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The 4th Comprehensive Africa Agriculture Development Programme (CAADP) Partnership Platform Meeting Pretoria, 26-27 March. Good Practices and Lessons On Nutrition. Role of Nutrition. Better nutrition is a prime economic growth and human wellbeing. Role of Nutrition.

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Good practices and lessons on nutrition

The 4th Comprehensive Africa Agriculture Development Programme (CAADP) Partnership Platform Meeting

Pretoria, 26-27 March

Good Practices and Lessons On Nutrition

Role of nutrition
Role of Nutrition Programme (CAADP) Partnership Platform Meeting

  • Better nutrition is a prime economic growth and human wellbeing

Role of nutrition1
Role of Nutrition Programme (CAADP) Partnership Platform Meeting

  • A. Adequate Nutrition stronger immunity

  • B. Stronger Immunity less illness & better Health.

  • C. Health Children learn better

  • D. Health Population more productive

Causes of child mortality worldwide
Causes of child mortality worldwide Programme (CAADP) Partnership Platform Meeting


attributable to


Relationship between nutrition and child survival

Deaths associated with under-nutrition



EIP/WHO. Caulfield LE, Black RE.Year 2000

Child survival findings from the lancet
Child survival findings from the Lancet… survival

  • “…group of effective nutrition interventions, including breastfeeding, complementary feeding, vitamin A & zinc could save 2.4 million children each year (nearly 25% of the 10 million under-five deaths)”

  • The Lancet, 2003

Not only an issue of child survival
Not only an issue of child survival survival

  • Nutrition is also important for:

    • Physical growth

    • Behavioral development, cognitive function

    • School attendance, performance

    • Ultimate income-generating capacity, economic development

    • Risk of non-communicable diseases

178 million children under 5 suffer from stunting
178 million children under 5 suffer from stunting survival

Prevalence of


Black et al (Lancet 2008)

Emerging issues
Emerging Issues survival

  • 1. food Insecurity

  • 2. low agricultural productivity

  • 3. Financial crisis

  • undernutrition.

Emerging issues - obesity survival

  • 8 out of the top 20 countries in overweight prevalence among children <5 are in Africa

  • Double burden of overweight and underweight: e.g. Djibouti: high overweight, wasting & stunting

Interventions to prevent nutritional stunting and underweight
Interventions to prevent nutritional survivalstunting and underweight

  • Pre-natal:

    • Improved maternal nutrition and health before and during pregnancy to improve maternal survival and pregnancy outcome, reduce LBW and nutrition related chronic diseases later in life.

  • Post-natal:

    • Protection, promotion and support of optimal BF;

    • Adequate complementary feeding (timing, amount, animal source foods);

    • Prevention and appropriate nutritional management of infections (diarrhea, HIV, malaria, TB others) and SAM, MAM;

    • Selected MNs: vitamin A, iodine, iron folic acid, zinc;

    • Psycho-social stimulation;

    • Healthy life style – food, physical exercise and health.

Impact of vitamin a on child mortality
Impact of vitamin A on child mortality survival

Overall 23% reduction in child mortality with vitamin A supplementation





Vitamin A supplementation survival

(%, full coverage for 6-59 month old children)

Eastern and Southern Africa

Source: UNICEF Global Database, Nov 2008

Optimal breastfeeding 0 6 months
Optimal breastfeeding 0-6 months survival

Key Messages

Early initiation of breastfeeding (within1 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

Estimated decrease of child mortality: 13%

WHO Infant & Child Feeding Recommendations, 2001

Exclusive breastfeeding rates <6 mos survival in ESAR - 6 countries (above 50%)


Source: UNICEF SOWC 2009

Burden of non exclusively breastfed children esar
Burden of non-exclusively breastfed children, ESAR survival

Source: UNICEF database 2008

Sharp improvements in ebf are possible
Sharp improvements in EBF are possible! survival

Source: PFC 2007 & SOWC 2009

A comprehensive approach results in these sharp improvements in ebf rates
A comprehensive approach results in these sharp improvements in EBF rates

  • How: through implementation at scale of a comprehensive, context-specific approach to IYCF at all levels:

    • Most countries don’t have comprehensive approach, and don’t implement at scale. Challenges faced can be overcome.

  • Promotion,support and protection of breastfeedingneed to go together

    • Promotion = comprehensive evidence-based communication strategy;

    • Support = trained HW and counselors and community based support structures;

    • Protection = Code and maternity protection

  • Implementation of “quick wins” toreach the “low hanging fruit”:

    • e.g. on giving water before six months

5 action areas of a comprehensive iycf strategy breastfeeding and complementary feeding
5 action areas of a comprehensive IYCF strategy in EBF rates(breastfeeding and complementary feeding)

  • National level actions (policy, legislation, planning, budget, M&E)

  • Health system level actions

  • Community level actions

  • Communication for development

  • IYCF in especially difficult circumstances including emergencies and HIV

Evidence based activities
Evidence-based activities in EBF rates

  • Maternity care practices: Institutional changes in maternity care practices have been shown to effectively increase breastfeeding initiation and duration rates

  • Professional support:professional counsellors shown to be most effective in extending the duration of any breastfeeding

  • Lay and peer support:Lay counsellors shown to be most effective in increasing the duration of exclusive breastfeeding

  • Community based breastfeeding promotion and support: five studies in developing countries provide evidence that various types of community based breastfeeding promotion and support can improve breastfeeding practices in developing countries. Large scale programmatic experience & results documented in 10-country case study.

  • Media and social marketing: A Cochrane review suggests that media campaigns have been shown to improve attitudes towards breastfeeding and increase initiation rates. Social marketing has been established as an effective behavioural change model for a wide variety of public health issues

  • Support for breastfeeding in the workplace: Evidence from industrialized countries has shown how workplace support programmes increases the duration of breastfeeding

A quick win: targeting water in Ghana in EBF rates


More progress possible if target water & CF



Main Findings in EBF rates

CHDs achieved high coverage (above 80%) of VAS bi-annually, and led to increase in VAS coverage ranging from 15 to 90 ppts

High coverage (above 80%) of de-worming was achieved, resulting to significant increase as it was not delivered through other means prior, while measles immunization increased by about 10 ppts

The impact of CHDs on vitamin A deficiency could be estimated quantitatively in only Ethiopia and Zambia, as data for the other countries were incomplete. There were substantial falls in low serum retinol (in Zambia among children six to fifty-nine months old they fell from 66 per cent in 1997 to 54 per cent in 2003) and night blindness (in selected regions of Ethiopia) among children six to fifty-nine months it declined from 4.0 per cent in 1996 to 0.8 per cent in 2005, most likely attributable to VAS/CHDs. Based on known efficacy studies, this is expected to reduce significantly child mortality rates in these countries.

Vitamin A+ delivery throughChild Health Days in Ethiopia, Madagascar, Tanzania, Uganda, Zambia and Zimbabwe

Successes and challenges on idd elimination in burundi kenya madagascar rwanda uganda zimbabwe

UNICEF supported documentation of in EBF rates

country experiences has shown that

the essential requirements of

successful USI programmes are:

High-level government commitment,

reflected in evidence-based national policy

legislation and standards, and allocation of

sufficient resources for continuous

consumer education on the damage of IDD

to brain development and benefits of

iodized salt consumption, regular

monitoring and enforcement;

Buy-in by salt producers, wholesalers and


Consumers who know about IDD and

demand for iodised salt;

A national coalition to monitor

implementation and enforcement of laws.

Successes and challenges on IDD elimination in Burundi, Kenya, Madagascar, Rwanda, Uganda, Zimbabwe

Scale up of community management of acute malnutrition ethiopia and malawi
Scale-up of community management of acute malnutrition: Ethiopia and Malawi

  • Community management of acute malnutrition (CMAM), comprehensive system for identifying, referring, and treating children with acute malnutrition:

    • Community-based screening,

    • Referral to appropriate level of care, based on degree of wasting and presence of complications;

    • Specific treatment protocols, food supplements, medicines;

    • M&E, supply management.

  • Ethiopia implementing largest IMAM program ever – target to reach 100,000 new admissions/month

  • Malawi close to reaching countrywide coverage.

  • Somalia/Madagascar/Uganda piloting uses of RUFs for moderate malnutrition

Unicef contribution to the un comprehensive framework for action
UNICEF contribution to the UN comprehensive framework for action

  • Outcomes to meet immediate needs

    • • Emergency food assistance, nutrition interventions and safety nets enhanced and made more accessible;

    • • Smallholder farmer-led food production boosted;

    • • Trade and tax policy adjusted;

    • • Macroeconomic implications managed.

  • Outcomes to build longer-term resilience and contribute to food security

    • • Social protection systems expanded

    • • Growth of smallholder farmer-led food availability sustained;

    • • International food markets improved;

    • • International bio-fuel consensuses developed.

  • Global information and monitoring systems strengthened

Challenges to scale up
Challenges to scale-up action

  • Placing malnutrition prevention/control at the centre stage in the development and political agenda

  • Adequate nutrition human resources base at the key levels and across sectors

  • In-country technical capacity for nutrition (very few nutritionists, especially French and Portugese speaking)

  • Mainstreaming nutrition into either pre-service and in-service training

  • Sustainability and Government ownership.

  • Lack of funds for critical interventions

  • Quality control, monitoring and impact evaluation of the food fortification programme, routine quality data collection on IYCF core indicators

Challenges to success
Challenges to success action

  • Inter-sectoral communication, coordination, consistent messages:

    • Health

    • Social Welfare

    • Agriculture

    • Education

    • Economics & industrial development

    • Community & women’s development

  • Effective delivery platforms for community outreach (training, motivation, supervision)

  • Effective BCC strategies

  • Nutrition training and applied research capacity

  • Sustained financing mechanisms for at least 5-10 years.

Conclusions and recommendations
Conclusions and recommendations action

  • Adequate nutrition is essential for child survival, physical growth and development, and future economic capacity, hence directly relevant for achieving MDGs

  • Key nutrition strategies are available to reduce malnutrition and related complications:

    • Maternal supplementation during pregnancy;

    • Protection, promotion and support of optimal BF practices;

    • Timely introduction and responsive feeding of adequate amounts of high quality CFs;

    • Nutritional management of infectious diseases (diarrhea, HIV, malaria, TB others) and SAM, MAM;

    • Selected MNs (supplementation, fortification, promotion of diversified diets) – vitamin A, iodine, Iron folic acid, zinc etc.

  • The investment in nutrition should be based on costed comprehensive nutrition plans of action, with the aim of accelerating progress towards MDGs and targeting high vulnerable populations affected by food and economic crisis and the ongoing HIV Pandemic.

Opportunities action

  • Overwhelming scientific evidence on the significance of nutrition for maternal, newborn and child survival and development (Lancet series), and for national social and economic development

  • Rich country experiences on what has worked

  • Commitment to revitalize agriculture and food security, in therefore need to ensure that nutrition is central core.

  • Partnership building on nutrition and food security, targeting key vulnerable groups – urban and rural poor, smallholder farmers - women, HIV affected and infected