NUTRITIONAL POLICIES IN THE HEALTH SECTOR

NUTRITIONAL POLICIES IN THE HEALTH SECTOR The problem of malnutrition is complex, requiring a combination of various policies and programs to effectively alleviate it.

A multi-sectoral approach is often required to address the problem of malnutrition- especially the underlying causes.

The best means of channeling sectoral efforts at malnutrition control in an active manner is through an inter-sectoral national nutrition policy.

An analyses of causes, resources & power is also necessary in order to understand the political economy of nutrition better, & come up with realistic policies.

Policies should be based on knowledge from relevant research and be constantly evaluated for their real impact on food and nutrition security in communities.

The "ultimate decision on the choice of priorities however mainly rests with the politician". What is a policy?

A POLICY is a plan of action, statement, ideals, etc. proposed or adopted by a government, political party, an organization, etc (Dictionary def.).An effective national nutrition policy describes the problem, with quantified data, and contains sectoral plans of action for malnutrition control.

Most attempts to improve food and nutrition security in most developing countries have been ineffective. Why? Because govts concentrate too much on providing food and too little on enabling people to meet their nutritional needs themselves. Hence the needs to revise most countries Food & Nutrition policies. We therefore need the political will & vision to initiate & push thru programs, often at community level to effectively address the underlying causes of malnutrition.The present status of National Nutrition Policy A declaration made by the head of a state referring to the serious consequences of malnutrition in the country, and stating the determination of the government to take suitable measures to eradicate or control the problem

A compilation of all ongoing or proposed sectoral measures in nutrition and nutrition related areas within the national socio-economic plan of the country (Check the national development plan) A statement or an official resolution of the government indicating measures that each sector is proposing to take to tackle the problem. (This is often implied in the nutrition plan of action of 1994 and various government departments within which nutrition activities fall) A properly developed national nutrition policy prepared as a result of an inter-sectoral review followed by programme planning. (This is what we currently lack here in Kenya)

NUTRITIONAL POLICIES IN HEALTH1. National Policy on Infant and Young Child Feeding Practices2. Growth Monitoring and Promotion3. Integrated Health and Nutrition Interventions4. Selective feeding programs- children; pregnant & lactating women

National Policy on Infant and Young Child Feeding Practices.Summary Statement

Every facility providing maternal and Child Health (MCH) services should:1. Adhere to the national Infant Feeding Policy which should be routinely communicated to all health staff and strategically displayed

2. Train all health care staff in skills necessary to implement this policy

3. Provide information to all pregnant 7 lactating mothers & their partherns on the benefits & management of Breastfeeding

4. Assist mothers initiate breastfeeding within within the first 30 minutes of birth

5. Give newborn infants no food or drink other than breastmilk unless medically indicated (see specific guidelines on infants of HIV infected mothers)

6. Show mothers how to breastfeed and to maintain lactation even if they should be separated from their infants

7. Practice rooming in, allow infants to remain together with the mother 24 hrs a day

8. Encourage breastfeeding on demand

9. Encourage & actively promote excluysive breastfeedingfor infants up to 6 months

10. Provide information and demonstrate to mothers how to introduce & prepare appropraitae nutritious com[lementary foods to their infants after 6 months.

11. Encourage mothers to breastfeed for at least 24 months ( see guidelines for HIV infected mothersd)

12. Foster establishement of breastfeeding support groups and other support groups and refer mothers to them on discharge from hospital or clinic

13. Not accept any free samples and supplies of breastmilk substitutes

14. Not allow any publicity by manufacturers or agents of breastmilk substitutes

15. Not give any feeds using bottles or teats.UN POLICY STATEMENT ON HIV AND INFANT FEEDING (2001)

When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV infected mothers is recommended.

Otherwise, exclusive breast-feeding is recommended during the first six months of life.

To minimize HIV transmission risk, breast-feeding should be discontinued as soon as possible taking into account local circumstances, the individual womens situation and the risks of replacement feeding. FEEDING OPTIONS FOR HIV POSITIVE MOTHERS Breastmilk substitutes

Home-prepared formula

Unmodified cows milk

Commercial infant formula

Modified breastmilk

Early cessation of breastfeeding

Expressed and heat treated breastmilk

Other breastmilks

Breastmilk banks

Wet-nursing

INTEGRATING NUTRITION IN HEALTH SERVICES

Nutrition interventions should be part of all health contacts with pregnant and lactating women and children under 2 years. Health workers should give the appropriate nutrition supplements or nutrition counselling at all contacts with these target groups in health facilities and during outreach in communities. Health workesr should support community based workers and private providers to reach the priority target groups not attending clinics.

Important contact points

Prenatal care

Delivery

Postpartum care

Immunization contacts

Well baby visits

Sick child care

Nutrition protocols to be implemented include: Ten steps of the BFHI to support breastfeeding in maternity services

Implementing the code of marketing of BM substitutes

Following infant and young child feeding recommendations of IMCI

Using micronutrient supplementation protocols correctly

Implementing appropriate measures in diagnosing & treating sick/malnourished children.

Providing appropriate guidance to HIV positive mothers about feeding options.

Nutrition interventions in Maternal Health services

Give prenatal iron/folate supplements to all pregnant women where anaemia or iron deficiency is a risk

Promote adequate diets and reduced workloads during pregnancy and after delivery

Implement the ten steps of BFHI wherever births take place

Protect the public and mothers from promotion of products under the scope of the international code of marketing of breastmilk substitutes

Give postpartum vitamin A to women at delivery in areas at risk of Vitamin A deficiency.

Give mebendazole for hookworm, prophylaxis for malaria

Routinely screen for severe anaemia

Nutrition interventions in child health services

1. Observe and assess breastfeeding provide individual counseling

2. Assess complementary feeding and counsel

3. Give preventive doses of vitamin A supplements every 4-6 months to all children 6-59 months where anaemia is a risk.

4. Weigh all children to see if they are growing adequately

5. Screen, treat and refer children for severe malnutrition, severe anemia and clinical signs of Vitamin A deficiency.