Chapter Two:

Maternal, child health and

nutrition
AMCHS
2016 EC
By Tinsae S
TINSAE S 1
 2.1 Maternal Health
Maternal health refers to the health of
women during pregnancy, childbirth
and the postnatal period.
• Maternal and child health are
interconnected
• Investing in these areas yields long-term
benefits for families and communities.

TINSAE S 2
 Cont’d…Maternal
• Ensuring safe pregnancies, childbirth, and
postpartum care is essential.
• Access to skilled birth attendants, prenatal
care, and emergency obstetric services
can reduce maternal mortality.
• Addressing anemia, malnutrition, and
infections during pregnancy is vital.

TINSAE S 3
 Cont’d…Maternal
• A new target was stipulated to reduce maternal
mortality.
• One target under SDG 3 is to reduce the global
maternal mortality ratio to less than 70 per
100 000 births,
• With no country having a maternal mortality rate
of more than twice the global average.

TINSAE S 4
 Overview and components of
maternal health services
• Ethiopia made a striding change in maternal
death over the last decades,
–the MMR decreased from 871 per
100,000 in 2000 to 401 per 100,000 in
2017 (12,000 mothers every yr.
• Direct obstetric complications account for
85% of the deaths. TINSAE S 5
• Maternal health encompasses the health
care dimensions of
– Family planning,
– Preconception,
– Prenatal(anc), and
– Postnatal care

TINSAE S 6
 Family Planning Services
• Family planning is the practice of controlling
the number and timing of pregnancies, for the
health and well-being of individuals and
families.
• Ethiopia has also prioritized adolescent and
youth-friendly family planning services

TINSAE S 7
Ethiopia government Commitment Objectives
• Proportionally increase financing of family planning
services.
• To increase the “no stockout” status of at least three
modern contraceptive methods from 63% to 90%.
• To reduce teenage pregnancy among adolescent girls
from 13% to 7% by 2025 and 3%.
• Ensure the availability of quality and safe family
planning information and services to decrease the
unmet need for family planning from 22% to 17%.

TINSAE S 8
 FP Service eligibility
• Any reproductive-age person
—male or female, regardless of marital status
—is eligible for FP services, including
information, education, and counseling.
• FP services shall be delivered through the
following service delivery modalities:
–Community-based services
–Facility-based services /AYRHS
–Social marketing
–Outreach services
TINSAE S 9
 Maternal Health programs
• Quality and equitable antenatal care 1st & 4th
services
• Quality and evidence based labor and delivery
service
• Postnatal care 24hr stay
• Emergency obstetric and newborn care
• Maternal and perinatal death surveillance and
response system
• Obstetric and gynecologic problems referral and
network system
• Prevention and management of obstetric fistula and
pelvic organ prolapse
• Expansion of maternity waiting homes at each
public health facilities TINSAE S 10
 Maternal Health initiatives
• Access and quality of Antenatal Care
• Strengthen skilled birth attendance at health
facilities
• Improved postpartum health care coverage
• Improved C/S service coverage
• Reduced the number of stillbirths
• Implementation of catchment based mentorship
• Strengthen maternal health commodities and blood
supply to reduce maternal mortality
• Increased treatment services to Fistula and Uterine
prolapse
• Strengthening safe abortion services
TINSAE S 11
 2.2 Child Health and Nutrition
[Link] Health:
[Link] programs protect children
from preventable diseases.
[Link] breastfeeding for the first six
months supports optimal growth and
development.
[Link] growth monitoring and nutrition
interventions are crucial.
TINSAE S 12
 Immunization
Ethiopia started the EPI in 1980 to reduce
mortality and morbidity from vaccine-preventable
diseases among children and mothers
The Ethiopian Federal Ministry of Health
(FMOH) has prepared a plan to increase the
immunization coverage rate to 80% of the
population, in 90% of the woreda (districts) in
the country TINSAE S 13
 EPI….
Vaccine-preventable diseases included in the EPI in Ethiopia are;

 Tuberculosis (TB) Liver disease caused

 Poliomyelitis (polio) by hepatitis B viruses
 Diphtheria  Pneumonia and other
 Pertussis(whooping infections caused by
cough)
Streptococcus
 Tetanus
pneumonia bacteria
 Measles
 Diarrheal diseases
Pneumonia and meningitis
caused by Haemophilus caused by rotaviruses
influenzae type b bacteria
TINSAE S 14
 Types of vaccine

There are five general types of vaccine

 Live-attenuated vaccines
 Inactivated vaccines
 Sub-unit vaccines
 Recombinant vaccines
 Conjugate vaccines
TINSAE S 15
 Vaccine
 Vaccine is a harmless preparation of antigens

 It is made from killed or weakened viruses or bacteria,

or antigens extracted from the infectious agents

 Immunization should happen before the person develops

a vaccine-preventable infection

 Vaccines are usually given to babies and young children,

either by injection or swallowing liquid drops

TINSAE S 16
Live-attenuated vaccines
 This vaccines are prepared from viruses or bacteria that are
whole, active and able to cause infection, but they have been
weakened in the laboratory
 Attenuated: means made weak so the infectious agents in the
vaccine should cause no disease at all
 It activate the immune system very effectively, because
they cause a similar reaction in the body as if to a natural
infection
Example:
 Measles and oral polio vaccine (OPV) (antiviral vaccine)
 Bacillus of Calmette and Guerin (BCG) (antibacterial)

TINSAE S 17
Inactivated vaccines
 Whole-cell inactivated vaccines are produced by first
growing viruses or bacteria in the laboratory and then
inactivating (killing) them with heat or chemicals

 They cannot cause a disease because they are not alive

Example: Pertussis component of the pentavalent vaccine

 The whole-cell inactivated version of this vaccine
contains the Bordetella Pertussis bacteria, which
cause whooping cough
TINSAE S 18
Sub-unit vaccines
 Are made from parts of infectious agents, or certain
chemicals produced by bacteria
Because the vaccine does not contain whole organisms, they
cannot cause disease in immunized people
Example: The diphtheria and tetanus components of the
pentavalent vaccine
 Diphtheria and tetanus bacteria each produce special toxins
, harmful chemicals that cause the symptoms of these
diseases
 A sub-unit version of the Pertussis vaccine also exists now
TINSAE S 19
Recombinant vaccines
 Are produced by inserting genetic material from a
disease-causing organism into a harmless cell, which
then makes lots of copies of the antigens of the infectious
agent

The antigens are then purified and used as a vaccine

Example: hepatitis B vaccine, HPV vaccine

TINSAE S 20
Conjugate vaccines
 A conjugate vaccine is made by conjugating (joining
together by chemical bonds) an antigen from an
infectious agent and a large “carrier” protein
The combination makes the antigen more immunogenic
than it would be on its own
Example:
 Haemophilus influenza type b (Hib) vaccine
included in the pentavalent vaccine in Ethiopia
 Pneumococcal conjugate vaccine (PCV)
TINSAE S 21
Target Group Identification, Resource
Mapping and Action Plan preparation

TINSAE S 22
 EPI eligible target group
 Eligible or target groups are peoples who are entitled
for vaccination with a particular vaccine
Example:
 For BCG vaccine, the target population is all live births
(i.e. complete expulsion from the mother, regardless of
duration of pregnancy, showing any evidence of life)

 For all other vaccines in the Expanded Program on

Immunization (EPI) in Ethiopia, the target population is
all surviving infants (i.e. survive to their first birthday)
TINSAE S 23
 EPI eligible target people…

Question 1: estimate target population for BCG vaccine in

a kebeles with 5000 total population by taking 3.46% live
birth conversion factor of the year?

= 5000 x 3.46 / 100= 173 children

Question 2: calculate for the rest vaccine using surviving

infant conversion factor of 3.19%?

= 5000 x 3.19/100= 159.5 ≈ 160 children

Note: the regional conversion factors used are changeable

TINSAE S 24
 Resource mapping
It is a process that enables community members
to identify or inventory existing services and
organizations matched to a particular purpose

It helps to know were certain resources are

located

TINSAE S 25
 Preparation of an action plan to reach eligible

Action plan should include

 Activity to be performed
 Time when to do
 Who will do it
 How that person (or people) will do it, and
 What resources will be needed
 The first and most important estimate is the total size of
the population and the number in the target
population for your activities
TINSAE S 26
 Preparation of an action plan…
 Estimation of resources needed should be determined
in advance, it includes; people, materials, time, finance
and information

 The next step is to allocate people (e.g. community

volunteers), materials, time and finance to each of the
activities in your plan

 Once the action plan for the year is complete, it should

be communicated to all stakeholders
TINSAE S 27
 Preparation of an action plan…

 You should arrange a meeting with local government

and community volunteers to discuss your plan, and gain
their approval and support
 Once approved, it is your responsibility to implement
the plan

 You have to keep all stakeholders well informed about

progress during the year

TINSAE S 28
 Planning your immunization programme

For any activity to improve the health and wellbeing of

your community, you need to have a plan.

It is often said that if you fail to plan, you plan to fail.

You will be expected to develop an annual

immunization action plan.

TINSAE S 29
 Collecting basic information about
the community
Before you can begin to make an effective plan for any
health intervention, you must first collect some basic
information about the community you serve.

For example:
The size of the total population of your kebele,

size of the target population –clients for

immunization.
TINSAE S 30
 Collecting basic information….

A map of your kebele showing the location of

homes, health facilities and other buildings, and
geographical features such as paths, ponds, rivers or
forests.

The distances (in kilometres, or travel time by

walking)

TINSAE S 31
Cont…

Figure 8.2 Routes that local people can

take to reach the Health Post are visible
in this map from a rural kebele of
Ethiopia.
TINSAE S 32
 Cont…

Details of transport and communication networks in

the area:

e.g. roads, and the availability of telephone,

radio or TV coverage.
The location of potential partners who could assist
you,
e.g. community associations, employers, private
institutions, charitable organizations, etc
TINSAE S 33
Steps in the planning process
Step 1 Assess need:
 Identify the problems and clarify the situation you want
to improve.
Step 2 Identify and prioritize:
 Select your priorities for action
 – what are the most important issues to tackle?

Step 3 Set goals and objectives:

 What is the overall goal of your activities, what are your
specific objectives (targets) and in what time scale do you
aim to achieve them?
TINSAE S 34
 Cont…
Step 4 Develop strategy:

 What is your action plan? What activities, resources

(people, equipment) and finances will be needed to achieve
your objectives? How will you explain your action plan and
gain community support for it?

Step 5 Implementation:

 How will you deliver your plan? Do you have everything

you need to make it successful?

TINSAE S 35
Cont…

Step 6 Monitor and evaluate:

 What data will you collect and how will you evaluate
the impact and outcomes of your activities?

 How will you measure progress towards meeting your

objectives?

TINSAE S 36
 Immunization needs assessment
Health needs assessment

 Is the process of identifying and understanding the health

needs of your community.

 It includes identifying any problems and their possible

causes that make it harder to meet those needs.

TINSAE S 37
Some ways to address low immunization
coverage rates
Improved communication with the local
community about the huge benefits and very low risks
of immunization.
More in-service training, updating or supportive
supervision for you and other health workers,
including community volunteers.
Mobilization of additional people, equipment,
finances or other resources to improve delivery of the
immunization programme.

TINSAE S 38
 Cont…

Change of immunization strategy,

 e.g. increased use of outreach or local

immunization days.
Focus group discussions with community members to
find out why immunization coverage is low.

Regular review meetings with kebele leaders and local

health officials to assess progress.
TINSAE S 39
 Cont…

Partnerships with other organizations (e.g.

community associations, charities, private sector) to
assist in delivering the programme.

Remember that some solutions may not be appropriate

to your setting, or may not be feasible in your kebele.

For example, in-service training may not be

affordable in the short term, or assist with your
immunization activities.
TINSAE S 40
 Identify and prioritize problems

Prioritization
Is the process of informed decision-making about what
to do first, second, third and so on, when there are
competing claims on human and other resources.

It is impossible to solve all problems at once because

there are always many resource constraints.
TINSAE S 41
Criteria for prioritization
Magnitude of the problem – what percentage of
the population is at high risk of developing the
disease, or is already affected by it?
Severity of the problem – how serious is the
disease in question, in terms of its impact on health
and the risk of death?

Socioeconomic impact of solving the problem –

how will the social and economic circumstances of
individuals, families and the community benefit if
immunization coverage increases?
TINSAE S 42
 Cont…
Feasibility of tackling the problem – do solutions exist,
and is it realistic to increase immunization coverage with
the available technical resources, personnel and
organizational capabilities?
Affordability of tackling the problem – is the financial
support adequate for an improved immunization
programme?
Acceptability to the beneficiaries of tackling the
problem in the ways suggested — does it meet
community and government concerns?

TINSAE S 43
 Examples
Consider two diseases: pneumonia and the common
cold. Which of these has the greatest magnitude and
which has the greatest severity?
Ans. The number of people who suffer from a common
cold is much higher than the number with pneumonia,
but pneumonia is a much more serious disease than the
common cold.
So the magnitude of the problem is greater for the
common cold, but the severity of the problem is greater
for pneumonia.

TINSAE S 44
 Cont…

A simple scoring chart, like the one in Table 8.1, can

help you to rank priorities for each of the health
problems identified in your needs assessment.

For each problem, you decide on a score from 1 to 5 for

each column, where:

1 = concern about this criterion is very low

5 = concern about this criterion is very high

TINSAE S 45
 Setting goals and objectives

Once you have identified problems with feasible

solutions and ranked your priorities,

Then you must set clear objectives (or targets) for each
problem in your priority list, in order to make progress
towards your overall goal.

In this case, the goal is to increase the immunization

coverage rate in your community.
TINSAE S 46
 Monitoring and evaluation indicators
Monitoring and evaluation are crucial parts of any health plan.

Monitoring refers to the continuous observation and collection of

relevant data, and evaluation means analyzing the data to see if
you are meeting your objectives. Therefore, you need to select
reliable indicators of progress for each of the objectives in your
action plan.

Collecting and analyzing data from these indicators is an essential

activity during the implementation of your immunization

programme.
TINSAE S 47
 Indicators of progress in immunization programmes

Some of the main EPI indicators of progress that are

commonly used to monitor and evaluate immunization
programmes are;

Immunization coverage rate for each vaccine, i.e. the

percentage of all eligible children who have received all
doses of a vaccine under one year of age, according to the
EPI schedule.

TINSAE S 48
 Cont…
Percentage of fully
immunized children aged
under one year, who have
received all recommended
doses of all vaccines
(including measles2
vaccine at age 15 to 18
months), according to the
EPI schedule.

Chart showing immunization coverage rates during five years at Fura

kebele, SNNPR, Ethiopia. The black bar to the right of each year shows
the number of fully immunized children.
TINSAE S 49
 Cont…
Percentage of
pregnant women
with adequate TD
doses, defined as
receiving any of
TD3, TD4 or TD5.
This indicator is
often abbreviated to
TD2+ (because more
than two doses of
TD vaccine have
been given).

TINSAE S 50
 Cont…
Dropout rates: the percentage of children and mothers
not completing all the scheduled EPI immunizations.

Reported new cases in the community of:

- Neonatal tetanus

- Acute flaccid paralysis (AFP)

- Measles in children under five years of age

 - All vaccine-preventable diseases.

Report completeness, accuracy and timeliness.

TINSAE S 51
 Exclusive breastfeeding

Exclusive breastfeeding (EBF) is recommended

for the first six months of age by the World Health
Organization.

It is the most cost-effective intervention to reduce

infant morbidity and mortality worldwide

Children and adolescents who were breastfed as

babies are less likely to be overweight or obese.

TINSAE S 52
 Indicators

• Proportion of infants 0-5

months of age who are fed
exclusively with breast milk
• Prevalence of exclusive
breastfeeding among infants < 6
months old
• Timely initiation of
breastfeeding

TINSAE S 53
 Growth monitoring
• It is the regular measurement of a child’s size
to document growth and detect early
changes.
• It involves assessing growth adequacy and
identifying any issues related to nutrition or
health.

TINSAE S 54
 ICCM/IMNCI
• Integrated Community Case Management of
childhood illness (iCCM) and integrated
management of newborn and child
illness(IMNCI)
• IMCI is an integrated approach that focuses
on the health and well-being of the child.
• IMCI aims to reduce preventable mortality,
minimize illness and disability, and promote
healthy growth and development of children
under five years of age.

TINSAE S 55
• The IMNCI approach is designed for use in
clinical settings at all levels of health care
where children under 5 years are managed.
– These are dispensaries, health centers, sub-
county hospitals, county hospitals and
national referral hospitals including, faith
based and private health facilities

TINSAE S 56
I. Assess and classify sick young infant age up
to 2 months
II. Assess and classify the sick child (age 2
months up to 5 years)

TINSAE S 57
ASSESS

CLASSIFY

IDENTIFY

TREAT

TINSAE S 58
TINSAE S 59
 COMMUNITY BASED NEW BORN
CARE
The CBNC programme is a key milestone of
the Ethiopian HEX Program.
Its quality of care assessment focuses on
investigating facility readiness, system
integration, health workforce potential and
HEW competence to provide quality newborn
care services. TINSAE S 60
• CBNC was launched in March 2013 by the
Government of Ethiopia in collaboration with
its implementing partners
– UNICEF,
– Integrated Family Health
– Program-IFHP
– Last 10Kilometres, and
– Save the Children.
TINSAE S 61
 ……CBNC
The implementation of CBNC used the following
guiding principles to ensure rapid, high-quality
implementation.
1) Government leadership and ownership
2) Spanning the continuum of care
3) Balance between preventive and curative care at
the community level
4) Quality service
5) Community participation
6) Strong health system support
7) Phased implementation approach and partnership.
TINSAE S 62
• Improving linkages between health centers and
health posts to improve ANC, intra partum,
postnatal and newborn care through “four Cs”
(1) early prenatal and postnatal Contact with the
mother and newborn;
(2) Case-identification of newborns with signs of
possible severe bacterial infection
(3) Care, or treatment that is appropriate and
initiated as early as possible
(4) Completion of a full seven- day course of
appropriate antibiotics.
TINSAE S 63
• CBNC implementation involves the scaling-up
of community based maternal and newborn
health (MNH) services in:
1. Early identification of pregnancy
2. Provision of focused antenatal care (ANC)
3. Promotion of institutional delivery
4. Safe and clean delivery

TINSAE S 64
5. Provision of immediate newborn care,
including application of chlorhexidine on the
cord
6. Recognition of asphyxia, initial stimulation
and resuscitation of the newborn baby
7. Prevention and management of hypothermia
8. Management of pre-term and low birth
weight neonates
9. Management of neonatal sepsis and very
severe disease (VSD) at community level
TINSAE S 65
• The quality of the CBNC programme has been
conceptualized and assessed across for key
domains.

TINSAE S 66
A. Health system readiness to provide quality
CBNC services needs:
• A functional infrastructure at health post
level
• CBNC essential drug supply
• Supportive supervision of health post staff
• Streamlined data management processes at
PHCU level, especially standardization of the
indicator definitions across the health system

TINSAE S 67
B. Health system integration within the PHCU
for quality CBNC services needs:
• An intact and responsive supply chain for
CBNC antibiotics
• Improved record keeping of CBNC services
• An effective referral process between health
posts
and health centers including transport and
necessary documentation
TINSAE S 68
C. Potential of health workers and volunteers
to deliver quality CBNC services needs:

• Regular needs assessment

• Periodic refresher trainings

• Optimization of the potential of WDA leaders

to create demand for CBNC services

TINSAE S 69
D. Management of young infant illness needs:
• Periodic examination of diagnostic and
management skills
• Addressing observed gaps with supervision
and mentoring

TINSAE S 70
 2.3 Nutrition program
Nutrition programs have been scaled up to
reach more children and women.

Types of Malnutrition
o Stunting
o Underweight
o Wasting

TINSAE S 71
 In Ethiopia, malnutrition is one of the major
public health challenges.
• Over the past decade, Ethiopia has
significantly reduced malnutrition but the
problem is still high

TINSAE S 72
• The 2019 mini EDHS estimated the
national prevalence of
– stunting among children at 37 percent,
– underweight at 21 percent and
– wasting at 7 percent.
• Between 2005 and 2019 the prevalence of
all the three child under nutrition declined.

TINSAE S 73
• National food and nutrition policy (FNP)
The national food and nutrition policy endorsed
by the council of ministers in 2018.
• The policy is based on the global conceptual
framework for nutrition security as a change
model to address the existing causes of nutrition
insecurity at various levels.
• The policy framework focuses on short, medium
and long-term strategies in an integrated way to
address the different layers of nutrition problems.
TINSAE S 74
• the objective of ensuring optimal nutritional
status of the population along the life cycle, the
team works on the following initiatives
– Optimal nutrition through the first 1000 days plus
– Emergency Nutrition Response and Management
of Acute malnutrition
– Comprehensive community and facility based
nutrition intervention
– Strengthening National Food fortification
initiative
– Multi-sectoral Nutrition Coordination and Linkage
TINSAE S 75
 Nutritional indicators
• Adolescent underweight:5-19 yr below the
median BMI
• Adolescent overweight:
• Adolescent obesity:
• Adult diabetes:
• Adult underweight: Adults aged 18 and over
with a BMI of 18.5kg/m² or lower.
• Adult overweight: Adults aged 18 and over
with a BMI of 25kg/m² or higher.
TINSAE S 76
• Adult obesity: Adults aged 18 and over with a
BMI of 30kg/m² or higher.
• Anemia in women:
– Pregnant women with hemoglobin levels below
110 grams per liter at sea level.
– Non-pregnant women with hemoglobin levels
below 120 grams per liter at sea level.
• Childhood overweight:0-59 month age
• Childhood stunting:
• Childhood wasting:
• Continued breastfeeding at 1 year: 12-15 month
• Continued breastfeeding at 2 years: Children
20–23 months of age who are fed breast milk.
TINSAE S 77
• Early initiation of breastfeeding:
• Exclusive breastfeeding:
• Introduction of solid, semi-solid or soft foods:
• Low birth weight: Live births weighing less
than 2,500 grams.
• Minimum dietary diversity:
• Minimum acceptable diet: Children aged 6–
23 months
• Raised blood pressure: >140/90mmHg
• Salt: The mean intake of salt/sodium of adults
aged 25 and over, expressed in grams per day.
TINSAE S 78
Projects and programs

• SURE
The SURE program, supported by the
Children’s Investment Fund Foundation (CIFF),
is the first Government-led integrated health
and agriculture sector program for improving
practices in complementary feeding and
dietary diversity among young children.
• The program has been implemented in 50
woredas across the four agrarian regions.

TINSAE S 79
Seqota Declaration
• Seqota Declaration (SD) is a high-level
commitment of the Government of Ethiopia to
end stunting in children under two years by
2030.
• The SD was launched in July 2015 Addis Ababa
and has a 15 years roadmap builds on and
accelerates implementation of the National
Nutrition Program and currently the National
Food and Nutrition Policy.

TINSAE S 80
The SD is being implemented in three phases.
• The first phase called an Innovation Phase
(2016-2020).
• The second phase is the Expansion phase
(2021-2025) -expand promising practices and
lessons learning during the innovation phase.
• The final phase is the national scale-up phase
(2026-2030) where evidence-based multi-
sectoral interventions will be undertaken
throughout the country

TINSAE S 81
 Wasting (low weight-for-
height/length or WHZ
• Low weight-for-height is known as wasting.
• Wasting reflects recent, short-term (acute)
malnutrition or illness.
• It usually indicates recent and severe weight
loss because a person has not had enough
food to eat

TINSAE S 82
– Assessing height-for-age is useful when we
want to
• Assess the nutritional status of a
population (when we do a survey of a
community,).
– This is useful for our programme managers and
planners, who have to decide how to use funds
and other resources, and for people who
evaluate the effects of development projects

TINSAE S 83
 Stunting (low height/length-for-age
• It is an indicator of chronic childhood
malnutrition.
• Childhood stunting is the best overall indicator
of children's well‐being and an accurate
reflection of social inequalities.
• It is a manifestation of severe, irreversible
physical, physiological and
cognitive damage caused by
chronic malnutrition during a child's first 1,000
days
TINSAE S 84
• Underweight is defined as low weight-for-
age.
• A child who is underweight may be stunted,
wasted or both.

TINSAE S 85
 Nutritional assessment methods
1. Anthropometric Nutritional Assessment
• It involves the measurement of the size, weight,
and proportions of the body.
– MUAC (Mid upper arm circumference)
• (six months to five years)
– Weight and height
2. Clinical Nutritional Assessment
• Bilateral pitted edema
• Wasting
TINSAE S 86
Strategies and prevention and treatment
of malnutrition
• Strengthening nutrition in primary health care
systems
– Supporting lactating mothers and their families with
skilled breastfeeding counseling
– Improving access to prenatal micronutrient
supplements for pregnant women
– Scaling up the prevention and treatment of wasting
• including high-quality prenatal care and maternal
nutrition services, child health services,
counseling on breastfeeding promotion, and
adequate access to safe and nutritious foods
year-round.
TINSAE S 87
• Ensuring adequate vitamin A coverage
– Vitamin A is essential for optimal child
health and immune function.
– Supplying a child with two high doses of
vitamin A every year is one the most cost-
effective ways to protect children against
• Blindness,
• Diarrhea, and
• Other serious illnesses

TINSAE S 88
• Increasing dietary diversity and appropriate
complementary feeding
• Scaling and sustaining large scale food
fortification
– improves the nutrient content of foods
during the processing stage.
• Improving food safety

TINSAE S 89
 Nutritional program indicators
• they are essential for monitoring and evaluating the
effectiveness of nutrition interventions.
• Here are some key indicators commonly used:
1. Stunting and Wasting Rates: in children under five
years old, reflecting long-term and short-term
deficiencies.
2. Micronutrient Deficiencies: Prevalence of
deficiencies in essential vitamins and minerals, such
as iron, vitamin A, and iodine, which are critical for
health and development.
3. Dietary Diversity: Assesses the variety of foods
consumed, indicating the quality of the diet and
potential nutrient adequacy.
4. Breastfeeding Practices: Rates of exclusive
breastfeeding and continued breastfeeding at different
ages, which are crucial for infant nutrition and health.
TINSAE S 90