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Nirmal Choradia, Kruti Gandhi, Khushboo
    Jhala, Jennifer Jones, Katie Smyrski




                                    1
DEtermination to reach a goal…

      Development and Education
           With one DEvelopment in mind…




                  to   DE
                       DEEPEN the lives of others




                                             2
Development and Education for Evolving Processes
                         in Energy and Nutrition
                                                   3
4
 Development  and Education for Evolving
 Processes in Education and Nutrition

       2 Components:

              1.) Developing a local sustainable form
              of nutritional self-sustenance for SAM
              individuals

              2.) Educating the community about how
              to live healthy, nutritional lifestyles




                                                        5
1.) There are two corresponding phases in the first
  developmental component:

     Identifying cases of Sever Acute Malnutrition in
      children and providing an instant source of nutrition
      through RUTFs

     Equipping the community to begin a local RUTFs
      production facility with primitive tools

2.) There are 3 main topics addressed in the
  second educational component:

     Home gardening
     Hygiene and sanitation
     Maternal and child health


                                                      6
A pilot study carried out in the zone of
Bale in the region of Oromiya based in
the city of Robe but directed towards a
nearby village

Why we chose Bale:
       Based on agriculture and already
        implemented irrigation systems, it is
        compliant with the infrastructure
        needed to carry out our plan making it
        feasible to build upon 2
       High prevalence of SAM cases   2




o   Upon evaluation of this pilot study, we hope
    to expand this to villages throughout the
    region




                     7
•Lack  of education is a serious
predicament resulting in
malnourishment because many are
illiterate and unknowledgeable about
nutrition, family planning, breast-
feeding and parenting

•Stat:In a specific study done on
elementary school education,
incorporation of a nutritional
education system decreased the
malnourishment rate from 36% to
29%6

•Feasibility


               8
•RUTF – Ready to Use Therapeutic
Foods
•Stat: A six-week treatment of
RUTF is generally enough to carry
a child back to healthy
development. A study has shown
that 95% of malnourished children
on this type of treatment recover
in 6 to 8 weeks. One study has
shown that RUTF is an
improvement to milk based
formulas9
•Malawi,   Bangladesh7




              9
 Project
        Coordinators will first teach the local
 head community members the background of
 SAM and how to identify cases.

    Once trained, community members will collect
     baseline data on SAM cases and post-intervention
     data on SAM cases




                                              10
The Project
Coordinators will
then begin to teach
them the background
and process of
making RUTFs using
local, sustainable
materials




       11
   WHO:
       a very low weight for height (below -3z scores of the
        median WHO growth standards), by visible severe
        wasting, or by the presence of nutritional edema5
       Target Audience: Children under age 5 showing these
        symptoms
       Tape measure and scale provided by the program




                                                       12
 What   the program provides:
  A production facility
  Containers and churners
  oil press
  CMV (vitamin) tablets
  Bee harvesting facility
  Goats
  Seeds
  Solvatten
 *don’t be alarmed, yes, we did think about the
   cost-analysis. (shown later).

                                            13
Common             New Formulation10
  Formulation10    Goat Milk
Milk Powder        Honey
Sugar              Safflower Oil
Vegetable Oil      Vitamins/Minerals
Vitamin/Minerals   Peanut Butter
Peanut Butter




                                14
 Solar-powered
  water filtration
 Up to 10 gallons of
  purified water
  every 4 hours
 Cheap - $35 per
  system
 Lasts for up to 5
  years11


                        15
 What      is provided by NGO partnerships:

    MERLIN: Project Coordinators
        Language, established with Ethiopian government
    Heifer: goats
    Peace Corps: Bee harvesting techniques
    Nutriset: Vitamin and mineral supplements
    Helen Keller Institute: Seeds
    The Hunger Project: health and nutrition basis
     for women




                                                     16
 Cultural   issues:
     Bale is a predominantly Muslim and Christian region
     We did not find any religious or ethical conflicts
      with the process of this program
     The food could be incorporated with local tribe
      food such as porridge to alleviate possible bad
      taste8


 Legal/ethical    issues:
     By working through the already established NGOs,
      legal issues of imposing on territory without
      permission would be circumvented
     All the patents on RUTF production have either
      been nullified or expired

                                               17
 Toprevent excessive unsanitary practices
 within the RUTF production process, a
 separate facility aside from the actual village
 residences will be built

 Some  individuals have disliked the taste of
 the nutritional paste. A common practice to
 circumvent this problem is mixing it with a
 local food –porridge, which has shown to
 work


                                         18
 Itis a sustainable program in which even
  after the 1 million dollars is gone, the
  program can still retain its infrastructure and
  process within the village
      Regeneration of food – fuels the internal
       economy




                                                   19
SWOT Analysis
                            D.E.E.P.E.N.
(Development & Education for Evolving Processes in Energy & Nutrition)
               STRENGTHS                                      WEAKNESSES
•Cost-effective compared to in-patient          •Time constraint (wait for crops to grow)
treatment
•Community involvement: self-efficacy           •Cultural values: women tend to be shy
•High rate of women’s participation during      •Technology (Oil Press) very laborious to
program formulation                             operate, design not appropriate for women
•Multi-dimensional approach

            OPPORTUNITIES                                         THREATS
•Improve delivery turnaround (nutrition)        •Limited funds
•Conduct a baseline study                       •Non-compliance
•Ministry of Agriculture, Food, and Fisheries   •Program affected by displacement of
gender focal point to provide support           people/livestock due to droughts/floods
•Educational advancements                       •Program affected by HIV/AIDS/diseases
•Job opportunities

                                                                        20
 Home    Base Cost:
    2 Project Managers – $80,000
    Electronics and Office Space – $9,000
    Transportation – $19,000
 Cost   Per Village:
    RUTF Starter Ingredients – $4140
    Clean water – $2,100
    Production facility – $16,000
    Other – $2,000

 Total: $132,240 for 1 village
                                             21
 Home    Base Cost:
    2 Project Managers – $80,000 per year
    Electronics and Office Space – $7,000
    Transportation – $4,000
 Cost   for Village
    CMV - $150




                                             22
I am
 ambitious
                   powerful
                   I am
                   determined
                        I am.
                    Beautiful
resilient
I am Imaginative
                         23
1.Photo
http://images.google.com/imgres?imgurl=http://www.runforwater.ca/images/media/Ethiopia_children2_Mark_Cho
w.jpg&imgrefurl=http://www.runforwater.ca/Media/PhotoDownloads.html&usg=__bd-zzHbp7UDFg4v4S7M_-
WC7zGk=&h=2056&w=3090&sz=2905&hl=en&start=18&um=1&itbs=1&tbnid=VtucGRIsvilnxM:&tbnh=100&tbnw=
150&prev=/images%3Fq%3DEthiopia%2Bchildren%26um%3D1%26hl%3Den%26rlz%3D1C1CHNG_enUS351U
S351%26gbv%3D2%26tbs%3Disch:1
2. Bale information
http://www.ocha-eth.org/Reports/downloadable/GoroBaleSNNPRFinalConcernFeb06.pdf
3. Photo 2
http://andybraner.typepad.com/.a/6a00e54ed0df52883301157249b4b9970b-800wi
4. Photo 3
http://www.runfororomia.com/images/oromia2.gif
5. Case definition of SAM
http://whqlibdoc.who.int/hq/1999/a57361.pdf
6. Nutritional fact education works
http://www.jstor.org/stable/994185?seq=7




                                                                                         24
7. Bangladesh
Hossain et. Al. Experience in Managing Severe Malnutrition in a
Government Tertiary Treatment Facility in Bangladesh. J Health Pop
Nature. Feb 2009.

8. Porridge
http://www.compactforlife.com/bp-100-rutf-how-to-use/

9. RUTF works
http://www.worlded.org/WEIInternet/gwe/index.cfm

10. RUTF formulation
http://fex.ennonline.net/102/4-3-2.aspx

11. Water
http://www.solvation.se/


                                                           25
26
NCHS/WHO normalized reference values for
  weight-for-height and weight-for-length




                                            27
•   Vitamin A Supplementation program- design, implement and monitor programs
    that deliver vitamin A to young children and to new mothers. Also promote
    consumption of Vitamin A enriched foods.

•   Homestead Food Production- increasing local food production systems by
    creating gardens and poultry and livestock farms. Provides support as well as
    start-up supplies.

•   Food Fortification and Biofortification- developing packets to distrubute to
    families to add supplements to foods being prepared in the home. Also
    working on fortifying the plants that are being grown.

•   Managing Acute Malnutrition- uses existing community structures and trains
    community to identify cases of SAM. Uses inpatient for severe cases, and
    outpatient such as RUTFs.

•   Essential Nutrition Actions- breastfeeding promotion, prenatal nutrition,
    iodine use, edema control, etc.

•   http://www.hki.org/reducing-malnutrition/




                                                                         28
•   Nutrition Surveillance and Data Collection

•   Pilot program initiated in two villages in Sudan in 1992. Aimed at training
    local community members how to do nutrition surveillance and
    socioeconomic analysis of women and children. Taught individuals how to
    collect basic anthropometrics, food consumption data, market
    conditions, and changes in family norms. Collected data every three
    months.

•   Results of this Pilot Program: Had succeeding in their main objectives.
    Showed that community-based nutrition surveillance was cost effective.
    Involving the community ensured sustainability.

•   We should implement a training program similar to this one in Sudan.
    Train local people to do the data collection. Had outside data analyst to
    help with nutrition surveillance and analysis. This will help us monitor
    and evaluate the effectiveness of our program.

•   http://www.emro.who.int/Publications/EMHJ/0202/07.htm



                                                                     29
   Merlin: international organization that focuses on
    improving health care systems in impoverished nations.
    Partnered with the Ethiopian Government to help improve
    the nutrition of the country. Includes water collection and
    sanitation, nutritional education and health promotion.
       Merlin established a nutrition program in the Bale region in Oromiya to combat
        the problem of severe malnutrition.
       http://www.merlin.org.uk/Where-we-work/Ethiopia.aspx

   Heifer International: helps fight world hunger through
    community involvement. Provides livestock to families that
    can not regularly afford such luxuries.
       Offices in the near-by countries of Rwanda and Tanzania
       http://www.heifer.org




                                                                             30
   Peace Corps: developed to help lesser developed countries
    educate their people. Volunteers are trained with a
    specific skill, then go into a country and teach their skill to
    the local people.
       Past project in Malawi included teaching local how to properly harvest beehive
        for the production of honey
       Peace Corps currently have a HIV/AIDS education projects located in Ethiopia
       http://www.peacecorps.gov/index.cfm?shell=learn.whatvol.env.sampleprojects

   Nutriset: focus is on providing developing countries with
    vitamins and nutrients that they lack
       Collaborates with such organizations at PlumpyField and Edesia
       Provides vitamins and minerals to help establish RUTF production




                                                                             31

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Group 5

  • 1. Nirmal Choradia, Kruti Gandhi, Khushboo Jhala, Jennifer Jones, Katie Smyrski 1
  • 2. DEtermination to reach a goal… Development and Education With one DEvelopment in mind… to DE DEEPEN the lives of others 2
  • 3. Development and Education for Evolving Processes in Energy and Nutrition 3
  • 4. 4
  • 5.  Development and Education for Evolving Processes in Education and Nutrition 2 Components: 1.) Developing a local sustainable form of nutritional self-sustenance for SAM individuals 2.) Educating the community about how to live healthy, nutritional lifestyles 5
  • 6. 1.) There are two corresponding phases in the first developmental component:  Identifying cases of Sever Acute Malnutrition in children and providing an instant source of nutrition through RUTFs  Equipping the community to begin a local RUTFs production facility with primitive tools 2.) There are 3 main topics addressed in the second educational component:  Home gardening  Hygiene and sanitation  Maternal and child health 6
  • 7. A pilot study carried out in the zone of Bale in the region of Oromiya based in the city of Robe but directed towards a nearby village Why we chose Bale:  Based on agriculture and already implemented irrigation systems, it is compliant with the infrastructure needed to carry out our plan making it feasible to build upon 2  High prevalence of SAM cases 2 o Upon evaluation of this pilot study, we hope to expand this to villages throughout the region 7
  • 8. •Lack of education is a serious predicament resulting in malnourishment because many are illiterate and unknowledgeable about nutrition, family planning, breast- feeding and parenting •Stat:In a specific study done on elementary school education, incorporation of a nutritional education system decreased the malnourishment rate from 36% to 29%6 •Feasibility 8
  • 9. •RUTF – Ready to Use Therapeutic Foods •Stat: A six-week treatment of RUTF is generally enough to carry a child back to healthy development. A study has shown that 95% of malnourished children on this type of treatment recover in 6 to 8 weeks. One study has shown that RUTF is an improvement to milk based formulas9 •Malawi, Bangladesh7 9
  • 10.  Project Coordinators will first teach the local head community members the background of SAM and how to identify cases.  Once trained, community members will collect baseline data on SAM cases and post-intervention data on SAM cases 10
  • 11. The Project Coordinators will then begin to teach them the background and process of making RUTFs using local, sustainable materials 11
  • 12. WHO:  a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional edema5  Target Audience: Children under age 5 showing these symptoms  Tape measure and scale provided by the program 12
  • 13.  What the program provides:  A production facility  Containers and churners  oil press  CMV (vitamin) tablets  Bee harvesting facility  Goats  Seeds  Solvatten *don’t be alarmed, yes, we did think about the cost-analysis. (shown later). 13
  • 14. Common New Formulation10 Formulation10 Goat Milk Milk Powder Honey Sugar Safflower Oil Vegetable Oil Vitamins/Minerals Vitamin/Minerals Peanut Butter Peanut Butter 14
  • 15.  Solar-powered water filtration  Up to 10 gallons of purified water every 4 hours  Cheap - $35 per system  Lasts for up to 5 years11 15
  • 16.  What is provided by NGO partnerships:  MERLIN: Project Coordinators  Language, established with Ethiopian government  Heifer: goats  Peace Corps: Bee harvesting techniques  Nutriset: Vitamin and mineral supplements  Helen Keller Institute: Seeds  The Hunger Project: health and nutrition basis for women 16
  • 17.  Cultural issues:  Bale is a predominantly Muslim and Christian region  We did not find any religious or ethical conflicts with the process of this program  The food could be incorporated with local tribe food such as porridge to alleviate possible bad taste8  Legal/ethical issues:  By working through the already established NGOs, legal issues of imposing on territory without permission would be circumvented  All the patents on RUTF production have either been nullified or expired 17
  • 18.  Toprevent excessive unsanitary practices within the RUTF production process, a separate facility aside from the actual village residences will be built  Some individuals have disliked the taste of the nutritional paste. A common practice to circumvent this problem is mixing it with a local food –porridge, which has shown to work 18
  • 19.  Itis a sustainable program in which even after the 1 million dollars is gone, the program can still retain its infrastructure and process within the village  Regeneration of food – fuels the internal economy 19
  • 20. SWOT Analysis D.E.E.P.E.N. (Development & Education for Evolving Processes in Energy & Nutrition) STRENGTHS WEAKNESSES •Cost-effective compared to in-patient •Time constraint (wait for crops to grow) treatment •Community involvement: self-efficacy •Cultural values: women tend to be shy •High rate of women’s participation during •Technology (Oil Press) very laborious to program formulation operate, design not appropriate for women •Multi-dimensional approach OPPORTUNITIES THREATS •Improve delivery turnaround (nutrition) •Limited funds •Conduct a baseline study •Non-compliance •Ministry of Agriculture, Food, and Fisheries •Program affected by displacement of gender focal point to provide support people/livestock due to droughts/floods •Educational advancements •Program affected by HIV/AIDS/diseases •Job opportunities 20
  • 21.  Home Base Cost:  2 Project Managers – $80,000  Electronics and Office Space – $9,000  Transportation – $19,000  Cost Per Village:  RUTF Starter Ingredients – $4140  Clean water – $2,100  Production facility – $16,000  Other – $2,000 Total: $132,240 for 1 village 21
  • 22.  Home Base Cost:  2 Project Managers – $80,000 per year  Electronics and Office Space – $7,000  Transportation – $4,000  Cost for Village  CMV - $150 22
  • 23. I am ambitious powerful I am determined I am. Beautiful resilient I am Imaginative 23
  • 24. 1.Photo http://images.google.com/imgres?imgurl=http://www.runforwater.ca/images/media/Ethiopia_children2_Mark_Cho w.jpg&imgrefurl=http://www.runforwater.ca/Media/PhotoDownloads.html&usg=__bd-zzHbp7UDFg4v4S7M_- WC7zGk=&h=2056&w=3090&sz=2905&hl=en&start=18&um=1&itbs=1&tbnid=VtucGRIsvilnxM:&tbnh=100&tbnw= 150&prev=/images%3Fq%3DEthiopia%2Bchildren%26um%3D1%26hl%3Den%26rlz%3D1C1CHNG_enUS351U S351%26gbv%3D2%26tbs%3Disch:1 2. Bale information http://www.ocha-eth.org/Reports/downloadable/GoroBaleSNNPRFinalConcernFeb06.pdf 3. Photo 2 http://andybraner.typepad.com/.a/6a00e54ed0df52883301157249b4b9970b-800wi 4. Photo 3 http://www.runfororomia.com/images/oromia2.gif 5. Case definition of SAM http://whqlibdoc.who.int/hq/1999/a57361.pdf 6. Nutritional fact education works http://www.jstor.org/stable/994185?seq=7 24
  • 25. 7. Bangladesh Hossain et. Al. Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh. J Health Pop Nature. Feb 2009. 8. Porridge http://www.compactforlife.com/bp-100-rutf-how-to-use/ 9. RUTF works http://www.worlded.org/WEIInternet/gwe/index.cfm 10. RUTF formulation http://fex.ennonline.net/102/4-3-2.aspx 11. Water http://www.solvation.se/ 25
  • 26. 26
  • 27. NCHS/WHO normalized reference values for weight-for-height and weight-for-length 27
  • 28. Vitamin A Supplementation program- design, implement and monitor programs that deliver vitamin A to young children and to new mothers. Also promote consumption of Vitamin A enriched foods. • Homestead Food Production- increasing local food production systems by creating gardens and poultry and livestock farms. Provides support as well as start-up supplies. • Food Fortification and Biofortification- developing packets to distrubute to families to add supplements to foods being prepared in the home. Also working on fortifying the plants that are being grown. • Managing Acute Malnutrition- uses existing community structures and trains community to identify cases of SAM. Uses inpatient for severe cases, and outpatient such as RUTFs. • Essential Nutrition Actions- breastfeeding promotion, prenatal nutrition, iodine use, edema control, etc. • http://www.hki.org/reducing-malnutrition/ 28
  • 29. Nutrition Surveillance and Data Collection • Pilot program initiated in two villages in Sudan in 1992. Aimed at training local community members how to do nutrition surveillance and socioeconomic analysis of women and children. Taught individuals how to collect basic anthropometrics, food consumption data, market conditions, and changes in family norms. Collected data every three months. • Results of this Pilot Program: Had succeeding in their main objectives. Showed that community-based nutrition surveillance was cost effective. Involving the community ensured sustainability. • We should implement a training program similar to this one in Sudan. Train local people to do the data collection. Had outside data analyst to help with nutrition surveillance and analysis. This will help us monitor and evaluate the effectiveness of our program. • http://www.emro.who.int/Publications/EMHJ/0202/07.htm 29
  • 30. Merlin: international organization that focuses on improving health care systems in impoverished nations. Partnered with the Ethiopian Government to help improve the nutrition of the country. Includes water collection and sanitation, nutritional education and health promotion.  Merlin established a nutrition program in the Bale region in Oromiya to combat the problem of severe malnutrition.  http://www.merlin.org.uk/Where-we-work/Ethiopia.aspx  Heifer International: helps fight world hunger through community involvement. Provides livestock to families that can not regularly afford such luxuries.  Offices in the near-by countries of Rwanda and Tanzania  http://www.heifer.org 30
  • 31. Peace Corps: developed to help lesser developed countries educate their people. Volunteers are trained with a specific skill, then go into a country and teach their skill to the local people.  Past project in Malawi included teaching local how to properly harvest beehive for the production of honey  Peace Corps currently have a HIV/AIDS education projects located in Ethiopia  http://www.peacecorps.gov/index.cfm?shell=learn.whatvol.env.sampleprojects  Nutriset: focus is on providing developing countries with vitamins and nutrients that they lack  Collaborates with such organizations at PlumpyField and Edesia  Provides vitamins and minerals to help establish RUTF production 31