{"metadata":{"id":"00ddd31dc6dd4e0db3147726a52438a4","source":"gardian_index","url":"https://cgspace.cgiar.org/rest/bitstreams/b38ab22e-c462-4de0-bb5c-933b1b8ca6d7/retrieve"},"pageCount":44,"title":"","keywords":[],"chapters":[{"head":"Table of Contents","index":1,"paragraphs":[{"index":1,"size":114,"text":"A ccording to the Uganda Demographic and Health Survey (UDHS 2016), 33% of the Ugandan population was malnourished in 2016, 29% percent of children under 5 were stunted, 11% were underweight, 3.6% were wasted, 11.8% had low birth weight. Prevalence of anemia among women of child bearing age was at 31.8%. The current levels of malnutrition in Uganda are unacceptable. In Acholi region, 31% of children below 5 years of age are stunted, 4% are wasted and 15% are under weight. In Central region, 19% of children under 5 years are stunted, 4% are wasted and 7% are underweight. Therefore, nutrition warrants greater investment and commitment for Uganda to realize its full development potential."},{"index":2,"size":37,"text":"Among the main contributors of malnutrition is the low awareness of the available options and in some instances -the poverty levels within certain regions that limits households from accessing enough food or providing the appropriate health care."},{"index":3,"size":49,"text":"It is upon this background that the Government of Uganda with the support from the International Fund for Agricultural Development funded two projects in Kalangala region and northern Uganda. The objectives of the projects were to improve households' income by increasing productivity of farmers through adoption of commercial farming."},{"index":4,"size":46,"text":"The VODPII project in Kalangala was to achieve its objective through promoting commercial production of oil palm thus increasing household incomes. In northern Uganda, PRELNOR aimed at increasing production of food crops especially maize, beans, cassava and rice so that farmers have excess surplus to sell."}]},{"head":"VODPII","index":2,"paragraphs":[{"index":1,"size":58,"text":"In 2003 the Government of Uganda, International Fund for Agricultural Development (IFAD), BIDCO and individual farmers in Kalangala under Kalangala Oil Palm Growers Trust (KOPGT) teamed up to establish an oil palm project with expertise from Malaysia, the pilot was rolled out on Bugala Island with plans to expand the project to other neighbouring islands in the district."},{"index":2,"size":38,"text":"The project was designed to improve the livelihood of the people of Uganda and Kalangala in particular, more so on the nutrition status of the poor and reduction on the national cost burden of importation of vegetable oils."}]},{"head":"PRELNOR","index":3,"paragraphs":[{"index":1,"size":48,"text":"Although only 20% of the Uganda population lives in Northern Uganda, it accounts for 38% of the poor in Uganda with 26% of all the chronically poor living in the area. IFAD included Northern Uganda, particularly the Acholi region, as a high priority in the IFAD project pipeline."},{"index":2,"size":45,"text":"Most farmers returning from the IDP camps rely on the natural fertility of the soils, with minimal or no inputs leading to low yields and productivity. The sub-region has excellent potential for agricultural development, which is needed for lifting the rural poor out of poverty."},{"index":3,"size":26,"text":"The PRELNOR project aims to achieve increased incomes through; adoption of improved farming practices, improving market processes and structures and providing climate specific information to situation"}]},{"head":"Nutrition in Uganda","index":4,"paragraphs":[{"index":1,"size":133,"text":"Training manual for Project Management Unit Members | 5 enable improved farming. This Guide is therefore designed for use by field level staff. The guide gives details that are aimed at enabling the field service providers within PRELNOR and VODP II projects to gain an understanding major concepts in nutrition, identifying nutrition needs for different categories of people, identifying different forms of malnutrition, their causes, consequences, management and preventive strategies. Nutrition indicators and their measurement and monitoring methods are also included. Finally, information on food safety and hygiene is also given. The target trainees include: field level staff (Community based facilitators, Household Mentors and Unit leaders) following the trainings, the field extension service providers will have gained knowledge and skills that can be transferred to communities and household members in projects' target regions."}]},{"head":"Outcome","index":5,"paragraphs":[{"index":1,"size":97,"text":"This training guide is intended to build capacity of Project management Team to transfer knowledge on basic concepts regarding appropriate dietary patterns and use of existing farming systems for better household nutrition. In referring to this manual, the Project management team will be able to transfer the information gained to community level field extension workers. The expected impact is that enhanced knowledge of the links between agriculture, nutrition and health, formation and/or upgrading of existing home gardens into comprehensive gardens as well as proper dietary and health practices will eventually lead to enhanced nutrition and health status."}]},{"head":"Outputs","index":6,"paragraphs":[{"index":1,"size":41,"text":"Number of Project Management Unit members trained and able to train their field extension workers. This will be measured on number of households reached with the intervention, Number of households trained by extension field workers that can implement the recommended practices."}]},{"head":"Users of the Guide","index":7,"paragraphs":[{"index":1,"size":38,"text":"This guide it to be used in creating awareness of the field extension workers with regards to nutrition to enable mainstreaming of nutrition into PRELNOR & VODP II projects. It will be used for training Project management Team."}]},{"head":"Overview of the Training Guide","index":8,"paragraphs":[{"index":1,"size":6,"text":"The guide has 6 Main sections:"},{"index":2,"size":25,"text":"1. Basic Concepts in Nutrition 2. Recommended Feeding practices 3. Malnutrition, its forms and causes 4. Food and nutrition assessment 5. Food safety and hygiene"}]},{"head":"Nutrition assessment and related nutrition indicators","index":9,"paragraphs":[{"index":1,"size":94,"text":"Each section includes a time allocation, a pre-test, an overview of the learning objectives, materials needed, notes and facilitator fact sheets pertaining to the section. Also contained is an activity that generates discussion and helps in recapping information while focusing on the key learning objectives. Activity: (using a flip chart, ask at least three participants their understanding of the concepts below, What is good nutrition? What are some of the common nutrient groups? What are some local food sources of the common nutrient groups? What is the function or use of these nutrient groups?"}]},{"head":"(Facilitator asks at least three participants to describe their understanding of nutrition)","index":10,"paragraphs":[{"index":1,"size":41,"text":"After the participants provide the responses the facilitator moves forward to provide the right definition and details as provided in the session technical notes and ensuring there is great participation and discussion during the process and welcoming questions and making clarifications."}]},{"head":"Session technical notes","index":11,"paragraphs":[{"index":1,"size":23,"text":"Nutrition is all about the study of food and how our bodies use it as fuel for growth, reproduction and maintenance of health."},{"index":2,"size":15,"text":"Nutrition comprises the process of providing the nutrients needed for health, growth, development and survival."},{"index":3,"size":18,"text":"Food is any substance (solid, semi-solid, or liquid) taken into the body to provide one or more nutrients."}]},{"head":"Good nutrition is important for:","index":12,"paragraphs":[{"index":1,"size":6,"text":"Physical activity, movement, work, and warmth."},{"index":2,"size":16,"text":"Physical growth and brain development essential for learning, so good nutrition is especially important for children."},{"index":3,"size":9,"text":"Body building, replacement and repair of cells and tissues."},{"index":4,"size":9,"text":"Protection from illnesses, fighting infections and recovery from illnesses."},{"index":5,"size":17,"text":"For good health to be maintained, a daily diet of foods must accomplish the above four functions."},{"index":6,"size":18,"text":"The things in food that help us accomplish one or more of the four functions are called nutrients."}]},{"head":"Basic Concepts in Nutrition","index":13,"paragraphs":[]},{"head":"Learning Objectives","index":14,"paragraphs":[{"index":1,"size":22,"text":"At the beginning of the session the facilitator is expected to understand the entry level knowledge of participants regarding the session content."},{"index":2,"size":10,"text":"At the end of this session participants are expected to:"},{"index":3,"size":6,"text":"Briefly describe what good nutrition is."},{"index":4,"size":11,"text":"List at least six nutrients found in foods and their function."},{"index":5,"size":18,"text":"List at least five local sources of carbohydrates, proteins, vitamins and minerals. Carbohydrates (starches, sugars and dietary fire)."}]},{"head":"Fats Proteins","index":15,"paragraphs":[{"index":1,"size":1,"text":"Water."}]},{"head":"Micro (small) nutrients","index":16,"paragraphs":[{"index":1,"size":23,"text":"These are needed in small amounts. There are many of these but the ones most likely to be lacking in the diet are:"},{"index":2,"size":6,"text":"Minerals -iron, iodine, zinc and calcium."},{"index":3,"size":9,"text":"Vitamins -vitamin A, B-group vitamins, folate and vitamin C."},{"index":4,"size":14,"text":"Whether or not a food is a good source of a nutrient depends on:"},{"index":5,"size":51,"text":"The amount of nutrient in the food. Foods that contain large amounts of micronutrients compared to their energy content are called 'nutrient-rich' (or sometimes 'nutrient-dense') foods. They are preferred because they help ensure that the diet provides all nutrients needed. The Appendix lists foods that supply useful amounts of different nutrients."},{"index":6,"size":9,"text":"The amount of the food that is eaten usually."},{"index":7,"size":16,"text":"How readily available the nutrient in the food is for absorption and use by the body."}]},{"head":"Nutrients, functions and sources","index":17,"paragraphs":[{"index":1,"size":3,"text":"Time: 40 Minutes"}]},{"head":"Carbohydrates","index":18,"paragraphs":[{"index":1,"size":39,"text":"Carbohydrates provide your body with the fuel it needs to keep running. Depending on how quickly they convert to sugar in the body, they can be simple or complex, carbohydrates are mainly in form of starches, sugars or fiber."},{"index":2,"size":37,"text":"Starch and sugars provide energy needed to keep the body breathing and alive, for movement and warmth, and for growth and repair of tissues. Some starch and sugar is changed to body fat as storage of energy."},{"index":3,"size":35,"text":"The fiber in carbohydrates makes faeces soft and bulky and absorbs harmful chemicals, and so helps to keep the gut healthy. It slows digestion and absorption of nutrients in meals, and helps to prevent obesity."}]},{"head":"Sources of carbohydrates","index":19,"paragraphs":[{"index":1,"size":5,"text":"Main sources of carbohydrates are:"}]},{"head":"Cereals","index":20,"paragraphs":[]},{"head":"Starchy roots and tubers","index":21,"paragraphs":[{"index":1,"size":3,"text":"Maize/ maize flour "}]},{"head":"Fats and oils","index":22,"paragraphs":[{"index":1,"size":12,"text":"The fats and oils in foods serve many important functions such as;"},{"index":2,"size":34,"text":"Nutrient: Fat supplies essential fatty acids, which are needed for normal growth of infants and children and for production of hormone-like compounds that regulate a wide range of body functions and keep you healthy."},{"index":3,"size":15,"text":"Transport: Fat carries fat-soluble vitamins (A, D, E, and K) and assists in their absorption."},{"index":4,"size":10,"text":"Sensory: Fat contributes to the smell and taste of food."},{"index":5,"size":11,"text":"Texture: Fat helps make foods tender (especially meats and baked goods)."},{"index":6,"size":15,"text":"Satiety: Fat gives food satiety, so you feel full and satisfied longer after a meal."},{"index":7,"size":27,"text":"Energy: Fat provides a concentrated source of calories. This is good if you are travelling long distances, expending a lot of energy, and carrying your own food."},{"index":8,"size":8,"text":"In the body, fat has the following roles:"},{"index":9,"size":18,"text":"Fats are the body's main form of stored energy (important in times of illness and diminished food intake)."},{"index":10,"size":10,"text":"Fats provide most of the energy to fuel muscular work."},{"index":11,"size":13,"text":"Fat pads internal organs and insulates our bodies against temperature extremes and damage."},{"index":12,"size":13,"text":"Fats form the major material of cell membranes (especially brain and nerve cells)."},{"index":13,"size":10,"text":"Fats are converted to many important hormones (including sex hormones)."},{"index":14,"size":21,"text":"Fat is a good thing! It's only when there is too much of a good thing that it can become problematic."}]},{"head":"Requirements","index":23,"paragraphs":[{"index":1,"size":41,"text":"Fat needs are expressed as 'percent of total energy needs'. The percent of total energy that should come from fat in a healthy balanced diet is: 30-40 percent for children on complementary feeding and up to the age of two years;"},{"index":2,"size":17,"text":"15-30 percent for older children and most adults; for active adults up to 35 percent is acceptable;"},{"index":3,"size":15,"text":"At least 20 percent up to 30 percent for women of reproductive age (15-45 years)."},{"index":4,"size":25,"text":"Consuming more fats beyond what the body needs leads to overweight, and increases the risk of diseases like heart diseases, high blood pressure and diabetes."}]},{"head":"Proteins","index":24,"paragraphs":[{"index":1,"size":56,"text":"Proteins are the building blocks for muscles, organs and many of the substances that make up our bodies. They provide essential amino acids that the body uses to make muscle tissue. The body needs proteins and calories every day. Proteins also facilitate the production of enzymes that govern the body's processes such as growth and digestion."},{"index":2,"size":41,"text":"When you don't get enough of calories and protein everyday, your body breaks up its own supplies to make up for the lack of energy. This robs your body of the calories it needs to stay healthy leading to weight loss."}]},{"head":"Plant sources","index":25,"paragraphs":[{"index":1,"size":18,"text":"• Soy products (tofu, tempeh, soy milk, and other products made from soy), beans, peas, seeds, and nuts."},{"index":2,"size":19,"text":"• There are also small amounts of protein in breads, cereals, and other grains, as well as in vegetables."},{"index":3,"size":18,"text":"• Plant sources of protein are considered \"incomplete\" because they are missing one or more essential amino acids."},{"index":4,"size":10,"text":"• Soy protein is the one exception--it is considered \"complete.\""}]},{"head":"Sources of Proteins","index":26,"paragraphs":[{"index":1,"size":10,"text":"Protein can be found in both animal and plant foods."}]},{"head":"Animal sources","index":27,"paragraphs":[{"index":1,"size":9,"text":"• Meats, poultry, fish, eggs, cheese, milk and yogurt."},{"index":2,"size":33,"text":"• These foods are considered \"complete\" or \"high quality\" proteins because they contain all the \"essential\" amino acids. \"Essential\" means that they must be consumed in our diet; our bodies cannot manufacture them."},{"index":3,"size":9,"text":"• Edible insects: Grasshoppers, termites, white ants, crickets, caterpillars  "}]},{"head":"Requirements","index":28,"paragraphs":[{"index":1,"size":73,"text":"Requirements vary by age, sex, gender and activity (see appendix 1) but the general requirement is approximately 0.75 g per kg of body weight per day. Not consuming enough protein leads to reduced growth rate, loss of muscle and build-up of fluid in the body as the body breaks down the muscles to obtain the protein and energy needed for daily functions. In children it also leads to retarded growth and proteinenergy malnutrition."},{"index":2,"size":37,"text":"It should also be noted that consumption of high amounts of animal protein sources that are accompanied with a lot of fat like meats, milk and eggs leads to excess consumption of fat which has negative effects."}]},{"head":"Vitamins and Minerals","index":29,"paragraphs":[{"index":1,"size":16,"text":"Vitamins include both Fat-soluble (vitamins A, D, E, and K) and water-soluble (B-group and C vitamins)."},{"index":2,"size":10,"text":"Vitamins help the body turn food into energy and tissues."},{"index":3,"size":15,"text":"There are 13 vitamins in all: vitamin A; the vitamin B complex, which includes thiamine, "}]},{"head":"Sources","index":30,"paragraphs":[{"index":1,"size":28,"text":"• Orange vegetables, such as orange sweet potato and carrots, and orange fruits, such as mango and pawpaw and red palm oil are excellent sources of vitamin A."},{"index":2,"size":20,"text":"• Red meat, red offal and liver of all types are a very rich source of iron and vitamin A."},{"index":3,"size":12,"text":"• Most citric fruits and fresh (not overcooked) vegetables provide vitamin C."},{"index":4,"size":10,"text":"• Dark green vegetables supply folate and some vitamin A."},{"index":5,"size":21,"text":"• Many vegetables (e.g., tomatoes, onions) provide additional important micronutrients that may protect against some chronic conditions such as heart disease. "}]},{"head":"Requirements","index":31,"paragraphs":[{"index":1,"size":8,"text":"Vitamins and minerals are required in small quantities."},{"index":2,"size":20,"text":"Requirements are based on age, sex and activity level but consumption of a variety of fruits, vegetables and whole grains."},{"index":3,"size":29,"text":"The best way to make sure we get enough of each micronutrient and enough fibre is to eat a variety of vegetables and fruits and whole grains every day."}]},{"head":"Water","index":32,"paragraphs":[{"index":1,"size":35,"text":"Water just may be the most important nutrient. In fact, the body is more than half water. You can live without food for several weeks, but you can go less than a week without water."},{"index":2,"size":13,"text":"The body needs water to function. It is necessary for Maintaining body temperature;"},{"index":3,"size":5,"text":"Transporting nutrients throughout the body;"},{"index":4,"size":3,"text":"Keeping joints moist;"},{"index":5,"size":2,"text":"Digesting food;"},{"index":6,"size":6,"text":"Ridding the body of waste products."},{"index":7,"size":22,"text":"(Think of the use of water when building a house, without the water, the cement, sand and concrete will not be useful.)"}]},{"head":"Sources","index":33,"paragraphs":[{"index":1,"size":1,"text":"Water;"},{"index":2,"size":3,"text":"Fruit Juices; Soup;"},{"index":3,"size":1,"text":"Milk;"},{"index":4,"size":1,"text":"Porridge;"},{"index":5,"size":16,"text":"Non-caffeinated drinks (caffeinated and alcohol beverages contain diuretic substances that cause the body to lose water)."},{"index":6,"size":25,"text":"Requirements 1.5 liters/day or 8 glasses a day Not drinking enough water leads to constipation, dehydration, dry skin, and build-up of toxins in the body."}]},{"head":"Recommended feeding practices","index":34,"paragraphs":[{"index":1,"size":18,"text":"Activity: (using a flip chart, the facilitator asks at least three participants their understanding of the concepts below,"},{"index":2,"size":15,"text":"2. Do the different family members (age group and condition) have the same food needs?"}]},{"head":"After the participants provide the responses the facilitator moves forward to provide the right definition and details as provided in the session technical notes and ensuring there is great participation and discussion during the process and welcoming questions and making clarifications.","index":35,"paragraphs":[]},{"head":"Session technical notes","index":36,"paragraphs":[]},{"head":"Balanced meal","index":37,"paragraphs":[{"index":1,"size":58,"text":"A balanced diet provides the correct amounts of food energy and nutrients needed during the day to cover the dietary requirements of the person eating it. A balanced diet must be composed of a variety of different foods from different food groups so that it contains all the many macronutrients and micronutrients the person needs in sufficient quantities."}]},{"head":"A good meal should contain:","index":38,"paragraphs":[{"index":1,"size":28,"text":"A staple food. Look at the list of carbohydrate foods made in the previous session and see if it contains the local staple foods. Add them if necessary."},{"index":2,"size":15,"text":"Other foods that may be made into a sauce, stew or relish. These should include:"},{"index":3,"size":6,"text":"• Legumes and/or foods from animals"},{"index":4,"size":5,"text":"• At least one vegetable"},{"index":5,"size":48,"text":"• Some fat or oil (but not too much) to increase the energy and improve taste and facilitate absorption of some nutrients like fat-soluble vitamins. Most of the fat or oil should be from foods containing unsaturated fatty acids (See sources of fats listed in the previous session)."},{"index":6,"size":49,"text":"It is good to eat fruits with a meal (or as a snack) and to drink plenty of water during the day. Avoid drinking tea or coffee until 1-2 hours after a meal (when food will have left the stomach) as these reduce the absorption of iron from food."}]},{"head":"Learning Objectives","index":39,"paragraphs":[{"index":1,"size":24,"text":"At the beginning of the session the facilitator is expected to understand the entry level knowledge and behavior of participants regarding the session content."},{"index":2,"size":10,"text":"At the end of this session participants are expected to:"},{"index":3,"size":18,"text":"Know how to plan for a balanced meal Understand the food pyramid concept when planning and serving meals"},{"index":4,"size":14,"text":"Briefly describe the main differences between the food needs for the different family members  "}]},{"head":"Encourage families to use:","index":40,"paragraphs":[{"index":1,"size":7,"text":"Several groups of foods at each meal."},{"index":2,"size":25,"text":"Different vegetables and fruits at different meals because different vegetables and fruits contain varying amounts of the different micro-nutrients. The more colors consumed the better."},{"index":3,"size":35,"text":"Serve meat, poultry, and offal or fish daily if possible because these foods are the best sources of iron and zinc (which are often lacking in diets, especially the diets of young children and women)."}]},{"head":"Snacks","index":41,"paragraphs":[{"index":1,"size":6,"text":"Snacks are foods eaten between meals."},{"index":2,"size":45,"text":"Below are examples of foods that make good snacks Fresh milk, soured milk, yoghurt, cheese, roasted groundnuts, soybeans, melon seeds, sesame seeds, eggs, fried fish, bread, boiled/roasted maize cob, boiled or roasted cassava, plantain, yam, sweet potato, bananas, avocado, tomatoes, mangoes, oranges, pawpaw, passion fruits."},{"index":3,"size":73,"text":"Eating snacks like these is a good way of improving a diet which may lack food energy and nutrients. However, frequent eating (snacking) throughout the day increases the risk of tooth decay, particularly where oral hygiene is poor. This is particularly true for artificially sweetened snacks that stick to the teeth. It is better to eat the fruit than make juice as many people discard the fiber in the fruits when making juice."}]},{"head":"The Food Pyramid","index":42,"paragraphs":[{"index":1,"size":89,"text":"Although your food intake varies from meal to meal and from day to day, keeping a balanced view of your diet is a good idea. The food pyramid (see figure 5) is meant to be a guideline not rigid set of rules. It is healthy to eat more of the foods from the bottom levels of the pyramid and fewer of those from the top. The top of the pyramid is for foods that should be consumed in small quantities because large amounts are not good for the body."},{"index":2,"size":17,"text":"The Food Pyramid as a guide helps to promote the 3 basic rules for a healthy diet:"},{"index":3,"size":87,"text":"Variety means that you must include many different foods from each level of the Food Pyramid because no single food can supply all of the nutrients that your body needs on a daily basis. This can help to expand your food choices. It is best to eat foods of all colours. The more colours and textures in your daily meals, the better range of nutrients you'll get. You can choose to vary different foods in a day or aim to vary different foods across a whole week."},{"index":4,"size":37,"text":"Balance means that you must eat the right amounts of foods from all levels of the Food Pyramid each day. This way you will get all the calories and nutrients you need for proper growth and development."},{"index":5,"size":17,"text":"Moderation means that you are careful not to eat too much of any one type of food."},{"index":6,"size":71,"text":"Good nutrition during pregnancy and appropriate health seeking behavior are very important for both mother and child Pregnant women should receive ante-natal care from health facility. They should receive iron supplementation because of increased iron needs during pregnancy A pregnant or breastfeeding woman needs to eat enough food to supply the extra energy, protein, vitamins and minerals needed by the growing fetus or baby during breastfeeding. Her meals must be balanced."},{"index":7,"size":26,"text":"Early initiation of breastfeeding (within the first 30 minutes of delivery) whether at hospital, at home, or at the midwife's, and give colostrum to the baby."}]},{"head":"Colostrum protects infant from disease by providing the infant's first vaccine","index":43,"paragraphs":[{"index":1,"size":108,"text":"Exclusive breastfeeding of all children below 6 months of age. Breast milk provides all the nutrients needed to satisfy huger and promote growth No other foods or drinks should be given to children below 6 months of age. This reduces infections and diarrhoea Children at 6 months and above should be given a balanced diet in addition to the breast milk. These foods should not be too thin as they will not provide enough nutrients. The facilitator asks the participants to mention their understanding of the term malnutrition. The responses on a flip chart and the then gives the right content as detailed in the session technical notes."}]},{"head":"Session technical notes","index":44,"paragraphs":[{"index":1,"size":27,"text":"Malnutrition is the condition that develops when the body does not get the right amount of the nutrients it needs to maintain healthy tissues and organ function."}]},{"head":"Under Nutrition","index":45,"paragraphs":[{"index":1,"size":89,"text":"Under nutrition is a deficiency of food energy or nutrients, which leads to nutrient deficiencies. It is caused by inadequate intake or poor absorption of nutrients in the body. Acute malnutrition, chronic malnutrition, stunting, wasting, and underweight and micronutrient deficiencies occur because of undernutrition, and they can have serious consequences on the development and health of infants and young children. Undernutrition is one of the leading causes of mortality for young children across the globe and is often caused by an interaction between inadequate dietary intake and frequent illness."}]},{"head":"Over Nutrition","index":46,"paragraphs":[{"index":1,"size":37,"text":"Over nutrition is a condition caused by abnormal or excess fat accumulation in the body that may lead to health problems and reduced life expectancy. Overnutrition starts as overweight and if left uncontrolled may progress to obesity."}]},{"head":"Causes of malnutrition","index":47,"paragraphs":[{"index":1,"size":97,"text":"Malnutrition occurs when a person does not receive nutrients in the required amounts (less or excess). This can be a result of several factors and is a result of inadequate food intake and the health status (immediate causes, which are at an individual level). These factors in turn are affected by the individual or household's access to food, the care available, the availability of suitable health services and an unhealthy environment (underlying causes). The resources available in a household and community and how they are used are issues that influence underlying causes of malnutrition (see figure below)."}]},{"head":"Learning Objectives","index":48,"paragraphs":[{"index":1,"size":22,"text":"At the beginning of the session the facilitator is expected to understand the entry level knowledge of participants regarding the session content."},{"index":2,"size":12,"text":"At the end of the session, the participants should be able to:"}]},{"head":"Identify kinds of malnutrition in their community","index":49,"paragraphs":[]},{"head":"Understand causes of the kinds of malnutrition in their community","index":50,"paragraphs":[{"index":1,"size":20,"text":"Understand the consequences of malnutrition in the community Share actions they can take to prevent malnutrition among children and women"}]},{"head":"Time:","index":51,"paragraphs":[{"index":1,"size":2,"text":"60 minutes"}]},{"head":"Materials needed:","index":52,"paragraphs":[{"index":1,"size":9,"text":"Photos of children with different clinical signs of malnutrition "}]},{"head":"Forms of malnutrition A. Chronic malnutrition","index":53,"paragraphs":[{"index":1,"size":15,"text":"Chronic malnutrition is malnutrition caused by long-term food deprivation or illness. An example is stunting."}]},{"head":"Stunting","index":54,"paragraphs":[{"index":1,"size":39,"text":"This refers to a child having short height for their age. It can begin during pregnancy and through infancy (up to 5 year of age). If not corrected before two years of the child's age, the effects become irreversible. "}]},{"head":"Conceptual framework for analysing the causes of malnutrition","index":55,"paragraphs":[]},{"head":"B. Acute malnutrition","index":56,"paragraphs":[{"index":1,"size":21,"text":"Acute malnutrition is a result of short-term lack of food deprivation or illness that results in sudden weight loss or oedema."}]},{"head":"i. Underweight","index":57,"paragraphs":[{"index":1,"size":39,"text":"This refers to a child having a weight that is too low for their age. When severely underweight, the child is weak, has poor physical stamina and a weak immune system leaving them prone to other infections and illnesses."}]},{"head":"ii. Wasting","index":58,"paragraphs":[{"index":1,"size":27,"text":"Wasting refers to a child having a weight that is too low for their height. It is a strong predictor of mortality of children under 5 years."}]},{"head":"C. Micronutrient deficiencies i. Iron deficiency anaemia","index":59,"paragraphs":[{"index":1,"size":48,"text":"• Iron is required for the synthesis of haemoglobin, which transports oxygen to the cells in our body. It is required by every growing cell and therefore is essential for child growth and development. It is involved in energy production, immunity, and regulation of the central nervous system."},{"index":2,"size":20,"text":"• Iron deficiency may lead to iron deficiency anaemia, a condition experienced when the body is not making enough haemoglobin."},{"index":3,"size":35,"text":"• Signs of iron deficiency anaemia include fatigue, weakness, tiredness, loss of appetite, headaches, shortness of breath and paleness. Pale skin (especially on palms), pale lips and paleness on the inside of the bottom eyelid."},{"index":4,"size":12,"text":"• Iron deficiency during early childhood can impair physical and cognitive development."},{"index":5,"size":25,"text":"Signs of anaemia can be seen in the figure 8 below.  • Vitamin A helps keep eyes healthy, promotes vision, and provides protection against infection."},{"index":6,"size":16,"text":"• Vitamin A is needed by the tissues that line our lungs, gastrointestinal tract and eyes."},{"index":7,"size":27,"text":"• Without adequate vitamin A, these tissues are susceptible to bacterial invasion; as such, deficiency is associated with frequent illness and severe deficiency may result in blindness."},{"index":8,"size":17,"text":"• Signs of vitamin A deficiency include night blindness, Bigot's spots and keratomalacia (in order of severity)."},{"index":9,"size":13,"text":"• This deficiency is associated with high rates of respiratory and diarrheal infections."},{"index":10,"size":22,"text":"• Iodine is essential in the proper functioning of the thyroid gland, which helps to regulate the body's use of energy (metabolism)."},{"index":11,"size":17,"text":"• Iodine is essential for physical and mental growth, and it is particularly important during foetal development."},{"index":12,"size":16,"text":"• Goitre, a swelling of the thyroid gland, is the most notable symptom of iodine deficiency."},{"index":13,"size":20,"text":"• Severe maternal iodine deficiency can result in cretinism, whereby the child is born with severe physical and mental retardation."},{"index":14,"size":27,"text":"• Less severe forms of iodine deficiency in young children can cause mental deficits such as lower mental development, lower cognitive function and reduced ability to focus."},{"index":15,"size":8,"text":"• Goitre is reversible whereas cretinism is irreversible."},{"index":16,"size":8,"text":"ii. Vitamin A deficiency iii. Iodine deficiency disorder "}]},{"head":"Over nutrition","index":60,"paragraphs":[{"index":1,"size":16,"text":"Overnutrition is an excess consumption of energy and nutrients. It can lead to overweight and obesity."},{"index":2,"size":17,"text":"Being overweight or obese increases the likelihood of having diabetes and heart-related diseases like high blood pressure."},{"index":3,"size":61,"text":"Overweight and obesity ranges are determined by using weight and height to calculate a number called the body mass index (BMI). An adult who has a BMI between 25 and 29.9 is considered over weight and an adult who has a BMI of 30-35 is considered obese and an adult with a BMI of 40 or more, or 30 or more."},{"index":4,"size":12,"text":"BMI is established through dividing weight in kg by height (cm) squared."}]},{"head":"Cycle of malnutrition","index":61,"paragraphs":[{"index":1,"size":70,"text":"The consequences of malnutrition in an individual can extend to later in life. In addition, the effects can also affect future generations. This particularly occurs for women, where their nutrition status affects the unborn child. A stunted girl is likely to become a stunted adolescent and later a stunted woman. This affects her health, productivity, and nutrition. Which in turn increases the chance that her children will be born malnourished. "}]},{"head":"Prevention of undernutrition","index":62,"paragraphs":[{"index":1,"size":14,"text":"• Promotion of exclusive breastfeeding and continued breastfeeding up to 2 years and beyond"},{"index":2,"size":5,"text":"• Appropriate complementary feeding practices"},{"index":3,"size":8,"text":"• Supplementation with Vitamin A and iron/folic acid"}]},{"head":"• Immunization and deworming","index":63,"paragraphs":[{"index":1,"size":5,"text":"• Promotion of maternal nutrition"},{"index":2,"size":7,"text":"• Appropriate water, sanitation and hygiene practices"}]},{"head":"• Growth Monitoring and Promotion","index":64,"paragraphs":[]},{"head":"At the end of the session, let the facilitator ask whether there are any additional questions or points of clarification. After all clarifications are made (if any), the facilitator closes the session and mentions the next session and its facilitator.","index":65,"paragraphs":[]},{"head":"How to Prevent Malnutrition in Our Communities","index":66,"paragraphs":[{"index":1,"size":3,"text":"Feeding young children"},{"index":2,"size":16,"text":"• All new born babies should be put on the breast within one hour of birth"},{"index":3,"size":32,"text":"• New born babies should be fed only on breastmilk and not given any other food/drink (like animal milks, tea, water, soup, porridge, soda, juice, etc.) until they are six months old."},{"index":4,"size":27,"text":"• When babies are six months old, they should continue to be given breast milk AND also fed with other nutritious foods 3 to 4 times daily."},{"index":5,"size":8,"text":"• The foods for young children must contain:"},{"index":6,"size":7,"text":"Fruits (like avocado, pawpaw, mangoes, ripe bananas)"},{"index":7,"size":9,"text":"Vegetables (like mashed dodo/amaranth, spinach, [young] deep greeny leafs),"},{"index":8,"size":5,"text":"Pulses/legumes (like beans, peas, soy),"},{"index":9,"size":13,"text":"• Baby porridge should be enriched with avocado, groundnuts, mukene, ripe sweet bananas,"},{"index":10,"size":27,"text":"• Mashed pumpkin or Irish-potatoes are good foods for a young child. These foods can be enriched with avocado, groundnuts, mukene, soy flour, fortified cooking oil, meats)"},{"index":11,"size":24,"text":"• Babies should be fed on 1 or 2 snacks between meals (this can include, papaw, orange fleshed sweet potato, ripe bananas, mangoes, tomatoes."}]},{"head":"Keep clean and hygienic","index":67,"paragraphs":[{"index":1,"size":9,"text":"• Use toilets to defecate and throw children's faces"},{"index":2,"size":13,"text":"• Wash hands before food preparation/cooking, before feeding/eating and after visiting the toilet"},{"index":3,"size":21,"text":"• Keep compounds around the home clean, sweep all wastes, faecal matter, droppings of animals and get rid of stagnant water"},{"index":4,"size":17,"text":"• Always have treated water in the home (boiled or chlorinated) for drinking. Drink only treated water."}]},{"head":"Seek appropriate health care","index":68,"paragraphs":[{"index":1,"size":10,"text":"• Attend the clinics (for antenatal, immunization, supplementation, deworming, check-ups)"},{"index":2,"size":14,"text":"• Immediate treatment of fever (high temperature), diarrhea, poor (difficult) breathing, poor eating/ breastfeeding"},{"index":3,"size":9,"text":"• Seek advice on child spacing and family planning"}]},{"head":"Mitigate emergencies","index":69,"paragraphs":[{"index":1,"size":9,"text":"• Prepare savings to build wealth and deter emergencies"},{"index":2,"size":12,"text":"• Invest in productive assets (livestock, businesses, better seeds and farming inputs)"},{"index":3,"size":16,"text":"• Plant fruits (avocado, papaw, etc) and vegetables (pumpkin, amaranth, orange fleshed sweet potato, traditional vegetables)"}]},{"head":"Gender","index":70,"paragraphs":[{"index":1,"size":22,"text":"• Have cohesion in the family to work together and make decisions together for improved feeding, health and wealth in the family"}]},{"head":"Food safety and hygiene","index":71,"paragraphs":[]},{"head":"Method: Presentations and discussion","index":72,"paragraphs":[{"index":1,"size":10,"text":"Activity 1: Brainstorming, question and answer as slides are presented."}]},{"head":"The facilitator asks the participants to mention their understanding of the terms mentioned below, writes the responses on a flip chart and then gives the right content as detailed in the session technical notes.","index":73,"paragraphs":[{"index":1,"size":10,"text":"1. Mention any 5 practices related to good personal hygiene."},{"index":2,"size":13,"text":"2. What do you understand by safe storage of food (raw) and water?"},{"index":3,"size":12,"text":"3. Name three important practices in preparing, cooking and storing food safely."}]},{"head":"The facilitator takes 10 minutes to wrap up the session, making any clarification needed. Supplement the points they share with points from the manual if they have not been mentioned","index":74,"paragraphs":[]},{"head":"Session technical notes","index":75,"paragraphs":[]},{"head":"Why foods and drinks must be safe and clean","index":76,"paragraphs":[{"index":1,"size":72,"text":"It is important that the food we eat and the water we drink is clean and safe. So it is essential to prepare meals in a safe, hygienic way. If germs get into our foods and drinks, they may give us food poisoning (resulting, for example, in diarrhea or vomiting). The people most likely to become sick are young children and people who are already ill, particularly people living with HIV/ AIDS."},{"index":2,"size":6,"text":"Basic rules of hygiene aim to:"},{"index":3,"size":21,"text":"• Prevent germs from reaching foods and drinks. Many germs come from human or animal faeces. Germs can reach food via:"},{"index":4,"size":13,"text":"Dirty hands, flies and other insects, mice and other animals and dirty utensils"},{"index":5,"size":9,"text":"Water supplies if they are not protected from faeces."},{"index":6,"size":34,"text":"• Prevent germs from multiplying in foods and reaching dangerous levels. Germs breed fastest in food that is warm and wet (e.g., Porridge), especially if it contains sugar or animal protein, such as milk."}]},{"head":"Learning Objectives","index":77,"paragraphs":[{"index":1,"size":26,"text":"At the beginning of the session the facilitator is expected to understand the entry level knowledge and behavior of participants in regard to the session content."},{"index":2,"size":11,"text":"By the end of the chapter, learners should be able to:"},{"index":3,"size":10,"text":"List at least four practices importance in good personal hygiene;"},{"index":4,"size":9,"text":"Practice good hygienic during food preparation, cooking and storage"}]},{"head":"Time: 60 minutes","index":78,"paragraphs":[]},{"head":"Materials needed:","index":79,"paragraphs":[{"index":1,"size":9,"text":"Flip chart, Flip chart, board, Marker pens, Block notes"},{"index":2,"size":9,"text":"To help families have clean, safe foods and drinks:"},{"index":3,"size":45,"text":"• Find out about disposal of feaces, hand washing practices, the source and storage of water and ways in which food is prepared. This helps you identify ways in which germs may be reaching food and water, and foods in which germs may be breeding."},{"index":4,"size":31,"text":"• Suggest practical ways to improve water and food hygiene. Some of the suggestions listed below may be relevant and useful. But remember not to overburden families with too much advice."}]},{"head":"Clean and safe water","index":80,"paragraphs":[{"index":1,"size":3,"text":"Advise families to:"},{"index":2,"size":48,"text":"• Use safe water, such as treated pipe water, or water from a protected source, such as a borehole or protected well. If the water is not safe, it should be boiled (rapidly for one minute) before it is drunk or used in uncooked foods (e.g., fruit juices)."},{"index":3,"size":10,"text":"• Use clean, covered containers to collect and store water."},{"index":4,"size":11,"text":"• Use clean materials to filter your water in need be."},{"index":5,"size":9,"text":"• Use clean utensils to serve and drink water."}]},{"head":"Buying and storing food","index":81,"paragraphs":[{"index":1,"size":3,"text":"Advise families to:"},{"index":2,"size":23,"text":"• Buy fresh foods, such as meat or fish, on the day they will eat them. Look for the signs of poorquality food."},{"index":3,"size":14,"text":"• Cover raw and cooked foods to protect them from insects, rodents and dust."},{"index":4,"size":20,"text":"• Store fresh food (especially foods from animals) and cooked foods in a cool place, or a refrigerator if available."},{"index":5,"size":21,"text":"• Keep dry foods such as flours and legumes in a dry, cool place protected from insects, rodents and other pests."},{"index":6,"size":33,"text":"• Avoid storing leftovers for more than a few hours (unless in a refrigerator). Always store them covered and reheat them thoroughly until hot and steaming (bring liquid food to a rolling boil)."}]},{"head":"Preparing food","index":82,"paragraphs":[{"index":1,"size":5,"text":"Advise people preparing food to:"},{"index":2,"size":20,"text":"• Keep food preparation surfaces clean. Use clean, carefully washed dishes and utensils to store, prepare, serve and eat food."},{"index":3,"size":12,"text":"• Prepare food on a clean table where there is less dust."},{"index":4,"size":11,"text":"• Wash vegetables and fruits with clean/safe water. Peel if possible."},{"index":5,"size":31,"text":"• Prevent raw meat, offal, poultry and fish from touching other foods, as these animal foods often contain germs. Wash surfaces touched by these raw foods with hot water and soap."},{"index":6,"size":14,"text":"• Cook meat, offal, poultry and fish well. Meat should have no red juices."},{"index":7,"size":14,"text":"• Boil eggs so they are hard. Do not eat raw or cracked eggs."},{"index":8,"size":18,"text":"• Boil milk unless it is from a safe source. Soured milk may be safer than fresh milk."}]},{"head":"Hygiene around the home","index":83,"paragraphs":[{"index":1,"size":3,"text":"Advise families to:"},{"index":2,"size":14,"text":"• Keep the surroundings of the home free from animal faeces and other rubbish."},{"index":3,"size":22,"text":"• Keep rubbish in a covered bin and empty it regularly in appropriate places (pits, compost) so as not to attract flies."},{"index":4,"size":16,"text":"• For easy waste management separate the waste such as plastic, glass, paper and food/plant remains."},{"index":5,"size":15,"text":"• Make compost for the garden with suitable waste food, garden rubbish and animal faeces."},{"index":6,"size":69,"text":"Composting destroys germs in faeces. The compost pit should be at least partially shaded and at least 2 feet from a structure like your house or a fence. It should be at a place convenient for you to add materials, access to water and good drainage. In addition you should take into consideration the direction of the wind so that the smell or odors doesn't come to the house."}]},{"head":"Toxins and chemicals","index":84,"paragraphs":[{"index":1,"size":79,"text":"Food and water is unsafe if it contains toxins or dangerous chemicals. A toxin called \"aflatoxin\" is produced by a molds that grows on cereals and legumes. Eating aflatoxin can make someone seriously ill. Moulds should be prevented from growing on any food items and this can be done by drying crops thoroughly and storing them in a dry place. People should desist from eating moldy foods or giving them to animals but these can be added to compost."},{"index":2,"size":16,"text":"Pesticides and other harmful agricultural chemicals may get into food or water and cause poisoning if:"},{"index":3,"size":10,"text":"• The chemical is not used in the recommended way;"},{"index":4,"size":10,"text":"• The empty containers are used for food or water."}]},{"head":"Advise people to:","index":85,"paragraphs":[{"index":1,"size":8,"text":"• Follow carefully the instructions for using chemicals;"},{"index":2,"size":9,"text":"• Be strict about keeping chemicals away from children;"},{"index":3,"size":14,"text":"• Never put food or water into containers that have been used for chemicals;"},{"index":4,"size":18,"text":"• Wash hands after using chemicals, and wash any foods (e.g., Fruit) that have been sprayed with them."}]},{"head":"Activity","index":86,"paragraphs":[{"index":1,"size":12,"text":"Discuss steps that can be taken to put these recommendations into practice."}]},{"head":"Food and nutrition assessment","index":87,"paragraphs":[{"index":1,"size":2,"text":"Method: Discussion/question/answer"}]},{"head":"Dietary assessment part I Activity:","index":88,"paragraphs":[{"index":1,"size":30,"text":"The facilitator asks for a volunteer among the participants. The participant shares what they (or their household) consumed the day before the training started. Sharing all foods eaten and drunk."},{"index":2,"size":12,"text":"The facilitator probes for in-between meals, and details of the foods consumed."},{"index":3,"size":102,"text":"The facilitator then uses this example to show the participants how to determine the dietary diversity scores whether household of individual i.e. Minimum dietary diversity score for women. The facilitator used the food groups discussed earlier and works together with the participants to establish whether the example sites meets the required diversity. About 2-3 other volunteers with one describing how they fed their child is done to ensure understanding on how to determing whether different household members are meeting the required dietary diversity. The session's technical notes are used to provide details on the dietary diversity indicators and make any clarifications needed."}]},{"head":"Session technical notes","index":89,"paragraphs":[{"index":1,"size":54,"text":"Food intake can be measured in terms of quantity and quality. However, based on our communities and the capacity of service providers available, it is difficult to capture quality. We therefore focus on assessing quality. The quality of the diets is measured by assessing the diversity of the diets at individual and household level."},{"index":2,"size":41,"text":"Assessment of dietary diversity is about consumption of a balanced diet, one that has a variety of different foods from different food groups one that provides the correct amounts of nutrients needed by the body to maintain health, growth, and development."}]},{"head":"Household dietary diversity score (HDDS)","index":90,"paragraphs":[{"index":1,"size":33,"text":"The household dietary diversity score (HDDS) reflects the economic ability of a household to access a variety of foods. An increase in dietary diversity is associated with socio-economic status and household food security."}]},{"head":"Learning Objectives","index":91,"paragraphs":[{"index":1,"size":24,"text":"At the beginning of the session the facilitator is expected to understand the entry level knowledge of participants in regard to the session content."},{"index":2,"size":10,"text":"At the end of this session participants are expected to: "}]},{"head":"Individual dietary diversity score (IDDS)","index":92,"paragraphs":[{"index":1,"size":48,"text":"Individual dietary diversity scores aim to reflect nutrient adequacy. An increase in individual dietary diversity score is related to increased nutrient adequacy of the diet. Individual scores are preferable to household scores because they provide more specific reflection of the quality of the diet and status of nutrition."},{"index":2,"size":95,"text":"When assessing individual dietary diversity, the foods consumed by the individual over a 24-hour period are established. This included all food eaten or drunk both at home and away from home. After establishing the different foods consumed, the foods are grouped into the respective food groups. 12 food groups are used, similar to those for household dietary diversity above. Consumption of 3 or less food groups is considered low dietary diversity, consumption of between 4-5 food groups is considered moderate dietary diversity while consumption of more than 6 food groups is considered high dietary diversity."}]},{"head":"Dietary diversity of women","index":93,"paragraphs":[]},{"head":"Minimum Dietary Diversity Score for Women (MDDS-W)","index":94,"paragraphs":[{"index":1,"size":52,"text":"The Minimum Dietary Diversity Score for Women is a food group diversity indicator that has been shown to reflect an additional key dimension of diet quality that is micronutrient adequacy. The foods consumed over a 24-hour period are established including all food eaten or drunk both at home and away from home."},{"index":2,"size":14,"text":"After establishing the different foods consumed, the foods are grouped into 10 food groups."},{"index":3,"size":15,"text":"Consumption of foods from any 5 food groups and above indicates meeting minimum dietary diversity."},{"index":4,"size":44,"text":"Food groups are: 1. All starchy staples; 2. Beans peas; 3. Nuts and seeds; 4. Dairy; 5. Flesh foods (meats); 6. Eggs; 7. Vitamin A rich dark green leafy vegetables; 8. Other vitamin A rich vegetables and fruits; 9. Other vegetables; 10. Other fruits."}]},{"head":"Children dietary diversity i. Minimum meal frequency (MMF)","index":95,"paragraphs":[{"index":1,"size":24,"text":"This is a proxy for the child's energy requirements and is based on how much energy the child needs whether breast fed or not."},{"index":2,"size":37,"text":"Breastfed children are considered to be fed with a minimum meal frequency if they receive solid, semi sold or soft foods at least twice a day (6-8 months) or at least 3 times a day (9-23 months)"},{"index":3,"size":30,"text":"Non-breastfed children aged 6-23 months are considered to be fed with a minimum meal frequency if they receive solid, semi sold or soft foods at least 4 times a day"},{"index":4,"size":37,"text":"It is measured as a proportion of breastfed and nonbreastfed children 6-23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more."},{"index":5,"size":10,"text":"Calculation of the proportion of women with minimum dietary diversity"}]},{"head":"ii. Minimum dietary diversity (MDD)","index":96,"paragraphs":[{"index":1,"size":25,"text":"This indicator looks at food groups a child eats. This indicator is a measure for adequate macro and micronutrients and diet variety other than breastmilk."},{"index":2,"size":23,"text":"Their diet is assessed based on 8 food groups. If a child eats at least four or more food groups, it is assumed "}]},{"head":"iii. Minimum Acceptable Diets (MAD)","index":97,"paragraphs":[{"index":1,"size":69,"text":"Proportion of children 6-23 months of age who receive a minimum acceptable diet (apart from breast milk). This indicator measures both the minimum feeding frequency and minimum dietary diversity, as appropriate for various age groups. If a child meets the minimum feeding frequency and minimum dietary diversity for their age group and breastfeeding status, then they are considered to receive a minimum acceptable diet. Minimum is considered as follows:"},{"index":2,"size":12,"text":"-2 times for breastfed infants (6-8months -3 times for breastfed children (9-23months)"},{"index":3,"size":5,"text":"-4 times for non-breastfed children/infants"},{"index":4,"size":24,"text":"Meal is defined as any solid. Semi-solid or liquid food given to the child alone or within a composite dish within the previous day."},{"index":5,"size":57,"text":"Breastfed children 6-23 months of age who had at least the minimum dietary diversity and the minimum meal frequency during the previous day Non-breastfed children 6-23 months of age who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day"},{"index":6,"size":37,"text":"This composite indicator will be calculated from the following two fractions: In the past four weeks, did you or any household member have to eat fewer meals in a day because there was not enough food? 7"},{"index":7,"size":27,"text":"In the past four weeks, was there ever no food to eat of any kind in your household because of lack of resources to get food? 8"},{"index":8,"size":24,"text":"In the past four weeks, did you or any household member go to sleep at night hungry because there was not enough food? 9"},{"index":9,"size":26,"text":"In the past four weeks, did you or any household member go a whole day and night without eating anything because there was not enough food?"}]},{"head":"Household food security indicators and measurement","index":98,"paragraphs":[{"index":1,"size":11,"text":"Time: 20 minutes Materials needed: Weighing scale, Height board, MUAC tapes"}]},{"head":"Method. Presentation and discussion","index":99,"paragraphs":[]},{"head":"Activity:","index":100,"paragraphs":[{"index":1,"size":47,"text":"After explaining minimum meal frequency, minimum dietary diversity and minimum acceptable diets for children, the facilitator presents the following children in different households. All children are 1 year old and are breast fed. And below are the number of meals and number of food groups they consumed."},{"index":2,"size":19,"text":"The facilitator reviews the refine points for each of these indicators for the example as shown in the table"},{"index":3,"size":35,"text":"The facilitator then asks the participants if the minimum meal frequency, minimum dietary diversity, and minimum acceptable diets have been met for each of the children. Placing an X or √ (for yes or no) "}]},{"head":"Anthropometric assessment","index":101,"paragraphs":[{"index":1,"size":3,"text":"Time: 60 Minutes"}]},{"head":"Method: Presentations and discussion","index":102,"paragraphs":[]},{"head":"Activity:","index":103,"paragraphs":[{"index":1,"size":13,"text":"After nutrition indicators and after the introduction of the section on anthropometric indicators"},{"index":2,"size":36,"text":"Facilitator requests for 5 Participants to volunteer, and each volunteer is allocated a measurement. Facilitators take 10 minutes teaching the volunteers how to take the respective measurements. Volunteers take 10 minutes to practice taking the measurements."},{"index":3,"size":26,"text":"The activity allows participants to cover the anthropometric measurements, how they are made and how the results are interpreted .The measurements to be taken will include:"},{"index":4,"size":6,"text":"1. MUAC 2. Weight 3. Height"}]},{"head":"Length","index":104,"paragraphs":[{"index":1,"size":19,"text":"Each group then takes 5 minutes to present how to take the measurements to the rest of the participants."},{"index":2,"size":13,"text":"The rest of the participants then take 15 minutes practicing the other measurements."},{"index":3,"size":24,"text":"Following this, the facilitator takes 10 minutes explaining the growth charts and how to plot the measurements to determine the nutrition status (stunting, underweight  "}]},{"head":"Household hunger scale (HHS)","index":105,"paragraphs":[{"index":1,"size":25,"text":"Most appropriate to use in areas of substantial food insecurity essentially a behavioural measure, captures more severe behaviours. It is based on 3 main questions:"},{"index":2,"size":22,"text":"• Was there ever no food to eat of any kind in your house because of lack of resources to get food?"},{"index":3,"size":19,"text":"• Did you or any household member go to sleep at night hungry because there was not enough food?"},{"index":4,"size":22,"text":"• Did you or any household member go a whole day and night without eating anything because there was not enough food?"},{"index":5,"size":30,"text":"For each of the questions one asks how often the occurrence was observed: never (0 times), rarely (1 or 2 times), sometimes (3-10 times, and often (more than 10 times)."},{"index":6,"size":15,"text":"One can either choose to use the HFIES or the HHS based on the context."}]},{"head":"Nutrition status assessment","index":106,"paragraphs":[{"index":1,"size":4,"text":"1. Time: 60 Minutes"}]},{"head":"Method: Presentations and discussion and demonstrations","index":107,"paragraphs":[]},{"head":"Activity:","index":108,"paragraphs":[{"index":1,"size":38,"text":"The facilitator introduces the section on nutrition status assessment. The facilitator explains that good nutrition care starts with good assessment of the nutritional status. The facilitator explains various methods of assessment which include; anthropometry, dietary, clinical and biochemical"}]},{"head":"methods. The facilitator then gives introductory paragraph about several methods, biochemical and anthropometric and scope of this manual in relation to the projects","index":109,"paragraphs":[{"index":1,"size":33,"text":"Participants form 2 groups, and each group is allocated 2 measurements. Facilitators take 10 minutes teaching the groups how to take the respective measurements. Groups take 10 minutes to practice taking the measurements."}]},{"head":"Technical session notes","index":110,"paragraphs":[{"index":1,"size":23,"text":"Anthropometry is the measurement of the human body's physical dimensions. The measures are used to establish the nutrition status of individuals and populations."}]},{"head":"Height / length 1) Height","index":111,"paragraphs":[{"index":1,"size":17,"text":"This measurement is taken for children two years and above and/or for those greater than 85 cm."},{"index":2,"size":9,"text":"The following as steps for taking accurate height measurements"},{"index":3,"size":11,"text":"• Set the measuring board vertically on a stable level surface."},{"index":4,"size":8,"text":"• Remove the child's shoes and any head-covering."},{"index":5,"size":16,"text":"• Place the child on the measuring board, standing upright in the middle of the board."},{"index":6,"size":38,"text":"• The child's heels and knees should be firmly pressed against the board by the assistant while the measurer positions the head and the cursor. The child's head, shoulders, buttocks, knees and heels should be touching the board."},{"index":7,"size":10,"text":"• Read and announce the measurement to the nearest 0.1cm."},{"index":8,"size":17,"text":"• Record and repeat the measurement to the measurer to make sure it has been correctly heard"}]},{"head":"1) Length","index":112,"paragraphs":[{"index":1,"size":24,"text":"This measurement is taken for children below two years of age and/or for those who are less than 85 cm or unable to stand."},{"index":2,"size":11,"text":"• Place the measuring board horizontally on a flat, level surface."},{"index":3,"size":9,"text":"• Remove the child's shoes and any head covering."},{"index":4,"size":18,"text":"• Place the child so he/she is lying down and face up in the middle of the board."},{"index":5,"size":23,"text":"• Allow the assistant to hold the sides of the child's head and position the head until it is touching the head board."},{"index":6,"size":39,"text":"• Allow the measurer to place his/her hands on the child and firmly hold the child's knees together while pressing down. The soles of the feet should be flat on the foot piece, toes pointing up at right angles."},{"index":7,"size":27,"text":"• The measurer should immediately remove the child's feet from contact with the footboard with one hand while holding the footboard securely in place with the other."},{"index":8,"size":45,"text":"• Read and record the measurement as shown in diagram above Ask the mother/caregiver to remove any clothing that may cover the child's less active arm. If the child can stand and it is possible, the child should stand erect and sideways to the measurer."},{"index":9,"size":24,"text":"Bend the arm at 90. Estimate the midpoint of the upper arm by locating the tip of the shoulder and tip of the elbow."},{"index":10,"size":31,"text":"Straighten the child's arm and wrap the tape around the arm at the midpoint. Make sure the numbers are right side up. Make sure the tape is flat around the skin."}]},{"head":"Oedema","index":113,"paragraphs":[{"index":1,"size":48,"text":"Oedema is a build-up of fluids in the tissues causing abnormal swelling of the hands and feet or other body parts. The body requires nutrients for various processes that lead to normal fluid balance. Oedema caused by malnutrition has to occur in both limbs at the same time."}]},{"head":"Measuring oedema","index":114,"paragraphs":[{"index":1,"size":8,"text":"• Apply normal thumb pressure on both feet"},{"index":2,"size":15,"text":"• Count the numbers 101, 102, 103 to estimate three seconds without using a watch"},{"index":3,"size":10,"text":"• Check if a shallow print persists on both feet"},{"index":4,"size":21,"text":"• If the print persits in both feet, it implies the child has nutritional odema (pitting oedema) and is severely malnourished"}]},{"head":"Recommendations","index":115,"paragraphs":[{"index":1,"size":17,"text":"• If no oedema is found (0): Advise the caregiver to continue with healthy feeding the baby"},{"index":2,"size":14,"text":"• If oedema is found, the child should be referred to a health facility."},{"index":3,"size":9,"text":"• Follow-up to ensure the child went for healthcare"}]},{"head":"Referral of malnourished children","index":116,"paragraphs":[{"index":1,"size":14,"text":"It is important that the malnourished children identified are referred to a health facility."},{"index":2,"size":99,"text":"The existing government health structures can be used, starting with a referral to the village health worker Community Health Extension Workers (CHEWs) are individuals within the community who are equipped to further refer the child to the appropriate health facility. The participants and the project management team can also be guided to develop an appropriate referral and reporting system. Because of its complexity and proneness to mistakes, Weight-for-Height/Length the persons taking the measurement need to be trained on how to use the equipment and that there is a need to do more than 1 measurement to catch any errors."},{"index":3,"size":24,"text":"Weight-for-Height implies the following steps:-Taking the height or length Calculating the weight for height/length percentages Taking the weight of a child/adolescent using electronic scales:"},{"index":4,"size":10,"text":"1. Place the electronic scale on a flat, level surface."},{"index":5,"size":9,"text":"2. Check and readjust the weight reading to zero."},{"index":6,"size":4,"text":"3. Undress the child."},{"index":7,"size":11,"text":"4. Make him/her stand on the middle of the scale's surface."},{"index":8,"size":38,"text":"5. When the child is settled and the weight reading is stable record the weight to the nearest 100g. Make sure that nobody holds the child during weighing and that the child stands freely without holding onto anything."},{"index":9,"size":23,"text":"6. Read and announce the value from the scale. The assistant should repeat the Value for verification and record 7. Record it immediately."},{"index":10,"size":11,"text":"Taking the weight of a caregiver with child using electronic scales:"},{"index":11,"size":10,"text":"1. Place the electronic scale on a flat, level surface."},{"index":12,"size":9,"text":"2. Check and readjust the weight reading to zero."},{"index":13,"size":4,"text":"3. Undress the child."},{"index":14,"size":39,"text":"4. Ask the caregiver to stand on the scale's surface in the middle and record their weight to the nearest 100g when the caregiver is settled and the weight reading is stable 5. Hand the child to the caregiver."},{"index":15,"size":22,"text":"6. When the caregiver is settled with the child and the weight reading is stable record the weight to the nearest 100g."},{"index":16,"size":21,"text":"7. Read and announce the value from the scale. The assistant should repeat the value for verification and record it immediately."}]},{"head":"Adults body mass index (BMI)","index":117,"paragraphs":[{"index":1,"size":50,"text":"A quite different anthropometric index is used to measure acute protein-energy malnutrition (sometimes called \"chronic energy deficiency\") in adults). This is the body mass index (BMI) unlike weight-for-height in children, you divide weight by height, or rather, and you divide weight in kilograms by the square of height in meters:"},{"index":2,"size":105,"text":"The cut-off point defining malnutrition is the same for all adults, regardless of their age, height, or sex: The household dietary diversity score (HDDS) is meant to reflect, in a snapshot form, the economic ability of a household to access a variety of foods. The increase in dietary diversity is associated with socio-economic status and household food security (household energy availability). To measure household dietary diversity, 12 standard food groups. Consumption of less than 4 food groups is considered low dietary diversity, consumption of between 4-5food groups is considered moderate dietary diversity while consumption of more than 6 food groups is considered high dietary diversity."},{"index":3,"size":33,"text":"Individual dietary diversity scores aim to reflect nutrient adequacy. Studies in different age groups have shown that an increase in individual dietary diversity score is related to increased nutrient adequacy of the diet."},{"index":4,"size":64,"text":"House Hold Hunger Scale (HHS); this focuses on the food quantity dimension of food access and does not measure dietary quality. It can be used to monitor prevalence of hunger over time, assess food security situation, monitor and evaluate the impact of ant hunger policies and programs, provide information for early warning of nutrition and food security surveillance. This involves asking 3 main questions:"},{"index":5,"size":22,"text":"• Was there ever no food to eat of any kind in your house because of lack of resources to get food?"},{"index":6,"size":19,"text":"• Did you or any household member go to sleep at night hungry because there was not enough food?"},{"index":7,"size":22,"text":"• Did you or any household member go a whole day and night without eating anything because there was not enough food?"},{"index":8,"size":9,"text":"For each question one asks how frequently that happened."},{"index":9,"size":47,"text":"HHS should therefore not be used as a standalone measure of food security but instead as one of the tools to measure complimentary aspects of food insecurity (such as anthropometric data, House hold income and expenditure, Food production and consumption and House hold and individual dietary diversity."}]}],"figures":[{"text":" plans for PMU members "},{"text":"Figure 2 . Figure 2. Example sources of animal protein. "},{"text":"Figure 3 . Figure 3. Example sources of plant protein. "},{"text":"Figure 4 . Figure 4. Example sources of vitamins and minerals. "},{"text":" Cereals and grains (6 slices of bread / 2 cupped palms Cooked Ugali, Matoke, Boiled banana / 3 cupped palms cooked Rice / 3 medium pieces of Cassava or Sweetpotatoes) "},{"text":"Figure 5 . Figure 5. The food pyramid. "},{"text":" Continue breast feeding up to at least 2 years of age even as you provide other foods If a child is sick, encourage them to eat and drink, even if they have little appetite. Increase breastfeeding frequency, provide more fluids (water, juice, soup) Ensure the diet includes foods rich in protein, vitamin A and iron to ensure the child's growth Obtain vitamin A supplementation for children under 5 years from the health centre Deworm all children every 6 months starting at 2 years Ensure that children are fully immunized and keep the health card/book safely Use iodized salt in the home for the whole family. Iodine promotes physical development and prevents miscarriages Have a backyard garden with different green leafy vegetables to provide the vegetables needed by the family throughout the year Important nutrition points to remember 3.0. Malnutrition Method: Presentations and discussion Activity 1: Brainstorming, question and answer as slides are presented. "},{"text":"Figure 6 : Figure6: showing conceptual framework of malnutrition(UNICEF, 1991)     "},{"text":"Figure 8 : Figure 8: clinical signs of anemia (source-UNICEF 2014) "},{"text":"Figure 9 : Figure 9: Picture showing Bigot's sport in a person with vit A deficiency (source-UNICEF 2014) "},{"text":"Figure 10 : Figure 10: Picture showing goitre as an advanced sign of iodine deficiency (source-UNICEF 2014) "},{"text":"Figure 13 .Figure 14 : Figure 13.Figure 2.Measuring the length of a child below 2 years of age.(source: Modified from multiple indicator cluster surveys) "},{"text":"Figure 15 . Figure15.assessment of bilateral oedema(UNICEF 1991)     "},{"text":"  "},{"text":"  "},{"text":"  "},{"text":"Types of nutrients Facilitator asks the participants to mention the types of nutrients they know of and examples of food items available in their community that are rich in each of the nutrients listed, let participants mention as many types as they can. After the participants provide the responses the facilitator moves forward to provide the right information and details as provided in the session technical notes and ensuring there is great participation and discussion during the process and welcoming questions and making clarifications.  Time: 60 minutes Time:60 minutes Method: Question / answer Method:Question / answer Materials needed: Flip chart, Flip chart board, Marker pens, Block notes Materials needed: Flip chart, Flip chart board, Marker pens, Block notes Session technical notes Session technical notes 1. Macro (big) nutrients 1. Macro (big) nutrients These are nutrients needed in large amounts. They These are nutrients needed in large amounts. They include:  include:  "},{"text":" Which continues the cycle. It is therefore important that interventions to address and prevent malnutrition are taken at each stage of the life cycle. An illustration of the cycle of malnutrition   An illustration of the cycle of malnutrition The Cycle of Undernutrition  The Cycle of Undernutrition Inadequate food and health care PREGNANT WOMEN Low weight gain Increased maternal  Inadequate food and health carePREGNANT WOMEN Low weight gain Increased maternal  mortality  mortality ADOLESCENTS Stunted growth Decreased physical capacity ADULT MEN AND WOMEN Poor health Poor productivity in the work force INFANTS Low birth weight High mortality rate Impaired mental development Increased risk of adult ADOLESCENTS Stunted growth Decreased physical capacityADULT MEN AND WOMEN Poor health Poor productivity in the work forceINFANTS Low birth weight High mortality rate Impaired mental development Increased risk of adult   chronic disease chronic disease Inadequate food and health care CHILDREN Stunted growth Impaired immunity Reduced mental capacity Inadequate food and health care Frequent infections Inadequate food and health careCHILDREN Stunted growth Impaired immunity Reduced mental capacityInadequate food and health care Frequent infections Frequent infections   Frequent infections Copyright 2010, John Wiley & Sons, Inc.  Copyright 2010, John Wiley & Sons, Inc.  "},{"text":"Table showing child dietary diversity score exercise   Minimum Minimum Minimum MinimumMinimumMinimum  meal dietary acceptable diet mealdietaryacceptable diet  frequency diversity  frequencydiversity Reference 3 times a 4 food Has both Reference 3 times a4 foodHas both  day groups minimum meal daygroupsminimum meal    frequency, frequency,    minimum dietary minimum dietary    diversity diversity 1 2 (No) 4 (yes) No 12 (No)4 (yes)No 2 3 (yes) 3 (no) No 23 (yes)3 (no)No 3 4 (yes) 3 (no) No 34 (yes)3 (no)No 4 3 (yes) 5 (yes) Yes 43 (yes)5 (yes)Yes  "},{"text":"Table showing questions used to assess household food insecurity  1 Worry that you would not have enough food 1Worry that you would not have enough food  because of a lack of food, money or other because of a lack of food, money or other  resources?  resources? 2 Not able to eat healthy and nutritious food 2Not able to eat healthy and nutritious food  because of a lack of food, money or other because of a lack of food, money or other  resources?  resources? 3 Eat a limited variety of food because of a lack of 3Eat a limited variety of food because of a lack of  food, money or other resources? food, money or other resources? 4 Skip a meal because of a lack of food, money or 4Skip a meal because of a lack of food, money or  other resources?  other resources? 5 Eat a smaller meal than you felt you needed 5Eat a smaller meal than you felt you needed  because of a lack of food, money or other because of a lack of food, money or other  resources?  resources? 6 Have no food to eat of any kind in your household 6Have no food to eat of any kind in your household  of a lack of resources to get food? of a lack of resources to get food? 7 Were hungry but not able to eat of a lack of 7Were hungry but not able to eat of a lack of  resources to get food?  resources to get food? 8 Go a whole day without eating anything at all 8Go a whole day without eating anything at all  because of a lack of resources to get food? because of a lack of resources to get food? The answers are placed on a scale of severity of food The answers are placed on a scale of severity of food insecurity as shown below:  insecurity as shown below: Mild food insecurity  Severe food insecurity Mild food insecuritySevere food insecurity Uncertainty regarding Compromising on food Reducing food quantities, Experiencing Uncertainty regardingCompromising on foodReducing food quantities,Experiencing ability to obtain food quality and variety skipping meals hunger ability to obtain foodquality and varietyskipping mealshunger  "},{"text":" Is a food group diversity indicator that has been shown to reflect one key dimension of diet quality especially micronutrient adequacy. Ten food groups are considered here namely; 1. All starchy staples; 2. Beans peas; 3. Nuts and seeds; 4. Dairy; 5. Flesh foods (meats); 6. Eggs; 7. Vitamin A rich dark green leafy vegetables; 8. Other vitamin A rich vegetables and fruits; 9. Other vegetables; 10. Other fruits. Consumption of foods from any 5 food groups and above indicated meeting minimum dietary diversity. Anthropometric equipment needed Minimum Dietary Diversity Score for Women  Anthropometric equipment needed Minimum Dietary Diversity Score for Women (MDDS-W):   (MDDS-W): Height: height boards Weight: weighing scales MUAC: MUAC tapes Height: height boardsWeight: weighing scalesMUAC: MUAC tapes  "}],"sieverID":"99f097c2-c502-4046-a5ba-0703aa69313f","abstract":"Key messages from the sessions 4:30 -4.50 pm (20 minutes)Way forward How they will mainstream nutrition into the PRELNOR and VODP II frame work 4:50 -5:00pm Closure"}