1. The Essential Nutrition Actions approach: An action oriented approach to nutrition… Presented by: Agnès B. Guyon,MD,,MPH

2. ENAWhat are the Essential Nutrition Actions?

3. Breastfeeding Women’s Nutrition Feeding of sick children Complementary Feeding Anemia Iodine Vitamin A ENAProven actions Estimated decrease of child mortality: 25%

4. 1. Optimal Breastfeeding Estimated decrease of child mortality: 13%

5. 1. Promotion of Breastfeeding Key Messages • Timely Initiation of breastfeeding (1 hour of birth) • Exclusive Breastfeeding until 6 months • Breastfeed day and night at least 10 times • Correct positioning & attachment • Empty one breast before switching to the other WHO Infant & Child Feeding recommendations, 2001

6. 2. Appropriate Complementary Feeding Estimated decrease of child mortality: 6%

7. 2. Complementary Feeding to BF Key Messages • Introduce appropriate complementary foods at 6 months • Continue breastfeeding until 24 months & more • Increase the number of feedings with age • Increase density, quantity and variety with age • Responsive feeding • Ensure good hygiene(use clean water, food & utensils) WHO Infant & Child Feeding recommendations, 2001

8. 3. Feeding the sick child WHO Infant & Child Feeding recommendations, 2001

9. 3. Feeding of the sick child Key Messages • Increase breastfeeding & complementary feeding during and after illness (IMCI- Integrated Management of Childhood Illness) • Appropriate Therapeutic Feeding WHO Infant & Child Feeding recommendations, 2001

10. 4. Women’s Nutrition

11. 4. Women’s Nutrition Key Messages • During pregnancy and lactation: Increase feeding Iron/Folic Acid Supplementation Treatment & prevention of malaria • De-worming during pregnancy • Vitamin A capsule after delivery

12. 5. Control of Vitamin A Deficiency Estimated decrease of child mortality: 2%

13. 5. Control of Vitamin A Deficiency Key Messages • Promote breastfeeding: source of Vitamin A • Vitamin A rich foods • Maternal supplementation • Child supplementation • Food fortification

14. 6. Control of Anemia

15. 6. Control of Anemia Key Messages • Supplementation for women and children (IMCI) • Deworming for pregnant women and children (twice/year) • Malaria control • Iron-rich foods • Fortification

16. 7. Control of Iodine Deficiency Disorders

17. 7. Control of Iodine Deficiency Disorders Key Message • Access & consumption by all families of iodized salt

18. How the Essential Nutrition Actions expands coverage of nutrition support in the health sector?

19. ENA Six critical contacts points in the lifecycle PREGNANCY : TT, antenatal visits, iron/folic acid, de-worming, anti-malarial, diet, EBF, risk signs, FP, STI prevention, safe delivery, iodized salt DELIVERY: safe delivery, EBF, vitamin A, iron/folic acid, diet, FP, STI prevention IMMUNIZATION: vaccinations, vitamin A, de-worming, assess and treat infant’s anemia, FP, and STI referral POSTNATAL AND FAMILY PLANNING:EBF, diet, iron/folic acid, diet, FP, STI prevention, child’s vaccination SICK CHILD: monitor growth, assess and treat per IMCI, counsel on feeding, assess and treat for anemia, check and complete vitamin A /immunization/ de-worming WELL CHILD AND GMP: monitor growth, assess and counsel on feeding, iodized salt, check and complete vaccination/ vitamin A /de-worming

20. Need to integrate into other health programs Child Survival EPI+ Community IMCI Health facilities IMCI Reproductive Health Women’s Nutrition Lactation Amenorrhea Method ENA National Immunization Days Polio Measles Infectious Diseases Control of Malaria Tuberculosis HIV&AIDS (PMTCT) Nutrition programs Positive deviance Community GM/P

21. How the Essential Nutrition Actions expands coverage of nutrition support outside the health sector?

22. Need to integrate into other sectors Schools Adolescent nutrition De-worming Iron supplementation School lunch Agriculture Food diversification Food security Women’s farmers clubs ENA Emergency Women to women support Micro-credit Income generation Nutrition education Sanitation Clean water & sanitation Public health education Prevention of diarrhea, malaria, ARI

23. How to Implement the Essential Nutrition Actions?

24. ENACreate a positive environment and context (1) Partnerships at all levels Policies and guidelines Mass Media

25. ENAHarmonize training (1) • Training • - Pre-service • In-service

26. ENAEmphasis role of the community (1) Community IEC-BCC Materials same key messages

27. Take home messages

28. ENA: Multiple approach Advocacy Policy Training Pre-Service & In-Service Negociation Community Action Mass Media Leveraging of resources Partners

29. ENA approach provides a simple & clear framework that guides “specific” actions to improve nutrition at “specific” points in time

30. ENA approach pulls together all existing vertical programs in a sensible 'action-oriented' way... • Nothing new except the ‘packaging' and the way it is operationalized...

31. ENA approach greatly expands the coverage potential for ‘nutrition’ contacts far beyond the traditional Growth Monitoring & Promotion programs

32. ENAAdequate nutrition forhuman and sustainable development Thank You Prepared by Drs. Agnes Guyon and Victoria Quinn (AED/LINKAGES)