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  • 1. The Essential Nutrition Actions: An action oriented approach to nutrition…
  • 2. 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.
  • 3. Presentation outline: • 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
  • 4. ENA Why?  not integrated  viewed as separate vertical programs  in competition with one another  not action oriented (non-specific & fuzzy)  focused only on GM/P activities Over past 30-40 years nutrition interventions were often…
  • 5. ENA Why?  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’ In the past 10 years growing consensus is that nutrition interventions need to be…
  • 6. Majority of growth faltering occurs during first year of life ENA When shouldweintervene?
  • 7. Majority of child growth faltering occurs during first year of life
  • 8. Many Ethiopia babies are born malnourished due to poor maternal nutrition before & during pregnancy 25 25 27 39 32 40 41 44 26 16 24 24 0 10 20 30 40 50 60 Total AddisD ireD aw a Am hara H arari SN N P O rom iya TigrayBen-G um zG am bela Affar Som ali Percentage
  • 9. • infant & young child feeding, especially 0-24 months • nutrition of girls & women Focus on:
  • 10. ENA What to Integrate? 7 action areas7 action areas
  • 11. Federal MOH based on the ENA approach: proven actions to prevent malnutrition Control of Anemia Optimal Breastfeeding Control of Vitamin A deficiency Control of Iodine Deficiency Disorders Women’s Nutrition Complementary Feeding to BF Feeding of the sick child Estim ated decrease ofchild m ortality: >23% Child Survival Strategy, MOH Ethiopia, Sept 2004
  • 12. ENA Links with other health interventions Child SurvivalChild Survival ReproductiveReproductive HealthHealth BreastfeedingBreastfeeding Essential Nutrition ActionsEssential Nutrition Actions
  • 13. 1. Promotion of Optimal Breastfeeding Exclusive Breastfeeding for the first 6 months of life National Strategy forIYCF, FedMOH, April 2004 Estim ated decreaseof child m ortality: 4%
  • 14. 1. Promotion of Optimal Breastfeeding  Early Initiation of BF within 1 hour of birth  Exclusive BF until 6 months  BF day and night at least 10 times  Correct positioning & attachment  Empty one breast and switch to the other Key Messages National Strategy forIYCF, FedMOH, April 2004
  • 15. 2. Complementary Feeding to BF at 6 months of age National Strategy forIYCF, FedMOH, April 2004 Estim ated decreaseof child m ortality: 8%
  • 16. 2. Complementary Feeding to BF  Continue BF until 24 months and more  Increase the number of feedings with age  Increase density and quantity with age  Diversify diet using variety of foods  Responsive feeding  Food hygiene Key Messages National Strategy forIYCF, FedMOH, April 2004
  • 17. 3. Feeding of the sick child  Increase breastfeeding & complementary feeding during and after illness (IMCI- Integrated Management of Childhood Illness) for infants 6 months & older, feed 1 extra meal each day for two weeks following the illness Appropriate Therapeutic Feeding Key Messages National Strategy forIYCF, FedMOH, April 2004
  • 18. 4. Women’s Nutrition  During pregnancy and lactation -Iron/Folic Acid Supplementation -Treatment & prevention of malaria - Increase food intake  one extra meal each day during pregnancy  two extra meals each day during lactation  Deworming during pregnancy  Vitamin A Capsule within 45 days of delivery Key Messages National Strategy forMN, FedMOH, April 2004 Estim ated decreaseof child m ortality: 1%
  • 19. 5. Control of Vitamin A Deficiency  Breastfeeding: source of Vitamin A  Vitamin A rich foods  Maternal supplementation  Child supplementation  Food fortification Key Messages National Strategy forMN, FedMOH, April 2004 Estim ated decreaseof child m ortality: 10%
  • 20. 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 National Strategy forMN, FedMOH, April 2004 Estim ated decreaseof child m ortality: 0.4%
  • 21. 7. Control of Iodine Deficiency Disorders  Access & consumption by all families of iodized salt Key Messages National Strategy forMN, FedMOH, April 2004
  • 22. ENA WheretoIntegrate? 7 Proven Behaviors 6 Critical Contact Points
  • 23. 1. Health facility level:1. Health facility level: integrate ENA actions into existing health contacts at all health services; 2. Community-level:2. Community-level: work with community-based organizations & networks from all sectors; and 3. Behavior change:3. Behavior change: reinforce ENA actions through behavior change communication at all levels, including inter-personal communication, mass media and community mobilization. ENA When shouldweintegrate?
  • 24. DELIVERY: safe delivery, BF, Vitamin A, iron/folic acid, diet, FP, STI prevention PREGNANCY : TT, antenatal visits, BF, iron/folic acid, de- worming, anti-malarial, diet, risk signs, FP, STI prevention, safe delivery, iodized salt POSTNATAL AND FAMILY PLANNING: , diet, BF, iron/folic acid, diet, FP, STI prevention, child’s vaccination WELL CHILD AND GMP: monitor growth, assess and counsel on infant feeding, iodized salt, check and complete vaccination SICK CHILD: monitor growth, assess and treat per IMCI, counsel on infant feeding, BF, assess and treat for anemia, check and complete vitamin A /immunization/ de-worming IMMUNIZATION: vaccinations, vitamin A, BF, de-worming, assess and treat infant’s anemia, FP, and STI referral Critical contacts for infant feeding, & women’s nutrition: life cycle
  • 25. Child Survival EPI+ Community IMCI Health facilities IMCI Reproductive Health Women’s Nutrition Lactation Amenorrhea Method Infectious Diseases Control of Malaria Mosquito net & Treatment Tuberculosis HIV/AIDS (PMTCT) National Immunization Days Polio Measles ENAENA Essential Nutrition Actions expands nutrition coverage within the health sector…
  • 26. SchoolsSchools Adolescent nutrition De-worming Iron supplementation School lunch AgricultureAgriculture Food diversification Food security Women’s farmers clubs SanitationSanitation Clean water & sanitation Public health education Prevention of diarrhea, malaria, ARI EmergencyEmergency Food Supplementation CTC TFC EOS ENAENA Essential Nutrition Actions expands nutrition coverage outside the health sector… Community Nutrition Com Workers: HEP,DA,etc Positive deviance Community GM/P
  • 27. ENA Needtoharmonizeatall levels Communities (families) Health workers • Public • Private •District MOH Team •NGOs •Hospital Administration •Community Leaders •Community volunteers •Existing Groups NationalNational Regional Districts Health Facilities •Planners •Donors •Academia •Journalists
  • 28. Four key program components in Ethiopia 3. Community:3. Community: negotiating fornegotiating for better ENA practicesbetter ENA practices 2. Training for Capacity Building2. Training for Capacity Building 1. Policy & Partnerships ENAENA 4. BCC & Mass Media4. BCC & Mass Media
  • 29. Conclusion 1. ENA approach pulls together existing vertical programs in a sensible 'action-oriented' way... Nothing new except the ‘packaging' and way promotion of nutrition is operationalized...
  • 30. 2. The ENA approach has potential to address over 23% of underfive deaths in Ethiopia
  • 31. 3. ENA approach greatly expands coverage of nutrition support beyond GM/P contact
  • 32. 4. ENA approach provides simple & clear framework that guides “specific” actions to improve nutrition at “specific” points in time
  • 33. 5. ENA approach provides excellent training framework on which to train service providers
  • 34. Implications…
  • 35. ENA and implications for Child Survival…  We know what to do to prevent malnutrition and save child lives…  We know how to do it…
  • 36. Challenge that remains ‘just to do it’ -political commitment -investment of resources
  • 37. THANK YOU

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