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info4africa/MRC KZN Community Forum | 25 March 2014 | The Department of Health’s Approach to Nutrition Matters.
 

info4africa/MRC KZN Community Forum | 25 March 2014 | The Department of Health’s Approach to Nutrition Matters.

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Speaker: Ms Zamazulu Mtshali – Deputy Manager for the Integrated Nutrition Programme (INP), KwaZulu-Natal Department of Health ...

Speaker: Ms Zamazulu Mtshali – Deputy Manager for the Integrated Nutrition Programme (INP), KwaZulu-Natal Department of Health
Ms Mtshali's presentation will highlight studies that show the presence of nutritional transition in KwaZulu-Natal, where both under and over-nutrition are prevalent. Within the context of the HIV and AIDS pandemic and food insecurity, the high prevalence of under-nutrition, micronutrient deficiencies and emergent over-nutrition presents a complex series of challenges.
Over the years, significant gains have been made with regards to scaling up nutrition, with the development of policies and guidelines for the implementation of nutrition strategies. There is now a renewed focus on specific priority groups for nutrition interventions to have a bigger impact.

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    info4africa/MRC KZN Community Forum | 25 March 2014 | The Department of Health’s Approach to Nutrition Matters. info4africa/MRC KZN Community Forum | 25 March 2014 | The Department of Health’s Approach to Nutrition Matters. Presentation Transcript

    • KZN DOH APPROACH TO NUTRITION (Integrated Nutrition Programme INP) 25 March 2014 Info 4 Africa Forum Presenter: Ms Zamazulu Mtshali
    • The Integrated Nutrition Programme Vision Optimum Nutrition for all South Africans Mission Improvement of the nutritional status of all South Africans through the implementation of integrated nutrition strategies
    • Principles  Good nutrition for all South Africans should be promoted as a basic human right and as an integral component and outcome measure of the country’s social and economic development  Nutrition programmes should be integrated, sustainable, environmentally sound, people and community driven  There should be a clear strategy for promotion of nutritional well being and the nutritional status of the population must be monitored  Nutrition policies, strategies and programmes are dependent on the development of human and institutional capacities and the provision or adequate financial resources  Existing structures and programmes should be used to address nutrition concerns  An integrated primary health care approach, which includes monitoring to generate useful information for better targeting of services, will be adopted in this programme
    • Nutrition • Nutritional status influenced by three broad factors: food, health and care • Optimal nutritional status: when people have access to affordable, diverse, nutrient-rich food; appropriate maternal and child-care practices; adequate health services; and a healthy environment including safe water, sanitation and good hygiene practices. • These factors directly influence nutrient intake and the presence of disease • Food, health and care are affected by social, economic and political factors
    • Millennium Development Goals
    • KZN Scenario 1 in 20 children die before their 5th birthday Of these…  38% die outside the health service  55% die in association with HIV  33% have underlying severe malnutrition (Save Children, 2011)
    • KZN SCENARIO  KZN bears a disproportionately high burden of poverty with 63% to 82% of households living on less than R800 per month (District Health Barometer)  Malnutrition remains one of the leading comorbidities for children under the age of 5 years. Between 2010/11 and 2011/12, the severe malnutrition under-5 year incidence decreased from 7/1000 to 6.7/1000 (DHIS).  HIV incidence 37,4% (Antenatal Seroprevalence Survey, 2011)  > 50% child deaths were related to HIV  Diarrhea & Pneumonia: 2 leading causes of death in children <5yrs  SANHANES-1 2012 found more stunting (H/A<-2SD) in KZN  Increase in overweight and obesity (W/H > +2SD) in Children 2-5 years Nationally and KZN
    • Nutrition Scenario • Concern: Malnutrition; HIV, AIDS & TB • PLWHA, poor nutrition worsens the effects of HIV by further weakening the immune system. • HIV interferes with the ability to access, handle, prepare, eat and utilize food, thus increasing the risk of malnutrition • Food and nutritional intake can affect adherence to antiretroviral drugs (ARVs) as well as their effectiveness. • Food insecurity and inadequate knowledge of good nutrition • Nutrition in transition situation where both under and over nutrition (underweight, stunting, wasting, overweight & obesity) exist in same community • Consequences: Non communicable diseases: diabetes, hypertension, cardiovascular illnesses
    • KZN Situational Analysis Year Stunting Underweight Wasting Overweight 1994 (SAVACG) 16% 4% 1% 7% 1999 (NFCS) 19% 6% 9% 4% 2005 (NFCS) 15% 5% 1% 6% 2012 (SANHANES) Boys Girls 13.5% 14.4% 3.4% 1.5% 2.4% 6.3% Table indicating the anthropometric status of children aged 1-9 years in KwaZulu Natal Source: Health Review 2008, Health Systems Trust, SANHANES 2013
    • INDICATOR PROVINCIAL STATUS NATIONAL STATUS Infant mortality rate (IMR)18 42/1 000 45/1000 Child mortality rate (U5MR)18 61/1 00018 59.4/1000 Maternal Mortality Rate18 165.5 /100 00018 150/100 000 Low birth weight19 12.5% 8% Exclusive Breastfeeding20 0 – 3 months (14weeks) 0 – 5 months 34.3% 10% 7% Stunting9 Boys Girls 13.5% 14.4% 16.7% 13.7 Wasting9 Boys Girls 2.4% - 3.8% 1.7% Severe Malnutrition 0.5%18 2.8% Underweight9 Boys Girls 3.4% 1.5% 1.4% 3.6%
    • Household food insecurity 63-73% 75% of households Food consumption 43.4% of children eat less than they should. 43.2% experience hunger1 10% of children 6 to 15 years don’t eat Breakfast. 50% of children 1 to 9 years consume less than half of the RDA for key vitamins and minerals Consumption of iodised salt 87.6%1 62.4% of households RtHC coverage 62.2% 75% Poverty 63% 57% of population live in poverty Diarrhoea 17.8% 13.2% HIV/ AIDS (ANC) 37.5% 24.8% Measured Hypertension9 8.4% 10.2% Cardio vascular unfitd (18-40 years)Females Males 35.2% 25.5% - - Diabetes (Self-reported) Females Males 9.6% 4.6% 6% 4% CHD (Self-reported) Females Males 5.6% 2.3% 2.9% 1.5% Hypertension Self-reported) Females Males 24.9% 15.8% 20.6% 12.0% VAD prevalence Too low observations to record (SANHANES 2012) 43.6% Iodine deficiency: 16.5% 21.4% Iron deficiency (16 – 35years) Too low observations to record (SANHANES 2012) 9.7% HIV/ AIDS23 15.8% (1,622,870)
    • Opportunities to scale-up Nutrition Interventions • Four priority areas of government for the health sector: • Increasing life expectancy, • Decreasing maternal and child mortality • Combating HIV&AIDS, decreasing burden of disease from TB, • Strengthening health system effectiveness • Window of opportunity: the first 1000 days of life • Renewed focus on Breastfeeding • Focus on Non-Communicable Diseases (NCD) • Re-engineering of the PHC ( 3 Streams) – Ward-based health care teams – District-based health care teams – School health services • Community health worker cadre • Political will to address all forms of malnutrition
    • Provincial Strategic Direction • Guided by the: – Provincial Growth and Development Plan – KZN Health Strategy • Nutrition is included in the Annual Performance Plan – Prevalence of underweight Children under 5 years – Child under 5 severe acute malnutrition incidence – Children not gaining weight rate under 5 years – Vitamin A Coverage 12-59 months
    • Strategic Direction  Enhancement of IYCF (MBFI, HBM Banks, Regulation 991)  Complementary feeding  Micronutrient Supplementation  Communication Strategy: Social Media & Marketing  Integrated Management of Acute Malnutrition  Re-orientation of HCW (including CCGs, NAs, Family Health Outreach Teams)  Phila Mntwana Centres, Framework for Accelerating Community-based MNCWH and Nutrition Interventions  Focus on Non-Communicable Disease (NCD)
    • KZN Specific Nutrition Policies  Infant and Young Child Feeding in the context of HIV Policy (G68.2010)  KZN Guidelines for the Preparation of Powdered Infant Formula in the Public Sector (Cir G10.2010)  Implementation Guidelines for Nutrition Interventions at Health Facilities (Cir G73.2013)  Vitamin A Supplementation Programme (Cir G96.2012)  MNCWH & Nutrition Community Framework  Kwazulu-Natal Provincial Guidelines on the Integrated Management Of Acute Malnutrition -IMAM (Cir 2014)
    • KZN Specific Nutrition Policies • Infant and Young Child Feeding in the context of HIV Policy (G68.2010) – 20th of April 2010: KZN-DOH Head of Department approved implementation of IYCF policy revision for implementation with effect from 1 January 2011 This included a decision to stop issuing of free infant formula to mothers in the PMTCT programme Phased out approach – 2 Indicators added to DHIS in April 2011 • Early breastfeeding initiation (1 hour of birth) • Exclusive breastfeeding at 14 weeks • KZN Guidelines for the Preparation of Powdered Infant Formula in the Public Sector (Cir G10.2010)
    • KZN Specific Nutrition Policies • Implementation Guidelines for Nutrition Interventions at Health Facilities (Cir G73.2013) – Comprehensive policy that provide guidance for implementation of nutrition services at all levels of care • Vitamin A Supplementation Programme (Cir G96.2012) – Update of the supplementation protocol – Issuing of Vitamin A by CCGs to increase 12-59 months coverage – Stopping Vitamin A to post-partum mothers
    • KZN Specific Nutrition Policies • MNCWH & Nutrition Community Framework – In August 2010, the Head of Department approved the framework for accelerating community based maternal, neonatal, child and women’s health and nutrition interventions. – This framework focuses on the community based approach to care for women and children at the household level, with the community care givers (CCGs), being recognized as key role players. • Kwazulu-Natal Provincial Guidelines on the Community- Based Management Of Acute Malnutrition (Cir G 102.2012) – Policy includes management of malnutrition at these levels of care: • Inpatient Care • Community Outreach • Outpatient Care
    • Target Groups Children 0 - 23 months. Children 2 – 14 years At risk pregnant women At risk lactating women HIV and AIDS and TB clients Chronic diseases of lifestyle
    • PRIMARY PREVENTION INTERVENTIONS  Provide nutrition education and other relevant information on:  Protect, support and promote breastfeeding  Encourage appropriate complementary feeding of young children  Nutrition during pregnancy and lactation  Growth monitoring and promotion  Food Based Dietary Guidelines  Supplementation with High Dose Vitamin A Capsules
    • SECONDARY TREATMENT INTERVENTIONS  IMAM (Integrated Management of Malnutrition)  NACS (Nutrition Assessment Counselling & Support)  Details on Entry and Exit Criteria for Therapeutic Feeds and Multivitamin Intervention Supplementation
    • Nutrition Assessment Screening Counselling and Support • Malnutrition in children as a proxy of family malnutrition • Proper assessment and screening to ensure that all underweight children are detected early and treated accordingly • Provision of adequate anthropometric equipment (baby scales and length measures) was procured for all PHC facilities. • The National Road-to Health-Booklets (RtHBs) are essential tools in ensuring that regular growth monitoring and promotion occurs at all levels of care, especially PHC.
    • Therapeutic Supplementation Programme • A programme currently exists to ensure that all patients presenting with underweight and severe malnutrition receive therapeutic feeds. • Food supplements to underweight children • Nutrition supplements for those with AIDS/TB related malnutrition porridge and milk supplements for legible clients • Legible pregnant and lactating women receive therapeutic supplements • Therapeutic supplements for the aged, chronically ill and children >5yrs.
    • Nutrition Indicators • Number of underweight Pregnant women receiving therapeutic supplements. • Number of underweight lactating women receiving therapeutic supplements. • Number of underweight HIV+ patients 15 years and older receiving therapeutic supplements. • Number of underweight TB patients 15 years and older receiving therapeutic supplements. • Malnourished children under 5 years of age receiving therapeutic supplements. • Child under 5 food supplementation coverage
    • Nutrition Advisor Programme  In 2011 the structure was approved to have Nutrition Advisors at PHC  Part of Primary Health Care engineering strategy  All fixed clinics are earmarked to have Nutrition Advisors  Posts were filled from a pool of CCGs and Youth Ambassadors  Currently, 396 Nutrition Advisors are working at PHC facilities  Phase 2 newly trained Nutrition Advisors starting 1 April 2014  Job Purpose: To promote nutrition services at the primary Health Care level according to the needs of the community in order to promote optimal nutritional status.
    • Nutrition Advisor Programme  Providing support in the implementation of integrated Nutrition Programme interventions such as Nutrition Supplementation Programme, Growth Monitoring and Promotion, Vitamin A Supplementation Programme Infant feeding, Young child feeding, Nutrition and Health Education  Participate in (and conduct) community outreach programmes in the districts by being involved with Family Health Outreach Teams; School Health Teams; Operation Sukuma Sakhe.  Conduct nutrition interventions in Phila Mntwana sites / centres such as nutrition education, growth monitoring  Provide nutrition interventions such as nutrition and health education, screening and distribution of nutrition IEC material during community events
    • MUAC • The introduction of Mid-Upper Arm Circumference Tapes (MUAC) • MUAC tapes aim to ensure early detection of underweight and prevent severe malnutrition at community level. • Reliable screening tool and a population based indicator to address the Millennium Development and monitor progress: – MDG Goal 1 – Reduction in Poverty – MDG Goal 4 Reduction in Child mortality • This tool can be utilized at all levels from Community Based Care Workers up to Medical Professionals. • Community Health Worker cadre is trained on how to use MUAC for screening and refer to health facilities for intervention where required • Main tool used for screening at Phila Mntwana centres
    • Ngiyabonga