Integrating the Essential Nutrition Actions ENA Approach for New Born Health

1
Integrating the Essential Nutrition
Actions(ENA) Approach for New Born Health
Presented by Dr. Agnes Guyon, AED - LINKAGES
2

• Presentation
• Situation analysis
• Where?
• When?
• Why?
• The Essential Nutrition Actions approach
• Optimal breastfeeding practices
• Womens Nutrition
• Some results
• Challenges

3
Neonatal Survival Series

• The Bellagio Child Survival Series (The Lancet
  2003) identified newborn survival as a priority,
  lacking information and action
• 99 of newborn deaths are in developing countries
  - yet most information and investment is on
  high-tech solutions for the 1 of deaths in rich
  countries
• Every year 4 million babies die in the first 4
  weeks of life
• 10,000 per day
• 450 per hour
• 1.12 million a year in Africa alone

4
Neonatal deaths and the Millennium Development
Goals
Source Lawn al Lancet 2005
Millennium Development Goal 4 can only be
achieved if neonatal deaths are addressed 29 of
under 5 deaths in East and Southern Africa are
neonatal
5
Where? 4 million newborn deaths
Places where most babies die are where coverage
of care is lowest
99 of newborn deaths are in low/middle income
countries 66 in Africa and Southeast Asia
Source Lawn al Lancet 2005
6
When? 4 million newborn deaths
Up to 50 of neonatal deaths are in the first
24 hours
75 of neonatal deaths are in the first week
3 million deaths
Birth and first week is key when most babies
die when coverage of care is lowest
7
Why? 4 million newborn deaths
Almost all are due to preventable conditions
Source Lawn JE et al Lancet 2005
8
Evidence based interventions for reducing
neonatal mortality

• Tetanus toxoid (33-58)
• Clean delivery practices (58-78)
• Early exclusive breastfeeding (55-87)
• Prevention management of hypothermia (18-42)
• Community-based pneumonia management (18-35)

9
The problem of malnutrition and
intergenerational links implications for NNH
Non optimal feeding practices Micronutrient
deficiencies
Increased risk of death Child growth failure
Early pregnancy
Low birth weight babies
Low weight and height in teens
Increased risk of death
Small adult women
Chronic under nutrition Micronutrient
deficiencies
10

• Presentation
• Situation analysis
• Where?
• When?
• Why?
• The essential Nutrition Actions approach
• Optimal breastfeeding practices
• Maternal Nutrition
• Some results
• Challenges

11

• The ENA approach
• - pulls together existing vertical programs in a
  sensible 'action-oriented' way...
• - greatly expands coverage beyond GM/P contact
• Nothing new except the packaging' and the way
  promotion of nutrition is operationalized...

12
The ENA approach proven actions to prevent
malnutrition
Womens Nutrition
Estimated decrease of child mortality
23 National Strategy for IYCF, Fed MOH, April
2004
Control of Anemia
13
Promotion of Optimal Breastfeeding
Key Messages
Ethiopia estimated decrease of child mortality
4

• 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

National Strategy for IYCF, Fed MOH, April 2004
14
Special groups
Low Birth Weight and pre-term babies

• Breasfeeding according to gestation age
• Breasfeeding positions
• Kangaroo Mother Care in HF
• Hand expression of breast milk
• Feeding with a cup

HIV/AIDS Emergency situation
15
Womens Nutrition
Key Messages
Ethiopia estimated decrease of child mortality
1

• During pregnancy and lactation
• Iron/Folic Acid Supplementation
• Treatment prevention of malaria
• Increase food intake
• one extra meal each day during pregnancy
• two extra meals each day during lactation
• De-worming during pregnancy
• Vitamin A Capsule within 45 days of delivery

National Strategy for MN, Fed MOH, April 2004
16
Practical steps to integrate ENA within MNCH
2. Training for Capacity Building
1. Policy Partnerships
ENA
3. Community negotiating for better ENA
practices
4. BCC Mass Media
17
Expanding Coverage of Nutrition Support Life
Cycle (Continuum of Care)
POSTNATAL FP
SICK CHILD
PREGNANCY
GMP
IMMUNIZATION
DELIVERY
Agriculture Education Micro-credit Emergency
Outside the health sector
Within the health sector
Child survival Neonatal Reproductive
health Infectious diseases Community approach
18
ENAKey steps (1)
Policies guidelines Advocacy partnerships
at all levels
19
ENA Key steps (2)

• Training
• - Pre-service
• In-service

Baby Friendly Hospital facilities
20
ENA Key steps (3)
Community involvement
21
ENA Key steps (4)
IEC-BCC Materials same key messages
Mass Media reinforce same messages
22
Poopy and radio/TV
Counseling cards
Newsletters
Health booklet
Job aids
23

• Presentation
• Situation analysis
• Where?
• When?
• Why?
• The essential Nutrition Actions approach
• Optimal breastfeeding practices
• Maternal Nutrition
• Some results
• Challenges

24
Timely Initiation of Breastfeeding(within 1 hour
of delivery)
25
Exclusive breastfeeding(infants 0 26
MadagascarReplication for Scale up, 2003-2004
27
In MadagascarMicronutrient supplementation for
women

p 28
In MadagascarWomens nutrition during pregnancy
lactation

p 29
In EthiopiaTimely Initiation of Breastfeeding (1
hour of birth)

pAmhara Oromia 2004-2006 SNNPR 2003-2006
30
In EthiopiaExclusive Breastfeeding 0-5 months

pAmhara Oromia 2004-2006 SNNPR 2003-2006
31
Challenges

• Increase awareness at all levels
• Support health providers including pre-service
• Improve Baby-Mother friendly health facilities
• Reach special groups (HIV, emergency,
  adolescents)
• Enroll communities
• Overcome family and community obstacles

32
ENA have implications for Child Neonatal
Survival and MDGs
In conclusion

• We know what to do on large scale to prevent
  malnutrition and save child lives
• We know how to do it

33
The challenge that remains just to do it
Thank you
34
Sources Nutrition and Breastfeeding Promotion.
Quinn V. Guyon A. Martin L. Neka Tebeb H,
Sagoe-Moses C. 1.12 millions neonatal deaths in
Africa. Lawn J. PPT Child Survival Forum.
Tanzania 2005 The Essential Nutrition Actions
approach. Guyon A. PPT. Ethiopia 2006 Feeding Low
Birth Weight babies. Facts for feeding. The
LINKAGES project. AED. 2005 LINKAGES
Achievements. EXPO LINKAGES. May 2006 Community
Assessment in Ethiopia. LINKAGES-ESHE. August
2006