Milk and malnutrition after ‘Sendong’

More than 40 days after the onslaught of floods brought on by Tropical Storm “Sendong,” there are good news and bad news.

The good news, as reported by Social Welfare Secretary Dinky Soliman in my column last Wednesday, is that survivors in Cagayan de Oro and Iligan City and environs are, as they say, “moving on.” Some families previously living in cramped and overcrowded evacuation centers can look forward to moving into their own houses in safe areas. Mental health professionals are being recruited to help with the mental, emotional and spiritual recovery of those traumatized by the disaster, especially the children. In short, in the affected areas, response has moved on from recovery and relief to rehabilitation and rebuilding.

But the bad news, according to Unicef, is that malnutrition among children in the affected areas “has increased significantly and raises concern.” During the latest screening supported by Unicef, 207 children were found to be acutely malnourished, a 50-percent increase compared to the initial screening carried out during the early days following the floods. (Although Unicef notes that the sample size used was small.)

Sendong, it seems, only made a bad situation worse. “Malnutrition is an especially serious concern for Mindanao, where a significant number of children are already undernourished. Sendong dealt an additional blow to these children’s health. That is why we need to keep a close eye on the situation of these vulnerable young children,” Dr. Abdul Alim, Unicef Philippines’ representative, says.

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“During emergencies such as floods, families who have lost loved ones and homes also lose their ability to get adequate nutritious food and also the means to prepare healthy meals,” notes Unicef. “The increase in malnutrition rates may be attributed to this compromised food supply and the food quality of families who are now displaced. For infants, an exacerbating factor is the widespread donations of powdered milk, which undermines breastfeeding, leading to a loss of the protective nutrients found in breast milk. Lack of exclusive breastfeeding puts babies’ health in jeopardy, because of the increased risk of diarrhea and other infections. Globally, an infant not breastfed is six times more likely to die.”

From my own personal experience, bottle-feeding with the use of powdered infant formula is fraught with risks. One needs access to a reliable supply of potable water and of fuel needed to boil it. The bottles and nipples need to be sterilized by boiling them. And the sterilized supplies and powdered milk itself must be kept safe from contamination. Even when the formula has been prepared properly, many things can make the milk unsafe: flies and other insects flitting on the bottles, bottles being dropped repeatedly on dirty floors, unclean hands handling the water, supplies and milk.

Or as a Unicef guide states: “Babies who are not breastfed are vulnerable to infection and to developing diarrhea. Babies with diarrhea easily become malnourished and dehydrated and so are at real risk of death.”

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Not only babies are vulnerable. Children under five years, says Unicef, especially those under two years, “are also at risk of increased illness and death in emergencies. Breastfeeding still protects these children and the WHO recommends that breastfeeding be continued until at least two years of age. Young children also need enough nourishing food that is safely prepared—this too can be a real challenge in an emergency.”

This brings us to the problem of donations of powdered formula or milk, which are among the first and most common items sent in response to disasters. “In the confusion that surrounds emergencies, these products are often distributed in an uncontrolled way and used by mothers who would otherwise breastfeed their babies,” says Unicef, adding that indiscriminate use of donated milk “results in unnecessary illness and death for infants.”

An investigation of the post-flood death of more than 500 children in Botswana in 2005-2006 found that nearly all the babies who died were formula-fed. The risk of hospitalization for babies who were not breastfed was 50 times greater than that of breastfed infants.

Precautions needed for bottle-fed infants likewise apply to young children. The water used to mix the milk must be safe and potable, and the cups and glasses used must be clean. Otherwise, the children run the risk of falling ill from diarrhea and other water-borne diseases.

What an awful realization for donors who believed that donations of milk to disaster survivors would alleviate children’s hunger and improve their health!

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Worse, says Unicef, some milk marketers may even use an emergency, such as the post-Sendong situation, “to enter new markets and increase sales.” Already, the Department of Health has issued a cease-and-desist order to a major milk manufacturer which was including its own infant and child milk formula brands to relief goods for distribution, in violation of Milk Code rules that prevent them from giving samples to the public.

Thus, Unicef appeals to the public who may want to donate milk to Sendong survivors not to give the milk directly to affected populations, but rather give the milk to the appropriate authority, such as the DOH, so that distribution of the milk can be carefully managed.

Meanwhile, Unicef suggests that mothers who are breastfeeding “should be given support and practical assistance to continue.” While mothers who have stopped breastfeeding completely “should be encouraged to restart breastfeeding, and the option of wet nursing (where another mother breastfeeds the baby) should be explored for babies without mothers.”