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