Mother, Infant and Young Child Nutrition & Malnutrition Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight
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Protection, Promotion and Support of Healthy Maternal, Infant and Young Child Feeding

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Home  »  Nutrition Protection, Promotion & Support  »  The Essential Nutrition Actions (ENA) Approach  »  Service Quality Self Assessment Tools  »  Tool 1: Facility Based  »  Delivery and immediate post-partum

The Essential Nutrition Actions (ENAs) Approach

Service Quality Self Assessment Tools - Facility Based
Delivery and Immediate Post-partum

Performance self-assessment tool for use by Key Stakeholders at key contact points - The following Essential Nutrition Actions (ENAs) are recommended:

Recommended ENAs at Delivery and immediate post-partum contact.

Key stakeholders: midwifes/health workers  at health facilities and trained birth attendants for home delivery.

Rating* Discuss and identify key gaps in provision and utilization of ENAs  at Delivery and Immediate Post Partum Contact.
Exclusive breastfeeding:

All mothers are assisted / advised to:

  • Give unrestricted skin-to-skin contact immediately after delivery.
  • Initiate breast-feeding within 60 minutes.
  • Give the colostrums or 'First Milk' to the baby
  • Empty one breast before switching baby to other breast.
  • Feed only breast milk - no water, glucose, or other fluids like tea and soda.
  • Breastfeed frequently and on-demand, day and night (at least 8 times).

NOTE: Service provider observes a breastfeed session to assess "positioning and attachment" and counsels/supports.

Total 1 ….


Infant feeding for HIV+ mothers, who opt to use breast-milk substitute:
  • All HIV positive mothers, who opt to use breast-milk substitutes, are supported to initiate the chosen option.
  • Privacy is ensured in the use of breast-milk substitute to prevent 'spillover' effects into the wider community.
Total 2 …..  
Maternal and Infant Vitamin and Mineral Deficiencies control:

1. Maternal Iron Deficiency Anaemia (IDA) control:

  • Service provider ensures mothers who did not take Iron/Folic Acid supplementation for six months have enough supplies to last to the next visit.

2. Infant Iron Deficiency Anaemia (IDA) control:

  • Cord clamping of all new born children delayed for two minutes at least.
  • New born children who are premature and/or with low-birth weight are identified for further follow-up.
Total 3 …..  
3.Vitamin A supplementation to all postpartum mothers:
  • All mothers receive one 200,000 IU dose of Vitamin A after delivery.
Total 4 …..  
OVERALL SCORE (TOTAL 1 + 2 + 3 + 4): .....  

Rating: 0 = insufficient; 1 = fair; 2 = good; 3 = very good; 4 = excellent

14 September, 2019

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