Gloria, what is the rationale for blanket feeding and targeted feeding to the same population in your programme?

1. To address the lack of appropriate food for children in this age group and sub-optimal feeding practises 2. give a product with high micro-nutrient content given the gaps in the current ration 3. address high GAM rates and stunting which are high in this age group. We also want to keep the SFP going since other age groups also suffer moderate malnutrition.I want to understand how this has been organized and how it has worked out in other programmes Thanks

Dear Gloria, If sub-optimal feeding practices, including shortfalls in complementary foods, are at the crux of an undernourished population of children, shouldn't interventions be targeted at this rather than short-term supplementary feeding? Interventions around infant and young child feeding may well include fortified complementary foods but should be located within a framework for infant and young child feeding that should also include strategies around maternal nutrition and health, exclusive and continued breastfeeding, and societal support to enable optimal feeding, eg working demands and conditions for mothers with young children. These sort of considerations - and concerns - are reflected in a brief dicussion paper produced by the IFE Core Group, in response to recent initiatives to address moderate malnutrition in young children, and shared with a WHO meeting on managing moderate malnutrition held in November 2008. It is available at:http://www.ennonline.net/resources/view.aspx?resid=692 Best regards Marie

Helooo all!! Thanks Marie. Agree with Marie.This is WFP is trying to do in Asia. MCHN for 6-24 mos/or 6-36 mos with essential package - including infant and young child feeding. In addition older children are included based on wt/ht and or MUAC criteria.This is currently being implemented in Timor Leste/Myanmar/Bangldesh/Cambodia. This goes with extensive education package. Rita

The local context is important to take into consideration. If the community is not involved and the coverage of the targeted SFP is low, with too long distances for mother to reach the closest SFP, I would understand a blanket feeding be considered for those households located too far from the targeted SFP sites and who are not benefiting from the targeted SFP. In some countries, a distamce has been defined beyond which the blanket is implemented, for a short period during the more at risk season. However, a strong programme on IYCF must be undertaken as well, with the community involvment

Operationally,do the blanket feeding to all but screen to identify those that are moderately malnourished and admit and manage according to SFP protocols.These should be able to run well alongside the existing Targeted SFP.Have separate patient cards to identify the two groups

With blanket SFP for children 6 to 24 months, what would be the duration or the programme or exit criteria.

I would like to encourage those implementing SFPs aimed at children in the 6-24month age range to include a sustained breastfeeding support and promotion intervention. Children in this age range still need the nutritional and immunological support offered by breastfeeding. Mothers (and perhaps more importantly - health care providers and communities) need to know that breastfeeding offers their children the best chance of surviving childhood. Young children who are not breastfed are more susceptible to diarrhoea, LRTI and a host of other infections that can compromise their health and nutritional status. It is also important to consider how it is that very young children have come to be malnourished. Often, malnutrition in the very young is a result of infection which is caused by premature introduction (ie before 6 months) of foods or fluids other than human milk or by artificial feeding with infant formula or some other milk or milk-like product. Educating communities about the importance of exclusive breastfeeding for the first six months, the dangers of giving babies anything other than human milk and providing skilled breastfeeding support to mothers is money well spent ... and likely to ameliorate the need for SFPs targetting older childen by ensuring that most children get to at least 6 months with a healthy nutritional status. Cheers Nina