NUTRITIONAL INTERVENTION

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Nutrition Intervention (cont’d...)
 Nutrition Intervention: is defined as purposefully
planned actions intended to:
 Positively change a nutrition-related behaviour or
environmental condition, for an individual, target
group, or the community at large.
 Corrective measure that is undertaken to resolve
nutritional problem

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 Nutrition Intervention (cont’d...)
• Nutrition intervention is directed at the etiologic or
causes of a diagnosis (nutrition problem)
• In the Ethiopian context, the commonest nutritional
problems are deficiency diseases
• Nutrition intervention consists of two components:
 Planning
 Implementation

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General principles of nutrition intervention
• Should consider the conceptual framework (layers of
causes and life cycle wise)
• Should integrate long term and short term intervention
• Every sector is responsible (multi-sectoral intervention)
• Should consider sustainability and participation of the
beneficiaries

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I. Preventive nutrition interventions

 Dietary modification (targets the immediate causes)--for diet

deficient of nutrients
 Dietary diversification (targets underlying causes)--for poor
dietary practices due to lack of knowledge or lack of access to
food
 Economic approaches (targets basic causes of malnutrition)--
lack of access to food and money to buy foods, by increasing
the educational level of the community, enhancing
establishment of micro financing, increasing job accessibility
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etc...
Dietary modification methods
1. Fortification (iodine, infant formulas)
2. Supplementation
 Vitamin A (targets children 6-59 months and lactating
mothers)
 Iron (pregnant, lactating women, adolescents, and children <
5 years)
 Folic acid (pregnant women)

 Zinc (children < 5 years with diarrhoea)

3. Germination (energy density) and fermentation (acid formation)

4.04/06/2024
Cooking in iron pots (adds iron to the food) 7
Dietary diversification methods includes:

• Diversified production (e.g. backyard gardening,

horticulture, animal farm like poultry)

• Diversified consumption

– Keeping diet diversified by taking nutrients from all

food groups

– Healthy eating (balancing)

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II. Curative/Rehabilitative Interventions
 Therapeutic Feeding Program

• TFPs provide a rehabilitative diet together with medical

treatment for diseases and complications associated with
severe acute malnutrition.

• The specific aim of TFPs is to reduce mortality among

severely malnourished individuals and to restore health

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TFP at Community Based Therapeutic Care (CTC)
• A new approach (2003/4) to alleviate acute malnutrition
in emergencies
– Aim to treat malnourished people in a timely, effective and cost
efficient manner.
– CTC assists the majority of people suffering from acute
malnutrition in their homes.
– It integrates supplementary and therapeutic feeding, hygiene and
health promotion.

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The core principles of CTC are:

– Maximum coverage and access: providing people with

good access to services
– Appropriate care Medical and nutrition care
– Care as long as it is needed
– Timeliness-case finding & rx before complications occur
– Sectoral integration

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Essential Nutrition Actions (ENAs)

 It is an integrated long term nutritional intervention

• An action oriented approach to nutrition

• If we use ENA approach to nutrition, estimated decrease
of child mortality is 25%
• There are seven action areas:

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1. Promotion of Breastfeeding

Key messages
• Timely initiation of breastfeeding (1 hour of birth)

• Exclusive breastfeeding until six months

• Breastfeed day and night at least 10 times

• Correct positioning & attachment

• Empty one breast before switching to the other

• Estimated decrease of child mortality is 13% if the child is

optimally breastfed

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Observe for signs of milk transfer
• Sustained suck/swallow pattern with occasional pauses
• Audible swallowing
• Relaxed arms and hands
• Moist mouth
• Satisfied after feeding

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 Breastfeeding

Breast milk Breastfeeding

• Perfect nutrients • Helps bonding and development

• Easily digested; efficiently used • Helps delay a new pregnancy

• Protects against infection • Protects mothers’ health


Costs less than artificial feeding
 Nutrients in human and animal milks

Human Cow Goat

Fat

Protein

Lactose
Differences in the quality of proteins in different milks

Human milk Cow’s milk

Whey protein

Curds

Easy to digest Difficult to digest

 Protection against infection

1. Mother infected 2. White cells in mother’s

body make antibodies to
protect mother

4. Antibodies to mother’s 3. Some white cells go to

infection secreted in milk breast and make
to protect baby antibodies there
 Differences between colostrum and mature milk

Foremilk Hindmilk

Fat

Protein

Lactose

Colostrum Mature milk

 Psychological benefits of breastfeeding

• Emotional bonding
– close, loving relationship between mother and baby
– mother more emotionally satisfied
– baby cries less
– baby may be more emotionally secure
• Development
– children perform better on intelligence tests
 Disadvantages of artificial feeding

• Interferes with bonding

• More diarrhoea and persistent diarrhoea

• More frequent respiratory infections

• Malnutrition; Vitamin A deficiency

• More allergy and milk intolerance

 Disadvantages of artificial feeding

• Increased risk of some chronic diseases

• Obesity

• Lower scores on intelligence tests

• Mother may become pregnant sooner

• Increased risk of anemia, ovarian cancer & breast cancer in mother

 Assessing a breastfeed

• Check if the infant is breastfed in the previous hour

• If the infant has not fed in the previous hour, ask the mother to put her
infant to the breast.

• Observe the breastfeed for 4 minutes.

– Is the infant well positioned?

– Is the infant able to attach?
 …
Cont’d
Good positioning
– Infant’s head and body straight
– Facing her breast
– Infant’s body close to her body
– Supporting the infant’s whole body
Good attachment
– Chin touching the breast
– Mouth wide open
– Lower lip turned outward
– More areola visible above than below the mouth
Common breastfeeding Difficulties

• Not enough milk’

• Baby Refuses to feed

2. Appropriate complementary feeding

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

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 Complementary Feeding

 Complementary feeding means giving other foods in

addition to breast milk

 These other foods are called complementary foods

 Complementary food should be initiated after 6

months of child birth
 …cont’d
• Food offered from
spoon stimulates
muscle development

• At 6 months, offer small

portions of semisoft
food on a spoon
Energy required by age and the amount supplied from breast milk

1000 Energy Gap

800
Energy (kcal/day)

600
Energy from
400 breast milk

200

0
0-2 m 3-5 m 6-8 m 9- 12-23 m
11 m
Age (months)
Stomach size
 Gap for iron

Absorbed iron needed and amount provided

1.2 Iron gap
Absorbed iron

0.8 Iron from

(mg/day)

birth
stores
Iron from
0.4 breast
milk

0
0-2 m 3-5 m 6-8 m 9-11 m 12-23 m
Age (months)
 30/5

Gap for vitamin A

Vitamin A needed and amount

400
provided Vitamin A
gap
Vitamin A (µg RE/day)

300
Vitamin A
from
200 birth
stores
Vitamin A
100 from breast
milk

0
0-2 m 3-5 m 6-8 m 9-11 m 12-23 m
Age (months)
3. Feeding of the sick child

Key messages:
• Increase breastfeeding and complementary feeding
during and after illness
• Appropriate Therapeutic Feeding.

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 Feeding during recovery

• Give extra breastfeeds

• Feed an extra meal

• Give an extra amount

• Use extra rich foods

• Feed with extra patience and love

4. Women's nutrition

Key messages: during pregnancy and lactation

 Increase feeding
 Iron/folic Acid Supplementations
 Treatment and prevention of malaria
 De-worming during pregnancy
 Vitamin-A capsule after delivery

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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
Key messages:
 Supplementation of women and children
 De-worming for pregnant women and children (twice/year)
 Malaria control
 Iron rich foods
 Fortifications

7. Controls of iodine deficiency disorders

Key message: access and consumption by all families of iodized salt

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Contact points for application of the ENAs
• There are six critical contact points in the lifecycle

1. During Antenatal Care

 Antenatal visit, Iron/Folic Acid
 De-worming
 Maternal diet
 EBF
 Safe delivery, iodized salt

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2. Delivery

 Safe delivery
 EBF
 Vitamin A, Iron/Folic Acid
 Diet, FP and STI

3. Postnatal and family planning

 EBF, Diet, Iron/Folic Acid
 FP, STI prevention
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4. Immunizations
 Vaccination, Vitamin-A supplementation
 De-worming
 Assess and treat infant's anemia

5. 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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6. Sick child
 Monitor Growth
 Assess and treat
 Counsel on feeding
 Assess and treat for anemia, vitamin-A deficiency
 Immunization/de-worming

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Thank you