Women's and Adolescents' Health and Nutrition

See Also: Assessments, Monitoring & Evaluation; Emergency Nutrition; HIV/AIDS; Household Food Consumption; Infant and Children's Nutrition

Women's nutrition affects a wide range of health and social issues, including pregnancy outcomes, family care, household food security, and local and national economic development. Anemia is the most common form of malnutrition, afflicting an estimated 47 percent of women worldwide, and anemia in pregnancy is one of the leading causes of maternal death. Women in developing countries are also regularly deficient in vitamin A, iodine, and energy. The importance of women's nutrition has not successfully translated into program activities, particularly outside of pregnancy.

FANTA-2 works to heighten the focus on women's and adolescent's nutrition and increase implementation of programming that targets women's health through its technical assistance to USAID missions and PVO partners around the world. FANTA-2 is improving advocacy for women's nutrition through the development of evidence-based models that highlight the consequences of malnutrition for policymakers and other audiences. Work continues on a guide that will facilitate the consistent measurement of women's nutrition indicators and standardize data collection and analysis. The guide will help PVO program managers integrate specific women's nutrition activities into their existing maternal and child health and nutrition (MCHN) frameworks and monitor and evaluate these activities. These initiatives emphasize outputs in advocacy and program implementation and take advantage of FANTA-2's ability to bring the PVO community and other health and nutrition agencies into the process.

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 strengthen efforts to improve the nutritional status of women, FANTA supported the development of several additional models that can be used with PROFILES and describe the functional outcomes of women's nutritional status. These models are based on new epidemiological evidence and include the effects of iron deficiency anemia on work productivity, maternal mortality, and perinatal mortality and the effects of vitamin A deficiency on maternal mortality.

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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. Nutrition Counseling for People Living with HIV and/or Tuberculosis in Cote d’Ivoire: Flipchart and Flipchart User's Guide (2011): To help facility-based providers and community counselors promote the uptake of key nutrition behaviors among people living with HIV (PLHIV) and/or tuberculosis in Cote d’Ivoire, FANTA-2 completed the nutrition counseling materials, Conseils en Nutrition Pour Les PVVIH et/ou Malades de la Tuberculose (Nutrition Counseling for PLHIV and/or Tuberculosis),and developed an accompanying user’s guide, Guide D’Utilisation de la Boite a Images Pour le Conseil en Nutrition Des Personnes Infectees et Affectees Par le VIH et/ou Malades de la Tuberculose (Guide to Using the Flipchart for Nutrition Counseling for Persons Infected or Affected by HIV and/or Tuberculosis).

2. Government of Sudan CMAM Training Course on Inpatient Management of Severe Acute Malnutrition: Training Materials (2011): FANTA-2, in collaboration with national partners in Sudan, adapted and built on the World Health Organisation (WHO)'s 1999 publication Management of severe malnutrition: A manual for physicians and other senior health workers, WHO's 2002 Training course on the management of severe malnutrition, the 2009 Government of Sudan Community-Based Management of Severe Acute Malnutrition manual, and other materials to develop training materials for inpatient management of SAM designed for physicians, nurses, and nutritionists in hospitals in Sudan. While the training course focuses on inpatient care, the training materials are compatible with the Community-Based Management of Acute Malnutrition (CMAM) approach and the Sudan context.

3. Uganda National Action Plan 2011-2016 with District Messages (2011): The Government of Uganda has developed a 5‑year Uganda Nutrition Action Plan (UNAP), a framework for addressing the country’s nutrition issues. The goal of this plan is to improve the nutrition status of all Ugandans, with emphasis on women of reproductive age, young children, and infants. The plan is intended to reduce the magnitude of malnutrition in Uganda and its impact on the individual, the household, the community, and the nation at large. The government also produced a short document targeted at district- and lower-level leaders to raise awareness of the nutrition situation in Uganda and to introduce the UNAP. 

4. Report on the Review of the Integration of Community-Based Management of Acute Malnutrition into the Ghana Health System, August/September 2010 (2011): The Severe Acute Malnutrition Support Unit (SAM SU) was established by the Ghana Health Service (GHS) to provide technical assistance countrywide as CMAM scaled up. Each region has commenced CMAM service implementation in one or two districts within a limited number of outpatient care and inpatient care sites. These sites will serve as learning sites for the region to inform gradual scale-up to other districts in the region. The SAM SU requested FANTA-2 to conduct a review of CMAM activities at the learning sites, including plans for scaling up. The objectives of the review were to assess the integration of CMAM services into the learning sites, assess learning sites’ performance, review recent plans and initiatives to scale up CMAM in Ghana, and provide recommendations for strengthening those plans.

5. Review of Community-Based Management of Acute Malnutrition Implementation in West Africa, Summary Report (2011): This report summarizes the findings of reviews of Community-Based Management of Acute Malnutrition (CMAM) in four West African countries (Burkina Faso, Mali, Mauritania, and Niger). The report discusses the key determinants to achieving maximum impact of CMAM integration, scale-up, and quality improvement, which are grouped in five domains: the enabling environment for CMAM, competencies for CMAM, access to CMAM services, access to CMAM supplies, and quality of CMAM. Optimal practices, a summary of findings, constraints, and practical recommendations are provided for each key determinant.

6. Toolkit: For Countries Applying for Funding of Food and Nutrition Programs Under the Global Fund to Fight AIDS, Tuberculosis and Malaria (Round 11) (2011): The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the largest multilateral donor funding services for people living with HIV, people affected by HIV and AIDS, and people with active tuberculosis. An inter-agency team, consisting of WFP, WHO, PEPFAR, and FANTA-2, worked to create this toolkit in order to strengthen Round 11 proposals for Global Fund funding. The toolkit can be used by countries considering inclusion of food and nutrition activities for the first time and by experienced countries that want to scale up their response or broaden the range of their food and nutrition support activities to address emerging problems. It provides potential Round 11 applicants with the information needed to include a food and nutrition component in their Global Fund proposals, have food and nutrition more consistently integrated into them, and improve the overall quality of their applications.

7. Household Hunger Scale (2011): FANTA-2, in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and Tufts University, developed the Household Hunger Scale (HHS), a field-practical method and simple tool to measure household food deprivation and compare data across cultures. The HHS can help improve geographic targeting of food insecurity interventions and monitoring and evaluation of food security policies and programs. The HHS will soon be an indicator for both the USAID Food for Peace program and Feed the Future initiative.

8. Acceptability of a Lipid-Based Nutrient Supplement among Guatemalan Infants and Young Children (2011): This study assessed the acceptability of lipid-based nutrient supplements (LNS) among children 6–18 months of age in Suchitepéquez, Guatemala. A new flavor (cinnamon) was developed and tested alongside the “regular” peanut LNS flavor. A 2-day test-feeding trial using a cross-over design was carried out to test both LNS flavors, followed by a 2-week home-use trial. LNS was mixed with a small quantity of home-prepared complementary food. The proportion of LNS consumed by the children, and the caregivers’ organoleptic preferences and perceptions of product use were assessed. The study concluded that both LNS flavors were acceptable in this population, with a tendency toward a higher acceptability for the peanut flavor.

9. Materials for Mozambique's Nutrition Rehabilitation Program (2011): FANTA-2 was one of a group of partners that assisted the Mozambique Ministry of Health in developing national protocols, training materials, and job aids for the national Nutrition Rehabilitation Program (Programa de Reabilitação Nutricional [PRN]). The PRN is based on the Community-Based Management of Acute Malnutrition (CMAM) approach. The Manual for Nutrition Treatment and Rehabilitation, Volume I (Manual de Tratamento e Reabilitação Nutricional, Volume I) contains protocols for the treatment of acute malnutrition for children 0–15 years with or without HIV and/or tuberculosis. The manual is accompanied by job aids, which are aimed at helping implementation of inpatient and outpatient treatment. The Facilitators Training Guide and Participants Handouts are used to train health facility staff and community-based health workers. All materials are in Portuguese.

10. Challenges for Safe Replacement Feeding among HIV-Positive Mothers in Hai Phong and Ho Chi Minh City, Vietnam: A Qualitative Study of Mothers, Fathers, Health Care Providers, and Other Experts (2011): A report of the results from a study of infant and young child feeding (IYCF) practices among HIV-positive women in two Vietnamese cities with high HIV prevalence, Hai Phong and Ho Chi Minh City. The study’s primary purpose was to determine whether HIV-positive women could safely follow the advice of health care providers to provide replacement feeding to their infants. The report is accompanied by a research note that summarizes the study findings and recommendations.

11. Zambia Nutrition Guidelines for Care and Support of People Living with HIV and AIDS, and Zambia Counseling Flipchart – Eating and Living Well with HIV and AIDS: Good Nutrition Makes a Difference (2011): Zambia’s Ministry of Health, National AIDS/AIDS/STI/TB Council, and National Food and Nutrition Commission worked with partners to revise the 2004 Nutrition Guidelines for Care and Support of People Living with HIV and AIDS and 2006 flipchart Eating and Living Well with HIV and AIDS: Good Nutrition Makes a Difference to provide updated information to individuals and organizations on nutrition assessment, counseling, and support (NACS) for people living with HIV (PLHIV). The updates to the guidelines and the flipchart harmonize the entry and exit criteria for nutrition product support between the existing Integrated Management of Acute Malnutrition (IM-AM) program and the NACS program.

12. Anthropometry: Assessing Children Under 5 Bookmark (2011): FANTA-2 has produced a bookmark that presents clear information on the anthropometry used to assess the nutritional status of children under 5 years of age. Common definitions, cutoffs, and classifications are detailed in an easy-to-use format. This bookmark replaces the FANTA bookmarks published from 2002 through 2006, and is available in multiple languages.

13. Household Hunger Scale: A Cross-Cultural Method to Measure Household Hunger (2011): After nine years of research and testing, FANTA-2, in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and Tufts University, has developed the Household Hunger Scale (HHS), a field-practical method and simple tool to measure household food deprivation that allows for valid comparison across cultures. The HHS can help improve geographic targeting of food insecurity interventions and M&E of food security policies and programs. The HHS will soon become a USAID Food for Peace required indicator, as well as a Feed the Future indicator.

14. Namibia's Nutrition Assessment, Counselling and Support for PLHIV Operational Guidelines (2010): Based on a 2008 assessment’s findings, FANTA helped the Ministry of Health and Social Services (MOHSS) develop a strategy and operational plan on nutrition and HIV that defines the components of and resource needs for a PEPFAR-funded Food By Prescription program for PLHIV. The guidelines serve as the framework for planning, resource mobilization and monitoring of nutrition care and support implementation.

15. PM2A: Title II Preventing Malnutrition In Children Under Two Approach and the Title II Technical Reference Materials, Revised November 2010: A new edition of the USAID Office of Food for Peace's Technical Reference Materials (TRM) on PM2A has been released. The PM2A TRM provides guidance for current and potential multi-year non-emergency program Awardees and is based on current program knowledge and experience. This version includes a discussion of family planning as a useful complementary health service, and also includes updated terminology.

16. The Nutrition Program Design Assistant: A Tool for Program Planners (NPDA) (2010): This two-part tool was developed to help nutrition program planning teams design community-based nutrition programs. A simple Reference Guide and Workbook, the NPDA is best used in collaboration with a range of partners, including ministry staff, community leaders and representatives and local organizations. The NPDA provides a framework for programmers to analyze the nutrition situation and offers guidance for design teams to choose the most appropriate nutrition approaches based on the specific context and need. It also helps programmers avoid an approach that would be inappropriate or ineffective in the specific context.

17. Training Guide for Community-Based Management of Acute Malnutrition (CMAM) (2008/2010): FANTA-2 worked with partners to develop a generic Training Guide for Community-Based Management of Acute Malnutrition (CMAM). The first version of the training guide in English was released in November 2008. While working on the French translation of the guide, FANTA-2 incorporated new WHO recommendations into the French version. Due to high demand, we are releasing the French version of the training guide while still working on updating the original English version.

18. Generic Guidelines and Job Aids for Community-Based Management of Acute Malnutrition (CMAM), November 2010 Draft Version (2010): FANTA-2 is working with partners to create a package of Community-based Management of Acute Malnutrition (CMAM) generic guidelines and job aids that can be adapted at the country level using national guidelines, local considerations, and WHO recommendations. The current November 2010 draft is still being reviewed and finalized, however, it is being shared due to high demand.

19. Indicators for Assessing Infant and Young Child Feeding Practices Series (2008-2010): As the culmination of a World Health Organization (WHO)-led effort to develop and reach consensus on a set of simple, valid and reliable infant and young child feeding (IYCF) indicators, this publication series describes and provides guidance for collection of eight core and seven optional IYCF indicators that can be assessed in population-based surveys, including the Demographic and Health Survey (DHS), Multiple Indicator Cluster Survey (MICS) and Knowledge, Practice, Coverage Survey (KPC).

20. Dietary Diversity as a Measure of the Micronutrient Adequacy of Women’s Diets in Resource-Poor Areas: Results from Five Countries (2009): 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.  The WDDP has analyzed data sets from five countries: Bangladesh, Burkina Faso, Mali, Mozambique and the Philippines.

21. 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.

22. 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.

23. 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.

24. 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.

25. Maternal Anemia: A Preventable Killer (2006): Recent meta-analysis showed that Iron Deficiency Anemia (IDA) is associated with 22% of maternal deaths and 24% of neonatal deaths. The analysis also showed that correcting anemia of any severity reduced the risk of death. This is a new finding and different from the earlier view that only severe anemia is associated with increased mortality. The new brief, "Maternal Anemia: A Preventable Killer," details the causes and consequences of iron deficiency, IDA and anemia, and emphasizes the importance of implementing a package of interventions to address multiple causes of anemia. The brief is a product of a collaboration among USAID's A2Z Micronutrient and Child Blindness Project, ACCESS Program, and Food and Nutrition Technical Assistance (FANTA) Project.

26. Essential Health Actions to Improve Maternal Nutrition in Africa (LINKAGES Project) The health sector can promote and support behaviors to improve maternal nutrition. This publication identifies actions that program managers can integrate into existing health programs. For maximum effect, improving women’s nutrition should begin long before pregnancy. The actions presented here, however, focus on pregnancy, a time when health systems can more easily reach women.

27. Strategies, Policies and Programs to Improve the Nutrition of Women and Girls (2000) This document summarizes the rationale for improving women's nutrition, emphasizing a life cycle approach, the experiences of the various program options that have been put in place, and the opportunities for policies and programs to improve the nutrition of women and girls.

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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.

International Center on Research on Women (ICRW) [http://www.icrw.org]
ICRW's mission is to improve the lives of women in poverty, advance women's equality and human rights, and contribute to the broader economic and social well-being through research, capacity building, and advocacy on issues affecting women's economic, health, and social status in low- and middle-income countries.

The LINKAGES Project [http://www.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.

The Manoff Group [http://www.manoffgroup.com]
The Manoff Group is a woman-owned small business that provides assistance in communications and behavior-centered planning, management and evaluations for health, nutrition, and population projects. For over 30 years, The Manoff Group has brought innovations in qualitative research methods, communication strategies, media planning, and the creation of training materials to health, family planning, environment, and nutrition programs around the globe.

Save the Children [http://www.savethechildren.org/publications/]
Interesting and illustrative report The State of the World’s Mothers from Save the Children, which helps children in need in 15 U.S. states and more than 35 developing nations around the world. The report examines issues of health, education, economic opportunities, food security and after-school support for mothers living in poverty around the world. Illustrative personal stories and country studies are drawn from a variety of countries.

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.

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.

World Bank's Health, Nutrition and Population [http://www.worldbank.org/html/extdr/thematic.htm]
This site contains information on World Bank nutrition activities and publications that assist clients improve health, nutrition, and population outcomes of poor people and protect people from the impoverishing effects of illness, malnutrition, and high fertility. The World Bank also publishes a weekly compendium of food and hunger news from around the world.

World Health Organization's (WHO) Nutrition for Health and Development Program [http://www.who.int/nut/]
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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