Nutrition

Maternal anemia, even moderate cases, increases the risk of dying during childbirth. The 2008 Lancet series on maternal and child undernutrition estimated that 20% of maternal deaths are due to maternal iron-deficiency anemia and stunting in women, thus adding 115,000 deaths to the total maternal deaths from obstetric complications annually. The updated 2013 Lancet series on maternal and child undernutrition highlighted the contribution of maternal iron deficiency to poor birth outcomes, including low birth weight and perinatal mortality, as well as recent studies, which revealed that women taking iron-folic acid supplements during pregnancy deceased the risk of mortality in their children by 30% to 50%, with most of the effect occurring in the first day of life.

Iron deficiency during pregnancy can also reduce iron stores at birth, which can comprise cognitive development and increase risk of mortality for the child. However, despite the known life-threating consequences of anemia and compelling emerging data, there is little attention given at global and country levels to reduce the burden of maternal anemia. Maternal anemia control programs are the primary maternal nutrition program worldwide, yet these programs lack adequate funding and support from multiple sectors. This has led to a failure to significantly reduce maternal anemia in developing countries, especially within the context of an integrated approach to address anemia from both nutrition and disease control perspectives.

Maternal undernutrition during pregnancy can contribute to restrictions in fetal growth and up to one-fifth of stunting, an indicator of chronic malnutrition in children, according to the updated 2013 Lancet series on maternal and child under-nutrition. Although prevalence of stunting has declined in the last decade from 40% to 26%, levels remain high in Africa and south-central Asia.

Stunting is a complex process that occurs from conception until the child’s second birthday (known as “the first 1,000 days”) primarily due inadequate infant and young child feeding and recurrent/chronic illness. Improving the nutritional status of children less than two years of age can be achieved through adequate dietary intake, home fortification with micronutrient powders/sprinkles and/or micronutrient supplements (i.e., iron), along with “nutrition-sensitive” interventions to improve water and sanitation and the quality and quantity of the food supply.

In developing countries, stunting prior to two years of age compromises adult height attainment, ability to learn and grade completion in school, productivity, and income. And because anemia is estimated to result in a 10% reduction in lifetime earnings and contributes to a loss of national gross domestic product of 1-2%, national governments and international donors should make eradicating anemia a priority. In most settings, both short stature and the consequences of iron deficiency on brain development that occur before two years of age are not reversible, although some studies have demonstrated catch-up growth after the of age two.

Strategic Approach
The MCHIP Nutrition Team consists of nutritionists working in their countries to give technical assistance to governments at all levels. The aim is to improve the effectiveness and scale-up of nutrition program implementation and, in some cases, to introduce new interventions and technologies. The Nutrition Team, based at MCHIP’s headquarters in Washington, DC, provides support and mentoring to the Program’s team of country-level nutritionists in the field and facilitates the sharing of global and regional nutrition experiences and best practices for nutrition program design, implementation, and monitoring and evaluation. The Team works with global donors and partners to identify and promote ways to improve program implementation of neglected nutrition problems, including the prevention of anemia and stunting.

Our focus is on improving maternal and child nutrition globally, with an emphasis on nutrition integration and prevention in three areas: integrated anemia prevention and control, conjoining nutrition and disease control efforts to reduce the burden of anemia; prevention of pre-eclampsia; and infant and young child nutrition to prevent stunting. MCHIP is a global leader in providing technical assistance to translate current evidence and World Health Organization guidelines into effective activities and programs on the ground. The Program provides a forum for dialogue on new approaches to facilitate in reducing anemia by leading global symposiums (in Dhaka, Bangladesh and Johannesburg, South Africa) on integrated anemia prevention, and giving guidance on the introduction of calcium supplementation to prevent pre-eclampsia.

MCHIP is a leader in presenting work that is on the global forefront of nutrition on infant and young child feeding, stunting, maternal nutrition, and anemia prevention and control at international conferences in Grange over Sands, England and Granada Spain. The Team provides up-to-date, evidence-based learning for the global community through our K4Health toolkit on integrated anemia prevention and control (see an overview of the toolkit contents here), our Nutrition Series Brown Bags, and our blogs from the field.

Key Contributions to Nutrition
MCHIP provides evidence-based technical advising at the country level to:

  • Develop an infant and young child feeding program review for the Ministry of Health and nutrition strategy to support the National Food and Nutrition Security Policy in Zimbabwe;
  • Collaborate with the  Division of Nutrition, Kenya, to develop national tools on the Baby Friendly Community Initiative and nutrition indicators monitoring tool and to support program implementation in Maternal, Infant and Young Child Nutrition-Family Planning programming in Bondo district;
  • Conduct an anemia control program review and secondary analyses of DHS in Rwanda;
  • Hold two consultation meetings on anemia prevention and controlone in Kenya that resulted in a national work plan on anemia, and one in Rwanda that resulted in recommendations and identified actions by development partners to develop and implement multi-sectoral operational plans to prevent and control anemia.
  • Provide technical input to training curriculums, baseline and end line data collection, and program implementation.
  • Providing direct technical assistance to countriessuch as EgyptKenyaRwandaZimbabwe and Yemenhas identified supply problems related to health workers. MCHIP has helped create messages on iron folic-acid (IFA) supplementation, including that women often forget to take IFA has resulted in use of cell phones to provide daily reminders for women to take IFA supplements in Kenya.

Nutrition Integration with Other Sectors
In Kenya, MCHIP is implementing an integrated approach to maternal and child health and nutrition. One example is with the integration of Maternal Infant and Young Child Nutrition (MIYCN) and Family Planning between Kenya’s Division of Nutrition and Division of Reproductive Health. Behavior change communication materials and tools with key messages were developed, pre-tested and rolled out with supportive supervision tools and training materials in Bondo district of Nyanza province. An evaluation of this integration and the sharing of findings will occur once finalized.

Also in Kenya, the MCHIP team has collaborated with the Division of Nutrition and Child and Adolescent Health to develop BCC materials for piloting the integration of nutrition messages into oral rehydration therapy (ORT) corners. This strategy allows mothers to access ORT, a simple, low-cost method for hydrating and protecting infants and young children from mortality due to diarrhea. In addition, the corners provide information on how to optimally feed children, including during and after an episode of diarrhea. The inclusion of this information at the ORT corner optimizes the mother’s time spent waiting for maternal and child health services.

Using the MCHIP supported MIYCN guidelines, the MCHIP/Kenya team will support the Division of Nutrition and the AIDS, Population and Health Integrated Assistance (APHIAplus) health programs to strengthen community level support for MIYCN interventions by building the capacity of health workers and community health workers in Igembe North and East Pokot districts to establish and sustain community support groups. In Igembe North, this initiative will integrate key high impact nutrition interventions such as: exclusive breast feeding; complementary feeding; water, sanitation and hygiene; growth monitoring and promotion; vitamin A supplementation; IFA supplementation; and diarrheal disease management.