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close this book Community Nutrition Action for Child Survival
View the document Table of contents
View the document Introduction
View the document How to use community nutrition action for child survival
close this folder Part I - Community nutrition problems and interventions
close this folder Unit 1 - The nutrition of women and children
View the document Session 1: What is malnutrition?
View the document Session 2: Focus on the nutrition of women and children
View the document Session 2: Focus on women and children
View the document Session 3: Important causes of malnutrition in women and children
View the document Session 4: Community nutrition action for child survival
close this folder Unit 2: Measuring and monitoring growth in young children
View the document Session 1: Measuring growth
View the document Session 2: Arm circumference
View the document Session 3: The road to health chart
View the document Session 4: The thinness chart
View the document Session 6: Counseling, referral and follow-up of malnourished children
close this folder Unit 3: PROMOTING BREASTFEEDING
View the document Session 1: The importance of breastfeeding
View the document Session 2: Helping mothers breastfeed
View the document Session 3: Breastfeeding information for Kenyans
close this folder Unit 4: Introducing weaning practices in the community
View the document Session 1: Changing weaning practices
View the document Session 2: Making improved meaning foods in the home
View the document Session 3: Weaning food practice
View the document Session 4: Case study: Village weaning food projects in Thailand
View the document Session 5: Weaning foods - Village production techniques
close this folder Unit 5: Preventing diarrhea
View the document Session 1: Preventing diarrhea*
View the document Session 2: Diarrhea home management
View the document Session 3: Community activities to prevent diarrhea*
close this folder Unit 6: Immunization
View the document Session: Improving immunization coverage - The community's role
close this folder Unit 7: Family planning and nutrition
View the document Session 1: Family planning and nutrition
View the document Session 2: Providing the facts about family planning
View the document Session 3: Community-based distribution of family planning methods
close this folder Part II - Planning nutrition action projects
close this folder Unit 1: Working with the community to improve nutrition
View the document Session: Simulation exercise
close this folder Unit 2: Finding the causes of malnutrition
View the document Session 1: Conducting a community nutrition mini-survey
View the document Session 2: Analyzing community nutrition information
close this folder Unit 3: Deciding what to do
View the document Session 1: Visits to on-going nutrition projects
View the document Session 2: Case studies/panel discussion
close this folder Unit 4: Planning nutrition action projects
View the document Session 1: Describing the problem
View the document Session 2: Writing project goals and objectives
View the document Session 3: Choosing project activities
View the document Session 4: Developing a project work plan
View the document Session 5: Planning how to evaluate
View the document Session 6: Preparing a budget
close this folder Unit 5 - Session: Writing a project proposal/Mini-Workshop
View the document Session: Writing a project proposal Mini-Workshop
close this folder Part III - Project management systems
close this folder Unit 1: Training community nutrition workers
View the document Session 1: Introduction
View the document Session 2: Assessing training needs/writing objectives
View the document Session 3: Choosing training methods
View the document Session 4: Scheduling training content
close this folder Unit 2: Evaluating progress
View the document Session 1: What do he need to know? How can we find out?
View the document Session 2: Records and reports
View the document Session 3: A prototype record keeping system
View the document Session 4: Evaluating activities with the community
close this folder Unit 3 - Supervising community nutrition activities
View the document Session 1: The role of the supervisor
View the document Session 2: Identifying and solving problems
View the document Session 3: Problem-solving/role play
View the document Session 4: Planning and conducting supervision visits

Session 2: Focus on women and children

Women and young children are more likely than most other groups to become malnourished because of the events in their lives that increase their nutritional requirements. The body demands extra food during periods of growth, physical work and illness. Women and young children often experience two or three of these conditions at the same time. In many communities, their needs for extra foods are not met.

The period of greatest nutritional demand on women and children begins at conception and continues through the fetal and infant periods until about three years of age. The periods that demand greatest food intake and the problems associated with them are:

Pregnancy

Pregnancy increases a woman's need for food. She is eating for two people, herself and the baby growing inside of her. If she does not eat the foods she needs, her baby may be born weak and sickly, and her own body and health may suffer. Even under optimal conditions after birth, infants who have been retarded in growth during fetal life sometimes continue to grow slowly for many years. They may also show a tendency towards poorer intellectual performance, compared with infants who grew normally before birth.

Mothers from poor sectors of society frequently have only an inadequate diet available and have very limited opportunities for proper antenatal care, including the prevention and treatment of anemia, malaria and other infections. This largely explains why lower birth weights are found in these groups. Poor diet may be caused by low income, inadequate food production, lack of knowledge about nutrition or food taboos imposed during pregnancy. Also, a woman's activity rarely decreases during pregnancy. Many women continue to till the soil, carry wood and water, and take part in other strenuous jobs until delivery.

To insure the best fetal growth and give every child a good start in life, it is important to prevent and treat infectious diseases and high blood pressure during pregnancy, and to make the mother and father understand the importance of a good and sufficient diet during pregnancy. In addition, both parents should understand the need to slow the mother's work pace, and so allow her to have sufficient rest before delivery.

Breastfeeding

Research has confirmed the universal superiority of mother's milk both nutritionally and from an anti-infective point of view. Breastfeeding is also valued for child-spacing and emotional bonding between mother and baby.

Breastfeeding should begin as soon after birth as possible. Colostrum, the first milk produced by the breasts after birth, provides important protection against infection as well as nutrients for the growing infant. To insure adequate breast milk production and growth of the infant, Breastfeeding should be "on demand. " Breast milk alone is sufficient for an infant from birth through four to six months of age. Breastfeeding should continue as long as possible (2-3 years) to provide continued protection from illness and important nutrients for growth and development.

Good maternal nutrition is important during the Breastfeeding period. Additional food and liquids should be consumed as in pregnancy. If the Breastfeeding woman's diet is inadequate, she may become weak. The quality of breast milk also depends on the adequate nutrition of the mother and, of course, the quality of breast milk affects the growth of the infant.

The declining pattern of Breastfeeding is one of the world's most serious nutrition problems. It has been estimated that some 10 million cases of infant marasmic diarrhea occur in developing countries each year, many as a result of early termination of Breastfeeding and introduction of feeding bottles and breast milk substitutes.

Weaning

From six months to two years of age, Breastfeeding should continue, but a growing child also needs to eat other foods in sufficient quantities to meet his body's requirements. This is called the weaning period when new foods are gradually added to the infant's diet. It is a critical period in the life of the child, because new foods and exposure to contaminated foods, water and utensils mean that weaning age children are more likely to become sick from diarrhea and other infections. This is also a period of rapid physical and mental development. If children are not given sufficient amounts of food and a diet rich in body-building, energy and protective foods during these critical years, they will stop growing. They may become sick more often than well-nourished children, and some will die. Those who live, but have been severely malnourished during this period, may never reach their physical and mental potential during life.

Infection and Malnutrition

One of the greatest dangers of the weaning period is the change from sterile breast milk to animal milk, semi-solid and solid foods, which are often acquired, stored and fed in unsanitary conditions. The weaning process is associated with the highest rate of infection, particularly of the gastrointestinal tract, that the child will experience in its entire lifetime. Infections, in turn, prepare the way for malnutrition and increase the negative effects of an inadequate diet.

Diarrhea is the most common infection of the weaning period; it is also the disease that kills more children in the world today than any other. A malnourished child will get diarrhea an average of four times as often and is also more likely to die from a diarrhea! infection than a well-nourished child.

Measles, tuberculosis, malaria, whooping cough and parasitic infections also have very detrimental effects on young children during infancy and weaning. These illnesses are both made more serious by malnutrition and can contribute to malnutrition. Immunization and improved nutrition are the keys to preventing measles, tuberculosis, whooping cough and other serious childhood illnesses that can cause and make malnutrition worse.

Child Spacing and Malnutrition

The amount of time between births is very important for the health of women and children, as is the total number of births in a woman's lifetime. Infants are more likely to survive if at least three years are allowed between births. This gives a woman's body the chance to rest after pregnancy and breastfeeding, before beginning this demanding cycle again. Adequate spacing between births helps to avoid depletion of the woman's body and deprivation of the growing fetus.

Spacing also reduces the total number of births and increases each child's share of family resources, especially food. Children from smaller families with several years allowed between births are generally better nourished, better educated and more productive than those from large, poorly spaced families.