Interventions for Malnutrition and Micronutrient Deficiency

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Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Advice to mothers on ensuring breastfeeding including early initiation, exclusive breastfeeding for the first 6 months of life and for at least till the child is two years * Counselling on appropriate and timely complementary feeding and healthy infant and young child nutrition Counselling on good hygiene practices including hand hygiene and quitting smoking Community based MUAC and bilateral edema screening for early identification * Community engagement on Infant and Young Child Nutrition IYCN * Counselling on micronutrient supplementation -Vit. A Supplementation, albendazole Counselling on use of therapeutic and supplementary foods with malnourished children * Education on use of safe water and good compound practices Counselling on when to seek medical help at facility level. * Counselling on use of family MUAC. Self-screening of children 6-59 months by mothers	Exclusive breastfeeding, early initiation of breastfeeding and complementary feeding, * Vitamin A supplementation * Hygiene, sanitation and deworming for preschool children * Follow up/home visits to ensure nutrition products for malnourished children are given to patients Examine/assess children during home/school visits for signs of acute malnutrition using MUAC and Edema to identify and refer identified		Refer children identified with MUAC<12.5cm to next level Follow up cases of moderate and severe acute malnutrition treated at facility Ensure compliance with treatment and advice
Primary Care
Same as Community Level plus * Group and focused counselling of mothers and carers at facility level on MIYCN - Early initiation of breastfeeding, EBF, Appropriate and timely complementary feeding, food demonstrations. Counselling on feeding of the sick child. * Feeding on good hygiene practices. * Growth monitoring and promotion	Breast breastfeeding and complementary feeding; * Routine and outreach of vitamin A and deworming administration * Hygiene, sanitation promotion * Community based growth monitoring * Nutrition products for malnourished children. * Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) without Complications Educate mothers on feeding of children through provision of practical examples using local foods Provide treatment to correct other specific deficiencies Treat moderate cases with balanced local oral diet Provide children with multivitamin supplement * Conduct food demonstrations on local food preparation
Referral Facility: General
Advice to mothers on ensuring breastfeeding including exclusive breastfeeding for the first 6 months of life and for at least till the child is two years Counselling on Healthy nutrition for the under 5s Counselling on Good hygiene practices including hand hygiene Growth monitoring	Early initiation and exclusive breastfeeding and complementary feeding * Vitamin A administration and deworming * Counselling on hygiene, sanitation practices * Facility based growth monitoring * Use of Local foods for complementary feeding and nutrition products for malnourished children. Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) with Complications Provision of therapeutic meals for clinical management of patients Educate mothers on feeding of children through provision of practical examples using local foods Treat moderate cases with balanced oral diet, correct fluid and electrolyte imbalances Provide macronutrients for severe cases by appropriate means (orally, feeding tube, nasogastric tube) Provide children with multivitamin supplement Provide treatment to correct other specific deficiencies
Referral Facility: Specialist
Counselling of mothers/caregivers on Breastfeeding- including early initiation and exclusive breastfeeding for the first 6 months of life and for at least till the child is two years Counselling on Healthy IYCN for the under 5s Counselling on Good hygiene practices including hand hygiene Growth monitoring and promotion -screening for malnutrition BFHI promotion	Early initiation and exclusive breastfeeding and complementary feeding * Vitamin A administration and deworming * Counselling on hygiene, sanitation practices Facility based growth monitoring * Use of Local foods for complementary feeding and nutrition products for malnourished children. Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) with Complications by the national IMAM Protocol * Management of SAM without complications and Management of MAM as per National IMAM protocol. Therapeutic meals for clinical management of under-fives Nutrition counselling Educate mothers on feeding of children through provision of practical examples using local foods Treat existing infections in severe cases Oral macronutrients for severe cases Feeding by feeding tube, nasogastric tube, gastrostomy tube) Multivitamin supplement as appropriate Counsel caregivers on feeding the sick child. Lactose free liquid oral food supplements

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Advice to mothers on ensuring breastfeeding including early initiation, exclusive breastfeeding for the first 6 months of life and for at least till the child is two years * Counselling on appropriate and timely complementary feeding and healthy infant and young child nutrition Counselling on good hygiene practices including hand hygiene and quitting smoking Community based MUAC and bilateral edema screening for early identification * Community engagement on Infant and Young Child Nutrition IYCN * Counselling on micronutrient supplementation -Vit. A Supplementation, albendazole * Counselling on use of therapeutic and supplementary foods with malnourished children * Education on use of safe water and good compound practices * Counselling on when to seek medical help at facility level. * Counselling on use of family MUAC. Self-screening of children 6-59 months by mothers	Exclusive breastfeeding, early initiation of breastfeeding and complementary feeding, * Vitamin A supplementation * Hygiene, sanitation and deworming for preschool children * Follow up/home visits to ensure nutrition products for malnourished children are given to patients Examine/assess children during home/school visits for signs of acute malnutrition using MUAC and Edema to identify and refer identified		Refer children identified with MUAC<12.5cm to next level Home follow-up of cases of moderate and severe acute malnutrition to ensure compliance with treatment and advice
Primary Care
Same as Community Level plus Group and focused counselling of mothers and carers at facility level on MIYCN Early initiation of breastfeeding, EBF, Appropriate and timely complementary feeding, food demonstrations. Counselling on feeding of the sick child. Feeding on good hygiene practices. * Growth monitoring and promotion	Breast breastfeeding and complementary feeding * Routine and outreach of vitamin A and deworming administration * Hygiene, sanitation promotion * community based growth monitoring Nutrition products for malnourished children. * Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) without Complications Educate mothers on feeding of children through provision of practical examples using local foods Provide treatment to correct other specific deficiencies Treat moderate cases with balanced local oral diet Provide children with multivitamin supplement * Conduct food demonstrations on local food preparation
Referral Facility: General
Advice to mothers on ensuring breastfeeding including exclusive breastfeeding for the first 6 months of life and for at least till the child is two years Counselling on Healthy nutrition for the under 5s Counselling on Good hygiene practices including hand hygiene Growth monitoring	Early initiation and exclusive breastfeeding and complementary feeding; * Vitamin A administration and deworming * Counselling on hygiene, sanitation practices Facility based growth monitoring Use of Local foods for complementary feeding and nutrition products for malnourished children Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) with Complications Provision of therapeutic meals for clinical management of patients Educate mothers on feeding of children through provision of practical examples using local foods Treat moderate cases with balanced oral diet, correct fluid and electrolyte imbalances Provide macronutrients for severe cases by appropriate means (orally, feeding tube, nasogastric tube) Provide children with multivitamin supplement Provide treatment to correct other specific deficiencies
Referral Facility: Specialist
Counselling of mothers/caregivers on Breastfeeding- including early initiation and exclusive breastfeeding for the first 6 months of life and for at least till the child is two years Counselling on Healthy IYCN for the under 5s Counselling on Good hygiene practices including hand hygiene Growth monitoring and promotion -screening for malnutrition BFHI promotion	Early initiation and exclusive breastfeeding and complementary feeding Vitamin A administration and deworming * Counselling on hygiene, sanitation practices * Facility based growth monitoring * Use of Local foods for complementary feeding and nutrition products for malnourished children Examine children during home visits for signs of acute malnutrition and advise parents accordingly		Management of Severe Acute Malnutrition (SAM) with Complications by the national IMAM Protocol * Management of SAM without complications and Management of MAM as per National IMAM protocol. Provision of therapeutic meals for clinical management of under-fives Nutrition counselling for the clinical management of both inpatient and outpatients Educate mothers on feeding of children through provision of practical examples using local foods Treat existing infections in severe cases Provide macronutrients for severe cases by appropriate means (orally, feeding tube, nasogastric tube, gastrostomy tube) Provide children with multivitamin supplement as appropriate Counsel caregivers on feeding the sick child. Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide children with multivitamin supplement