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  »  Well-Baby care, Post-natal care, Immunization and Growth Monitoring

The Essential Nutrition Actions (ENAs) Approach

Service Quality Self Assessment Tools - Facility Based
Well-Baby care, Post-natal care, Immunization and Growth Monitoring

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

Recommended ENAs at Well-Baby care contact.

Key stakeholders: health-workers, supporting staff  and VHT

Rating* Discuss and identify key gaps in provision and utilization of ENAs at Well-Baby care contact
Exclusive breastfeeding (EB) for infant 0-6 months:

Service provider observes a breastfeed session to assess position and attachment and counsels

  • Service provider asks about  any complications or challenges a mother is facing and counsels on solutions.
  • Service provider assesses and counsels to make sure the mother:
    - Has not introduced other foods/fluids to the baby.
    - Feeds the baby on-demand, day and night (at least 8 times).
    - Empties one breast before giving the other.
  • All HIV negative / not knowing status lactating mothers are encouraged to go for testing and to practice safer sex while breastfeeding.
  • All HIV+ mothers who are breastfeeding are counselled on when and how to interrupt breastfeeding.

NOTE: Lactating mothers can continue breastfeeding also during illness and pregnancy.

Total 1: ….  
Infant feeding (0-6 months) for HIV+ mothers/caregivers, who opt to use breast-milk substitute (BMS):
  • All HIV+ mothers are counselled privately to avoid spill-over.

Service provider:

  • Asks mothers to bring their own cup and spoon to show (even mark on the cup) average amounts of animal's milk or formula per feed based on baby's age.
  • Observes a feeding session to assess preparation, use of cup and spoon and sanitation maintenance.
  • Asks about  any complications or feeding challenges a mother is facing and counsels on solutions.
  • Assess to make sure the mother is not breastfeeding the baby (i.e. mixed feeding).
Total 2: ….  
Maternal nutrition including Iron Deficiency Anaemia control:

All lactating mothers are counselled on:

  • Increased energy intake through two additional meals a day.
  • Varied diet (cereal/starchy roots plus animal foods/legumes/nuts plus fruit/vegetable).
  • Reduced workload.
  • Daily use of iodized salt for all family members.
  • All lactating mothers are assessed to ensure they take daily Iron/Folic Acid or multiple micronutrient supplementation, if the six months were not completed during pregnancy.
Total 3: ….  
Complementary feeding for children over 6 months:

All mothers are counselled on:

  • How to continue breastfeeding until two years (if not HIV+).
  • When and why to start complementary feeding (6 months).
  • How to provide children with frequent small feeds throughout the day.
  • How to increase the amount and density of food as the child gets older and use a separate bowl for each child.
  • How to ensure the child has a variety of food, use energy dense foods and use of fortified foods.
  • How to interact with the child during feeding (active feeding).
  • How to safely prepare and store the child's food.
Total 4: ….  
Early detection and referral of children with malnutrition:

1. Monthly growth monitoring using the Salter Scale and the Child Health Card

  • All children are weighed and growth is plotted on the Child Heath Card and their mothers are adequately informed and counselled.
  • Children who do not gain weight for more than two months or are losing weight or fall below the bottom line are promptly referred / treated.
Total 5: ….  
2. Malnutrition screening for children using MUAC tape
  • Children over 6 months with length above 65 cm are screened using MUAC tape if they look malnourished and if they do not have a previous growth record.

    MUAC Resources - Sources for MUAC Straps

  • Children with moderate and severe malnutrition are promptly referred / treated.
Total 6: ….  
Infant Vitamin and Mineral Deficiencies (VMD) control:
1. Infant Iron Deficiency Anaemia (IDA) control:
  • All infant born premature or with low birth weight receive supplementation of iron without folic acid at 61st day according to protocol.
  • All children, especially infant on animal's milk, are screened for Anaemia using pallor.
  • Children with pallor are referred or treated according to protocol  and in conjunction with the measures to prevent and control malaria (WHO Guideline 1998 and Uganda Anaemia Policy 2002).
  • Bi-annual de-worming of children between 1-5 years
Total 7: ….  
2. Vitamin A Deficiency (VAD) control:
  • All mothers receive one 200,000 IU dose of Vitamin A within 8 weeks after delivery.
  • All infant under 6 months not on breast milk are given 50,000 IU of Vitamin A.
  • All children aged 6months to 1 year receive one 100,000 IU dose of Vitamin A.
  • Children >12 months receive 200,000IU dose of Vitamin A every six months.
Total 8: .....  
OVERALL SCORE (TOTAL 1 + 2 + 3 + 4 + 5+6+7+8): .....  

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

14 September, 2019

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