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close this bookScurvy and its Prevention and Control in Major Emergencies (WHO; 1999; 70 pages)
View the documentAcknowledgements
View the documentScurvy: definition
open this folder and view contentsIntroduction
open this folder and view contentsScurvy
open this folder and view contentsVitamin C
open this folder and view contentsRecommended Daily Allowance (RDA)
open this folder and view contentsSources of vitamin C
open this folder and view contentsStrategies to prevent scurvy in large refugee populations
View the documentCosts
open this folder and view contentsConclusions and recommendations
View the documentReferences
View the documentAnnex 1
View the documentAnnex 2
View the documentAnnex 3
View the documentBack Cover
 

Annex 1

Table A. Phases of refugee feeding operations and possible sources of vitamin C

Phase

Characteristics

Food source

Vitamin C source

Initiation/3-6 months

initial request for help filed

may be local or borrowing from other programmes

fortified food aid; vitamin C tablets; vitamin C-rich commodities; where feasible, locally procured fruits and vegetables; increased general ration

Establishment/6 months - 2 years

refugees dependent on food aid/minimal personal buying power

imported food aid

fortified food aid; where feasible locally procured fruits and vegetables; increased general ration; where feasible, germinated cereals/pulses; home gardens; local trading for vitamin C-rich foods

Protracted Refugee Operation/>2 years

efforts to develop inde-pendence and personal economic resource Employment pro-grammes maintained.

depending on local conditions, may involve tar-geting of food aid on basis of need

home gardens; local trading for vitamin C-rich foods

Note:
1. The first two phases are critical for the development of scurvy
2. Table is adapted from Hansch (1995)

Table B. Costs of various commoditites

Commodity

1m person days (USD)

Person/day (USD)

Total ration1

200 000

0.200

Ration with 30 g blended food1

215 000

0.215

Ration with 60 g blended food

230 000

0.230

Total ration +10%

220 000

0.220

Cereal (maize) not milled2

100 825

0.101

Cereal milled2

135 625

0.136

Cereal fortified* + milled2

150 025

0.150

Cereal (3/4 of cereal ration) + CSB (1/4 of cereal ration)2

147 125

0.147

Tablets (vitamin C @ 250 mg)3

1 170

0.001

Tomato paste @100 g/day4

96 000

0.096

Orange juice powder3 (reconstituted drink)

11 770

0.012

Fresh vegetables4**

100 000

0.100

1 Source: Machakos Workshop Report (1995)
2 Source: Beaton (1995)
3 Source: Toole (1995)
4 Source: UNHCR

* Fortified with micro nutrients (including vitamin C)
** Example Nepal (1993)

Table C. Cost comparisons

Commodity

I m person days (US$)

person/day (US$)

Blended foods increase 30 g to 60 g per day

15 000

0.015

Ration 10% increase (without blended foods)

20 000

0.020

Cereal milled and fortified compared to unmilled and unfortified

50 800

0.051

Cereal milled and fortified compared to milled and unfortified

14 400

0.014

Cereal milled and CSB (1/4 of cereal ration)* compared to unmilled, unfortified cereal ration

47 700

0.048

Cereal milled and CSB (1/4 of cereal ration)* compared to milled, unfortified cereal ration

11 500

0.012

*100 g CSB daily would be necessary in the general ration to provide missing micro nutrients e.g. vitamin C in blended foods 30-40 mg/100 g, RDA 30 mg

Table D. Some nutrition education messages that could prevent scurvy

Food storage and preparation

• Grow tomatoes, potatoes, onions, etc.
• on any available land and use waste water.
• *Do not store germinated pulses/grains.
• Store fresh vegetables and fruit for as short a time as possible.

Food production and consumption

• Vegetables should not be cut into small pieces before washing and cooking.
• Cook vegetables in minimum amount of water and also consume water.
• Cook food for as short a time as possible.
• Cover pot with lid while cooking to reduce cooking time.
• Eat food soon after cooking. Do not store cooked food.
• Cook blended food for not longer than 10 minutes.
• Blended food is good for the whole family, not only for infants.
• Eat as much fruit and vegetables as available.
• *Eat the sprouts and the shoots after germination

Medication

• *Take the vitamin C tablets regularly to prevent scurvy and death.

*Some examples of messages related to specific interventions.

Table E. Analytical values for some of the sailors' traditional antiscorbutics in the 18th century

 

Ascorbic acid
(mg/100g or/100 ml for liquids)

Cloud berries

80

Cranberries

5-10

Gooseberries, fresh

60-65

Gooseberries, preserved (as recommended by Lind)

0

Apple cider (fresh, unpasteurized)

4-5

Scurvy grass (leaves and buds)

200

Spruce pine needles

65-200

Spruce (leaves and young shoots)

30-270

Spruce (fresh aqueous infusion)

14-100

Spruce (fermented aqueous infusion)

<0.5

Freshly sprouted barley seed

30-100

Malt, dried & powdered

10

Cloud berries

80

Cranberries

5-10

Gooseberries, fresh

60-65

Gooseberries, preserved (as recommended by Lind)

0

Apple cider (fresh, unpasteurized)

4-5

Scurvy grass (leaves and buds)

200

Spruce pine needles

65-200

Spruce (leaves and young shoots)

30-270

Spruce (fresh aqueous infusion)

14-100

Spruce (fermented aqueous infusion)

<0.5

Source: Carpenter, 1986

Table F. Analytical values for the vitamin c content in mg/100 g of items in traditional inuit diets

 

Raw

Lightly boiled

Seal flesh

0.5-3

0.5-2.5

Seal liver

18-35

14-30

Whale skin (narwhal)

18

N.D.

Whale skin (Beluga)

35

N.D.

Blubber (Beluga)

5

N.D.

Animal flesh, raw (caribou, musk ox, polar bear)

0.8-1.8

0.5

Fish flesh (cod, char)

0.5-2

N.D.

Cod roe

44

N.D.

Bird flesh, raw

1-2

0.3-1

Licorice root

21

4

Mountain sorrel

36

5

Angelica

14

-

Source: Hoppner et al. 1978

Table G. Vitamin C contents of some uncooked foods

 

Vitamin C
mg/100 g

 

Vitamin C
mg/100 g

Fruits:

 

Vegetables:

 

peach

8

amaranth leaves

88

banana

13

beans, peas

10-30

cherry

8

broccoli

90-150

grapefruit

43

cabbage

30-60

guava

160

carrot

5-10

hawthorne berries

160-800

cauliflower

60-80

lime

27

garlic

12

mango

 

dark-green-leafy vegetables

100-150

ripe

4875

kale

120-180

unripe

 

leek

15-30

melons

13-33

onion

10-30

orange, lemon

50

parsley

170

papaya

64

pepper

125-200

pineapple

40

spinach

50-90

tangerine

30

tomato

24

raspberry

18-25

   

rose hips

1000

Cereals:

 

strawberry

40-90

millet, rice, wheat, maize

0

Animal products:

 

Tubers:

 

meats

0-2

cassava

36

liver, kidney

10-40

sweet potato

23

milk, cow

1-2

potato

36462

milk, human + camel

3-6

   

Source: FAO. Food composition tables. Minerals and vitamins for international use. Rome, 1954.

Table H. Intake levels of ascorbic acid in various parts of the world, in mg per person per day

Region

Extreme rangea)

Majority rangeb)

Comments

Africa

5-375

-

Low values for cereal and millet diets. High values for diets based on cassava, yams, etc.

Asia, including the Far East

10-150

25-70

Higher values are for China (Taiwan), where diets include a greater proportion of vegetables and fruits. Low values are for millet and rice diets in India and East Pakistan respectively.

Latin America

10-110

10-50

 

Near East

5-90

10-50

 

Europe

50-130

50-130

 

USA

-

100

 

a) Average lowest and highest per capita intakes reported in surveys

b) Lowest and highest per capita intakes of more than 80% of the population reported in surveys

Table I. Vitamin C losses in the processing and preparation of food

 

Ascorbic acid
(% remaining)

Potatoes

 
 

fresh dug main crop

30 mg/100 g

 

boiled, peeled

50-70% raw value

 

in jacket, baked

80% raw value

Milk

 
 

whole raw

2.0 mg/100 g

 

pasteurized

75% raw value

Cabbage

 
 

raw

60 mg/100 g

 

cooked

33% raw value

Frozen vegetables

75% raw value

Canned vegetables

85-40% raw value

Source: Marks, 1975
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