The document outlines training objectives for health workers in Kebbi State, Nigeria on nutrition services. The objectives are to: 1) Learn adult learning principles and curriculum content. 2) Improve knowledge of infant and young child feeding practices. 3) Improve skills in preventing and managing moderate malnutrition and preventing relapse of severe acute malnutrition in children under 5 using a food-based approach. The document provides guidance for trainers and covers key concepts such as infant and young child feeding, malnutrition treatments, and nutrition strategies like supplementation, fortification, and dietary diversification.

1. Training of Health Workers for the Delivery of Nutrition
Services (food-based approach to manage moderate
malnutrition, prevent malnutrition and relapse of SAM @
the PHC Facilities, Kebbi State

2. Training
Objectives

3. Training objective
1. To learn the principles of adult learning, effective
communication and familiarize with the knowledge and
skills content of the curriculum
2. To improve knowledge and skills on IYCF feeding practices
and achieving number of food groups in one meal and
3. to improve the trainer’s knowledge and skills on
prevention and management of moderate malnutrition
and prevention of relapse among recently recovered
severe acute malnutrition cases in children under five
using food-based approach and responsive care

4. As an instructor/facilitator…….
 Be mindful of local culture, language, dress appropriately
 Space and time management
 Position yourself
 Know your learners, call them by names
 Identify experts. Recognize expertise and experience of learners
 Be open to ideas & flexible. Do not ignore any decision made by learners.
 Communicate clearly, in a language acceptable and understandable. Avoid using jargons.
 Be willing to accept errors
 It is okay if you do not know an answer to a question
 Asking questions: Keep them simple and straight forward, involve everyone, provide feedback, facilitate
dialogue, motivate learners
 Give feedback
Be Prepared
Be Enthusiastic
Be Energetic
Make it enjoyable

5. Key concepts and terminologies

6. Acronyms
• EBF: Exclusive breastfeeding
• IYCF: Infant and Young Child Feeding
• WASH: Water, Sanitation and Hygiene
• CMAM: Community Management of Acute Malnutrition
• IMCI: Integrated Management of Childhood Illnesses
• WHZ: Weight for Height Z score
• MNP: Micro Nutrient Powder

7. Responsive care
The process of watching and tuning into
your child's cues, thinking about what they
might mean, and then responding to them in a
sensitive way. This is the best way to meet their
physical and mental needs

8. Four (4) food groups/Star
There are four food groups which may be added in a different order to create
a 4-star diet for children 6-23 months. These include:
1. Animal-source foods (meat, chicken, fish, liver), and eggs, milk, and milk
products
2. Staples (maize, wheat, rice, millet and sorghum); roots and tubers
(cassava, potatoes)
3. Legumes (beans, lentils, peas, groundnuts) and seeds (sesame)
4. Vitamin A-rich fruits and vegetables (mango, papaya, passion fruit,
oranges, dark- green leaves, carrots, yellow sweet potato, and pumpkin),
and other fruit and vegetables (banana, pineapple, watermelon,
tomatoes, avocado, eggplant and cabbage)

9. Planning a 4 Star Diet
31/3

10. SUPPLEMENTATION
•
It is a short term measure to address MND.
Twice a year children 6-59 months are being
given vitamin A supplements across the
country.
Pregnant mothers and adolescent girls are
given iron folate supplements.

11. FORTIFICATION
Food fortification through addition of
nutrients that may or may not be present
naturally in the food to improve its overall
nutritional quality has proven to be effective
in both prevention and sustenance of
adequate status of the Population.
There is mandatory fortification of flour,
edible vegetable oil, salt and sugar &
Voluntary fortification of some foods; milk,
drinks, etc.

12. BIO- FORTIFICATION
It focuses on making plant foods more nutritious as the plant is
growing rather than having nutrients added to the food when
they are being processed.
Introduction of bio- fortified foods such as; Orange fleshy
sweet potato, maize, cassava.

13. HOME FORTIFICATION- USING MNP
Micronutrient powders (MNP) are a mixture of vitamins
and minerals that are packaged in a 1 gram sachet and
are added and mixed into a small amount of any soft or
mashed, semi-solid food that can be consumed in one
feeding.
Home fortification is recommended to provide enough
essential nutrient for complementary foods .

14. DIETARY DIVERSIFICATION
 Dietary Diversification means consumption of as many
varieties of foods and animal products as possible,
especially locally available foods .e.g. grains, tubers, meat,
fish, fruits, vegetables, etc.
 This is aimed at increasing the consumption of varieties of
foods.

15.  Encourage the use of mixed diets at household and
community levels.
 Promote back yard and school gardening for production
of foods/fruits.
 Promote adequate complementary feeding.
 Increase intake of iron-rich foods.
TO PROMOTE DIETARY DIVERSIFICATION
;

16. MINIMUM MEAL FREQUENCY
• This is number of meals a child eats in a day to meet the
energy requirement. This varies with the months/age.
• A child 6-8 months eats at least twice in a day in addition to
breast milk while 9-23 months at least 3 times with breast milk.
• Non breastfed child eats 4 times daily.

17. MINIMUM DIET DIVERSITY
• This is the adequate micronutrient density of foods. It is
involves consumption of food from at least five groups;
• The five groups should be from eight food groups; breast milk,
grains, legumes/ nuts, dairy products, flesh foods, meat/ fish,
eggs, vitamin A rich foods, vegetables and other fruits&
vegetables.

18. MINIMUM ACCEPTABLE DIET
 To ensure appropriate growth and development.
This is the combination of Minimum Diet Diversify and
Minimum Meal Frequency
In Nigeria; (NDHS 2018);
10% (Non breastfeeding) and 11% meet MAD).
14% urban and 9%rural areas.
7% NO education and 23% secondary education.