3

Summary and Recommendations

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The CIN was asked to provide an estimated mean per capita energy requirement (EMPCER) that can be used to expedite decisions about the immediate purchasing and shipping of food rations in emergency situations. It is applicable in situations in which nothing is known except the estimate of the total number of people involved, and no other food is available. When the population has access to food from other sources, the amount of food required to meet the EMPCER should be adjusted accordingly.

The committee's EMPCER (calculated at 2,076 kcal [8.7 MJ]/day, and rounded up to 2,100 kcal [8.8 MJ]/day) falls within a wider range of scientifically justifiable EMPCERs, ranging from 1,900 to 2,500 kcal [7.9 to 10.5 MJ]). This range depends on a number of factors that influence the EMPCER. The committee concluded that there would usually be some information about the most important of these, even in the earliest stages of an emergency. This information should be used to modify the EMPCER at the earliest opportunity.

The committee is aware that a number of international agencies also have come to the decision that EMPCERs should be based on algorithms very similar to those proposed by the committee, that consider the most important factors affecting energy requirements. These agencies are currently negotiating among themselves to arrive at a unified process for calculating the EMPCER in different situations. The CIN endorses these efforts to adopt a universally agreed-upon algorithm or value, and urges USAID to assist this process.

There are also situations where a single, universally-agreed-upon number is necessary, for example, in emergency situations in which nothing is known ex-



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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations 3 Summary and Recommendations ◆ ◆ ◆ ◆ ◆ The CIN was asked to provide an estimated mean per capita energy requirement (EMPCER) that can be used to expedite decisions about the immediate purchasing and shipping of food rations in emergency situations. It is applicable in situations in which nothing is known except the estimate of the total number of people involved, and no other food is available. When the population has access to food from other sources, the amount of food required to meet the EMPCER should be adjusted accordingly. The committee's EMPCER (calculated at 2,076 kcal [8.7 MJ]/day, and rounded up to 2,100 kcal [8.8 MJ]/day) falls within a wider range of scientifically justifiable EMPCERs, ranging from 1,900 to 2,500 kcal [7.9 to 10.5 MJ]). This range depends on a number of factors that influence the EMPCER. The committee concluded that there would usually be some information about the most important of these, even in the earliest stages of an emergency. This information should be used to modify the EMPCER at the earliest opportunity. The committee is aware that a number of international agencies also have come to the decision that EMPCERs should be based on algorithms very similar to those proposed by the committee, that consider the most important factors affecting energy requirements. These agencies are currently negotiating among themselves to arrive at a unified process for calculating the EMPCER in different situations. The CIN endorses these efforts to adopt a universally agreed-upon algorithm or value, and urges USAID to assist this process. There are also situations where a single, universally-agreed-upon number is necessary, for example, in emergency situations in which nothing is known ex-

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations cept the estimated number of people involved. The committee urges USAID to assist in developing this number. Negotiating the number must take many biological, epidemiologic, political, and feasibility factors into consideration. Below, we present the biological considerations. The committee's EMPCER of 2,100 kcal/day would cover the energy needs of a “typical” population requiring emergency food aid in a developing country, assuming: (1) the population is distributed as indicated in the World Population Profile 1994 report for developing countries; (2) the average height of adult males is 170 cm and of adult females is 155 cm, which are the approximate heights of average males and females in sub-Saharan Africa and slightly greater than those of adults in South and Southeast Asia; (3) the weights of these adults are at the median for U.S. adults of the stated heights; and (4) the total energy expenditure of the adults is 1.55 and 1.56 times the BMR for males and females, respectively, which is consistent with a light level of physical activity. The committee examined the effects of varying these and other factors on its EMPCER. Factors considered included population distribution, assumed body size, physical activity level, proportion of infants who are breastfeeding, prevalence and severity of preexisting malnutrition in adults and children, and ambient temperature. The relative influence of these factors on the EMPCER is listed below, and recommendations for adjustment made where important: The strongest influence on the EMPCER is physical activity; an EMPCER of 2,100 kcal assumes light physical activity, and should be increased by about 100 kcal (418 kJ)/d for moderate activity, and by 400 kcal (1.7 MJ)/d for heavy activity. Thus, the EMPCER will need to be higher for populations walking long distances, or involved in agriculture or other manual labor. In the future, simple information should be gathered on the physical activity levels of populations requiring emergency food aid in different circumstances, in order to better predict the EMPCER increment for physical activity. For cold environmental temperatures, the EMPCER should increase by 100 kcal (418 kJ)/d at 15°C, 200 kcal (837 kJ)/d at 10°C, and 300 kcal (1.3 MJ)/d at 5°C. Information on probable environmental temperature is usually available in the initial planning stages. Because the CIN's calculations of EMPCER were based on the body size of adults in developing countries, an additional 100 kcal (418 kJ)/d would be needed for populations with a body size similar to that in industrialized countries. An EMPCER of 2,100 kcal (8.8 MJ)/d should be sufficient to permit catch-up growth for children with preexisting malnutrition, but not to restore adult body weight. Estimates of the increment to EMPCER necessary to restore weight gain over different periods of time have been provided. Theoretically, in populations who have lost body weight due to recent food shortages, it may

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations require several months of a substantial increment in energy intake to regain the weight that has been lost. The feasibility of attaining this goal must be balanced against scarce resources, and issues such as how much of the additional food would actually be consumed by the target individuals. Substituting a population distribution characteristic of industrialized countries had little effect on the EMPCER. However, unusual migration patterns, for example, where a majority of males would be absent from a population—a situation that might occur in certain refugee situations—were found to have a substantial impact on the EMPCER; thus, where such information is available, the committee suggests that the EMPCER be revised accordingly. Altering the proportion of infants who are breastfeeding was found to have little effect on the EMPCER; thus, the committee felt that no special correction for rates of breastfeeding is necessary. Special foods may be required for infants and young children when mothers are unable to breastfeed or suitable complementary foods are unavailable. The committee recommends that any EMPCER used for the purposes of planning emergency food aid rations be reevaluated as new data are obtained. Specifically, in the future, appropriate information should be collected on the experience and impact of using different EMPCER values. For example, a value of 1,900 kcal (7.9 MJ)/d is used currently by several international agencies. The CIN received some anecdotal information that this level of intake was adequate, but on biological grounds it is difficult to see how 1,900 kcal/d can meet energy requirements. The discrepancy might be explained by factors such as the availability of at least some other food in those populations, or an extremely low level of activity, but this is not known. In addition, it is essential to establish a system for the rapid assessment of the availability of local food in addition to that supplied by rations. This information is often not known until after the emergency situation has stabilized, but in some cases—e.g., droughts, other natural disasters, and sieges —it can be assumed from the onset that other foods will be available. Finally, the committee recommends that relief programs consider providing an additional amount of food that can be “monetized,” that is, sold for cash to purchase other essentials, such as cooking fuel, complementary foodstuffs, and the like.

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