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Nutrition Blended Learning Module for the Health Extension Programme

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Federal Democratic Republic of Ethiopia Ministry of Health Nutrition Blended Learning Module for the Health Extension Programme HEAT Health Education and Training HEAT in Africa Federal Democratic Republic of Ethiopia Ministry of Health The Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs) have developed this innovative Blended Learning Programme in partnership with the HEAT Team from The Open University UK and a range of medical experts and health science specialists within Ethiopia. Together, we are producing 13 Modules to upgrade the theoretical knowledge of the country’s 33,000 rural Health Extension Workers to that of Health Extension Practitioners, and to train new entrants to the service. Every student learning from these Modules is supported by a Tutor and a series of Practical Training Mentors who deliver the parallel Practical Skills Training Programme. This blended approach to workplace learning ensures that students achieve all the required theoretical and practical competencies while they continue to provide health services for their communities. These Blended Learning Modules cover the full range of health promotion, disease prevention, basic management and essential treatment protocols to improve and protect the health of rural communities in Ethiopia. A strong focus is on enabling Ethiopia to meet the Millennium Development Goals to reduce maternal mortality by three-quarters and under-5 child mortality by two-thirds by the year 2015. The Modules cover antenatal care, labour and delivery, postnatal care, the integrated management of newborn and childhood illness, communicable diseases (including HIV/AIDS, malaria, TB, leprosy and other common infectious diseases), family planning, adolescent and youth reproductive health, nutrition and food safety, hygiene and environmental health, non-communicable diseases, health education and community mobilisation, and health planning and professional ethics. In time, all the Modules will be accessible from the Ethiopian Federal Ministry of Health website at www.moh.gov.et; online versions will also be available to download from the HEAT (Health Education and Training) website at www.open.ac.uk/africa/heat as open educational resources, free to other countries across Africa and anywhere in the world to download and adapt for their own training programmes. Dr Kesetebirhan Admasu State Minister of Health Ethiopian Federal Ministry of Health i Acknowledgements Nutrition is one of the 13 Blended Learning Modules for the Ethiopian Health Extension Programme. Together with the practical skills training sessions that accompany each of the supported self-study texts, this programme will upgrade the Health Extension Workers who complete the curriculum to Health Extension Practitioners at Level-IV of the Ethiopian Occupational Standards. The upgrading programme is sponsored by the Ethiopian Federal Ministry of Health (FMOH) and the Regional Health Bureaus (RHBs). The FMOH gratefully acknowledges the receipt of funding for this programme from the Ethiopian Office of UNICEF (the United Nations Children’s Emergency Fund), The Open University UK, the Alan and Nesta Ferguson Foundation Trust UK, and AMREF (the African Medical and Research Foundation). We are also thankful for the support of the Ethiopian Office of UNICEF for freely enabling their expert to participate in the development of this Module. Nutrition was produced by a team of Ethiopian experts, who were trained and supported by experts in blended learning pedagogy from the HEAT (Health Education and Training) Team for Africa at The Open University UK. The contributors of original material are: Dr Abdulaziz Ali, FMoH and Food and Nutrition Technical Assistance (FANTA-2) Professor Tefera Belachew, Jimma University Dr Tewoldeberhan Daniel, UNICEF Ethiopia Dr Ferew Lemma Feyissa (Module Academic Coordinator), FMoH and Twinning Centre volunteer, American International Health Alliance The Editors of Nutrition are Dr Tom Heller, Senior Lecturer, and Lesley-Anne Long, HEAT Programme Director, with contributions from Dr Anita Rogers; all three are in the Faculty of Health and Social Care at The Open University UK. The other members of the HEAT Team are: Dr Basiro Davey, HEAT Deputy Director (Ethiopia) Alison Robinson, HEAT Programme Coordinator Dawn Partner, HEAT Senior Production Assistant Jessica Aumann, HEAT Programme Assistant Ali Wyllie, HEAT Lead eLearning Adviser We acknowledge the vital contributions of the Programme Coordinators within Ethiopia: Ato Mohammed Hussein Abeseko, UNICEF Ethiopia and the Federal Ministry of Health Ato Tedla Mulatu, AMREF Ethiopia The cover design for Nutrition is by Chris Hough, Learning and Teaching Solutions, The Open University UK. The cover photographs are reproduced with the permission of JICA Ethiopia (food sources in Ethiopia) and UNICEF Ethiopia/Indrias Getachew (Health Extension Worker with mother and child). Some of the illustrations in this Module were produced by Terefe Wondimagegnehu from the Federal Ministry of Health. We particularly wish to acknowledge our use in this Module of adapted extracts and illustrations from Nutrition for Developing Countries (second edition) by Felicity Savage King and Ann Burgess (1993) and Ethiopian Federal Ministry of Health National Guidelines including: Management of SAM; Prevention and Control of Micronutrient Deficiencies; Nutritional Care/Support for Children and Adults Living With HIV; Infant and Young Child Feeding; and Enhanced Outreach Strategy (EOS) for Child Survival Interventions (2006). The opinions expressed in this Module are those of the authors and do not necessarily reflect the views of any of the donor organisations whose generous support made the production of Nutrition possible. ii iii Contents Study Session 1 Food, Diet and Nutrition: an Overview 2 Nutrients and their Sources 3 Nutritional Requirements throughout the Lifecycle 4 Infant and Young Child Feeding 5 Nutritional Assessment 6 Common Nutritional Problems in Ethiopia 7 Preventing Micronutrient Problems in Ethiopia 8 Household Food Security 9 Managing Acute Malnutrition 10 Managing Severe Acute Malnutrition 11 Nutrition Education and Counselling 12 Nutrition and HIV 13 Nutrition Information System Notes on the Self-Assessment Questions (SAQs) iv Introduction to the Nutrition Module The national health strategy of Ethiopia emphasises the provision of effective health promotion and disease prevention services at the community level. The first Millennium Development Goal (MDG1) calls for the eradication of extreme poverty and hunger by 2015. Achievement of MDG1 is crucial for national socioeconomic progress and development. For this purpose, Ethiopia has developed a National Nutrition Strategy (NNS) and launched a National Nutrition Programme (NNP) in 2008. The vision of the NNS/NNP is ‘to ensure that all Ethiopians secure adequate nutritional status in a sustainable manner which is an essential requirement for a healthy and productive life’. The NNP, working hand in hand with the successful Health Extension Programme (HEP), has the potential to bring about major change to the status of health and nutrition in Ethiopia. The Nutrition Module is studied in parallel with a Practical Skills Training Programme at health facilities in your locality. This blended approach to learning will ensure that you achieve all the theoretical and practical competencies required to give effective nutritional care and support in your community. The Nutrition Module has 13 study sessions, starting with the basics of nutrition and finishing with a session on the Nutrition Information System in Ethiopia. The first three Study Sessions cover food, diet and nutrition; nutrients and their food sources (in Ethiopia); and nutritional requirements throughout the human lifecycle. Study Session 4 deals with infant and young child feeding in the context of our country. Following this, you will learn different methods of nutritional assessment (Study Session 5) both at individual and community level. In Study Sessions 6 and 7, the nutritional problems that are of public health importance in Ethiopia are elaborated; followed by household food security (Study Session 8). Study Sessions 9 and 10 cover the treatment and control of the main nutritional problems of Ethiopia, including severe micronutrient malnutrition. In Study Session 11 you will learn about education and how to counsel people in your community to prevent or address nutrition problems. Nutrition and HIV is considered in Study Session 12. Finally, in Study Session 13 you look at the Nutrition Information System in Ethiopia and your role in collecting data that helps to inform decision- making in relation to nutrition programmes and other interventions in Ethiopia. v vi Black plate (5,1) Study Session 1 Food, Diet and Nutrition: an Overview Study Session 1 Food, Diet and Nutrition: an Overview Introduction In this study session, you will learn about some of the basics of nutrition. You will learn what is meant by food and diet as well as the meaning of nutrition and nutrients in general. What food does to our body and how the body uses nutrients is also explained. Estimates of the eligible population for nutritional care and support are provided, using calculations from the Ethiopian census data. Finally, the relationship between health, nutrition and development is described, linking them with the Millennium Development Goals. The overall purpose of this session is to teach you some of the basics about nutrition
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