Protection, Promotion and Support of Healthy Maternal, Infant and Young Child Feeding

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The Essential Nutrition Actions (ENAs) Approach

Control of Iron Deficiency Anaemia (IDA)

1. Control of Maternal IDA

Iron/Folic Acid or multiple micronutrient supplementation:

• All pregnant women should receive 30 Iron/Folic Acid tablets a month for six months (180 tablets in total). Health workers should provide enough Iron/Folic Acid tablets to last until the next foreseen ante-natal care.
   
• All pregnant women should be counselled on side effects, compliance and safety of IFA supplements.
   
• All pregnant women should be counselled on importance of adhering with daily intake of one tablet of Iron/Folic Acid (daily intake of one IFA tablet - 60 mg iron + 400 µg folic acid) for six months.
   
• All pregnant women should be screened for pallor on every visit.
   
• Pregnant women with pallor should receive Iron/Folic Acid supplementation according to IDA treatment protocol.
   
• Breastfeeding women should continue to receive IFA supplementation in the first three months postpartum where prevalence of anaemia is equal or more than 40%. Where prevalence of anaemia is less than 40%, only breastfeeding women who did not receive the recommended amount during pregnancy should be provided with IFA supplementation in the first three-six months postpartum.

Adequate micro-nutrient intake

• All women should be counselled on how to increase iron-intake through locally available iron-rich sources including combining foods that help absorption and avoiding foods that hinder absorption.
   
• Low-income pregnant or lactating women who can not access the minimum required diet should be supported by means of fortified food supplementation and sprinkles.

De-worming in endemic areas

• All pregnant women should receive a single dose of Albendazole (400 mg) or a single dose of Mebendazole (500 mg) in the second trimester (4th - 6th month). If hookworms are highly endemic (prevalence more than 50%), pregnant women should be given a second does in the third trimester (7th - 9th month).
   
• All pregnant women should be advised on preventive measures (sanitation and foot-wear).

Malaria control in endemic areas

• All pregnant women should receive 2 Doses of IPT:
  
  First dose:       3 tablets SP once during the 4th to 6th months of pregnancy.
  Second dose: 3 tablets SP once during the 7th to 9th months of pregnancy.
   
• All pregnant and breastfeeding women should be promptly treated for clinical infections
   
• All pregnant and breastfeeding women should be counselled on how to use the Insecticide Treated Net (ITN)

2. Control of Child IDA

At delivery:

• Cord clamping of all new born children should be delayed for two minutes at least.
   
• New born children who are premature and/or with low-birth weight should be identified for further follow-up.

Iron/Folic Acid or multiple micronutrient supplementation:

• All children with normal birth weight should receive IFA supplementation (12.5 mg iron + 50 µg folic acid daily) from 6 to 12 months where prevalence of anaemia is less than 40% OR from 6 to 24 months where prevalence of anaemia is equal or more than 40%. NOTE: Iron dosage is based on 2 mg/iron body weight/day.
   
• All children born premature or with low birth weight should receive IFA supplementation (12.5 mg iron + 50 µg folic acid daily) from 2 to 24 months.
   
• All children should be screened for anaemia using pallor and treated according to the IDA treatment protocol.
   
• HIV exposed or infected children who are on home-modified animal milk should receive additional care (infant feeding in the context of HIV)

NOTE: Research is still on-going to determine the most cost-effective dosing regimen of iron supplementation to other population groups. The efficacy of once or twice-weekly iron supplementation appears promising for the following population groups: children 2-5 years - 20-30 mg iron; children 6-11 years - 30-50 mg iron; adolescents and adults - 60 mg iron (for girls or women of reproductive age, 400 folic acid should be included with the iron supplementation for the prevention of birth defects)

Adequate micro-nutrient intake

• Infants should be exclusively breastfed for the first six months and continue to be breastfed up to twenty-four months.
   
• At six months, infants have consumed all their iron stock-up from birth and need to be given locally available iron-rich sources in addition to breast milk.
   

• Children 6-35 months from low-income families that can not access the minimum required diet should be supported by means of fortified food supplementation and sprinkles.

De-worming in endemic areas

• All children aged 1-5 years should receive a single dose of Albendazole (200 mg for children 1 to 2 years and 400 mg for children over 2 years) or Mebendazole (250 mg for children 1 to 2 years and 500 mg for children over 2 years) every six months.
   
• Adequate sanitation and footwear can prevent infection from hookworms.

Malaria control in endemic areas

• All children should be promptly treated for clinical infections
   
• All children should sleep under a Insecticide Treated Net (ITN)

02 January, 2009