ACF International Network
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Action Against Hunger has developed its water and sanitation expertise over nearly three decades of field work, advancing a number of solutions for populations at risk from water insecurity.
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Central to the targeting of malnutrition, Action Against Hunger extends water and sanitation improvements to communities with little or no access to proper sources.
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Action Against Hunger's programs are sustainable because of our commitment to community participation—to build local capacity and harnesses a population's energy and resources.
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Though strategies may vary, our food security interventions all share a common goal: to fight hunger by preserving and strengthening livelihoods in a sustainable and contextual manner.
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Action Against Hunger’s innovative food security programs offer a broad range of solutions for generating income, boosting food production, and strengthening livelihoods.
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Our comprehensive approach to hunger involves extending water and sanitation services to communities faced with water scarcity, unsafe drinking water, and inadequate sanitation.
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Action Against Hunger occupies a unique place among international organizations: our expertise encompasses emergency relief, longer-term development, and the terrain in between.
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We have developed an effective method to treat acute malnutrition that includes field-tested protocols and nutritional products backed by an international scientific advisory committee.
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Action Against Hunger helps rehabilitate and restock public health infrastructure, fields mobile health clinics, and trains local medical personnel on preventative and diagnostic care.
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Our comprehensive programs address the linkages between disease and malnutrition by coordinating with local expertise and strengthening existing public health systems.
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Where We Work
December 13, 2006

New Life-Saving Products Inspire New Life-Saving Protocols
While ACF's scientists revolutionized the treatment of severe malnutrition, new nutritional products now enable new approaches like home treatment
By Henry Weil

Action Against Hunger’s scientists revolutionized the treatment of severe malnutrition with our formula for F100 milk. Now, the milk’s manufacturer has developed two additional products that are equally effective. One is BP100, a biscuit, and the other is Plumpy Nut, which resembles peanut butter. Each is nutritionally similar to F100 and has proven successfully therapeutic in the field.

Both new products can be used in our Therapeutic Feeding Centers (TFCs) as a supplement and alternative to F100. Equally important, they enable families of ACF’s beneficiaries to treat dangerously undernourished children at home, which hasn’t been possible previously. Home care can only increase our effectiveness because, for diverse reasons, many beneficiaries can’t come to our TFCs for the standard therapeutic protocol.

The ideal rescue-and-rehabilitation scenario

In optimal circumstances, children suffering from severe acute malnourishment are admitted to a TFC for a three-step treatment of rescue and rehabilitation.

  • Phase 1 (two to 10 days): Stabilization. In this phase, designed to stop physical deterioration and to rebalance a patient’s physiology—particularly cardiac, digestive and immunological functions—patients are given antibiotics, antimalarial medications, vitamin A and folic acid plus F75 milk, which is easier to digest than F100.
  • Transition phase (four to 10 days): Patients are given small quantities of full-strength F100 (too much can be lethal to patients with severe acute malnutrition) until they begin to gain weight and any edemas disappear. These are swellings that are symptomatic of kwashiorkor, a deadly condition that can accompany severe acute malnutrition.
  • Phase two (two weeks): Patients on a rich diet of F100 gain weight rapidly and become healthy enough to return home.

International relief agencies have long acknowledged that this protocol works and that a restorative diet of F100 milk cuts mortality rates from 25% to 5% in children younger than five. Our protocol is now recognized as the world’s standard for nutritional rescue.

When the scenario isn’t ideal

But our protocol requires that children and their caretakers live at a TFC for a month or so, and this isn’t always possible.

  • A child’s caretaker may be needed at home to care for other children or elderly family members, to work in the field or to prepare meals.
  • TFCs may be located far from a sick child’s home—or the route may be insecure due to political conflicts—making the journey to a center impossible.
  • TFCs can be crowded and less comfortable than life at home, prompting caretakers and their children to desert.
  • Because malnourished patients have minimal resistance to infection, patients who arrive at TFCs with diseases can quickly spread their illnesses. For this reason, patients may resist coming to TFCs.
  • Sometimes families from one local culture may be reluctant to send their relatives to a TFC in a territory dominated by a different culture.

The home-care solution

Beginning with a pilot program in Sierra Leone in 2003, ACF has experimented withNew nutritional products enable new protocols, like certainallowing families to treat their malnourished children at home. Using F100 milk, however, requires dissolving packets of powder in boiling water. The water must be clean, fuel must be available, and quantities must be measured carefully. When this isn’t possible, BP100 and Plumpy Nut provide an ideal solution because they are pre-packaged and ready-to-eat.

Caveats

Other relief organizations have experimented with home care for malnutrition and have achieved a 60% cure rate—below ACF’s rate at its TFCs, which is approximately 80% (5% due to mortality and 10%-15% due to patients going home mid-treatment).

Our scientists believe that, when possible, ACF’s entire three-phase protocol shouldn’t be conducted at home. Ideally, the first two phases should be monitored constantly at a TFC—or when a TFC isn’t available, at less rigid Supplementary Feeding Centers (SFCs), which are more easily set up and as a result can be dispersed more widely. In addition, home-care patients must be older than 12 months and not affected by edemas caused by kwashiorkor on their feet, legs and head.

ACF also sends observers to patients’ homes at least once a week to monitor each home-care patient’s progress, and patients must travel to a TFC or SFC once a week for a check-up.

Success

In part because most ACF patients spend the first two phases of their treatment in a TFC or SFC, our success rate with home care has topped the rates reported by other humanitarian organizations. In Lubumbashi, Democratic Republic of Congo, and in South Sudan, for example, our programs have produced a cure rate better than 70%. “These are really, really great results,” says Marie-Sophie Simon, Technical Coordinator at ACF - USA’s headquarters.

ACF – USA plans to extend home care to our missions in Kivu, DRC, and in Kenya. Our headquarters in Paris will do likewise at missions in Afghanistan, Myanmar and Sudan. “We’re going to be more and more flexible,” says Simon. “It’s definitely the future.”