INTERGRATION

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The Essential Nutrition Actions approach An
action oriented approach to nutrition
Presented by Agnès B. Guyon,MD,,MPH
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ENAWhat are the Essential Nutrition Actions?
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ENA Proven actions
Estimated decrease of child mortality 25
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1. Optimal Breastfeeding
Estimated decrease of child mortality 13
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1. Promotion of Breastfeeding
Key Messages

• Timely Initiation of breastfeeding (1 hour of
  birth)
• Exclusive Breastfeeding until 6 months
• Breastfeed day and night at least 10 times
• Correct positioning attachment
• Empty one breast before switching to the other

WHO Infant Child Feeding recommendations, 2001
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2. Appropriate Complementary Feeding

Estimated decrease of child mortality 6
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2. Complementary Feeding to BF
Key Messages

• Introduce appropriate complementary foods
• at 6 months
• Continue breastfeeding until 24 months more
• Increase the number of feedings with age
• Increase density, quantity and variety with age
• Responsive feeding
• Ensure good hygiene (use clean water, food
  utensils)

WHO Infant Child Feeding recommendations, 2001
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3. Feeding the sick child
WHO Infant Child Feeding recommendations, 2001
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3. Feeding of the sick child
Key Messages

• Increase breastfeeding complementary feeding
  during and after illness
• (IMCI- Integrated Management of Childhood
  Illness)
• Appropriate Therapeutic Feeding

WHO Infant Child Feeding recommendations, 2001
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4. Womens Nutrition
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4. Womens Nutrition
Key Messages

• During pregnancy and lactation
• Increase feeding
• Iron/Folic Acid Supplementation
• Treatment prevention of malaria
• De-worming during pregnancy
• Vitamin A capsule after delivery

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5. Control of Vitamin A Deficiency
Estimated decrease of child mortality 2
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5. Control of Vitamin A Deficiency
Key Messages

• Promote breastfeeding source of Vitamin A
• Vitamin A rich foods
• Maternal supplementation
• Child supplementation
• Food fortification

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6. Control of Anemia
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6. Control of Anemia
Key Messages

• Supplementation for women and children (IMCI)
• Deworming for pregnant women and children
  (twice/year)
• Malaria control
• Iron-rich foods
• Fortification

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7. Control of Iodine Deficiency Disorders
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7. Control of Iodine Deficiency Disorders
Key Message

• Access consumption
• by all families
• of iodized salt

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How the Essential Nutrition Actions expands
coverage of nutrition support in the health
sector?
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ENA Six critical contacts points in the lifecycle
PREGNANCY TT, antenatal visits, iron/folic
acid, de-worming, anti-malarial, diet, EBF, risk
signs, FP, STI prevention, safe delivery, iodized
salt
DELIVERY safe delivery, EBF, vitamin A,
iron/folic acid, diet, FP, STI prevention
IMMUNIZATION vaccinations, vitamin A,
de-worming, assess and treat infants anemia, FP,
and STI referral
POSTNATAL AND FAMILY PLANNING EBF, diet,
iron/folic acid, diet, FP, STI prevention,
childs vaccination
SICK CHILD monitor growth, assess and treat per
IMCI, counsel on feeding, assess and treat for
anemia, check and complete vitamin A
/immunization/ de-worming
WELL CHILD AND GMP monitor growth, assess and
counsel on feeding, iodized salt, check and
complete vaccination/ vitamin A /de-worming
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Need to integrate into other health programs
Child Survival EPI Community IMCI Health
facilities IMCI
Reproductive Health Womens Nutrition Lactation
Amenorrhea Method
ENA
National Immunization Days Polio Measles
Infectious Diseases Control of Malaria Tuberculosi
s HIVAIDS (PMTCT)
Nutrition programs Positive deviance Community
GM/P
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How the Essential Nutrition Actions expands
coverage of nutrition support outside the health
sector?
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Need to integrate into other sectors
Schools Adolescent nutrition De-worming Iron
supplementation School lunch
Agriculture Food diversification Food
security Womens farmers clubs
ENA
Emergency Women to women support
Micro-credit Income generation Nutrition
education
Sanitation Clean water sanitation Public health
education Prevention of diarrhea, malaria, ARI
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How to Implement the Essential Nutrition
Actions?
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ENACreate a positive environment and context (1)
Partnerships at all levels
Policies and guidelines
Mass Media
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ENAHarmonize training (1)

• Training
• - Pre-service
• In-service

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ENAEmphasis role of the community (1)
Community
IEC-BCC Materials same key messages
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Take home messages
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ENA Multiple approach
Advocacy
Policy
Training Pre-Service In-Service
Negociation
Community Action
Mass Media
Leveraging of resources
Partners
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• ENA approach provides a simple clear framework
  that guides specific actions to improve
  nutrition at specific points in time

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• ENA approach pulls together all existing
  vertical programs in a sensible 'action-oriented'
  way...
• Nothing new except the packaging' and the way
  it is operationalized...

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• ENA approach greatly expands the coverage
  potential for nutrition contacts far beyond the
  traditional Growth Monitoring Promotion programs

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ENAAdequate nutrition forhuman and sustainable
development
Thank You
Prepared by Drs. Agnes Guyon and Victoria Quinn
(AED/LINKAGES)