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. 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
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
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. 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. 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. 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. 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. 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. 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. 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
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. We Know That a Multisectoral Approach is
Critical
Source: Lancet 2013
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. 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. 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. 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
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