© 2010 MAMA Project, Inc. www.MAMAProject.org

CHILD SURVIVAL KITTools and supplies for Primary Care Health Workers:• FamilyHealthHistorycards

• VitaminACapsules

• Zinc-EnrichedDentifrice

• EssentialMicronutrientsforpreventionandtreatmentof malnutrition

• AmoxicillinandMetronidazolefortimelytreatmentofinfections

• Albendazoleforintestinalparasitecontrol

• WorkandSupplyLogs/ReferenceGuidelines/ EducationalMaterials

• Weighingscale

• LapInfantometerforlengthofinfants

• HealthFlagpoleforheightafter24months

• MidUpperArmCircumferencetapes

The Primary Care Health Worker, with the assistance of village health workers, traditional healers, midwives and other volunteers, is responsible for the health of the most vulnerable members of the community. These materials facilitate their work, particularly vigilance of nutritional status of women and children, early detection and appropriate management of life threatening conditions including noma and nutritional blindness.

Resourcing those who are the pillars of Community Primary Care

is crucial to the cause of child survival

© 2010 MAMA Project, Inc. www.MAMAProject.org

ACUTE MALNUTRITIONChildren who are suffering from extreme nutritional deficiency may fall into one or two distinct types, or may overlap both:

Kwarshiorkor MarasmusAge usually over 18 months Usually under 1 year old

Lacks protein-rich foods and other nutrients Lacks energy-rich foods and other nutrients Relatively more often in tropical countries Often in dry climate/drought/disaster/war

“Wet” malnutrition, but may also be wasted “Dry” malnutrition, but may have edemaAny edema means SEVERE malnutrition.

Child is not “fat”May be classified as moderate or severe

Swollen belly from fatty liver, edema and/or parasites May have swollen belly from parasites or weak muscles

These children are in grave immediate danger, and require urgent nutritional rehabilitation. However, most children who die from malnutrition will not appear obviously ill with kwashiorkor and/or marasmus. Deadly “Hidden Hunger”, or micronutrient malnutrition, is found in growth stunted infants and children. Community-wide interventions are required to improve the survival rates of those chronically malnourished children who actually represent a much higher percentage of the vulnerable population.

Kwashiorkor Swollen body, feetPoor appetiteLethargic, sadPale fragile skin/hair

MarasmusLoss of fat, muscle

Very hungry Irritable, anxious

Skin loose, wrinkled

© 2010 MAMA Project, Inc. www.MAMAProject.org

DEWORMINGIntestinal parasites, also called “Soil transmitted helminthes”arethemostcommoninfectionworldwide.Theprevalence rates of intestinal parasite infections in some resource poor communities can be over 90%. An esti-mated 2 billion people are infectedwithworms, and 300million suffer severe impairments because of high wormburdens.Intestinalparasitesarecausedbyenvironmental contaminationbyhumanandanimalwaste.

The three most common agents worldwide, with the descrip-tions of patterns of behavior:

• Ascaristhelargeroundwormwithavoracious appetite for calories and vitamins.• Hookwormtheparasitethatattachesitselftotheintestinallininganddinesonthe blood of its victim.• Whipworm,theonewhichattachestotherectum,causingprolapseandbleeding

Intestinal parasites are a major contributor to morbidity and mortality in developing countries, predisposing the host to: • Anemia. • Malnutrition. • Impairmentofphysicalgrowth-bothstuntingand wasting. • Poorintellectualdevelopment.

Deworming promotes child survival. Therefore, national lev-el deworming campaigns have become standard in many developing countries. One tablet of deworming medicine, usuallyAlbendazole,atacostof$.02,isgivenevery6monthsaccording to standardized protocols. It is easy, effective in controlling the worm burden, and usually very well accepted on the community level.

© 2010 MAMA Project, Inc. www.MAMAProject.org

VITAMIN AVitamin A Deficiency (VAD) is a serious public health problem in many develop-ing countries. It affects millions of women and children worldwide and is the lead-ing cause of preventable blindness in children. About 250,000 to 500,000 children become blind every year due to VAD and half of those children die within a year of becoming blind.

Vitamin A is Essential for Optimal Health, Growth, and Development

Inchildren,VADcompromisestheimmunesystem,increasingtheriskofsevereillnessanddeathfromseriousinfectiousdiseasessuchasdiarrhea,pneumonia,measles,andmalaria.Also,vitaminAplaysamajorroleinthematurationofcells,tissuesandorgansystems.Therefore,lackofvitaminAleadstopoortissueintegritywhichresultsinlackofgrowth,slowhealing,andweakbarrierstoinvadingmicroorganisms.ThusVADItisamajorcauseofchildmortalityandblindnessinthedevelopingworld.ImprovingthevitaminAstatusofyoungchildrenindevelopingcountriescanreducechilddeathratesupto50%.

More Action for Vitamin A Supplementation

VitaminAsupplementationisahighpriorityinChildSurvivalprograms.MajorprogresshasbeenmadeincombatingVADinmanydevelopingcountries,butmoreurgentactionisneededtoacceleratetheeffortstobringitundercontrol.Aquarteroftheworld’svitaminAdeficientchildrenliveinAfrica,with greatestnumberofchildrenaffectedlivingintheSahel, includingNigeria.Inlargeareasofthisregion,vitaminA supplementationprogramshavenotreachedthemost vulnerablechildren.

Themega-dosecapsulesareinexpensive,andsuppliedby UNICEFformassdistributioncampaigns.TheInternationalProtocolsarewidelyused, standardized,andhavebeenproventobesafeandwelltolerated.

ThenormsareeasilyimplementedandintegratedintootherChildHealthactivitiessuchasdewormingandimmunizationcampaigns.HighdosevitaminAhasalsobeenshowntoplayaroledecreasingmortalityinlifethreateninginfectiousdiseasessuchasmeasles,andcanevenpreventblindnessincasesofvitaminAdeficiencyeyedisease,eveninmanyadvancedcases,ifgivenbeforeirreversibledamageoccurs.

© 2010 MAMA Project, Inc. www.MAMAProject.org

BREASTFEEDINGDeworming promotes child survival. Therefore, national level deworming campaigns have becomestandardinmanydevelopingcountries.Onetabletofdewormingmedicine,usuallyAlbendazole,atacostof$.02,isgivenevery6monthsaccordingtostandardizedprotocols.Itiseasy,effectiveincon-trollingthewormburden,andusuallyverywellacceptedonthecommunitylevel.The Importance of Breastfeeding Exclusivebreastfeedingforthefirstsixmonthsofachild’slifepromoteshealthininfantsisthebestandmostcost-effectiveinterventiontoprovidenewbornswiththenutrientstheyneed.Everymothershouldfollowtheguidelines:• Breastfeedingshouldstartimmediatelyatbirthtogetthebenefitofcolostrum• Exclusivebreastfeedingistobepracticed:Nosugarwater,teaorcerealforsixmonthstoavoidingestionofmicrobes

• Continue breastfeedingfor24months• Wean to nutritious foods

Unfortunately, mothers in developing countries often choose not tobreastfeedtheirchildren,orweanthemtooearly.Thisdeniesthemofthe essential nutrients and antibodies they need for survival. Recentstudiesshowthatbarelyoneinthree infants isexclusivelybreastfeedduringthefirst6monthsoflife,andupto55%ofannualinfantdeathsfromdiarrhealdiseaseandacuterespiratoryinfectionsmaybetheresultofinappropriatefeedingpractices.Ifbreastfeedingisnotpracticedoraninfantisweanedtooearly,theyareinturnfedcomplementaryfoodswhichlacknutritionandsufficientenergyforgrowthanddevelopment.HealthofficialsfromthePanAmericanHealthOrganizationaffirmthatcomplementaryfeedingpracticesarefrequentlyill-timed,inappropriateandunsafe.

Reaching Full Human PotentialAdequatenutritioninthefirstyearoflifeisakeyfactorforinfantstobetterdeveloptheirfullhumanpotential.Infantswhoreceiveadequatenutrientsduringthefirstyearoflifeachieveoptimalgrowthandbraindevelopment.Failuretonourishaninfantproperlycanleadtopermanentdevelopmentalproblems.Itisthereforeimperativetostimulateoptimalsupportconditionsforallmotherswhilehighlightingthefundamentalbenefitsofbreastfeedingforthehealthofbothmothersandnewborns. Efforts to increase exclusive breastfeeding must be made. Educating mothersatthetimeofbirthaboutbreastfeedingwhileriddingdeveloping

nationsofbreastfeedingstigmamustbeatopprioritytoensureahealthypopulation.

© 2010 MAMA Project, Inc. www.MAMAProject.org

GROWTH MONITORINGChildren need to be weighed and measured regularly from birth to adulthood, while par-ents need to understand the results and learn what action to take.

Likewise,growthdataofpopulationsofchildrenmustbereadilyavailabletohealthauthoritiesandpolicymakerssothatthenutritionalneedsofchildrenforwhomtheyareresponsiblecanbead-dressedbypublichealthinterventions.Inorderforgrowthmonitoringdatatopromotechildsurvival,itmustbe:• Accurate• Correctlyinterpretedandunderstood• Actedupon!

In2007,theWorldHealthOrganizationreleasednewInternationalChildGrowthStandardsforchildrenages0-19which apply to all populations.TheWHOstatesthatthegrowthstandards“depictnor-malchildhoodgrowthunderoptimalenvironmentalconditionsandcanbeusedtoassesschildreneverywhere,regardlessofethnicity,socio-economicstatusandtypeoffeeding.”

Practical Application

Understandingthescienceof“Anthropometry”andusingthegrowthchartstoassesschildrencanbecomplicatedformothers,volunteers,andevenHealthWorkersandotherprofessionals.Therefore,MAMAProjectcreatedtoolsandsystems,includingeasytouseinterpretationchartstofacilitatetheapplicationofthesestandards.Theinformationgainedandrapidlyinterpretedcanhelpchildsurvivaleffortsbyhelpingtofocuscommunity-basednutritionalrehabilitationefforts.

Thebasicdatautilizedwhenpossibleareaccurateage,weight,lengthorheightmidupperarmcir-cumference,and,forwomenandchildren5-19,BodyMassIndex.

What tools can be used to monitor growth?• Lap Infantometer: Whilemotherholdsyoungchild,HealthWorkermeasureslengthandgivesinstantinterpretationwitheithercongratulationsorcounselonstepstotakeforgrowthfal-tering.• Health Flagpole: Childage2-19stepsonscale,thenstandsatflagpole.Fromthecharts,themothercanbetoldimmediatelyifherchildisnormaloracutelyorchronicallymalnourishedandtowhatseverity.• Nutrition Ruler: Children12-60months,canbescreenedformalnutritionandwomenofchild-bearingageforhighermaternityrisk.

© 2010 MAMA Project, Inc. www.MAMAProject.org

ESSENTIAL MICRONUTRIENTS

Diseasecausedbydeficientyofmorethanonemicronutrientarebestprevented/treatedbyreplenishingallnecessarynutrients.

Othermicronutrientsthatarenotusuallyassociatedwithaspecificdeficiencydiseaseincludethreeessentialminerals:Chromiumwhichisinvolvedinmetabolism;Manganesewhichplaysaroleinwoundhealing,cartilageandbonedevelopment,actsasananti-oxidantandactivatesimportantenzymes;Molybdenumwhichisinvolvedinmanyenzymepathways.

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© 2010 MAMA Project, Inc. www.MAMAProject.org

READY TO USE THERAPEUTIC FOOD (RUTF)Widespread malnutrition is causing maternal and child illness, disability and death in many parts of the world. The Sahel region of Africa is one of the most critical areas.

Food supplementation programs using manufactured and imported therapeutic foodssuch as nutritious enriched biscuits or pastes have been become an important part of community-basednutritionalrehabilitationprogramsthatarepositivelyimpactingthehealthofmanypopulationsatrisk.Butmostcommunitiesthatwouldbenefitfrominclusionin“RUTF”programsarenotreceivingtheseservices.

Fortifiednutritiousfoods thatmeet theWorldHealthOrgani-zation guidelines for the recommended caloric, fat, protein andmicronutrient composition of “RUTF” can be produced in rural agricultural villages out of foods that are readily available,and can be used to treat cases of malnutrition detected by surveillancegrowthmonitoringactivities.

UNIVERSALMicronutrient Home Food Fortification goes astep further to prevention ofmalnutrition bypromoting supple-mentalfortifiedfoodforeverywomanandchildatriskforundernutrition,notjustthosealreadysufferingfrommalnutrition.

“Nora LynneTM ESSENTIAL MICRONUTRIENTS”* wasformu-lated and is being introduced for this use. As an example, the following egg and oil mixture recipe creates a nutritious fortifiedfoodthatcanbeconsumeddailyineveryhousehold,byeverywomanand child. Itwould also be an improvedweaningfood, ideally after 6monthsof exclusivebreast feeding, and/or recommended as part of nutritional rehabilitation 1-3 times perdaydependinguponstateofnutrition.

Recipe: 1.Boilandmashonechickenegg.2.Mixwith2teaspoonsofoil(redpalmisbest)peregg.3.Sprinklemixturewithiodizedsaltandonescoop(.15cc)of“Nora LynneTM ESSENTIALMICRONUTRIENTS”.*FormulamodifiedformicronutrientmineralandvitaminneedsofmalnourishedwomenandchildreninSubSaharanAfrica,basedon fortificationformulausedbyMAMAProjectinHonduras,intheSuperCookiebeingconsumedbychildpicturedabove.

© 2010 MAMA Project, Inc. www.MAMAProject.org

IMMUNIZATIONS

Vaccinepreventablediseasesaccountforapproximately22%ofchilddeathsinNigeria,amountingtoover200,000deathsperyear.Internationaldonorcommunitieshaverecognizedtheneedforcontrolofchildhoodillnessesandpolioeradication,creatinganopportunetimetocontrolvaccinepreventableillnessesintheregion.Resistancetopoliovaccineisreportedlypersistinginsomeregions,howeversomerecentreportssuggestthatinsomecommunitiesthereisagreaterfeltneedforpreventionofdiseasesthatarefarmorecommoninthecommunities,suchasmeasles,malariaandmeningitis.Thissuggeststhatanintegratedandpermanent systemfordeliveryofroutinevaccinationservicesmaybemoreacceptabletosomesectorsofthepopulationsthathaveresistedpolioeradicationefforts.

WorldHealthOrganization(WHO)ImmunizationScheduleinNigeria:

Vaccine Age of Vaccination

Cost of Vaccine (WHO/UNICEF

2002)

Description of the Infectious Disease

BCG(Tuberculosis) Birth 7centsAirborne.Usuallycausespulmonaryinfection,butcanspreadtomanyotherorgans,caus-ingseriousillness,deathanddisability.AnuntreatedpersonwithactiveTBdiseasecaninfectonaveragebetween10and15peopleeveryyear..In2005,30%ofglobalincidenceofTBoccurredinAfricaamountingover2.5millionnewinfections.(WHO)

DTwP(Pertussis/WhoopingCough) 6,10,14weeks 7cents

Pertussis,orwhoopingcough,isadiseaseoftherespiratorytractcausedbybacteriathatliveinthemouth,nose,andthroat.Manychildrenwhocontractpertussishavecoughingspellsthatlastfourtoeightweeks.Verydangerousininfants.In2000,approximately39millionnewcasesemergedandthediseaseclaimed297,000livesworldwide.(WHO)Diphtheria:anupperrespiratorytractinfectionwiththroatswellingandanadherentmem-branethatcancausedeathbyasphyxiation.Tetanus-seebelow

Hepatitis B Birth; 10,16weeks 32-90cents

HepatitisBisapotentiallylife-threateningliverinfectioncausedbythehepatitisBvirus.Itisamajorglobalhealthproblemandthemostserioustypeofviralhepatitis.Itcancausechronicliverdiseaseandputspeopleathighriskofdeathfromcirrhosisoftheliverandlivercancer.Worldwide,anestimatedtwobillionpeoplehavebeeninfectedwiththehepa-titisBvirus(HBV),andmorethan350millionhavechronic(long-term)liverinfections.AvaccineagainsthepatitisBhasbeenavailablesince1982.HepatitisBvaccineis95%effectiveinpreventingHBVinfectionanditschronicconsequences,andisthefirstvaccineagainstamajorhumancancer.(WHO)

Measles 9months 14centsMeaslesisahighlycontagious,seriousdiseasecausedbyavirus.Itremainsaleadingcauseofdeathamongyoungchildrenglobally,despitetheavailabilityofasafeandef-fectivevaccine.Anestimated197000peoplediedfrommeaslesin2007,mostlychildrenundertheageoffive.Itisacommonprecursorofnutritionalblindnessandnoma.

Meningitis High-riskgroups 40centsMeningitisisaninfectionofthemeninges,thethinliningthatsurroundsthebrainandthespinalcord.SeveraldifferentbacteriacancausemeningitisandNeisseriameningitidisisoneofthemostimportant(WHO)

OPV(Polio) Birth;6,10,16weeks 10cents

Mainlyaffectschildrenunderfiveyearsofage.Onein200infectionsleadstoirreversibleparalysis.Amongthoseparalyzed,5%to10%diewhentheirbreathingmusclesbecomeimmobilized.PersistentpocketsofpoliotransmissioninIndia,northernNigeriaandAf-ghanistanandPakistanarekeyepidemiologicalchallenges.(WHO)

TT(Tetanustoxoid)

1stcontactpreg-nancy;TT2+6

monthsafter;TT3+1yearafter

7cents

TetanusiscausedbythebacteriumClostridiumtetani,thesporesofwhicharewidespreadintheenvironment.Thediseaseiscausedbytheactionofaneurotoxin,producedbythebacteriawhentheygrowintheabsenceofoxygen,e.g.indirtywoundsorintheumbilicalcordifitiscutwithanon-sterileinstrument.Tetanusischaracterizedbymusclespasms,initiallyinthejawmuscles.Asthediseaseprogresses,mildstimulimaytriggergeneral-izedtetanicseizure-likeactivity,whichcontributestoseriouscomplicationsandeventuallydeathunlesssupportivetreatmentisgiven.Tetanuscanbepreventedbytheadministra-tionoftetanustoxoid,whichinducesspecificantitoxins.Topreventmaternalandneonataltetanus,tetanustoxoidneedstobegiventothemotherbeforeorduringpregnancy,andcleandeliveryandcordcareneedstobeensured.(WHO)

YellowFever 9months 12-25centsYellowfeverisaviraldisease,foundintropicalregionsofAfricaandtheAmericas..Thereisnospecifictreatmentforyellowfever.Vaccinationishighlyrecommendedasapreventivemeasurefortravellersto,andpeoplelivingin,endemiccountries.

© 2010 MAMA Project, Inc. www.MAMAProject.org

NOMANoma (Cancrum oris):-Isanopportunisticinfectionthatoc-cursinchildrenwithimmunesystemscompromisedbymalnutrition-Startsasamouthulcerwhichifun-treatedintheearlystagecanrapidlypenetrate and destroy soft tissues and bonesoftheface,permanentlyrav-agingfeatures,andleavingthechildgrotesquelydisfigured-Claims140,000children/year,mostlyintheAfricanSahel,70-90%ofwhomdie

Predisposing factors:-Chronicmicronutrientmalnutritionbe-ginningbeforebirth-Lackofexclusivebreastfeedinginthefirstsixmonths-Poororalhygiene-Householdexposuretolivestock-Fecalcontaminationoffoodandwater-Lackoftimelyaccesstomedicalcare-Extremepoverty

What can be done to prevent noma:Micronutrient nutrition: Universalhomefoodfortificationforallwomenandchildren,totreatandpreventdeficiencyofessentialmicronutrientsareknowntobeassociatedwithnomaandimmunedeficiency,orallesionsandpoorhealing.Oral hygiene: Asimplezincenricheddentifriceusedwithatraditionalchewingstickcanpromoteoralhealth.Immunizations: Especiallymeaslesvaccination,sincenomausuallyfollowsmeasles,butalsoma-lariaandotherdiseasesthatcauseoverwhelminginfectioninmalnourishedchildrenSanitary and nutrition practices: Communityeducationforpromotionof:Exclusivebreastfeedingfor6months,betterinfantweaningpractices,incorporationoflocallyavailablenutritiousfoodssuchaseggsandoilintothedietofyoungchildren,andfoodandwatersanitation.Deworming and Vitamin A Capsule distribution: Childsurvivalinterventionsthathavehadgoodimpactonmaternalandchildhealthinmanydevelopingcountries.Improved access at the village level to early detection and treatment of noma: Healthwork-ersincloseproximitytochildrenatriskfornomamusthaveadependablesupplyofcurativemedi-cinestopreventtheprogressionofearlynomalesionstoirreversiblegangreneandpermanentlossoffacialfeatures.Eradication of poverty: Interventionsthatimprovematernalandchildhealthwillhelptobreaktheviciouscycleofpoverty,improvingtheintellectualandphysicalpotentialofmothersandtheirchildrenwhorepresentthehopeofthenextgeneration.

Treatment for noma:Oralantibioticsmustbestartedimmediatelyintheearlieststageofnoma,whenthereisviabletissuetobesaved.Anydelayintreatmentincreasestheriskoflossfacialfeaturesanddeath.Whiletransportationtothehospitalisbeingarranged,attentiontooralhygiene,fluids,andnutritionmustbegin.

© 2010 MAMA Project, Inc. www.MAMAProject.org

INFORMATION FOR DONORS• Essential Micronutrients: Widespread malnutrition is causingmaternalandchildillness,disabilityanddeathinmanypartsoftheworld.MAMAProject’s“Nora LynneTMESSENTIALMICRONUTRIENTS”canmakealifesavingdifferencefor womenandchildrenforabout$.01perday.

•Deworming the community costslessthan$.04perpersonperyear.MAMAisdeworm-ingmillionsofchildrenandadultsannually.

• Teaching Health, Training Volunteer and Primary Care Health Workers to save lives: Totrainandequippeopletocareforfamiliesatriskcosts$749pervillage

• Vitamin A Capsules are life and sight saving.Costislessthan$.04peryearandmaybedonated.

•Noma Eradication is a priority for Child Survival. Nomaisamarkerforconditionsthatkillchildren.Survivalwillrequirea coordinatedefforttobringeducationand resourcestomanyvillagesatrisk.

• Containers of donated lifesaving medicines and supplies areshippedregularlybyMAMAtosupportourwork.Thecostspercontainerusuallytotalover$8,000.

MAMAProject,Inc.isa501(c)3non-profitorganization. Contributionsaretax-deductible.