Infant & Child Nutrition

		WHO and UNICEF Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children, May 2009 WHO and UNICEF Meeting Report on Strengthening Action to Improve Feeding of Infants and Young Children 6-23 Months of Age in Nutrition and Child Health Programmes

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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	A brief description of each publication is provided below. By choosing the publication title, you are able to read a detailed description and to download the publication.

1. 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.

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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. FAO’s 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 America’s 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 children’s 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 UNICEF’s Progress of Nations and The State of the World’s 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 Organization’s 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 Program’s 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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