Nutrition Assessment, Counseling, and Support (NACS): Facilitator's Guide for Training Facility-Based Service Providers (2015)
NUTRITION ASSESSMENT, COUNSELING, AND SUPPORT (NACS)
FACILITATORS GUIDE
for Training
Facility-Based Service Providers
2015
TABLE OF CONTENTS
ABBREVIATIONS AND ACRONYMSIiv
ACKNOWLEDGMENTSv
Forewordvi
GUIDE FOR FACILITATORS1
A. Purpose1
B. Learning Objectives1
C. Preparation1
D. Course Format1
E. Facilitators3
F. Participants3
G. Venue4
H. Training Materials4
I. Supplies and Equipment5
J. Training Principles6
K. Before the Training7
L. During the Training7
M. Contents and Duration8
INTRODUCTORY SESSION15
0.1. Introduction and Training Overview (15 minutes)16
0.2. Pre-test (15 minutes)19
0.3. Expectations and Objectives (15 minutes)20
0.4. Participant Roles (10 minutes)20
MODULE 1. BASIC NUTRITION22
1.1. Nutrition Terms (30 minutes)24
1.2. Importance of Nutrition (30 minutes)26
1.3. Nutrient Requirements (40 minutes)28
1.4. Causes of Malnutrition (20 minutes)30
1.5. Clinical Features of Malnutrition (30 minutes)31
1.6. Consequences of Malnutrition (20 minutes)33
1.7. Nutrition and Infection (30 minutes)33
1.8. Preventing and Managing Malnutrition (30 minutes)37
MODULE 2. NUTRITION ASSESSMENT AND CLASSIFICATION40
2.1. The Importance of Nutrition Assessment (20 minutes)45
2.2. Anthropometric Assessment (3 hours)47
2.3. Biochemical Assessment (20 minutes)61
2.4. Clinical Assessment (35 minutes)62
2.5. Dietary Assessment (40 minutes)67
2.6. Classifying Nutritional Status (40 minutes)70
MODULE 3. NUTRITION EDUCATION AND COUNSELING74
3.1. Nutrition Education (50 minutes)78
3.2. Definition of CounselIng and Required Skills (1hour)80
3.3. Nutrition Counseling (2 hours)83
MODULE 4. FOOD AND WATER SAFETY AND HYGIENE88
4.1. The Importance of Food and Water Safety (30minutes)92
4.2. Keeping Food and Water Safe (35 minutes)95
4.3. Counseling on Food and Water Safety (30 minutes)98
MODULE 5. NUTRITION CARE FOR PREGNANT AND POSTPARTUM WOMEN101
5.1. Nutritional Needs during Pregnancy and Lactation (1 hour)103
5.2. Anemia in Pregnant Women (30 minutes)109
5.3. Counseling Pregnant and Lactating Women on Nutrition (45minutes)110
MODULE 6. NUTRITION CARE FOR INFANTS AND YOUNG CHILDREN113
6.1. Stunting (20 minutes)115
6.2. Breastfeeding (30 minutes)117
6.3. Infant Feeding for HIV-Positive Mothers (1 hour)120
6.4. Feeding Older Children (20 minutes)124
6.5. Counseling on Infant and Young Child feeding (30minutes)126
6.6. Management of Malnutrition in Children (15 minutes)128
MODULE 7. NUTRITION AND Medication129
7.1. Food and Nutrition Implications of ART (35 minutes)132
7.2. Counseling on Nutrition and ART (30 minutes)136
MODULE 8. NUTRITION SUPPORT139
8.1. Micronutrient Supplements (20 minutes)143
8.2. Point-of-use Water Treatment Products (15 minutes)144
8.3. Specialized Food Products to Treat Malnutrition (1hour)144
8.4. Specialized Food Product Logistics (45 minutes)150
MODULE 9. HEALTH FACILITY-COMMUNITY LINKAGES153
9.1. Nutrition Services along the Continuum of Care (15 minutes)155
9.2. Referrals between Health Facilities and Communities (25 minutes)157
9.3.Food Security and Livelihood Support (20minutes)159
9.4. Referral System (40 minutes)160
MODULE 10. NACS MONITORING AND REPORTING163
10.1. Purpose of Recording NACS Data (30 minutes)167
10.2. NACS Indicators (30 Minutes)179
10.3. NACS Data Collection and Reporting (1 hours)168
10.4. Preparation for Site Practice Visits (20 minutes)181
MODULE 11. SITE PRACTICE VISITS183
11.1. Preparation for the Site Practice Visits (25 minutes)184
11.2. Site Practice Visits (3 hours)184
11.3. Discussion of the Site Practice Visits (1 hour)185
MODULE 12. NACS ACTION PLANS187
12.1. Expected performance (40 minutes)189
12.2. Action Plans (1 hour)190
POST-TEST AND COURSE EVALUATION192
Post-test (20 minutes)192
Final Course Evaluation (10 minutes)193
RESOURCES194
Annex 1. NACS Training Needs Assessment196
Annex 2. Pre- and Post-Test198
Annex 3. Pre- and Post-test Answer Key200
Annex 4. Site Practice Visit Planning Guide203
Annex 5. Final Course Evaluation Form204
ABBREVIATIONS AND ACRONYMS
AIDSacquired immunodeficiency syndrome
ANCantenatal care
ARTantiretroviral therapy
ARVantiretroviral drug
BMIbody mass index
cmcentimeter(s)
CNACritical Nutrition Actions
ENAEssential Nutrition Actions
FANTAFood and Nutrition Technical Assistance Project
FBFfortified-blended food
ggram(s)
HAZheight-for-age z-score
Hbhemoglobin
HIVhuman immunodeficiency virus
IUinternational unit
IYCFinfant and young child feeding
kcalkilocalorie(s)
kgkilogram(s)
mmeter(s)
mlmilliliter(s)
MAMmoderate acute malnutrition
MOHministry of health
MUACmid-upper arm circumference
NACSnutrition assessment, counseling, and support
NGOnongovernmental organization
OIopportunistic infection
PEPFARU.S. Presidents Emergency Plan for AIDS Relief
PLHIVperson or people living with HIV
PMTCTprevention of mother-to-child transmission of HIV
RDA Recommended Dietary Allowance
RUTFready-to-use therapeutic food
SAMsevere acute malnutrition
TBtuberculosis
UNAIDSJoint United Nations Programme on HIV/AIDS
USAIDU.S. Agency for International Development
WASHwater, sanitation, and hygiene
WAZweight-for-age z-score
WHZweight-for-height z-score
WHOWorld Health Organization
NACS Training for Facility-Based Service Providers: FACILITATORS GUIDE
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ACKNOWLEDGMENTS
This training manual is a publication of the [relevant national authorities], prepared with financial and technical support from [relevant partner], through funding from [donor, organization, or program].
Development of the training manual was led and coordinated by [relevant authorities and partners].
Many of the graphics and messages in this guide come from the USAID-supported NuLife (Food and Nutrition Interventions) Project in Uganda, managed by University Research Co., LLC, and the USAID-supported WASHplus Project in collaboration with Plan International.
Printing of the manual was made possible by _______.
Cover photo: _______
Suggested citation: [author]. [year]. Nutrition Assessment, Counseling, and Support (NACS) Training Manual: Facilitators Guide. [place of publication: publisher].
[add relevant logos and branding information]
NACS Training for Facility-Based Service Providers: FACILITATORS GUIDE
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Foreword
Undernutrition plays a huge role in the global burden of disease. Optimal nutrition is a basic need that is crucial to the realization of [countrys] national development goals. A range of cost-effective health sector interventions to improve nutrition is available, making nutrition interventions one of the best approaches to improving health service efficiency and quality.
Nutrition has a wide-ranging influence on health. Malnutrition in pregnant and lactating women can lead to irreversible, lifelong consequences for their infants. Nutrition deficiencies during the first 2 years of life are associated with significant morbidity and mortality and delayed mental and motor development. These deficiencies can impair intellectual performance, reproductive outcomes, overall health status, and economic productivity during adolescence and adulthood.
Various national programs have been implemented to combat malnutrition and micronutrient deficiencies. [Data on the nutrition situation in the country].
Malnutrition and infection create a vicious cycle that weakens the immune system. Research has shown that good nutrition can improve the health and quality of life of people with chronic infectious diseases such as HIV, which is a major health problem in [country]. Although the national HIV prevalence rate among adults in [country] decreased from ___ percent in [year] to ___ percent in [year], the country has approximately ___ new cases annually.[footnoteRef:1] HIV and AIDS affect the nutritional status, quality of life, productivity, and longevity of a significant proportion of the population. [Data on the number of PLHIV, gender and regional variations, HIV-affected children, ART coverage].[footnoteRef:2] [1: [citation].] [2: [citation].]
Because malnutrition is a potential causal factor and nutrition an aid to treatment of many illnesses, health care providers need knowledge and skills to help clients improve their nutritional status, manage symptoms of illness and side effects of drugs, and avoid infections. Nutrition assessment, counseling, and support (NACS) should be a routine component of prevention, care, and treatment in health care services.
Recognizing the critical role of food and nutrition in effective health responses, the Government of [country] has supported the development of training materials for health care providers on NACS. These materials provide health care providers with knowledge and skills to improve the nu
