Hi,
According to my experience in emergency situation, Government with the support of WFP, distributed PlumpyDoz to all the U2 as a food supplement for children from 6 to 24 months to prevent malnutrition and micro nutrient deficiencies. These children are discharged from the preventive supplementary approach when they have 24 months. Howerver, anthropometric measurements were taken, to allow children to be referred to MAM or SAM programme in case their nutritional status was worsened.
Thanks.
Latifa

In my opinion better to use MUAC for screening because it is mostly used rapid assessment tools in emergency context and based on that we can consider whether to go for Plumpy doz or therapeutic food ie. RUTF.

According my experience in BSFP in Somalia
Blanket Supplementary Feeding Program (BSFP).
Blanket supplementary feeding program is set so as to provide a food supplement to all members of a
particular group like all children under 5 years, pregnant and lactating women.
When to implement BSFP? Usually started when 20% or more of children are malnourished or
assessment results show GAM levels of 15% or more with aggravating factors and sufficient resources
including food, personnel, and logistics are available1. In addition, when:
?? General food distribution systems are not adequately in place and/or not covering the
needs of certain vulnerable groups
?? There are problems in delivering/distributing the general ration
?? There are large numbers of mild and moderately malnourished individuals and likely
to become severe due to aggravating factors
?? There is anticipated increase in rates of malnutrition due to seasonally induced
epidemics
?? There are reported cases of micronutrient deficiency outbreaks, to provide
micronutrient-rich food to the target population
How do you select beneficiaries for BSFP? Select all children under five years or under ten year (less
than 110cm or 130 cm in height respectively), all pregnant mothers, and lactating mothers, the
chronically ill, disabled and the elderly (>60 years). The number of beneficiaries admitted in the
program will depend on availability of resources. If resources are very limited blanket feeding can be
targeted to children under 2 or 3 years old.
Food
commodity
Description Quantity/person/day
Recommended food commodities for supplementary feeding programmes
CSB/UNIMIX Both based on a cereal (usually maize), soya blend. The blend is
fortified with micronutrients each product has slightly different
micronutrient profile and suitable for malnourished children,
pregnant and lactating women.
International guidelines recommend that Sweet CSB/UNIMIX
are mixed with oil (and sugar if not already included) prior to
distribution to ensure the high energy density of the resulting
porridge. Hygiene conditions must strictly be observed during
pre-mixing and packing.
200-250g for dry ration
and between 100-150g
for wet rations.
If distributed as premix
for dry ration mix 200g
CSB+25g oil+20g sugar.
For wet ration combine
125g CSB +10g oil +10g
sugar
Supplementary
Plumpy®
New ready to use product designed specifically for the
management of moderate acute malnutrition with the similar
advantages to RUTF (Plumpynut) e.g. high energy density. Has
important logistical advantages, small risk of microbial
contamination, does not require pre-mixing and can be used at
home. Recommended for children 6 – 59 months
Give the child one sachet
(92g) to eat every day in
addition to breast milk
and other food the child
eats at home. Clean
drinking Water must be
offered with the
Supplementary Plumpy
Alternative food commodities for supplementary feeding programmes
Plumpynut® High quality fortified food that is designed for the treatment of
severe acute malnutrition. It is can be used at home without
pre-mixing and can be used as a temporary option in the
absence of a Ready to use Supplementary Food (RUSF) or
Fortified blended foods (recommended food)
Similar to RUSF, give one
sachet to eat per day.
Water must be offered
with the Plumpy Nut
BP5 This is a fortified compressed food which is eaten directly from
the package as a biscuit or can be crushed and used as porridge.
Six bars of BP5 biscuits
(330g) will provide all the
13
Can be used as a replacement for CSB/UNIMIX but not
specifically designed for this purpose, thus should not be used
as replacement for more than three months. 100g of BP5
provides minimum 458kcal,15.5g fat and 16g protein
NB: BP5 should not be provided to the severely malnourished
for more informations
https://docs.unocha.org/sites/dms/......

Thanks Abdullahi,
I read your reply and the PDF attached, seems the same. But I still did not get the answer of my question" Does it need anthropometric measurements"?

Thanks Sunil, I think the same you replied.

I think the decision for anthropometric measurement should come based on the availability of SFP/OTP. If these programs are available so there should be anthropometric measurement to introduce the eligible children to the appropriate program otherwise there is no need for the anthropometric measurement and all the children should receive Plumpy doz.

Thanks Shafiq,
No need for Anthro. measurement so how do you know this child is eligable for BSFP admission(he is not SAM or MAM)

Who are the target groups? There must be flexibility in defining and prioritizing groups depending on the context, however generally blanket SFPs target all children under five, or under age 2, or under 3 (if resources are constrained), pregnant and lactating women, adults showing signs of malnutrition and other at-risk groups (e.g., sick and older people). .

When to admit and discharge from blanket SFPs? Admission and discharge criteria for blanket SFPs do not rely on anthropometric indicators. Once the targeted groups have been defined, individuals who meet those criteria are admitted and after a specific time period or when the blanket SFP is closed all individuals are effectively “discharged”.

Hi
GAM Rate is over emergency threshold (15%), so MUAC screening is critical action to refer SAM /MAM cases to nearest CMAM center
even GAM Rate is below 5% and you implement BSFP as preventive strategy Height Anthropometric measurement must be used to identify target age groups (108 cm U5 & 96 cm U3 or 86 cm U2 for Children only)
that means Height measurement is essential tools in BSFP Program regardless there is an emergency or not
I hope this helpful

In a situation where we have the existence of CMAM Programs (SFP,OTP,SC) and the GAM rate is >15%, you can set up preventive nutrition programs apart from the GFD. Now that you want to start preventive nutrition for children <2yrs, they should be measured to know their progress and all those who are in the curative programs (OTP,SFP and SC) should be excluded unless they are graduates of MAM, because your already treating these children either under MAM or SAM.
my thoughts.

From Leah Richardson:

Save the Children has useful guidance on BSFP. See link below.

http://www.cmamforum.org/resource/980

There is also some guidance from WFP on Blanket supplementary feeding programmes (BSFP) in this document below, as well as advice on which products to use:

http://documents.wfp.org/stellent/groups/public/documents/resources/wfp247204.pdf

Best wishes,
Tamsin

In our own situation during the Ebola emergency situation; and Under the Nutrition Directorate of the Ministry of Health and Sanitation, a Six-Month Emergency plan was developed to address nutrition during the EVD Emergency. One key aspect of the plan was to implement Community-based identification of Acute Malnutrition using a “no-touch” policy. It required training caregivers in the use of standard MUAC tapes to assess the nutritional status of their children. Partners were involved and were responsible for conducting routine growth monitoring beneficiaries during the EVD Emergency using the MOHS-prescribed community-based screening protocols assisting the primary caregiver to assess her own children using the MUAC tapes.

Thanks Tamsin and all for the reply and the attached files and annexes,
I understand now better. So BSFP program is not subjected to anthropometric measurements in emergency situations. And it is good to do MUAC screening for the children not to addmit them in BSFP but to refer the SAM and MAM cases to nearby HFs.
Best

Thanks Tamsin and all for the reply and the attached files and annexes,
I understand now better. So BSFP program is not subjected to anthropometric measurements in emergency situations. And it is good to do MUAC screening for the children not to addmit them in BSFP but to refer the SAM and MAM cases to nearby HFs.
Best

From Adalbert Mena Fundi Eso:

Hi experience we have in Ethiopia Gambella region refugee's response where all nutrition implementing partners are managing BSFP activities, it is really important to conduct anthropometric measurements at least once per month for all 6-59 months admitted in BSFP. The main reason is to trace children who are deteriorating.
What we found when starting this mass screening of BSFP patients, some children were referred to OTP and major group in TSFP. To avoid this, it should be recommended to make a regular bi-weekly or monthly MUAC mass screening and W/H-Z score for all BSFP children as well as for PLW. This requires proper follow up and decision for nutrition programming coordinating agencies. Hope this information can help for the decision makers.

Thanks;

Adalbert Mena Fundi Eso

From Rachel Fuli at WFP:

The primary objective of BSFP is to prevent deterioration in nutritional status and related morbidity and mortality in members of at risk groups (children 6-23 months, 6-59 months and PLWs, TB patients) depending on resource availability or/and on the nutritional status of the target population at start. The enrolment criteria is based on age for children, pregnancy & nursing of infant < six months for women or those with chronic illness such as TB. This being the case, you do not need anthropometric criteria for admission in the programme. However, where there is OTP and/or SC in the targeted area, you conduct anthropometric measurements (MUAC and/or WFH) to screen and refer SAM cases to the appropriate programme. You may then conduct monthly anthropometry to ensure those who fall back to SAM are referred and treated. In case you did not plan for a SMART survey to assess the impact of BSFP then you compare the anthropometry at the beginning and end to assess the impact of the operation.