Service provider observes a breastfeed session to assess position and attachment and counsels

• Service provider asks about  any complications or challenges a mother is facing and counsels on solutions.
• Service provider assesses and counsels to make sure the mother:
  - Has not introduced other foods/fluids to the baby.
  - Feeds the baby on-demand, day and night (at least 8 times).
  - Empties one breast before giving the other.
• All HIV negative / not knowing status lactating mothers are encouraged to go for testing and to practice safer sex while breastfeeding.
• All HIV+ mothers who are breastfeeding are counselled on when and how to interrupt breastfeeding.

NOTE: Lactating mothers can continue breastfeeding also during illness and pregnancy.

• All HIV+ mothers are counselled privately to avoid spill-over.

Service provider:

• Asks mothers to bring their own cup and spoon to show (even mark on the cup) average amounts of animal’s milk or formula per feed based on baby’s age.
• Observes a feeding session to assess preparation, use of cup and spoon and sanitation maintenance.
• Asks about  any complications or feeding challenges a mother is facing and counsels on solutions.
• Assess to make sure the mother is not breastfeeding the baby (i.e. mixed feeding).

All lactating mothers are counselled on:

• Increased energy intake through two additional meals a day.
• Varied diet (cereal/starchy roots plus animal foods/legumes/nuts plus fruit/vegetable).
• Reduced workload.
• Daily use of iodized salt for all family members.
• All lactating mothers are assessed to ensure they take daily Iron/Folic Acid or multiple micronutrient supplementation, if the six months were not completed during pregnancy.

All mothers are counselled on:

• How to continue breastfeeding until two years (if not HIV+).
• When and why to start complementary feeding (6 months).
• How to provide children with frequent small feeds throughout the day.
• How to increase the amount and density of food as the child gets older and use a separate bowl for each child.
• How to ensure the child has a variety of food, use energy dense foods and use of fortified foods.
• How to interact with the child during feeding (active feeding).
• How to safely prepare and store the child’s food.

1. Monthly growth monitoring using the Salter Scale and the Child Health Card

• All children are weighed and growth is plotted on the Child Heath Card and their mothers are adequately informed and counselled.
• Children who do not gain weight for more than two months or are losing weight or fall below the bottom line are promptly referred / treated.

• Children over 6 months with length above 65 cm are screened using MUAC tape if they look malnourished and if they do not have a previous growth record.
• Children with moderate and severe malnutrition are promptly referred / treated.

• All infant born premature or with low birth weight receive supplementation of iron without folic acid at 61st day according to protocol.
• All children, especially infant on animal’s milk, are screened for Anaemia using pallor.
• Children with pallor are referred or treated according to protocol  and in conjunction with the measures to prevent and control malaria (WHO Guideline 1998 and Uganda Anaemia Policy 2002).
• Bi-annual de-worming of children between 1-5 years

• All mothers receive one 200,000 IU dose of Vitamin A within 8 weeks after delivery.
• All infant under 6 months not on breast milk are given 50,000 IU of Vitamin A.
• All children aged 6months to 1 year receive one 100,000 IU dose of Vitamin A.
• Children >12 months receive 200,000IU dose of Vitamin A every six months.