Understanding the Essential Nutrition Actions Framework_Agnes Guyon_5.5.14

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  • We have today two key references from renown institutions (World Health organizations and the Lancet series) to guide donors, governments, and program managers in scaling up high impact nutrition interventions
  • SUN takes a multi-sectoral approach to scale up nutrition specific interventions and put nutrition-sensitive policies into all key sectors
  • Understanding the Essential Nutrition Actions Framework_Agnes Guyon_5.5.14

    1. 1. Implementing High-Impact Nutrition Interventions At Scale: The ENA Framework 2014 Understanding the ENA Framework Pre-session CORE Group. May 5th, 2014 Agnes Guyon, MD, MPH
    2. 2.  Based on proven impact:  Women’s nutrition  Infant & young child feeding  Micronutrients  Action-oriented, with clear guidance Who should take what action Growing consensus that nutrition interventions need to be…
    3. 3. The High-Impact Nutrition Interventions Evidence-Based Direct Interventions to Prevent and Treat Undernutrition Promoting good nutritional practices: 1. breastfeeding 2. complementary feeding for infants after the age of six months 3. improved hygiene practices, including handwashing Increasing intake of vitamins and minerals: Provision of micronutrients for young children and their mothers: 4. periodic vitamin A supplements 5. therapeutic zinc supplements for diarrhea management 6. multiple micronutrient powders 7. deworming drugs for children (to reduce losses of nutrients) 8. iron-folic acid supplements for pregnant women to prevent and treat anemia 9. iodized oil capsules where iodized salt is unavailable Provision of micronutrients through food fortification for all: 10. salt iodization 11. iron fortification of staple foods Therapeutic feeding for malnourished children with special foods ($6.2 billion): 12. prevention or treatment for moderate undernutrition 13. treatment of severe undernutrition (‚severe acute
    4. 4. Two References (2013)
    5. 5. Control of Iodine Deficiency Disorders Control of Vitamin A Deficiency Optimal Breastfeeding (BF) Nutritional Care of the Sick & Malnourished Child Complementary Feeding with BFWomen’s Nutrition Control of Anemia Essential Nutrition Actions (ENA) Framework First Developed in 1997
    6. 6. ENA Uses the Life Cycle Approach
    7. 7. Focuses on the 1000 Day Window of Opportunity Before conception
    8. 8. Promotion: Support Women’s Nutrition In Adolescence, Before Pregnancies, and Between Pregnancies Promote & Support improved diet  Diversified diet and appropriate amount for adolescent needs  Increase mineral intake Provide Micronutrients  Iron-folic acid supplementation and treatment of anemia  Deworming With  Delay first pregnancy  Keep girls in school WHO 2013
    9. 9. Promotion: Support Women’s Nutrition (1) During Pregnancy & Lactation Promote & Support Improved Diet  Diversified diet  Increased food and MN intakes  1 extra meal/day when pregnant (550 Kcal/day)  2 extra meals/day when lactating (650 Kcal/day)  Consumption of iodized salt  Sleep under insecticide-treated nets With  Spacing of Pregnancy  Cessation of smoking, alcohol or other substances Women’s nutrition in the context of HIV and emergencies WHO ENA, 2013
    10. 10. Promotion: Support Women’s Nutrition (2) During Pregnancy and Lactation * Countries with anemia < 20% ** Countries with night blinder>5% *** Countries with low calcium intake **** Countries with < 20% iodized salt Provide Micronutrients  Daily iron-folic acid(30-60/0.4mg) or  Weekly 2-3 intermittent iron-folic acid (120/2.8mg) for non-anemic*  Daily (10 000IU) or Weekly (25 000IU) vitamin A**  Daily (1.5 gr) Calcium***  Daily or annual iodine**** With  Intermittent Preventive Treatment (ITP) of malaria  Deworming during pregnancy (twice)  Treatment of anemia  Timely cord clamping
    11. 11. Protection-Promotion-Support Breastfeeding < 6 months Protect Breastfeeding  Legislation & enforcement of breastmilk substitutes code Promote & Support key practices  Immediate initiation of breastfeeding  Exclusive breastfeeding for 6 months  Correct positioning & attachment  Breastfeed day and night at least 10 times  Empty one breast before switching to the other (Fore-milk vs hind milk)  Infant feeding in the context of HIV and emergencies Other practices (control & prevention of anemia)  Timely cord clamping WHO ENA 2013
    12. 12. Protection-Promotion-Support (1) Complementary Feeding with Breastfeeding 6-24 Months Promote & support Improved Diet  Introduce appropriate CF at 6 months  Continue breastfeeding until 24 months & more  Frequency:  Amount adapted to age  6-8 months: 200 kcal/day  9-11 months: 300 kcal/day;  12-23 months: 550 kcal/day  Diversity (fruits, vegetables, animal source, MNP, fortified CF, iodized salt)  Density: from mashed to family food  Utilization (handwashing, clean water, food & utensils)  Active feeding Protect CF Codex Alimentarius & Marketing of complementary food WHO ENA 2013  6-8 months: 2-3 meals/day  9-23 months: 3-4 meals/day, 1-2 snacks/day
    13. 13. Protection-Promotion-Support (2) Control & Prevention of MN Deficiencies WHO ENA 2013 Provide Vitamin A Supplementation  Biannual vitamin A Capsules for children 6-59 months  100 000IU for children 6-11 months  200 000IU for children 12-23 months Provide Iron-Folic Acid Supplementation  Daily iron-folic acid (2mg/kg) for 3 months for children 6-23 months  With treatment of malaria in endemic areas Provide Micronutrient Powder (MNP)  Daily for at least 2 months for children 6-23 months Provide Iodized Oil*  Annually (200 mg) for children 6-23 months * Countries with <20% iodized salt With  Biannual deworming for children 12-59 months  Malaria prevention & treatment
    14. 14. Nutritional Care Sick Child & Management of Acute Malnutrition Promote & Support of Improved Diet  0 to 24 months: increase breastfeeding frequency during and after illness  6 to 24 months & older: Increase feeding during illness and after illness (e.g., feed 1 extra meal each day for two weeks after illness) Provide Appropriate MN Treatment (following national protocols)  Vitamin A  Zinc for treatment of diarrhea with oral rehydration therapy  Anemia Management of moderate & severe acute malnutrition Nutritional care of HIV-positive children (6 months-14 years) WHO ENA 2013
    15. 15. Promotion-Support Nutrition-Sensitive WHO ENA 2013 Immunization  EPI  New vaccines (Rotavirus and Pneunococcus) Prevention of Childhood Illnesses  Essential Hygiene Actions (Handwashing, sanitation)  Household water treatment  Reduction of indoor air pollution  Context of HIV: Mother To Child Transmission Family Planning
    16. 16. Global Interventions Wheat and Maize Flour Fortification WHO ENA 2013
    17. 17. How & Where to Implement? Control of Iodine Deficiency Disorders Control of Vitamin A Deficiency Optimal Breastfeeding (BF) Nutritional Care of the Sick & Malnourished Child Complementary Feeding with BFWomen’s Nutrition Control of Anemia
    18. 18. We Know That a Multisectoral Approach is Critical Source: Lancet 2013
    19. 19.  A framework to operationalize the implementation of existing nutrition programs that:  pulls together existing vertical programs in a sensible 'action-oriented' way  greatly expands coverage to multi-contacts and multi-platforms.  Provides an excellent training framework on which to train service providers and community members:  Simple  Uses existing structures. The ENA Framework
    20. 20. Within the health sector: Use existing nutrition programs & increase their performance Child Health Newborn health Immunization Treatment of childhood illnesses Management of acute malnutrition Reproductive Health Lactation Amenorrhea Method With Family Planning Safe Motherhood Infectious Diseases Control of Malaria Tuberculosis HIV and AIDS (PMTCT)
    21. 21. DELIVERY: safe delivery, FP, STI prevention, Optimal delivery, VCT, ARVs, Delay cord clamping, early & exclusive breastfeeding, iron- folic acid, diet PREGNANCY: TT, antenatal visits, FP, STI prevention, safe delivery, VCT, Options, Safe Sex, danger signs, Diet, iron-folic acid, deworming, anti-malarial, iodized salt, calcium, vitamin A, preparation of breastfeeding POSTNATAL AND FAMILY PLANNING: STI prevention, child’s vaccination, VCT, Safe sex, Support to breastfeeding, diet, iron- folic acid, FP WELL CHILD AND GMP: check and complete vaccination, VCT, Safe Sex, Monitor growth, assess and counsel on child feeding, iodized salt SICK CHILD: assess and treat per IMCI/immunization/VCT, counsel on infant feeding, assess and treat for anemia, check and complete vitamin A, deworming IMMUNIZATION: vaccinations, FP, and STI referral, VCT, Safe Sex, Support to infant and young child feeding, vitamin A, deworming, assess and treat infant’s anemia Critical Contacts for Essential Nutrition Actions
    22. 22. Outside the Health Sector Use Existing Contacts to Extend Nutrition Coverage Agriculture Food diversification Food security Household food production Micro-credit Women’s farmers clubs Pre-service Education Doctors, nurses, and midwives Sanitation Clean water Public health education Mass Media TV Radio Local broadcasting Community Nutrition Community Workers Positive deviance Schools Children & Adolescent Deworming Iron supplementation
    23. 23. Maximizing contacts to enhance food diversity Critical Contacts Within the Agriculture Sector
    24. 24. Ultimate Goal: Saturation Within the Agriculture Sector Within the Health Sector
    25. 25. The remaining challenge: ‘just to do it’ Thank You

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