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 individuals in crisis situation.

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

A global strategy for responding to a nutritional crisis can only be developed following an assessment of the nutritional situation, with clear identification of intervention goals and target populations. The response may be general or targeted, and can include general distribution, blanket feeding, supplementary feeding programs, or therapeutic feeding programs.

THE DIFFERENT TYPES OF SPECIALISED FOOD PRODUCTS

Specialised foods are designed to meet specific nutritional needs and can be grouped into several categories:

Therapeutic milks (F75 and F100)

Used in the treatment of Severe Acute Malnutrition (SAM):

• F75: used during the initial phase
• F100: used during the rehabilitation phase

RUTF - Ready-to-Use Therapeutic Food

Used in the rehabilitation phase of Severe Acute Malnutrition (SAM) treatment. Not suitable for the initial phase due to 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

Used in the treatment of Moderate Acute Malnutrition (MAM) and as nutritional support in emergency contexts or to prevent malnutrition in nutritional programs.

• Examples: Plumpy'Sup, eeZeRUSF

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

LNS - Lipid-based Nutrient Supplements

LNS MQ (Medium Quantity)

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)

Ready-to-use product used to prevent malnutrition and nutritional support in emergencies.

• Examples: Nuttributter, eeZee20

Micronutrients Supplements (fortified paste with vitamins and minerals)

Used to correct dietary deficiencies, especially where diets lack of animal-based products.

• Examples: QBmix

Emergency Food Ration

Compressed biscuits used as nutritional substitutes or food supplements during the early phase of an emergency, before general ration distribution.

• Examples: BP5, NRG5

Infant Formulas (infant milks) and Breast-Milk Fortifiers

Used as breast milk substitutes or to enhance breast milk, when needed for infants with special nutritional requirements.

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

Tailored for patients with specific medical conditions (e.g., VHF, burns, HIV) and used under medical supervision. Can vary by:

• Age group: adults or children
• Caloric content: isocaloric or hypercaloric
• Protein content: normoprotein or hyperprotein
• Composition: semi-elemental, with or without fibres
• Forms: powder (for reconstitution), ready-to-use drinks, or ready-to-use bags for enteral (tube) nutrition (ready to hang).

Powders typically have a longer shelf-life (24 months), are more cost-effective than ready-to-use products, and simplify stock management and orders (less product references).

Contact your nutrition advisor before ordering FSMPs can serve as a sole food source or meal supplement (e.g., for VHF/Ebola patients unable to follow a normal diet or with severe anorexia).

Super Cereals (Pre-cooked Fortified Flours )

Used in:

• general distributions (WFP)
• family ration distributions
• supplementary and blanket feeding programs

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

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

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

• Examples: 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 the 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 applicable)
• consumption

Any issue or negligence at any of these stages can compromise the final product's quality. Therefore, strict adherence to recommended procedures at each stage is essential.

All suppliers of specialised food products must undergo a rigorous validation process to ensure that 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, perform a control check and a quality (organoleptic) evaluation for each donation (see procedure below).

Documentation

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

These certificates may include: health certificate, certificate of analysis (mandatory for any reception), certificate of origin, conformity certificate, GMO/non-GMO certificate, etc.

SUPPLY AND STOCK MANAGEMENT

Specialised food must be stored at temperatures below 30ºC to prevent quality issues and deterioration.

For detailed guidance, refer to procedure QA-NFOS-SOP2 "Storage and stock management of specialised food".

If storage conditions in the field exceed or have exceeded 30°C, it is recommended to conduct an analysis in a laboratory to assess the integrity of the product, particularly the vitamin content, as vitamins are the most fragile components and to determine a 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 on 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 - Super Cereals:

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

Sampling (for analyse in laboratory)

When products have been stored at temperatures above 30ºC, samples must be sent to a laboratory to check the level of fortification, especially vitamin content, which can decrease with heat. This analysis may result in an adjustment of the product's shelf life.

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