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