1. Complementary food working meeting 20.04.2015

2. Participants NCC, Anna Ziolkovska Akhmetov foundation, Olga Yudina CDC, Oleg Bilukha People in Need, Natalia Tserkevich UNICEF, Mutribjon Bahruddinov WFP RO, DouraMichele WFP, Nguyen Deborah

3. Caseload estimation Estimation of population in need: children 6-23 mo PopulationU20-6 mo6-11 mo12-23 mo 100%1.99%0.44%0.52%1.03% NGCAs of Donetska and Luganska Oblast 3,200,000 63,680 14,080 16,640 32,960 All IDPs in Ukraine (official data as of 17 April), including: 1,200,000 23,880 5,280 6,240 12,360 IDPs in Donetska Oblasts 450,000 8,955 1,980 2,340 4,635 IDPs in Luganska Oblasts 162,000 3,224 713 842 1,669 IDPs in Kharkiv Oblasts 162,000 3,224 713 842 1,669 IDPs in Zaporizhzhska Oblasts 87,000 1,731 383 452 896 IDPs in Dniprpetrovska Oblasts 73,000 1,453 321 380 752

4. Target groups 1 st priority NGCAs: 90%: 45,000 children 6-23 months (15,100+29,900) 2 nd priority IDPs: 90% : 13,000 children 6-23 months (4388+8612)

5. Energy requirements 650 kcal/day for children 6-11 months: – 50% (325kcal) – complementary food basket – 50% (325kcal) – breast-milk (diapers) or 2kg infant formula/month 900 kcal/day for children 12-24 months old: – 50% (450 kcal) – complementary food basket – 50% (450kcal) – breast-milk or family food

6. Monthly baby basket composition 6-11 months Itemsg, total Semolina1000 Fortified cereals1000 Baby meat puree400 Baby vegetable puree1200 Baby fruit puree1200 Total4800 About 300 UAH/basket

7. Notes: 6-11 mo basket 1 st priority OK for macro- and micronutrient content MNPs instead of fortified cereals to reduce the cost – UNICEF to explore

8. Monthly baby basket composition 12-23 months About 250 UAH/basket Itemsg, total Semolina1000 Buckwheat1000 Oats800 Rice1000 Meat puree800 Vegetable puree600 Fruit puree600 Total5800

9. Notes: 12-23 mo basket 2 nd priority MNPs is needed – UNICEF to explore If funding in limited possible only MNPs distribution Leaflet on how to adapt general food ration to children 12-23 moths – WFP to explore

10. Current baby baskets Translation: Baby basket (0-12 months) 1.Infant formula - 0.70kg 2.Baby cereals - 0.50 kg 3.Baby vegetable puree – 2kg 4.Baby fruit puree- 2kg 5.Pampers - 50 6.Semolina – 1,00kg Baby basket (12-35 months) 1.Baby cereals - 0.75 kg 2.Baby vegetable puree – 2kg 3.Baby fruit puree- 2kg 4.Semolina – 2,00kg 5.Oats – 0,80 kg

11. Suggestions for revision of current baby baskets (Akhmetov foundation, 0-11 mo) As blanket distribution of infant formula is prohibited by international standards and infants aged 0-6 months do not require anything but breast milk, the complementary food distribution should start from the age of 6 months. In addition no infant formula should be distributed to population without prior individual assessment of needs of each child. Only targeted distribution of infant formula to non-BF children is suggested. Some of the cereals (1kg) in the baby basket should be fortified as this is the only feasible way at this point to ensure that children receive necessary micronutrients. The cereals should be in assortment – both with milk and no-milk content due to different preferences of mothers and from variety of cereals as they provide different numbers of microelements. According to physiological requirements of children 6-11 months in order to provide animal protein there is a need to introduce meat purees (at least 400g a month to baby baskets). In order to decrease price, number of fruit and vegetable purees can be reduced to 1.2 kg each taking to consideration that they will have access to fortified cereals.

12. Suggestions for revision of current baby baskets (Akhmetov foundation, 12-36 mo) From the age of 24 months child is fully capable of eating family food, therefore Nutrition Sub-Cluster will only target with baby food distribution children up to age of 23 months (until the second birthday). Introduce a variety of cereals as they provide different micronutrients. As this basket content is low in important micronutrient provision of Multiple Micronutrient Powders for children 6-23 months will fulfil the requirement. This option is to be further explored. Increase quantity of meat puree to 800g at least due to growing need of children in animal protein In order to decrease price of basket and considering access of children to family food, number of fruit and vegetable purees can be reduced to 600 g each.

13. 13 UNICEF standard MNP (15 minerals and vitamins) Nutrient levels based on WHO RNI and RDAs for children 6- 24 mo.

14. 14 UNICEF MNPs 3 US cents/sachet Shelf life 2 years 1g/sachet (very light) 1 box = 30 sachets

15. Advantages: Delivery Concept Easy to use and high acceptability among families and children; focus on ages 6 – 24 months A food-based rather than a medical approach Does not require literacy Does not conflict with breast-feeding practices Used to promote the timely introduction of complementary foods at 6 months of age and proper weaning practices Can be used for other ages throughout the life cycle Light weight, easy to store and transport Inexpensive and low tech to manufacture. 15

16. 16 Experience from Haiti MNPs added to Supplementary Feeding Programme – MNPs distribution (30 sachets/60 days) alongside food distribution – Recommended dose: 1 sachet/day – Education Pamphlets in ration Mothers’ groups Instructions at distribution – At 2 and 9 mo after the start of the intervention children receiving BOTH WSB and MNP had significantly lower prevalence of anemia Menon et al. Journal of Nutrition. Jan 07.

17. Issues and constraints to MNP use/scale-up Product registration- Food or pharmaceutical Composition Packaging Production capacity Does sharing occur? Need more operational experience Need programme guidance Need quality documentation of scale-up experiences 17

18. Funding required (9.3 mln) for 6 months NGCAs, 6-11 months 3.7 mln (2.0 mln CF +1.7 mln BMS/diapers) NGCAs, 12-23 months 3.5 mln IDPs, 6-11 months 1.1 mln IDPs, 12-23 months 1 mln