people may be particularly affected, but it is not usually feasible to measure these aspects. Appropriate distribution mechanisms (see Food security–food transfers standard 5), the choice of food and discussion with the affected population may help contribute to improved food allocation within households (see Core Standard 1).
- Older people can be particularly affected by disasters. Risk factors which reduce access to food and can increase nutrient requirements include disease and disability, isolation, psychosocial stress, large family size, cold and poverty. Older people should be able to access food sources (including food transfers) easily. Foods should be easy to prepare and consume and should meet the additional protein and micronutrient requirements of older people.
- People living with HIV may face greater risk of malnutrition as a result of a number of factors. These include reduced food intake due to appetite loss or difficulties in eating, poor absorption of nutrients due to diarrhoea, parasites or damage to intestinal cells, changes in metabolism, and chronic infections and illness. The energy requirements of PLHIV increase according to the stage of the infection. PLHIV need to ensure that they keep as well nourished and healthy as possible to delay the onset of AIDS. Milling and fortification of food or provision of fortified, blended or specialist food supplements are possible strategies for improving access to an adequate diet. In some situations it may be appropriate to increase the overall size of any food ration. Consideration should be given to the provision of anti-retroviral therapy (ART) and the supportive role nutrition may play in tolerance and adherence to this treatment.
Persons with disabilities: Disabled individuals may be at particular risk of being separated from immediate family members and usual caregivers in a disaster. They also may face discrimination affecting food access. Efforts should be made to determine and reduce these risks by ensuring physical access to food, developing mechanisms for feeding support (e.g. provision of spoons and straws, developing systems for home visiting or outreach) and ensuring access to energy-dense and nutrient-dense foods. Specific nutritional risks include difficulties in chewing and swallowing (leading to reduced food intake and choking), inappropriate position or posture when feeding, reduced mobility affecting access to food and sunlight (affecting Vitamin D status), and constipation, which may for example affect individuals with cerebral palsy.
- Caregivers and those they are caring for may face specific nutritional barriers, e.g. they may have less time to access food because they are ill or caring for the ill, they may have a greater need to maintain hygienic practices which may be compromised, they may have fewer assets to exchange for food due to the costs of treatment or funerals and they may face social stigma and reduced access to community support mechanisms. It is important that caregivers be supported and not undermined in the care of vulnerable individuals; support offered should address feeding, hygiene, health and psychosocial support and protection. Existing social networks can be used to provide training to selected members of the population to take on responsibilities in these areas (see Protection Principle 4).