Specialised food products

Unlike basic food products (NFOO family), such as cereals (millet, sorghum...) or legumes (beans...), specialised food products‌ (NFOS family) are specifically designed to meet the needs of malnourished people in crisis situation.

These products are enriched with proteins, minerals, and vitamins according to the nutritional requirements of patients, considering factors such as age, the severity of malnutrition, associated pathologies, local dietary habits.

A global strategy for responding to a nutritional crisis can only be developed after assessing the nutritional situation and identifying the intervention goals and target population. The response can be general or selective, including options such as general distribution, blanket feeding, supplementary feeding programs,or therapeutic feeding programs.

THE DIFFERENT TYPES OF SPECIALISED FOOD PRODUCTS

Specialised foods can be categorised into different categories, each designed to meet specific nutritional needs:

Therapeutic milks (F75 and F100)

Therapeutic milks are used in the initial (F75) and rehabilitation (F100) phases of treatment for severe acute malnutrition.

RUTF: Ready-to-Use Therapeutic Food

RUTF is used during the rehabilitation phase for treating severe acute malnutrition. It should not be used in the initial phase due to its iron content.

Examples: Plumpy’nut, eeZeepaste, Valid Nutrition, Insta paste, BP100

Caution: RUTF should not be used in children under 6 months of age.

RUSF: Ready-to-Use Supplementary Food

RUSF is used for treating Moderate Acute Malnutrition (MAM) and can also be used for nutritional support in emergencies or as part of nutritional programmes to prevent malnutrition.

Examples: Plumpy'Sup, eeZeRUSF

Note: RUSF are sometimes referred to as LNS LQ (Large Quantity)

LNS: Lipid-based Nutrient Supplement (LNS MQ and LNS SQ)

• LNS MQ (Medium Quantity) is a ready-to-use product used to prevent Moderate Acute Malnutrition (MAM) in children aged 6 to 36 months. When consumed as a supplement to the regular diet, it balances the daily intake of micronutrients.

Examples: Plumpy doz, eeZee50

• LNS SQ (Small Quantity) is a ready-to-use product used to prevent malnutrition and provided nutritional support in emergencies.

Examples: Nuttributter, eeZee20

Micronutrients (fortified paste with vitamins and minerals)

Micronutrient supplements are used to address dietary deficiencies, particularly the lack of animal-based products.

Examples: QBmix

Emergency food ration

Compressed biscuits used as nutritional substitutes or food supplements in crisis situations, especially in the initial phase of an emergency before general ration distribution.

Examples: BP5, NRG5

Infant formulas (infant milks) and breast-milk fortifiers

These are substitutes for breast milk or fortifiers to enhance the nutritional quality of breast milk, depending on the needs of the infants.

Food for Special Medical Purposes (FSMP) (e.g. VHF patients, burn victims, HIV patients, etc.)

FSMP‌ products are specially designed for patients with specific medical conditions requiring tailored nutrition. They should be used under medical supervision and vary in terms of calories, protein, and other nutritional contents, as well as form (oral, enteral feeding, or both).

Types:

• adults or children
• isocaloric or hypercaloric
• normoprotein or hyperprotein
• semi-elemental
• with or without fibres
• available as powders for reconstitution, ready-to-use drinks, or ready-to-use bags for enteral (tube) nutrition (ready to hang).

Powders generally have a longer shelf-life (24 months) and are more cost-effective than ready-to-use products, reducing the number of product references and simplifying stock management and orders.

Contact your nutrition advisor before ordering these products. These products can be used as a sole source of food or as a meal supplement for VHF/Ebola patients unable to follow a normal diet or suffering from severe anorexia, for example.

Super Cereals (Pre-cooked fortified flours )

Super Cereals are used for general (WFP) and family ration distributions, supplementary feeding programs, and blanket feeding programs.

They are made from corn flour (CSB+) or wheat flour (WSB+) and soya cooked by extrusion or micronization, and fortified with minerals and vitamins.

Examples of Super Cereals: Unimix (MSF-UNICEF-UNHCR), CSB/CSB+ (WFP), WSB (WFP).

Super Cereal plus (+) are newer versions containing milk and are better adapted for children's nutritional needs.

Examples of Super Cereals Plus: CSB++

PURCHASE / ACCEPTANCE OF DONATION OF SPECIALISED FOOD PRODUCTS

It is essential to manage stocks of specialised food products by batch and shelf life. A batch is defined as a quantity produced under homogeneous conditions, although its exact definition may vary depending on the supplier's internal organisation.

The quality of yje product depends on every stage of the supply chain:

• supply of raw materials, manufacturing, packaging, storage at the supplier's premises
• transport
• storage
• distribution
• cooking (if necessary)
• consumption.

Any issue or negligence at any of these stages can impact the final product quality. Therefore, it is essential to adhere to the recommended procedures at every stage.

All suppliers of specialised food must undergo a rigorous validation process to ensure their products meet high-quality standards. Only validated suppliers should be used for purchases.

Local purchases are only permitted from validated suppliers. A list of validated suppliers is available from section pharmacists and nutrition referents.

All donations of specialised food products must be accompanied by a delivery bill (waybill) that specifies all batch numbers and best-before dates. Upon reception, conduct both a control check and a quality (organoleptic) evaluation for each donation (see procedure bellow).

Documentation

Each shipment of specialised food products may include various certificates, which can be requested from the field.

These certificates may include: health certificate, analysis certificate, certificate of origin, conformity certificate, GMO/non-GMO certificate, etc.

The certificate of analysis is mandatory for any reception of specialised food product.

SUPPLY AND STOCK MANAGEMENT

Specialised food should be stored at temperature below 30ºC to prevent quality issues and deterioration.

Refer to procedure QA-NFOS-SOP2 "Storage and stock management of specialised food" for guidance.

If storage conditions in the field exceed or have exceeded 30°C, it is recommended to conduct an analysis in a laboratory to verify that the vitamins (the most fragile) have not degraded and to determine the new shelf life. (see the sampling paragraph below).

Procedures for quality control

Control at Reception

Complete the "Check list for control upon receipt": NSFSCRECOSE (English), NSFSCRECOSF (French). These forms are also available ºon request from the section pharmacist or nutrition referent.

A certificate of analysis (one per batch number) must be provided by the supplier for each delivery.

Specific case for Super Cereals:

For Super Cereals, complete the specific checklist: NSFSQCONFFF (French) / NSFSQCONFFE (English).

Sampling (for analyse in laboratory)

When products are stored at temperatures above 30ºC, samples must be sent to a laboratory to check the level of fortification (as vitamin content decreases with temperature) and to potentially adjust the product's shelf life.

If a quality issue is suspected, it may be necessary to send samples to a laboratory. In this case, contact your section pharmacist or nutrition referent. You may be asked to complete the sampling report form, NSFSSAMPOSF (French) / NSFSSAMPOSE (English).