UNICEF, WHO and WFP Joint Statement on Appropriate Infant and Young Child Feeding in Haiti
UNICEF, WHO and WFP call for support for appropriate infant and young child feeding in the current emergency, and caution about unnecessary and potentially harmful donations and use of breast-milk substitutes.
 Joint Statement in English
Joint Statement in French
Dietary Diversity as a Measure of the Micronutrient Adequacy of Women’s Diets in Resource-Poor Areas: Results from Five Countries
In resource-poor environments across the globe, low-quality monotonous diets are the norm and the risk for micronutrient deficiencies is high. Women of reproductive age are among those most likely to suffer from micronutrient deficiencies, yet in developing countries there are very little data on women’s micronutrient status and the quality of women’s diets. Simple indicators are needed to characterize diet quality, assess key diet problems and monitor and evaluate intervention programs. While there have been attempts to design indicators of diet quality for women, the lack of uniformity in approaches has impeded progress.
In 2006, FANTA formed the Women’s Dietary Diversity Project (WDDP), a collaborative research initiative with the broad objective to use existing data sets with dietary intake data from 24-hour recall to analyze the relationship between simple indicators of diet diversity–such as those that could be derived from the Demographic and Health Surveys–and the micronutrient adequacy of women’s diets. With funding through the United States Agency for International Development Bureau for Global Health Office of Health, Infectious Disease and Nutrition, the WDDP has analyzed data sets from five countries: Bangladesh, Burkina Faso, Mali, Mozambique and the Philippines.
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Randomized, Double-Blind Controlled Clinical Effectiveness Trial Comparing a Novel 10% Milk Ready-to-Use Therapeutic Food with the Standard 25% Milk Ready-to-Use Therapeutic Food in the Treatment of Severe Acute Malnutrition in Rural Malawian Children
Standard therapy for cases of severe acute malnutrition without complications is home-based therapy with milk-peanut based ready-to-use-therapeutic food (RUTF). However, the cost of ingredients in RUTF limits its availability in resource-poor countries, with powdered milk constituting 67 percent of the cost. In this clinical effectiveness trial, severely malnourished children were given either a reduced milk formulation of RUTF (10 percent milk) in which milk was replaced with soy protein, or the standard formulation of RUTF (25 percent milk). Overall, children who received the 10 percent milk formulation had slower rates of weight gain and slower mid-upper arm circumference (MUAC) gain. Treating severely malnourished children with a 10 percent milk RUTF results in a lower rate of recovery and slower growth rates when compared to the standard 25 percent milk RUTF.
The clinical effectiveness trial was funded by the Hickey Family Foundation with additional support from USAID's Bureau for Global Health's Office of Health, Infectious Disease and Nutrition.
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Use of Lipid-based Nutrient Supplements (LNS) to Improve the Nutrient Adequacy of General Food Distribution Rations for Vulnerable Sub-groups in Emergency Settings
With co-funding from the Inter-Agency Standing Committee (IASC) Global Nutrition Cluster (GNC), FANTA-2 and UC Davis produced Use of Lipid-based Nutrient Supplements (LNS) to Improve the Nutrient Adequacy of General Food Distribution Rations for Vulnerable Sub-groups in Emergency Settings. The report is available from the UC Davis website. The report describes the potential role of LNS in improving the nutritional quality of foods provided in emergency settings and the optimal formulation of LNS for various target groups (e.g., infants and young children, pregnant and lactating women) in this context. The report will be published as a supplement in Maternal and Child Nutrition in 2010.
Review of Kenya’s Food by Prescription Program
Food and nutrition services are an important component of comprehensive HIV care aimed at improving the quality of life, productivity and survival of people living with HIV (PLHIV). Food by Prescription is an approach for integrating food and nutrition services into clinical HIV care and treatment services, and PEPFAR is supporting Food by Prescription programs in a growing number of countries. The first Food by Prescription program was implemented in Kenya beginning in 2006, and examination of the initial Kenya program can help inform the design and implementation of Food by Prescription in Kenya and other countries.
The Review of Kenya’s Food by Prescription Programme examines the operation and effectiveness of the program with a focus on specific issues such as the duration of food supplementation, loss to follow-up among clients, changes in client nutritional status and the food delivery system.
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Alternative Sampling Designs for Emergency Settings: A Guide for Survey Planning, Data Collection and Analysis
In emergency settings, rapid but statistically reliable population-based surveys are needed to provide humanitarian organizations and government agencies with essential information on the severity and magnitude of the situation so that appropriate analysis and response planning takes place. The most common method used in emergencies is a two-stage 30x30 cluster survey. This method provides reliable population-level estimates, but is time-and resource-intensive.
The guide provides information on three alternative sampling designs that are proven to be more time-and resource-efficient than the 30x30 cluster survey: the 33x6, the 67x3 and the sequential design. All three designs are hybrid designs, combining aspects of cluster sampling and analysis, with lot quality assurance sampling (LQAS) analysis.
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PM2A: Title II Preventing Malnutrition In Children Under Two Approach
and the Title II Technical Reference Materials
Food-assisted maternal and child health and nutrition (MCHN) programs traditionally work by identifying children under five years of age who are underweight and targeting interventions toward them. Global consensus suggests that changing who they target and relatively small changes in how these programs are implemented can greatly increase their effectiveness at preventing child malnutrition.
The Office of Food for Peace (FFP) has adopted the preventive approach, (which they have named "Preventing Malnutrition in Children under Two Approach - PM2A") as its recommended approach for all MCHN programming in multi-year Title II programs. The preventive approach targets all children from conception to 24 months of age with food and health and nutrition services until they are 24 months of age. The Title II Technical Reference Materials (TRMs) on PM2A are intended to help potential and current Awardees improve the design of their multi-year assistance programs (MYAPs) by incorporating PM2A.
Download the TRM on PM2A Access the background documents for PM2A
Nutrition Care and Support of People Living with HIV in Countries
in Francophone Africa: Progress, Experience, and Lessons Learned
Food and nutrition interventions play an important role in the
global response to the HIV pandemic, though, to-date, the main focus
has been on eastern, central and southern African countries where
the HIV pandemic is most severe. However, food and nutrition interventions
are important in West Africa as well, where HIV prevalence may not
be as high but malnutrition rates often are.
Nutrition Care and Support of People Living with HIV in Countries
in Francophone Africa: Progress, Experience, and Lessons Learned
presents the results of a 2008 review of progress in integrating
nutrition into the HIV care and support in 18 francophone countries
in western and central Africa. This report was prepared for and
presented at the Ouagadougou (Burkina Faso) WHO Consultation on
Nutrition and HIV in November 2008.
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the report
 Journal
of Nutrition, April 2009
Supplementary Feeding with Fortified Spreads Results in Higher
Recovery Rates than with a Corn/Soy Blend in Moderately Wasted Children
Moderately wasted children in sub-Saharan Africa are typically
treated with corn/soy blended flour (CSB) but this intervention
has shown limited effectiveness. Fortified spreads (FS) which are
energy-dense, lipid-based pastes with added powdered micronutrients
can be used as supplementary foods instead. Supplementary Feeding
with Fortified Spreads Results in Higher Recovery Rates than with
a Corn/Soy Blend in Moderately Wasted Children presents results
from a randomized clinical effectiveness trial which found that
moderately wasted children who received FS were more likely to recover
than those who received CSB.
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more about the article
Interagency
Review of Selective Feeding Programs in South, North and West Darfur
States, Sudan, March 8 – April 10, 2008
Selective feeding programs to treat acute malnutrition have been
operating in Greater Darfur for four years. Yet the region’s continuing,
complex emergency and extreme insecurity, as well as the current
political crisis threaten program implementation, coverage and sustainability,
while the population’s lack of access to food, water, health services
and sanitation increases malnutrition and threatens program outcomes.
FANTA-2's Interagency Review of Selective Feeding Programs in
South, North and West Darfur States, Sudan March 8 - April 10, 2008
assesses the quality, efficacy and effectiveness of Darfur's selective
feeding programs, and provides evidence-based recommendations for
improvement through activities such as training technical support,and
advocacy. The review covers selective feeding programs and services
for both center-based and community-based management of acute malnutrition.
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the report
 Cluster
Designs to Assess the Prevalence of Acute Malnutrition by Lot Quality
Assurance Sampling: A Validation Study by Computer Simulation
To assess acute malnutrition with a population based survey a large
sample size is generally required. This is true even when lot quality
assurance sampling (LQAS), an otherwise time and cost efficient
method, is used. Cluster sampling, or sampling observations in batches,
offers an alternative to the large simple random sample size that
would typically be needed for LQAS analysis.
The study "Cluster Designs to Assess the Prevalence of Acute Malnutrition
by Lot Quality Assurance Sampling: A Validation Study by Computer
Simulation," examines the classification error of three cluster
designs, a 67X3, a 33X6, and a sequential sampling scheme, to assess
the prevalence of acute malnutrition with LQAS. The study concludes
that for independent clusters with moderate intracluster correlation,
the three sampling designs maintain approximate validity for LQAS
analysis of acute malnutrition prevalence.
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the article
A
New Method to Estimate Mortality in Crisis-Affected Populations:
Validation and Feasibility Study
In emergency settings, data on mortality rates and the causes and
circumstances of death are crucial to guide health interventions
and monitor their effectiveness. Current methods to collect such
data require substantial resources and feature important methodological
limitations. In response FANTA with the London School of Hygiene
and Tropical Medicine, evaluated an alternative approach to obtaining
a population-based measure of mortality, the exhaustive measurement
(EM) method. The EM method captures deaths through an exhaustive
search for all deaths occurring in the community over a defined
and very short recall period. Unlike retrospective surveys, it provides
nearly real-time mortality estimates, which are more useful for
operational purposes in relief settings.
This report evaluates the validity of the EM method against a gold
standard measure of mortality based on capture-recapture analysis
in various operational settings (rural, urban, camp). Comparative
estimates of the time and cost required for data collection and
analysis using the EM method and retrospective surveys are provided.
Findings from the study suggest that the performance of EM method
is comparable to that of existing surveillance systems but appears
more feasible in terms of time and financial inputs, as well as
ethics, than alternatives. The method shows sufficient promise to
warrant further development.
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the report and use the mortality survey calculators
Training Guide for Community-Based Management of Acute Malnutrition
(CMAM)
A significant gap remains between need and capacity for management
of severe acute malnutrition (SAM) in children. This is despite
clear advances in the development and implementation of international
and national protocols for the management of SAM, as well as guidelines
and training for inpatient care of severely acutely malnourished
children. The Training Guide for Community-Based Management of
Acute Malnutrition (CMAM) aims to address this gap by increasing
knowledge of and building practical skills to implement CMAM in
both emergency and non-emergency contexts.
CMAM offers great potential for treating the majority of children
with SAM and no medical complications, at home through decentralized
outpatient care, while also providing for inpatient care for those
who need it: children with SAM and medical complications and infants
with SAM less than 6 months old. CMAM also includes community outreach
for early case detection and timely referral for treatment and may
include linkages to programs and services to manage moderate acute
malnutrition and prevent new cases of acute malnutrition from impairing
healthy growth or becoming life threatening.
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the training guide
 Nutrition,
Food Security and HIV: A Compendium of Promising Practices
Increasingly, countries in east, central, and southern Africa are
integrating nutrition and food security interventions into HIV services.
As the number, variety and reach of these programs expand, identification
and documentation of promising practices become valuable in order
to help understand what works, replicate successful approaches and
incorporate lessons into programs. The Regional Centre for Quality
of Health Care (RCQHC) in Uganda and the FANTA Project organized
extensive in-country reviews by local teams of nutrition, food security
and HIV programs in Kenya, Malawi, Tanzania, Uganda, and Zambia.
Nutrition, Food Security and HIV: A Compendium of Promising Practices
compiles, analyzes and describes the promising practices identified
through the reviews. The compendium was developed by RCQHC and the
FANTA Project with funding from USAID/East Africa.
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the compendium
 Nutrition
Care for People Living with HIV and AIDS: Training Manual for Community
and Home-Based Care Providers' Facilitators Guide and Participant
Handouts
Community and home-based care providers are front-line workers
in care and support of PLHIV. Their close contact with PLHIV and
affected household members and their familiarity with the household
environment offer a valuable opportunity for targeted nutrition
care and support. Nutrition Care for People Living with HIV and
AIDS: Training Manual for Community and Home-Based Care Providers
Facilitators Guide and Participant Handouts are designed to
equip community and home-based care providers with sufficient knowledge
and skills to provide nutrition care to PLHIV as part of ongoing
services. The materials are designed for training providers who
do not have extensive education or technical knowledge. Topics include
the relationship between nutrition and HIV, assessment of nutritional
status, methods for improving food intake, management of HIV and
AIDS complications, managing food and drug interactions, care for
HIV-positive women and children, food and water safety and hygiene,
and principles of counseling and networking. The facilitators guide
and participant handouts were developed by RCQHC and the FANTA Project
with funding from USAID/East Africa.
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the facilitators guide and participant handouts
 Strengthening
Agricultural Technologies among People Living with HIV: Lessons
Learned in the Border Towns of Busia, Kenya and Busia, Uganda
Many HIV-affected households lack sufficient access to food, and
there is a need to integrate livelihood strengthening approaches
into programs working with people living with HIV (PLHIV). In 2007
and 2008, FANTA worked with Family Health International's Regional
Outreach Addressing AIDS through Development Strategies (ROADS)
Project and with the Regional Centre for Quality of Health Care
to support the identification, diffusion and application of appropriate
technologies in two border towns of Kenya and Uganda to improve
the productivity of PLHIV agricultural activities.
"Strengthening Agricultural Technologies among People Living with
HIV: Lessons Learned in the Border Towns of Busia, Kenya and Busia,
Uganda" reports the results of this effort. The report recommends
identifying simple agricultural technologies and applying them through
linkages between PLHIV support groups and local agricultural institutions.
The activity and report were funded by USAID/East Africa.
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the report
 Indicators
for Assessing Infant and Young Child Feeding Practices: Part I Definitions
Improving infant and young child feeding (IYCF) practices of children
6 to 23 months of age is critical to improved nutrition, health
and development of the child. In contrast to a strong consensus
on exclusive breastfeeding up to 6 months of age, the lack of international
consensus on simple indicators of appropriate feeding practices
for children 6-23 months has hampered progress in measuring and
improving IYCF practices and infant and young child nutritional
outcomes.
As the culmination of a World Health Organization-led five-year
effort to develop and reach consensus on a set of simple, valid
and reliable indicators, Indicators for assessing infant and
young child feeding practices: Part I Definitions describes
eight core and seven optional indicators that are population-based
and can be derived from household survey data, such as the Demographic
and Health Surveys (DHS) and the Knowledge, Practice and Coverage
Surveys (KPC).
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the report
 Nutrition
and HIV/AIDS: A Training Manual for Nurses and Midwives
Nutrition interventions are an important component of comprehensive
care and support for people living with HIV (PLHIV). As front-line
care providers, nurses play a critical role in HIV care. In many
settings it is nurses who have the strongest opportunity to provide
routine counseling and other support to PLHIV. Equipping nurses
with nutrition and HIV knowledge and skills enables them to provide
effective nutrition care and support. Nursing school curricula in
the region often include little or no information on the subject.
Nutrition and HIV/AIDS: A Training Manual for Nurses and Midwives
is designed to address this gap by providing materials that nursing
school instructors can use to teach nursing students the knowledge
and skills needed for nutrition care and support of PLHIV. While
designed to be used for pre-service training, it can also be used
or adapted for in-service training.
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the Training Manual
International Workshop on the Integration of Community-Based Management
of Acute Malnutrition
Workshop Report Published by the Emergency Nutrition Network
(ENN)
The Workshop Report for the April 2008 International Workshop on
the Integration of Community-Based Management of Acute Malnutrition
(CMAM) provides an overview of the overarching issues, obstacles
and successes encountered in the integration of CMAM into national
health systems. These range from the importance of Ministry of Health
leadership, the need to strengthen capacities at most levels of
a health system, and provide simple protocols to facilitate implementation,
to the critical need for open and frequent information sharing.
The report highlights presentations and discussions by international
experts in CMAM, including those from USAID, UNICEF, WHO, developing
country Ministries of Health and NGO-implementers.
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the Report
 USAID's
Office of Food for Peace Occasional Paper 6
Emergencies in Urban Settings: A Technical Review of Food-Based
Program Options
Although food assistance needs in urban and peri-urban areas are
expected to require increased resources in the coming years, most
experience with food-based programs is in rural areas. Against this
backdrop, USAID's Office of Food for Peace Occasional Paper No.
6, Emergencies in Urban Settings: A Technical Review of Food-Based
Program Options, examines 11 common food-based programs to highlight
advantages, disadvantages, targeting and implementation modalities
in the urban context. The paper also presents tools to help determine
the most appropriate interventions and approaches for given settings.
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Occasional Paper 6
 A
Guide to Monitoring and Evaluation of Nutrition Assessment, Education
and Counseling of People Living With HIV
A Guide to Monitoring and Evaluation of Nutrition Assessment,
Education and Counseling of People Living With HIV provides
guidance and tools to support programs in monitoring and evaluating
nutrition interventions for people living with HIV (PLHIV). It is
designed for use by program managers, M&E officers and other program
and government health system staff who are responsible for designing
and implementing M&E systems. The guide can be used to select indicators,
set targets, plan data collection and tabulation processes and interpret
and use the information obtained.
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the guide
FANTA-2 Awarded to AED
Food and Nutrition Technical Assistance II Project (FANTA-2) works
to improve nutrition and food security policies, strategies and
programs through technical support to USAID and its partners, including
host country governments, international organizations and NGO implementing
partners. Focus areas for technical assistance include maternal
and child health and nutrition, HIV and other infectious diseases,
food security and livelihood strengthening, and emergency and reconstruction.
FANTA-2 develops and adapts approaches to support the design and
quality implementation of field programs, while building on field
experience to improve and expand the evidence base, methods and
global standards for nutrition and food security programming. The
project, funded by USAID, is a five-year cooperative agreement.
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more about FANTA-2
The FANTA-2 Project web site is made possible through
the support provided by the U.S. Agency for International Development
(USAID) under terms of the cooperative agreement GHN-A-00-08-00001-00
awarded to the Academy for Educational Development (AED). The information
provided on this web site is not official U.S. Government information
and does not represent the views or positions of USAID or the U.S.
Government.
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