Presentation 3.1 The Essential Nutrition Actions ... - Linkages Project

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Presentation 3.1 The Essential Nutrition Actions ... - Linkages Project

Presentation 3.1

The Essential

Nutrition Actions:

An action oriented

approach to

nutrition…


Theme 3 Learning Objectives

By the end of the session we shall be able to:

• Describe the Essential Nutrition Actions for maternal and

child nutrition

• Recite the key messages under each of the Essential

Nutrition Actions.


Presentation 3.1:

• Why ENA? Some background

• When to intervene?

• What actions to take?

– Seven action areas

• Where to take these actions?

– Six contact points

• Key program components

– Importance of harmonization

• Lessons learned


ENA

Why?

Over past 30-40 years nutrition interventions

were often…

not integrated

viewed as separate vertical programs

in competition with one another

not action oriented (non-specific & fuzzy)

focused only on GM/P activities


ENA

Why?

In the past 10 years growing consensus is that

nutrition interventions need to be…

integrated conceptually & programatically

infant & young child feeding

maternal nutrition

micronutrients

based on proven impact

action oriented with clear guidance « Who should take

what action when »


ENA

When should we intervene?

Majority of growth

faltering occurs during

first year of life


ENA

When should we intervene?

Many babies are

born malnourished

due to poor maternal

nutrition before &

during pregnancy


ENA

What to Integrate?

7 actions areas


ENA

Based on proven behaviors

Breastfeeding

Complementary

Feeding

Feeding

of sick children

Women’s Nutrition

Vitamin A Anemia Iodine


ENA

Links with other health interventions

Child Survival

Reproductive

Health

Breastfeeding

Essential Nutrition Actions


1. Promotion of Breastfeeding

Exclusive

BF for the

6 first

months

of life

WHO Infant & Child Feeding recommendations, 2001


1. Promotion of Breastfeeding

Key Messages

Early Initiation of BF

Exclusive BF until 6 months

BF day and night at least 10 times

Correct positioning & attachment

Empty one breast and switch to the other

WHO Infant & Child Feeding recommendations, 2001


2. Complementary Feeding to BF

at 6

months

of life


2. Complementary Feeding to BF

Key Messages

Continue BF until 24 months and more

Increase the number of feedings with age

Increase density, quantity and variety with age

Responsive feeding

Food Hygiene

WHO Infant & Child Feeding recommendations, 2001


3. Feeding of the sick child

Key Messages

Increase breastfeeding &

complementary feeding during and after

illness

(IMCI- Integrated Management of Childhood Illness)

Appropriate Therapeutic Feeding

WHO Infant & Child Feeding recommendations, 2001


4. Women’s Nutrition

Key Messages

During pregnancy and lactation

-Increase feeding

-Iron/Folic Acid Supplementation

-Treatment & prevention of Malaria

Deworming during pregnancy


Vitamin A Capsule after delivery


5. Control of Vitamin A Deficiency

Key Messages

Breastfeeding: source of Vitamin A

Vitamin A rich foods

Maternal supplementation

Child supplementation

Food fortification


6. Control of Anemia

Supplementation for women and

children (IMCI)

Deworming for pregnant women and

children (twice/year)

Malaria control

Iron-rich foods

Fortification

Key Messages


7. Control of Iodine Deficiency Disorders

Key Messages

Access & consumption

by all families

of iodized salt


ENA

Where to Integrate?

7 Proven Behaviors

6 Critical Contact Points


ENA

6 critical contacts in the lifecycle

PREGNANCY : TT,

antenatal visits, iron/folic

acid, de-worming, antimalarial,

diet, EBF, risk

signs, FP, STI prevention,

safe delivery, iodized salt

DELIVERY: safe

delivery, EBF, vitamin

A, iron/folic acid, diet,

FP, STI prevention

POSTNATAL AND

FAMILY PLANNING:

EBF, diet, iron/folic

acid, diet, FP, STI

prevention, child’s

vaccination

IMMUNIZATION:

vaccinations, vitamin A,

de-worming, assess and

treat infant’s anemia,

FP, and STI referral

WELL CHILD AND GMP:

monitor growth, assess

and counsel on feeding,

iodized salt, check and

complete vaccination/

vitamin A /de-worming

SICK CHILD: monitor growth,

assess and treat per IMCI,

counsel on feeding, assess and

treat for anemia, check and

complete vitamin A

/immunization/ de-worming


ENA

Where to integrate?

Health sector at facilities &

communities

Other sectors and contacts

• Antenatal visit

•Delivery

• Post-natal visit

• Immunization

• Well baby visit/GMP

• Sick child visit

• School programs

• Agricultural extension

• Emergency

• Community development

• Micro-credit projects


ENA

3 key Program Components

1. Health facility level: integrate ENA actions into

existing health contacts at all health services;

2. Community-level:

work with community-based

organizations & networks from all sectors; and

3. Behavior change:

3. Behavior change: re-inforce ENA actions through

behavior change communication at all levels, including

inter-personal communication, mass media and

community mobilization.


Need to harmonize

Health sector: policies, protocols & approaches

Child Survival

EPI+

Community IMCI

Health facilities IMCI

Infectious Diseases

Control of Malaria

Mosquito net & Treatment

Tuberculosis

HIV/AIDS (PMTCT)

ENA

Reproductive Health

Women’s Nutrition

Lactation Amenorrhea Method

National

Immunization Days

Polio

Measles


Need to harmonize

Other sectors: policies, protocols & approaches

Micro-credit

credit

Schools

Adolescent nutrition

De-worming

Iron supplementation

School lunch

Income generation

Nutrition education

ENA

Sanitation

Prevention of diarrhea,

malaria, ARI

Agriculture

Food diversification

Food security

Women’s farmers clubs

Emergency

Women to women

support


ENA

Need to harmonize at all levels

National

Regional

•Planners

•Donors

•Academia

•Journalists

Districts

Health Facilities

•District MOH Team

•NGOs

•Hospital Administration

Health workers

• Public

• Private

Communities

(families)

•Community Leaders

•Community volunteers

•Existing Groups


ENA

How to harmonize ? (1)

Partnerships at all levels

Coordination Working Groups

Policies, protocols, guidelines


ENA

How to harmonize? (2)

IEC-BCC Materials

same key messages

Mass Media

reinforce same messages


ENA

How to harmonize ? (3)

Training

- Pre-service

- In-service

- Communities


The Essential Nutrition

Actions strategy has given

a clear framework for

specific actions to improve

nutrition

Lesson # 1

ENA


The Essential Nutrition

Actions strategy is pulling

together all the existing

vertical programs in a

sensible 'action-oriented'

way...

Nothing new except the

‘packaging' ...

Lesson # 2

ENA


Lesson # 3

ENA

The Essential Nutrition

Actions strategy has

greatly expanded ‘nutrition’

contacts far beyond the

traditional Growth

Monitoring & Promotion

programs


Lessons # 4

ENA

Partnership

• Buy-in from health sector

• UNICEF-assisted activities

• WHO technical endorsement

• Key role of NGOs

• Existing community networks

• Pre-service training


ENA

Adequate nutrition for

human and sustainable development


THANK YOU

Prepared by Agnes Guyon (AED/LINKAGES) with input from

Victoria Quinn, AED/LINKAGES

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