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NUTRITION ESSENTIALS a Guide for Health Managers WHO/BASICS/UNICEF 1999

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NUTRITION ESSENTIALS a Guide for Health Managers WHO/BASICS/UNICEF 1999 NUTRITION ESSENTIALS A Guide for Health Managers WHO/BASICS/UNICEF 1999 ** Please note that this PDF version does not contain Figures 1-16 as described throughout the text. ACRONYMS ARI Acute Respiratory Infection BASICS Basic Support for Institutionalizing Child Survival BCG Bacillus of Calmette and Guerin (TB vaccine) BF Breastfeeding BFHI Baby Friendly Hospitals Initiative CBD Community Based Distribution CBO Community Based Organization CHA Community Health Agent CHW Community Health Worker CIDA Canadian International Development Agency DHS Demographic and Health Surveys EBF Exclusive BF HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome ICCIDD International Council for the Control of Iodine Deficiency Disorders IDD Iodine Deficiency Disorders IEC Information, Education, and Communication IMCI Integrated Management of Childhood Illness INACG International Nutritional Anemia Consultative Group IU International Unit IVACG International Vitamin A Consultative Group KAP Knowledge, Attitude, and Practice LAM Lactational Amenorrhea Method MCH Maternal and Child Health MDIS Micronutrient Deficiency Information System mg Milligram MICS Multiple Indicator Cluster Survey MOU Memorandum of Understanding NGO Non-governmental Organization NID National Immunization Day OPV Oral Polio Vaccine PRA Participatory Rural Appraisal TBA Traditional Birth Attendant UNICEF United Nations Children's Fund USAID United States Agency for International Development VAD Vitamin A Deficiency WHO World Health Organization CONTENTS CHAPTER 1 INTRODUCTION ..................................................................................... 1 BASIC FACTS ABOUT NUTRITION............................................................................. 2 GLOBAL SUPPORT FOR NUTRITION INTERVENTIONS .......................................... 3 THE ROLE OF HEALTH PROGRAMS IN IMPROVING NUTRITION.......................... 4 CHAPTER 2 PRIORITY NUTRITION INTERVENTIONS ............................................ 7 EXCLUSIVE BF ............................................................................................................. 8 APPROPRIATE COMPLEMENTARY FEEDING AND CONTINUED BF FOR 2 YEARS...................................................................................................... 10 ADEQUATE NUTRITIONAL CARE OF SICK AND MALNOURISHED CHILDREN................................................................................................................. 15 ADEQUATE VITAMIN A INTAKE................................................................................ 17 ADEQUATE IRON INTAKE ......................................................................................... 19 ADEQUATE IODINE INTAKE...................................................................................... 21 CHAPTER 3 DEVELOPING A PLAN TO STRENGTHEN NUTRITION IN DISTRICT HEALTH SERVICES .......................................................................... 28 IDENTIFY THE MAIN NUTRITION PROBLEMS ........................................................ 29 REVIEW EXISTING NUTRITION INTERVENTIONS ................................................. 34 DEFINE TARGET GROUPS, SET NUTRITION OBJECTIVES, AND DEVELOP A STRATEGY.......................................................................................... 35 IDENTIFY PROGRAM AND COMMUNITY RESOURCES ........................................ 40 CHAPTER 4 TECHNICAL GUIDELINES FOR INTEGRATING NUTRITION IN HEALTH SERVICES ...................................................................... 42 INTEGRATING NUTRITION INTERVENTIONS IN HEALTH SERVICES: KEY STEPS ......................................................................................................................... 42 CRITICAL HEALTH CONTACTS FOR NUTRITION INTERVENTIONS .................... 43 NUTRITION INTERVENTIONS IN MATERNAL HEALTH SERVICES ...................... 45 NUTRITION INTERVENTIONS IN CHILD HEALTH SERVICES ............................... 50 CHAPTER 5 FORMING COMMUNITY PARTNERSHIPS......................................... 56 WHY COMMUNITY PARTNERSHIPS ARE IMPORTANT ......................................... 57 THE ROLE OF THE PROGRAM MANAGER ............................................................. 57 OPTIONS FOR BUILDING PARTNERSHIPS............................................................. 58 TYPES OF COMMUNITY-BASED ACTIVITIES ......................................................... 61 CHAPTER 6 COMMUNICATIONS ACTIVITIES TO IMPROVE NUTRITION........... 68 WHY COMMUNICATIONS ACTIVITIES ARE IMPORTANT ...................................... 68 THE ROLE OF THE HEALTH MANAGER.................................................................. 69 DEVELOPING AND IMPLEMENTING A COMMUNICATIONS PROGRAM.............. 70 CHAPTER 7 SUPPORTING NUTRITION INTERVENTIONS.................................... 79 TECHNICAL GUIDELINES AND PROTOCOLS......................................................... 80 SUPPLIES.................................................................................................................... 80 TRAINING, SUPERVISION, AND INCENTIVES ........................................................ 84 COUNSELING AND EDUCATION MATERIALS ........................................................ 85 MONITORING AND EVALUATION............................................................................. 86 CHAPTER 8 NUTRITION PROTOCOLS ................................................................... 93 CHAPTER 1 Introduction Key Points w Malnutrition is the underlying cause of half the deaths for children under 5 years of age; it weakens the immune system and makes illnesses worse. w The nutrition of mothers and children is closely linked. Malnutrition often begins at conception and most of the damage from malnutrition is already done by the second year of the child's life. w Even mild and moderate malnutrition have severe consequences. More than 80% of deaths associated with childhood malnutrition involve mild or moderate, rather than severe, malnutrition. w Deficiencies of specific micronutrients, such as vitamin A, iron, and iodine, are widespread and have significant health effects. w The main underlying causes of malnutrition include inadequate access to food and nutrients, inadequate care of mothers and children, inadequate health services, and unhealthy environments. w A group of affordable and highly effective nutrition interventions is available to reduce malnutrition. Women, particularly pregnant and BF women, and children under 2 years of age, are priority target groups for this proven package of essential nutrition actions. Malnutrition, a widespread problem with devastating consequences, weakens immune systems and worsens illnesses. It is a factor in about half the deaths for children under 5 (see figure 1); malnourished children who survive have diminished learning capacity and lower productivity in adulthood. Malnutrition reduces the quality of life and financially drains families, communities, and countries. All social sector and development programs can successfully improve nutrition in their service areas. However, for many reasons, health programs are especially well suited to undertake efforts to improve nutrition: w Effective, feasible, and affordable interventions to improve nutrition are now available, and they work best when combined with interventions to reduce infections. w Good nutrition helps protect natural immunity, which is particularly important for health as resistance to drugs increases and new diseases emerge. w Health workers can be highly effective in motivating families and communities to improve the care and diets of women and children. This chapter introduces health managers to important nutrition concepts, explains why they must act on nutrition problems, and outlines the steps they can take. Included in the chapter are: w basic facts about malnutrition, including the causes of malnutrition and how maternal and child nutrition are linked; 1 w examples of global support for improving nutrition; and w the role of health programs in improving nutrition. Basic Facts About Nutrition Adequate nutrition is the intake and utilization of enough energy and nutrients, together with disease control, to maintain well-being, health, and productivity. "Malnutrition" includes generalized malnutrition (which manifests itself as stunting, underweight, and wasting in individuals) and deficiencies of micronutrients, such as vitamin A, iron, iodine, zinc, and folic acid. The most visible evidence of good nutrition is taller, stronger, healthier children who learn more in school and become productive, happy adults, who participate in society. Too little or too much consumption of energy and nutrients causes health damage. Individuals who are within acceptable norms for body size and biological indicators of micronutrient status are considered adequately nourished. Malnutrition does not need to be severe to pose a threat to survival. Worldwide, fewer than 20% of deaths associated with childhood malnutrition involve severe malnutrition; more than 80% involve only mild or moderate malnutrition. Although the immediate cause of death in mild and moderately malnourished children may be pneumonia or diarrhea, many children would not die if they were well nourished. Disease and inadequate dietary intake are the immediate causes of malnutrition in most individuals. Underlying these causes are barriers in the household and family: w Insufficient access to food. Families cannot produce or acquire enough food containing
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