Understanding the Essential Nutrition Actions Framework_Agnes Guyon_5.5.14
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Transcript of Understanding the Essential Nutrition Actions Framework_Agnes Guyon_5.5.14
Implementing High-Impact Nutrition Interventions At
Scale: The ENA Framework
2014
Implementing High-Impact Nutrition Interventions At
Scale: The ENA Framework
2014
Understanding the ENA FrameworkPre-session CORE Group. May 5th, 2014
Agnes Guyon, MD, MPH
Understanding the ENA FrameworkPre-session CORE Group. May 5th, 2014
Agnes Guyon, MD, MPH
Based on proven impact: Women’s nutrition Infant & young child feeding Micronutrients
Action-oriented, with clear
guidance
Who should take what action
when?
Growing consensus that nutrition interventions need to be…
The High-Impact Nutrition Interventions
Evidence-Based Direct Interventions to Prevent and Treat Undernutrition
Promoting good nutritional practices:1. breastfeeding 2. complementary feeding for infants after the age of six months3. improved hygiene practices, including handwashing
Increasing intake of vitamins and minerals: Provision of micronutrients for young children and their mothers: 4. periodic vitamin A supplements 5. therapeutic zinc supplements for diarrhea management6. multiple micronutrient powders 7. deworming drugs for children (to reduce losses of nutrients)8. iron-folic acid supplements for pregnant women to prevent and treat anemia9. iodized oil capsules where iodized salt is unavailable
Provision of micronutrients through food fortification for all: 10. salt iodization 11. iron fortification of staple foods
Therapeutic feeding for malnourished children with special foods ($6.2 billion):
1 2. prevention or treatment for moderate undernutrition 13. treatment of severe undernutrition (“severe acute malnutrition”) with ready-to-use therapeutic foods (RUTF).
Two References (2013)
Control of Iodine Deficiency Disorders
Control of Vitamin A Deficiency
Optimal Breastfeeding (BF)Nutritional Care
of the Sick & Malnourished Child
ComplementaryFeeding with BFWomen’s Nutrition
Control of Anemia
Essential Nutrition Actions (ENA) FrameworkFirst Developed in 1997
ENA Uses the Life Cycle Approach
Focuses on the
1000 Day Window of Opportunity
Before conception
Promotion: Support Women’s Nutrition In Adolescence, Before Pregnancies, and Between Pregnancies
Promote & Support improved diet Diversified diet and appropriate amount for
adolescent needs Increase mineral intake
Provide Micronutrients Iron-folic acid supplementation and treatment of
anemia Deworming
With Delay first pregnancy Keep girls in school
WHO 2013
Promotion: Support Women’s Nutrition (1)During Pregnancy & Lactation
Promote & Support Improved Diet Diversified diet Increased food and MN intakes
1 extra meal/day when pregnant (550 Kcal/day) 2 extra meals/day when lactating (650 Kcal/day)
Consumption of iodized salt Sleep under insecticide-treated nets
With Spacing of Pregnancy Cessation of smoking, alcohol or other substances
Women’s nutrition in the context of HIV and emergencies
WHO ENA, 2013
Promotion: Support Women’s Nutrition (2)During Pregnancy and Lactation
* Countries with anemia < 20% ** Countries with night blinder>5%*** Countries with low calcium intake**** Countries with < 20% iodized salt
Provide Micronutrients Daily iron-folic acid(30-60/0.4mg)
or Weekly 2-3 intermittent iron-folic acid (120/2.8mg) for non-anemic* Daily (10 000IU) or Weekly (25 000IU) vitamin A** Daily (1.5 gr) Calcium*** Daily or annual iodine****
With Intermittent Preventive Treatment (ITP) of malaria Deworming during pregnancy (twice) Treatment of anemia Timely cord clamping
Protection-Promotion-Support Breastfeeding < 6 months
Protect Breastfeeding Legislation & enforcement of breastmilk substitutes code
Promote & Support key practices Immediate initiation of breastfeeding Exclusive breastfeeding for 6 months
Correct positioning & attachment Breastfeed day and night at least 10 times Empty one breast before switching to the other (Fore-milk vs hind milk)
Infant feeding in the context of HIV and emergencies
Other practices (control & prevention of anemia) Timely cord clamping
WHO ENA 2013
Protection-Promotion-Support (1)Complementary Feeding with Breastfeeding 6-24
Months
Promote & support Improved Diet Introduce appropriate CF at 6 months Continue breastfeeding until 24 months & more Frequency: Amount adapted to age
6-8 months: 200 kcal/day 9-11 months: 300 kcal/day; 12-23 months: 550 kcal/day
Diversity (fruits, vegetables, animal source, MNP, fortified CF, iodized salt) Density: from mashed to family food Utilization (handwashing, clean water, food & utensils) Active feeding
Protect CFCodex Alimentarius & Marketing of complementary food
WHO ENA 2013
6-8 months: 2-3 meals/day 9-23 months: 3-4 meals/day, 1-2 snacks/day
Protection-Promotion-Support (2)Control & Prevention of MN Deficiencies
WHO ENA 2013
Provide Vitamin A Supplementation Biannual vitamin A Capsules for children 6-59 months
100 000IU for children 6-11 months 200 000IU for children 12-23 months
Provide Iron-Folic Acid Supplementation Daily iron-folic acid (2mg/kg) for 3 months for children 6-23 months
With treatment of malaria in endemic areas
Provide Micronutrient Powder (MNP) Daily for at least 2 months for children 6-23 months
Provide Iodized Oil* Annually (200 mg) for children 6-23 months
* Countries with <20% iodized salt
With Biannual deworming for children 12-59 months Malaria prevention & treatment
Nutritional Care Sick Child & Management of Acute
MalnutritionPromote & Support of Improved Diet 0 to 24 months: increase breastfeeding frequency during and after illness 6 to 24 months & older: Increase feeding during illness and after illness (e.g., feed 1 extra meal each day for two weeks after illness)
Provide Appropriate MN Treatment (following national protocols) Vitamin A Zinc for treatment of diarrhea with oral rehydration therapy AnemiaManagement of moderate & severe acute malnutritionNutritional care of HIV-positive children (6 months-14 years)
WHO ENA 2013
Promotion-SupportNutrition-Sensitive
WHO ENA 2013
Immunization EPI New vaccines (Rotavirus and Pneunococcus)
Prevention of Childhood Illnesses Essential Hygiene Actions (Handwashing, sanitation) Household water treatment Reduction of indoor air pollution Context of HIV: Mother To Child Transmission
Family Planning
Global Interventions
Wheat and Maize Flour Fortification
WHO ENA 2013
How & Where to Implement?
Control of Iodine Deficiency Disorders
Control of Vitamin A Deficiency
Optimal Breastfeeding (BF)Nutritional Care
of the Sick & Malnourished Child
ComplementaryFeeding with BFWomen’s Nutrition
Control of Anemia
We Know That a Multisectoral Approach is Critical
Source: Lancet 2013
A framework to operationalize the implementation of existing nutrition programs that: pulls together existing vertical programs in a sensible
'action-oriented' way greatly expands coverage to multi-contacts and multi-
platforms.
Provides an excellent training framework on which to train service providers and community members:
Simple Uses existing structures.
The ENA Framework
Within the health sector:Use existing nutrition programs & increase their
performance
Child HealthNewborn healthImmunization
Treatment of childhood illnesses
Management of acute malnutrition
Reproductive Health
Lactation Amenorrhea Method With Family Planning
Safe Motherhood
Infectious Diseases
Control of MalariaTuberculosis HIV and AIDS
(PMTCT)
21
DELIVERY: safe delivery, FP, STI prevention, Optimal delivery, VCT, ARVs, Delay cord clamping, early & exclusive breastfeeding, iron-folic acid, diet
PREGNANCY: TT, antenatal visits, FP, STI prevention, safe delivery, VCT, Options, Safe Sex, danger signs,Diet, iron-folic acid, deworming, anti-malarial, iodized salt, calcium, vitamin A, preparation of breastfeeding
POSTNATAL AND FAMILY PLANNING: STI prevention, child’s vaccination, VCT, Safe sex, Support to breastfeeding, diet, iron-folic acid, FP
WELL CHILD AND GMP: check and complete vaccination, VCT, Safe Sex, Monitor growth, assess and counsel on child feeding, iodized salt
SICK CHILD: assess and treat per IMCI/immunization/VCT, counsel on infant feeding, assess and treat for anemia, check and complete vitamin A, deworming
IMMUNIZATION: vaccinations, FP, and STI referral, VCT, Safe Sex, Support to infant and young child feeding, vitamin A, deworming, assess and treat infant’s anemia
Critical Contacts for Essential Nutrition Actions
Outside the Health SectorUse Existing Contacts to Extend Nutrition
CoverageAgriculture
Food diversificationFood security
Household food production
Micro-creditWomen’s farmers clubs
Pre-service EducationDoctors, nurses, and
midwives
SanitationClean water
Public health education
Mass MediaTV
RadioLocal broadcasting
Community Nutrition Community Workers
Positive deviance
SchoolsChildren & Adolescent
DewormingIron supplementation
Maximizing contacts toenhance food diversity
Critical Contacts Within the Agriculture Sector
Ultimate Goal: Saturation
Within the Agriculture Sector Within the Health Sector
The
remaining
challenge:
‘just to do
it’Thank You