The causes of malnutrition are multifaceted. Understanding these causes is critical to developing an appropriate response. High malnutrition rates are the consequence of inadequate dietary intake and/or disease. Factors contributing to inadequate dietary intake and disease can include inadequate household food security, inadequate maternal and child care, insufficient services, and an unhealthy environment. The root causes of malnutrition can ultimately be traced to the policies of broad formal and nonformal institutions, political, economic, and ideological structures, and potential resources.
If the causes of malnutrition are due to food availability, suggested interventions include: general food distributions; supplementary feeding programs (SFPs) to children under 5 years in age and pregnant and lactating women; community-based therapeutic programs (CTCs); and therapeutic feeding centers (TFCs). In addition, agriculture, livestock, and livelihood programs that will increase food availability must be initiated to have a long-term impact on the food security of the population.
If food access is causing high malnutrition rates, the type of intervention depends on the extent of the problem within the population. If the whole population does not have access to food, appropriate measures include: food for work or general food distribution; blanket supplementary feeding for the under-5 age group and pregnant and lactating women; and CTC and TFC as appropriate. If only parts of the population do not have access to food, food distribution should be targeted to vulnerable groups, focused SFPs can be initiated (ensure that the families of children in SFP are included in the program), and CTC and TFC can be started as appropriate.
If food is available on the market, cash can be provided to families to access this food. This will keep market prices stable and protect the livelihood of food producers. A targeted SFP can be initiated (ensure that the families of these children are included in the cash program), as well as a CTC and TFC if appropriate.
If food utilization by the body is inadequate, programs that address water, sanitation, and health, including child feeding practices, must be initiated.
Regardless of the causes of malnutrition, the gains made by the initiation of CTC and TFC in the absence of a functional health system are short lived. The health system must be able to provide vaccinations and preventative, as well as curative, services. Water and sanitation also play a vital role in the health and nutritional status of the general population, particularly the under-5 age group.
The types of feeding programs required to meet the food security needs of the displaced people will be determined by the initial needs assessment (see chapter II). Continuous monitoring will ensure adjustments to reflect changing conditions. Coordination of the feeding programs with health and other community services is essential.
Assistance must be culturally acceptable and appropriate to the nutritional needs of the displaced people. Foods prepared locally with local ingredients are preferable to imported foods. Infant feeding policies require particular attention.
Infants, children, pregnant and lactating women, the sick, and the elderly are very vulnerable to malnutrition and have special needs. Since the population has already probably suffered a prolonged food shortage, many will be malnourished by the time of the first assessment of their condition and needs.
If the displaced people are already suffering the effects of severe food shortages, immediate action must be taken to provide whatever food is available to them. The first priority is to meet the energy requirements of the population rather than protein needs. Supplying bulk cereal is the first objective of the general feeding program.
Beneficiaries must be involved from the start in the organization and management of the feeding programs. Special training for some displaced people may be necessary.
Simple nutrition education is important when unfamiliar foods or new methods of cooking and preparation have to be introduced to the population. Nutrition education should be organized with other health education activities to provide guidance on proper infant feeding, feeding of sick children, treatment of diarrhea, basic food hygiene, and the preparation of available foods for maximum nutritional benefit.
Particular attention must be paid to the provision of cooking fuel. A lack of cooking fuel can quickly lead to destruction of the vegetation around the camp and friction with the local population. On average, a family will use 5 kg of wood per day to cook on a simple wood stove.