Infant
& Child Nutrition
See Also: Assessments,
Monitoring & Evaluation; Community Therapeutic Care; Emergency Nutrition; Food Aid; HIV/AIDS; Household
Food Consumption; Women and Adolescent Nutrition
Malnutrition
contributes to more than half of all under-five childhood deaths throughout the
developing world. The associated effects of poverty, inadequate household access
to food, infectious disease, and inadequate breastfeeding and complementary feeding
practices often lead to illness, growth faltering, nutrient deficiencies, delayed
development, and death, particularly during the first two years of life.
There is universal consensus on the importance of infant and young child
feeding as a key determinant of child nutrition. Maternal and child health
and nutrition (MCHN) programs also commonly include activities to address
infant and young child feeding. FANTA-2 works to improve infant and child
nutrition and health outcomes by strengthening food security and nutrition
policy, strategies, and programs. An area of emphasis in FANTA-2's work
is improving the assessment, monitoring, and evaluation of infant and
young child feeding in the six through 23 months age period. Appropriate
feeding practices are complex and age-specific, and the need for improved
indicators to better assess infant and young child feeding (IYCF) is increasingly
recognized.
FANTA-2 indicators and measurement guidelines improve the collection,
tabulation, analysis, interpretation, and presentation of infant and young
child feeding data. FANTA-2 also supports research on dietary diversity,
an essential component of infant and young child feeding, and explores
the relationship between child nutritional status and infant and child
feeding practices. Results from these activities influence the design
of frequently used data collection instruments, such as the Knowledge,
Practice, and Coverage (KPC) and Demographic Health Survey (DHS) and help
partners better assess and measure changes in infant and child nutrition.

PROFILES [http://www.fantaproject.org/about/profiles.shtml]
is a process for nutrition policy analysis and advocacy that uses spreadsheet
models to estimate the functional consequences of malnutrition in terms that policymakers
understand and care about. To underscore the importance of nutrition in child
survival efforts, the FANTA project funded the development of a model to quantify
the effects of improvements in nutritional status, measured as weight-for-age,
on child mortality. The model is based on work conducted by Cornell researchers
David Pelletier and Ed Frongillo in which they determined that improvements in
child nutritional status over the past three decades have contributed significantly
to improvements in child survival, even taking into consideration socio-economic
and policy changes during this same period (download their report "Changes
in child survival are strongly associated with changes in malnutrition in developing
countries," 2003).
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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 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.
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Supplementary
Feeding with Fortified Spreads Results in Higher Recovery Rates than
with a Corn/Soy Blend in Moderately Wasted Children, Journal
of Nutrition (2009): 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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Training Guide for Community-Based
Management of Acute Malnutrition (CMAM) (2008): 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.
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Indicators
for Assessing Infant and Young Child Feeding Practices: Part I Definitions (2008): 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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Nutrition
and HIV/AIDS: A Training Manual for Nurses and Midwives (2008): Nutrition and HIV/AIDS: A Training Manual for Nurses and Midwives is designed to provide nursing school instructors with materials that
they 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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International Workshop
on the Integration of Community-Based Management of Acute Malnutrition, Workshop Report Published by the Emergency Nutrition Network (ENN) (2008): 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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Precision, Time, and
Cost: A Comparison of Three Sampling Designs in an Emergency Setting (2008) An article reporting on the FANTA and SC/US field test in Sudan,
"Precision, Time, and Cost: A Comparison of Three Sampling Designs
in an Emergency Setting", has been published in Emerging Themes in
Epidemiology.
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Review of Community-based
Management of Acute Malnutrition (CMAM) in the Post-emergency Context:
Synthesis of Lessons on Integration of CMAM into National Health Systems (2008): With Community Management of Acute Malnutrition (CMAM) incorporated
into government health facilities and protocols to varying degrees
in Ethiopia, Malawi and Niger, USAID's FANTA Project undertook a comprehensive
review of the challenges, successes and lessons learned from the experience
in these three countries. The synthesis report discusses recommendations
for successful and sustainable integration of CMAM, outlining specific
steps donors, Ministries of Health, the UN and NGOs can take to facilitate
the process and next steps needed to expand the knowledge and evidence
base for CMAM integration.
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Essential Nutrition
Actions in Public Health Programs in Ethiopia (2008): The
Essential Nutrition Actions (ENA) package is an approach to expand
the coverage of seven affordable and evidence-based actions to improve
the nutritional status of women and children, especially those under
two years of age. FANTA’s Review of Incorporation of Essential
Nutrition Actions into Public Health Programs in Ethiopia found
that the approach has been incorporated into the Ethiopia Federal
Ministry of Health system and multilateral and NGO programming, however,
improved training and other steps are necessary to further institutionalize
the approach. The review, requested by USAID/Ethiopia, examined a
number of facilitating and inhibiting factors to ENA integration in
the context of Ethiopia’s health system.
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Comparing Preventive
and Recuperative Approaches to Targeting Maternal and Child Health
and Nutrition Programs in Haiti (2007): FANTA's five-year
effectiveness study on food-assisted nutrition programs demonstrated
that a preventive approach is more effective in reducing child malnutrition
than a recuperative approach: after three years, the prevalence of
stunting, underweight and wasting was significantly lower in the preventive
communities than in communities where a recuperative approach had
been used. In preventive approaches to food-assisted maternal and
child health and nutrition programs, food is provided to all children
6-24 months in target areas with a high prevalence of malnutrition,
thus supporting growth and preventing malnutrition. In recuperative
approaches, food is used to rehabilitate children (typically those
under five) already suffering from malnutrition.
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Girl Guides Anemia
Prevention Badge Project (2007): FANTA and the Regional Center
for Quality of Health Care (RCQHC), in partnership with the African
Regional Office of the World Association of Girl Guides and Girl Scouts
(WAGGGS), designed the Girl Guides Anemia Prevention Badge Project,
a program to reach adolescent girls in East and Southern Africa with
information and activities on anemia prevention and control. Under
the program, Girl Guides (ages 7-18) can earn a badge in anemia prevention
through educational programs and community involvement in anemia control.
FANTA and RCQHC developed an Anemia Prevention Badge Handbook and
Workbook for the Girl Guides as well as a training manual for Girl
Guide leaders.
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Developing and Validating
Simple Indicators of Dietary Quality and Energy Intake of Infants
and Young Children in Developing Countries: Summary of Findings from
Analysis of 10 Data Sets (2006): Clear guidance for the international
community on optimal infant and young child feeding (IYCF) practices
has been achieved with the publication of the Guiding
Principles for Complementary Feeding of the Breastfed Child (PAHO/WHO
2003) and Guiding
Principles for the Non-Breastfed Child 6-24 Months of Age (WHO
2005). Over the past several years, FANTA has implemented a multi-stage
initiative to develop a set of indicators to assess IYCF practices
and to monitor and evaluate progress on improving IYCF practices worldwide.
FANTA has worked with IFPRI, University of California at Davis, WHO,
and collaborating researchers from several developing countries to
develop and validate indicators of feeding practices, specifically
related to the frequency of feeding and nutrient density of complementary
foods, for infants and young children 6 through 23 months of age in
developing countries.
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Community-based Therapeutic
Care (CTC): A Field Manual (October 2006): Community-based
Therapeutic Care (CTC): A Field Manual provides program managers,
practitioners, and technical specialists addressing severe acute malnutrition
with the essential design, implementation and evaluation protocols
for implementing the CTC approach. As the CTC model is evolving, this
first edition does not provide a step-by-step workbook for implementers,
but rather offers a solid foundation to build CTC programs at local
and national levels. The manual is a product of a collaboration between Valid International, Concern Worldwide,
USAID’s FANTA Project, and Development
Cooperation Ireland. Support for FANTA for the development of
CTC and the production of the manual came from the Office
of Foreign Disaster Assistance (OFDA) and the Office
of Health, Infectious Diseases and Nutrition at the U.S. Agency
for International Development.
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Food and Nutrition Bulletin
Volume 27, No. 3: Proceedings of an Informal Consultation on Community-based
Management of Severe Malnutrition in Children (September 2006)
: A special supplement was produced by the United Nations University
publication Food and Nutrition Bulletin to present the proceedings
of the 2005 WHO and Standing Commitee on Nutrition (SCN)'s informal
consultative meeting on community-based management of severe malnutrition
in children in Geneva. With support from FANTA, the meeting brought
together some 50 international experts and representatives from the
World Food Program (WFP), the United Nations High Commissioner for
Refugees (UNHCR), the Red Cross, research institutions, major international
non-governmental organizations, and representatives of ministries
of health. The consultation agreed on guiding principles for the implementation
of community-based management of severe acute malnutrition and next
steps for updating global recommendations and country level health
policies for the inclusion of management of severe acute malnutrition
as an essential intervention towards achieving the MDGs for poverty
and child mortality reduction. Next steps include the creation of
field guidelines and training modules will be developed based on the
general principles, conclusions, and recommendations derived from
the meeting, which, if implemented on a large scale, will prevent
thousands of child deaths.
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Infant and Young
Child Feeding Update (September 2006): Adequate nutrition
is critical to child health and development. The period from birth
to two years of age is particularly important because of the rapid
growth and brain development that occurs during this time. The Infant
and Young Child Feeding (IYCF) Update provides data on key indicators,
including new summary IYCF indicator for children 6-23 months. The
data are taken from the results of the Demographic and Health Surveys
(DHS) conducted between 1998 and 2004 in 43 countries in five regions
of the world: sub-Saharan Africa, North Africa/West Asia/Europe, Central
Asia, South/Southeast Asia, and Latin America and the Caribbean. Feeding
practices included in this update are related to breastfeeding practices,
feeding solid and semi-solid foods to breastfed and non-breastfed
children, micronutrient intake, and feeding during diarrhea. IYCF
Update was produced by USAID's
MEASURE DHS Project implemented by ORC/Macro.
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Impact of Title II MCHN
Programs on the Nutritional Status of Children (2004): This
paper presents the results of a recent review of the impact of Title
II MCHN programs on the prevalence of stunting and underweight in
target populations. Information on the impact of the Title II MCHN
program on child nutritional status was available for 29 programs.
The review focused on Title II MCHN programs that ended in 2000 and
2001, for which final evaluation or annual results reports with data
on anthropometry were available.
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Anthropometric Indicators
Measurement Guide (2003): This guide, revised in 2003, focuses
on the anthropometric assessment of infants and children to assist
PVOs in improving their M&E. It includes information on how to collect,
analyze, and report on key anthropometric indicators.
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Changes in
Child Survival are Strongly Associated with Changes in Malnutrition
in Developing Countries (2002): This report examines the relationship
between changes in child and under-5 mortality rates in developing
countries in the past two or three decades and changes in the general
nutritional status of children during the same period. Building on
earlier work, Pelletier and Frongillo use population-level (rather
than child-level) estimates of mortality and malnutrition, examine
dynamic relationships (changes in malnutrition and changes in mortality)
and use a much larger data set of developing countries. This report
has important implications for child survival policies and programs.
The report concludes that gaps in coverage of selected child survival
interventions are more likely and more serious in the more malnourished
populations.
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Assessing
Care: Progress Towards the Measurement of Selected Childcare and Feeding
Practices and Implications for Programs (2002): An important
sub-theme of the Accra Urban Food and Nutrition Study (AUFNS) was
the specific role of childcare as one determinant of the nutritional
status of children. The objectives of this report, which is based
on findings from the AUFNS, were to summarize progress toward the
measurement of selected childcare and feeding practices and discuss
the feasibility of these measurements in research and program contexts.
The report includes an extensive literature review on measuring selected
dimensions of care.
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Summary
Indicators for Infant and Feeding Practices: An Example from the Ethiopia
Demographic and Health Survey 2000 (2002): This document describes
analysis of the infant and child feeding data available in the Ethiopia
Demographic and Health Survey 2000 (EDHS). The main purpose of the
analysis is to support USAID/Ethiopia in the use and interpretation
of the infant/child feeding practices data. More broadly, the goal
is to promote greater use of the rich information on feeding practices
contained in the DHS data sets, and to demonstrate the usefulness
of this information for exploring relationships between infant/child
feeding practices and nutritional status outcomes.
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A Multiple-Method
Approach to studying Childcare in an Urban Environment. The Case of
Accra, Ghana (2002): The objective of the Accra Urban Food
and Nutrition Study (AUFNS), located at http://www.ifpri.org/pubs/ib/ib9_ghana.pdf,
was to gain an understanding of urban poverty and of the relationships
between poverty, food insecurity, and malnutrition in a major African
city. This report summarizes AUFNS findings, specifically regarding
the importance of care as an input to child nutrition and aims to
answer research questions on the importance of care as an input to
child nutrition, which care practices seem to be the most crucial
for child nutrition, which maternal and household resources contribute
the most to enhancing care in Accra, the program and policy responses
that promote optimal childcare practices in this urban context, and
how the three research approaches used to measure childcare in this
study complement each other.
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*Please note that links to these sites do not imply that FANTA supports either
the organization listed or the views and content presented.
CORE Group [http://www.coregroup.org]
CORE Group fosters collaborative action and learning among its 50+ members to advance the effectiveness and scale of community-focused public health practices. Established in 1997, CORE Group is a 501c(3) membership association based in Washington D.C. comprised of citizen-supported NGOs that work internationally in resource poor settings to improve the health of mothers, children, and communities.
Child
Survival Technical Support (CSTS) [http://www.childsurvival.com]
This project provides technical support to PVOs funded
by the USAID Child Survival program. The site includes a database of consultants
and projects, key child survival articles, recent child survival project information
and USAID relevant documents. Regular updates on new research and publications
are also provided.
Food
and Agriculture Organization (FAO) [http://www.fao.org/]
FAO works to alleviate poverty and hunger by promoting
agricultural development, improved nutrition and the pursuit of food security.
The Food and Agriculture Organization is active in land and water development,
plant and animal production, forestry, fisheries, economic and social policy,
investment, nutrition, food standards and commodities and trade. It also plays
a major role in dealing with food and agricultural emergencies. FAOs
website has news and detailed information on the program areas listed above, special
programs, statistical databases, links to regional offices, and hundreds of publications,
many of which are available on-line. Visitors can also search or browse through
more than 3,000 pictures in FAO's Photo Library.
International
Baby-Food Action Network (IBFAN) [http://www.ibfan.org]
The International Baby-Food Action Network promotes
breastfeeding and optimal infant feeding practices. IBFAN consists of public interest
groups working worldwide to reduce infant and child morbidity and mortality. The
website provides information about IBFAN's activities, members, resources and
publications.
International
Food Policy Research Institute (IFPRI) [http://www.ifpri.org]
A well-organized site from the International Food Policy Research Institute
(IFPRI), which operates as part of the Consultative Group on International Agricultural
Research (CGIAR). The site contains the full text of current and past issues of
the Institute's quarterly newsletter Research Perspectives, and full text versions
of over 100 research reports and abstracts, all of which can be downloaded. The
comprehensive Research Themes section gives project information on subthemes organized
under four principal sections: Environment and Production Technology, Food Consumption
and Nutrition, Markets and Structural Studies, and Trade and Macroeconomics.
LINKAGES [http://linkagesproject.org]
The LINKAGES Project (1996-2006) worked worldwide
to improve nutrition and reproductive health by providing technical support
to promote breastfeeding through influencing behavior change, improving
health service delivery, and advocating policy change. In
addition to providing information about the LINKAGES Project, the site
lists available publications and has an extensive list of annotated links
organized by subject area.
Pan
American Health Organization (PAHO) [http://www.paho.org/Selection.asp?SEL=TP&LNG=ENG&CD=HNUTRNSFT]
The Food and Nutrition Program of the Pan American
Health Organization contributes, through technical cooperation, to design,
implementation, and evaluation of interventions to improve food security
and the malnutrition situation in the Americas. The
site has links to the Institute of
Nutrition of Central America and Panama (INCAP) and the Caribbean
Food and Nutrition Institute (CFNI).
US
Agency for International Development (USAID)'s Global Health Bureau [http://www.usaid.gov/our_work/global_health/]
The U.S. Agency for International Development
(USAID) is the federal government agency that implements Americas foreign
assistance programs. USAID's commitment to improving global health includes confronting
global health challenges through improving the quality, availability, and use
of essential health services. USAID's strategy for global health seeks to stabilize
world population and protect human health through programs in maternal and child
health, HIV/AIDS, family planning and reproductive health, infectious diseases,
environmental health, nutrition and other life-saving areas.
UNICEF [http://www.unicef.org/]
UNICEF, the only UN organization dedicated
exclusively to children, works with other UN bodies, governments and NGOs
to improve childrens lives through community-based services in primary
health care, basic education, and safe water and sanitation in developing
countries. The website provides information
on child rights, a searchable database, downloadable publications, statistics,
and program activities and research. The site also has links to UNICEFs Progress of Nations and The State of the Worlds Children reports, educational projects and interactive pages for children,
and multimedia exhibitions.
United
Nations System Standing Committee on Nutrition (SCN) [http://www.unscn.org]
The United Nations System Standing Committee
on Nutrition is the focal point for harmonizing the policies and activities
on nutrition of the UN system. Its role is to serve as a coordinating
mechanism, for exchange of information and technical guidance, and to
act dynamically to help the UN respond to nutritional problems. The site
provides links to SCN news and reports on nutrition worldwide.
World
Bank [http://www.worldbank.org/html/extdr/thematic.htm]
This site contains information on World Bank nutrition
activities and publications. They also publish a weekly compendium of food and
hunger news from around the world.
World
Health Organization's (WHO) Nutrition for Health and Development [http://www.who.int/nutrition/en/]
The World Health Organizations Nutrition for
Health and Development Program works to strengthen and support the capabilities
and effectiveness of member states for assessing and addressing nutrition problems
and develops and maintains global nutrition databases to help states, organizations,
and institutions working to fight malnutrition. Information about the Programs
activities and outputs, research, publications (some available on-line) and the
Global Nutrition Data Banks can be accessed from the home page.
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