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The Essential Nutrition Actions:
An action oriented approach to
nutrition…
The Essential Nutrition Actions:
An action oriented approach to
nutrition…
Learning Objectives
By the end of the session we shall be able to:
• Describe the Essential Nutrition Actions for maternal and child nutrition
• Recite the key messages under each of the Essential
Nutrition Actions.
Learning Objectives
By the end of the session we shall be able to:
• Describe the Essential Nutrition Actions for maternal and child nutrition
• Recite the key messages under each of the Essential
Nutrition Actions.
Presentation outline:
• Why ENA? Some background
• When to intervene?
• What actions to take?– Seven action areas
• Where to take these actions?– Six contact points
• Key program components – Importance of harmonization
• Lessons learned
ENA Why?
not integrated
viewed as separate vertical programs
in competition with one another
not action oriented (non-specific & fuzzy)
focused only on GM/P activities
Over past 30-40 years nutrition interventions were often…
ENA Why?
integrated conceptually & programatically infant & young child feeding
maternal nutrition
micronutrients
based on proven impact
action oriented with clear guidance ‘Who’ should take ‘what’ action ‘when’
In the past 10 years growing consensus is that nutrition interventions need to be…
Majority of growth faltering occurs during
first year of life
ENA
When should we intervene?
Majority of child growth faltering occurs during first
year of life
Many Ethiopia babies are born malnourished due to poor maternal nutrition before & during
pregnancy
25 25 27
39
32
40 4144
26
16
24 24
0
10
20
30
40
50
60
Per
cen
tag
e
• infant & young child feeding, especially 0-24 months
• nutrition of girls & women
Focus on:
ENAWhat to Integrate?
7 action areas7 action areas7 action areas7 action areas
Federal MOH based on the ENA approach: proven actions to prevent malnutrition
Control of Anemia
OptimalBreastfeeding
Control of Vitamin A deficiency
Control of Iodine Deficiency Disorders
Women’s NutritionComplementaryFeeding to BF
Feeding of the sick child
Estim
ated
decrease
of
child
mort
ality:
>23%
Child Survival S
trategy, M
OH Ethiopia, Sept 2
004
ENALinks with other health interventions
Child SurvivalChild Survival ReproductiveReproductiveHealthHealthBreastfeedinBreastfeedin
ggEssential Nutrition ActionsEssential Nutrition Actions
1. Promotion of Optimal Breastfeeding
Exclusive
Breastfeeding for the first 6 months of life
National Strategy for IYCF, Fed MOH, April 2004
Estim
ated
decrease
of c
hild
mort
ality:
4%
1. Promotion of Optimal Breastfeeding
Early Initiation of BF within 1 hour of birth
Exclusive BF until 6 months
BF day and night at least 10 times
Correct positioning & attachment
Empty one breast and switch to the other
Key Messages
National Strategy for IYCF, Fed MOH, April 2004
2. Complementary Feeding to BF
at
6 months
of age
National Strategy for IYCF, Fed MOH, April 2004
Estim
ated
decrease
of c
hild
mort
ality:
8%
2. Complementary Feeding to BF
Continue BF until 24 months and more
Increase the number of feedings with age
Increase density and quantity with age
Diversify diet using variety of foods
Responsive feeding
Food hygiene
Key Messages
National Strategy for IYCF, Fed MOH, April 2004
3. Feeding of the sick child
Increase breastfeeding & complementary feeding during and after illness
(IMCI- Integrated Management of Childhood Illness)
for infants 6 months & older, feed 1 extra meal each day for two weeks following the illness
Appropriate Therapeutic Feeding
Key Messages
National Strategy for IYCF, Fed MOH, April 2004
4. Women’s Nutrition
During pregnancy and lactation-Iron/Folic Acid Supplementation-Treatment & prevention of malaria -Increase food intake
one extra meal each day during pregnancytwo extra meals each day during lactation
Deworming during pregnancy
Vitamin A Capsule within 45 days of delivery
Key Messages
National Strategy for MN, Fed MOH, April 2004
Estim
ated
decrease
of c
hild
mort
ality:
1%
5. Control of Vitamin A Deficiency
Breastfeeding: source of Vitamin A
Vitamin A rich foods
Maternal supplementation
Child supplementation
Food fortification
Key Messages
National Strategy for MN, Fed MOH, April 2004
Estim
ated
decrease
of c
hild
mort
ality:
10%
6. Control of Anemia
Supplementation for women and children (IMCI)
Deworming for pregnant women and children (twice/year)
Malaria control
Iron-rich foods
Fortification
Key Messages
National Strategy for MN, Fed MOH, April 2004
Estim
ated
decrease
of c
hild
mort
ality:
0.4
%
7. Control of Iodine Deficiency Disorders
Access & consumption by all familiesof iodized salt
Key Messages
National Strategy for MN, Fed MOH, April 2004
ENAWhere to Integrate?
7 Proven Behaviors7 Proven Behaviors
6 Critical Contact Points
6 Critical Contact Points
1. Health facility level:1. Health facility level: integrate ENA actions into existing health contacts at all health services;
2. Community-level:2. Community-level: work with community-based organizations & networks from all sectors; and
3. Behavior change:3. Behavior change: reinforce ENA actions through behavior change communication at all levels, including inter-personal communication, mass media and community mobilization.
ENA
When should we integrate?
DELIVERY: safe delivery, BF, Vitamin A, iron/folic acid, diet, FP, STI prevention
PREGNANCY : TT, antenatal visits, BF, iron/folic acid, de-worming, anti-malarial, diet, risk signs, FP, STI prevention, safe delivery, iodized salt
POSTNATAL AND FAMILY PLANNING: , diet, BF, iron/folic acid, diet, FP, STI prevention, child’s vaccination
WELL CHILD AND GMP: monitor growth, assess and counsel on infant feeding, iodized salt, check and complete vaccination
SICK CHILD: monitor growth, assess and treat per IMCI, counsel on infant feeding, BF, assess and treat for anemia, check and complete vitamin A /immunization/ de-worming
IMMUNIZATION: vaccinations, vitamin A, BF, de-worming, assess and treat infant’s anemia, FP, and STI referral
Critical contacts for infant feeding,& women’s nutrition: life cycle
Child SurvivalEPI+Community IMCIHealth facilities IMCI
Reproductive HealthWomen’s NutritionLactation Amenorrhea Method
Infectious DiseasesControl of Malaria
Mosquito net & Treatment Tuberculosis HIV/AIDS (PMTCT)
National Immunization DaysPolioMeasles
ENAENA
Essential Nutrition Actions expands nutrition coverage within the health sector…
SchoolsSchoolsAdolescent nutritionDe-wormingIron supplementationSchool lunch
AgricultureAgricultureFood diversificationFood securityWomen’s farmers clubs
SanitationSanitationClean water & sanitationPublic health educationPrevention of diarrhea, malaria, ARI
EmergencyEmergencyFood SupplementationCTCTFC EOS
ENAENA
Essential Nutrition Actions expands nutrition coverage outside the health sector…
Community Nutrition Com Workers: HEP,DA,etcPositive devianceCommunity GM/P
ENA Need to harmonize at all levels
Communities(families)
Health workers• Public • Private
•District MOH Team•NGOs•Hospital Administration
•Community Leaders•Community volunteers •Existing Groups
National National
Regional
Districts
Health Facilities
•Planners•Donors•Academia•Journalists
Four key program components in Ethiopia
3. Community: 3. Community: negotiating for negotiating for better ENA practicesbetter ENA practices
2. Training for Capacity Building2. Training for Capacity Building
1. Policy & Partnerships
ENAENA
4. BCC & Mass Media4. BCC & Mass Media
Conclusion
1. ENA approach pulls together existing vertical programs in a sensible 'action-oriented' way...
Nothing new except the ‘packaging' and way promotion of nutrition is operationalized...
2. The ENA approach has potential to address over 23% of underfive deaths in Ethiopia
3. ENA approach greatly expands coverage of nutrition support beyond GM/P contact
4. ENA approach provides simple & clear framework that guides “specific” actions to improve nutrition at “specific” points in time
5. ENA approach provides excellent training framework on which to train service providers
Implications…
ENA and implications for Child Survival…
We know what to do to prevent malnutrition
and save child lives…
We know how to do it…
Challenge that remains
‘just to do it’
-political commitment
-investment of resources
THANK YOU