Feb 12, 2016
NUTRITION IN HEALTH SERVICES
In service delivery - through clinics, health centers, also eg TBAs
preventive: GMP, counselling, micronutrient supplementation,perhaps targetted supplementary feeding
management of disease, incl nutrition (see IMCI)
facilitator - mobilizer interface
Community based (may be supported by other services than health)
preventive, incl GMP
minor treatment, ORT, ARI awareness ...
micronutrients
referral
ISSUES: coverage, targeting, content, intensity
NUTRITION IN HEALTH SERVICES
NUTRITION IN HEALTH SERVICES
In prevention of disease:
exclusive breastfeeding for 4-6 months, continued breastfeeding into second year of life
satisfactory quality and intake of complementary foods - vitamin A
women's nutrition, pre- and during pregnancy
iron (and malaria)
promote adequate care
In management of disease:
continued breastfeeding during infections
maintain diet during infection (especially persistent diarrhoea) and for recovery (catch-up)
vitamin A in measles and diarrhoea; other micronutrients
oral rehydration
control intestinal parasites
effective care during sickness and recovery
NUTRITION IN HEALTH SERVICES
Table 1 What problems are we trying to solve through school n/h programmes?
a. School child hunger, affecting performance, attendance, enrollment; and general nutritional status, hence also health.
b. School child malnutrition, especially micronutrients, affecting cognitive
development as well as problems under a.
c. School child health, both viral and bacterial infection (incl. HIV), and parasitic (e.g. intestinal worms).
d. Social support for destitute children, e.g. AIDS orphans.
e. Continued inappropriate child caring practices, esp. for the next generation.
f. Low school enrollment and attendance (especially of girls): food can be an
incentive.
g. Children in emergencies especially lack education
SCHOOL NUTRITION: PROBLEMS AND INTERVENTIONS
• pre-school malnutrition hence lowered educability
• current nutrition
• hunger - attention
• malnutrition - time-on-task
• present siblings malnutrition: child-to-child
• future children: nutrition in school curriculum
• information
• school anthropometric census
• check IDD and anemia
CURRENT NUTRITION
• hunger - breakfasts, snacks early in the day
• PEM - school feeding, as for hunger
• micronutrients - supplements, fortification
• parasitic infections - deworming (mebendazole etc, 6 monthly)
CURRENT NUTRITION
• hunger - breakfasts, snacks early in the day
• PEM - school feeding, as for hunger
• micronutrients - supplements, fortification
• parasitic infections - deworming (mebendazole etc, 6 monthly)
Enrollment Attendance Educationalperformance
Kids not in school
Behaviour Physical
Hunger
FOOD
Health & nutritional status
Health &nutritionprogrammes
Basic education programmePATHWAYS
Figure 1
Outcome
(e.g. test scores)
Environment — school, socio-economic ...
Poor Med Good
Better
Worse
Well nourished
Malnourished
Reported interaction between environment and nutrition on learning outcomes.
Figure 2A
Outcome
(e.g. test scores)
Environment — school, socio-economic ...
Poor Med Good
Better
Worse
Well nourished
Malnourished
Programme: effective ineffective
In a bad environment, kids don’t learn anyway, however nourished. They don’t learn either in a good environment if they’re hungry and/or malnour- ished. You need both good schooling and good nutrition to learn well.
Implications of effects of reported interactions
between school meals and school environment ,
on school learning.
Figure 2B
SCHOOL NUTRITION: IDEAS AND CAVEATS
• as nutrition intervention: wrong age, wrong SES
• commodities: beware milk and other wrongly conceived foods
• incentive role
• opportunity for fortification
Adolescents: supplementation; prevent pregnancy
Keep girls in school!
SCHOOL NUTRITION: IDEAS AND CAVEATS
• as nutrition intervention: wrong age, wrong SES
• commodities: beware milk and other wrongly conceived foods
• incentive role
• opportunity for fortification
Adolescents: supplementation; prevent pregnancy
Keep girls in school!
NUTRITION IN SCHOOLS -- HOW?
1. Policy decisions
why? what problems are we trying to solve? -- important to be clear: objectives get very confused (growth is not mainoutcome, school kids are not biologically or socially the mostvulnerable group; but micronutrient deficiencies are important,and hungry kids don't learn well -- food for thought)
what? -- school feeding? micronutrients? behaviour now andlater (this and next generation)? nursery pre-schools -- "ECD",is it really day care?
then
2. School feeding: whether, how and why; if poor design politicallyinescapable, use as micronutrient vehicle
3. School nutrition programs: behaviour, micronutrients, ...
4. Who pays? will they really and why? is it sustainable? does itreally need to be (heresy!) sustainable
5. Can school programs help community-based programs?Facilitators, data.
Table 2. Combinations of programmes needed for impact on educational outcomes.
Hunger/malnutrition School/learning environment
Poor
Better Extensive/serious
Basic h/nutr School meals Educational inputs
Basic h/nutr School meals
Absent
Basic h/nutr Educational inputs
Basic h/nutr