Care practices are important for understanding, preventing, and treating acute malnutrition. They include breastfeeding, psychosocial care, hygiene, and play sessions. Poor care practices can lead to problems like severe acute malnutrition in infants. Care practices should consider both quality and quantity of caregiver interaction. Systematic integration of care activities into nutrition centers could help improve medico-nutritional outcomes and the mother-child relationship. Staff training and further research on the impact are also suggested.

1. Care Practices and
Malnutrition/Malnutrition and
mental health
Amir Yarparvar
UNICEF Pakistan
TOT on CMAM
Hyderabad Jan 2011

2. 2
Objective…
• To highlight the
importance of Care
Practices in the
Understanding,
Prevention and
Treatment of
acute Malnutrition
in CMAM…

3. 3
UNICEF’s Conceptual Framework for Nutrition
Information, Education,
Communication
Resources and Control :
Human, economic and
organizational
Potential Resources
Political, cultural and social
structures
Child Survival, Growth and
Development
Outcome
Immediate
Determinants
Underlying
Determinants
Basic
Determinants
Household Food
Security
Health Services and
Healthy
Environment
Care practices
Adequate Dietary
Intake
Health

4. Care Practices
• “The behaviors and practices of caregivers that
provide the food, stimulation and emotional
support necessary for children’s healthy growth
and development. These practices translate
food security and health care into a child’s well-
being. Not only the practices themselves, but
also the way they are performed (with
affection and with responsiveness to children)
are critical to children’s survival, growth and
development” (Engle, 1995).

5. 5
What are the care practices ?
• Care for women
• Breastfeeding/Feeding
• Psychosocial care
• Food processing
• Hygiene Practices
• Home Health Education
• Play-sessions for mother
and child

7. Kabul - Afghanistan
• Severe acute
malnutrition of infants
under 6 months
• Leila
• Lack of breastmilk ?
– Knowledge and beliefs
– Cultural practices
– Depression and anxiety

9. 9
The caring practices have to be
considered in two aspects:
The quantity:
How much time does the caregiver
spend with the child?
The quality:
Responses, sensibility and
continuity of the responses to the
child’s needs.
Warmth, affection and acceptation.
Autonomy, support for exploration
and learning.

10. 10
Play sessions...
Using locally made safe toys

11. 11
NB Picture Description Age group
Developmental
objective
a, 4b
Butterfly
rattle
6 months
Sensorial
and micro-
motor
development
6 Sweet Ball 6 months
Sensorial
and micro-
motor
development
9 Book
6-12
months
Sensorial
and micro-
motor
development
49
9 wooden
cubes that
form 6
puzzles
12-59
months
Sensorial
and motor
development
Picture Description Age group
Developmental
objective
Playmobils: 5
characters, 1
baby chair
and rubber
ring
24-59
months
Symbolism
3 wagons
Wooden train
+ 14 wooden
pieces
12-59
months
Motor and
dexterity
development
Accordion
12-59
months
Sensorial
and dexterity
development
Wooden
Puzzle + 30
Pieces
24-59
months
Dexterity and
logical
development
Medical Set
+ 15 Pieces
(Medical
Tools)
24-59
months
Symbolism

13. Impact of Child Care Activities
• Medico-nutritional indicators
evolution
• Changes in staff attitude and
nutrition centre atmosphere
• Mother-child relationship
• Activity and interest of children
• Participation of mothers

14. What are our suggestions?
- Systematic integration of some care
practices activities in nutrition
centres?
- Staff training?
- Definition of assessment and impact
indicators
- Researching the impact on recovery
pace?