9.2.2 Where there is a supplementary feeding programme
Targeted supplementary feeding
There may be a targeted supplementary feeding programme (TSF) in your woreda. You looked briefly at these in Study Session 8. TSF is a programme where regular (three or six monthly) nutritional screening is done in the community followed by provision of blended food either by the health workers or food distribution agents in collaboration with the kebele administration. It is usually organised in a service package of an Enhanced Outreach Strategy and Child Health Days (EOS/CHD). Details of EOS/CHD are discussed later in this study session.
Nutritional advice to families should remain a priority, even in woredas where there is a TSF. However, long-term food security problems may affect the availability of food at home and make it harder for the family to follow your recommendations. Therefore in addition to the nutritional advice you give, targeted supplementary feeding is also usually provided for women and children with moderate acute malnutrition. In addition, people who have been discharged from a therapeutic feeding programme are also eligible for targeted supplementary feeding.
Various cereal-based blended foods are used as supplementary feed in TSF woredas. These cereal blends are composed of precooked cereals and legumes fortified with micronutrients. Commonly used blended foods in Ethiopia are Corn-Soy Blend (CSB), Famix and Unimix. In general, the composition is constituted from 79% of cereals, 20% legumes and 1% vitamins and minerals. In addition to the blended foods, edible oil is given to moderately malnourished women and children.
Supplementary feeding aims to provide the following nutrients:
- 1000-1200 Kcal with 10-15% from protein, 30-35% from fat and 50-60% from carbohydrates.
The recommended monthly ration to ensure the above nutrient intake is:
- 6-7.5 kg blended food + 0.9 gm oil + up to 0.6 gm sugar per beneficiary per month. Figure 9.2 shows a poster advertising the rations provided in a supplementary feeding programme.
For practical reasons, 25 kg of blended food is usually given to each beneficiary to use over the next three months together with three litres of oil. Usually, three or six-monthly community screenings are organised in TSF woredas following which the allocation of supplementary food will be made. Children and women with MAM during these screenings are registered and provided with a ration card to ensure they are enrolled into a TSF programme and receive the blended foods and oil. There is no specific discharge criteria in a TSF context; the regular community screenings are used to reassess the nutritional status of children and women, and decide whether they need to continue in (or join) the programme, depending on whether they fulfil the admission criteria.
How many kilos of blended food and litres of oil are given for moderately malnourished child getting TSF ration for three months?
Twenty five kilograms blended food and three litres of oil is provided for each moderately malnourished child as this is considered to provide sufficient nutrients to improve the child’s nutritional status.
Figure 9.3 is a poster showing how rations are used to produce a nutritious supplementary meal.
Supplementary feeding programme
In some woredas, NGOs undertake supplementary feeding programmes (SFPs) to provide support to moderately malnourished individuals. The main difference from the TSF is the opportunity for continuous screening and admission of new cases into supplementary feeding together with continuous follow-up of the weight gain and the condition of the moderately malnourished person. Such a close follow-up also provides an opportunity to assess why a certain child is not progressing as expected and to decide when to discharge those who continue to gain weight.
9.2.1 Where there is no supplementary feeding programme