Nutrition-Specific Interventions

 After completing Session , you will:

• Know the definition of nutrition-specific
interventions
• Be able to describe 10 key nutrition-specific
interventions
• Understand the role of the health system in
supporting nutrition
Understanding Nutrition Interventions
 
 
• Since the causes of malnutrition (both over- and
undernutrition) are multifaceted, there is increased recognition
that multi-sectoral approaches are required. the main
interventions for preventing and treating malnutrition
according to whether they are considered nutrition-specific or 
nutrition-sensitive.
• Nutrition-specific interventions are those that address the
immediate causes of malnutrition, with an aim of reducing
stunting, wasting, micronutrient deficiencies, and risks of
overweight. 
• Nutrition-sensitive interventions are those that address the
underlying causes of malnutrition, such as access to food,
caring practices, and access to health and hygiene services.
These interventions aim to create conditions that facilitate
good health and nutrient intake. 
10 Key Nutrition-Specific Interventions
• Ten nutrition-specific interventions at critical
points in the life cycle can have a dramatic
impact on reducing malnutrition globally.
• If scaled up to 90% coverage, it is estimated
that these evidence-based interventions could
reduce stunting by 20% and severe wasting by
60%:
10 Key Nutrition-Specific Interventions
1. Breastfeeding

• Breastmilk provides all of the vitamins, minerals, enzymes, and

antibodies that children need to thrive in their first 6 months.
• Recommended breastfeeding practices include:
• Early initiation of breastfeeding, immediately after birth
• Exclusive breastfeeding until the age of 6 months
• Continued breastfeeding, complemented by other nutritious
family foods, until 2 years of age and beyond

• Exclusive breastfeeding until an infant is 6 months of age is one of

the most effective of all child health interventions. Exclusive
breastfeeding means that an infant receives only breastmilk and no
other foods or liquids, including water or tea (even in hot weather).
• Breastfeeding confers many health and developmental
benefits.
• Optimal breastfeeding until a child is 2 years old can prevent
more than 800,000 deaths in children under age 5 and 20,000
deaths in women every year.
• Early initiation of breastfeeding is also good for the
mother’s health, reducing postpartum bleeding and helping
expel the placenta.
• New evidence indicates that breastfeeding may also be
protective against obesity and diabetes later in life.

 
Sources: UNICEF 2011; Victora et al. 2016; WHO 2009a
• Continued breastfeeding: Global
recommendations state that children should
continue to be breastfed until they are at least 2
years old.
• Did You Know?
• Exclusive breastfeeding has many benefits for
maternal health. It delays the return of the menstrual
cycle, helping the mother to recover her iron stores.
Exclusive breastfeeding can also act as a natural form
of birth control for the first 6 months after delivery,
providing menstruation has not restarted. Women
who breastfeed also have lower rates of
premenopausal breast and ovarian cancers.
• Source: WHO/UNICEF/USAID 2008
Barriers to Breastfeeding

• There are many barriers that prevent women from

carrying out the recommended breastfeeding
practices. Effective promotion of breastfeeding must
seek to protect and promote breastfeeding, while
also supporting families to overcome these barriers.
• Community and Cultural Pressures | Many
mothers are given poor advice or are pressured into
providing food, water, or breastmilk substitutes by
the people around them—especially their peers,
older women in the family, or their partners. 
• Although most women around the world are able to
successfully breastfeed, many need support to address
physical challenges, build their confidence, and overcome
common misperceptions about breastfeeding.
 
• Health Workers’ and Health Facility Practices | In many
low- and middle-income countries, infants are born without
a skilled birth attendant. When mothers do deliver in a
health facility, often health workers are not fully trained or
do not have the knowledge needed to support breastfeeding.
Women may also experience physical problems with
breastfeeding, such as cracked nipples, engorgement, or a
breast infection (mastitis), which require support and
specific care.
• Work-Based Barriers | Many countries lack
maternity legislation to support working mothers.
Often, mothers return to work soon after giving
birth, making it difficult to exclusively breastfeed or
continue breastfeeding for 2 years. Policies that
provide for paid maternity leave and workplace
protections for breastfeeding mothers are important
for supporting continued breastfeeding.
 
HIV and Infant Feeding
• Although HIV can be transmitted through
breastmilk, breastfeeding is generally the safest
option for an infant in resource-poor settings. 
WHO released updated guidance on infant feeding and
HIV in 2016. This guidance seeks to inform context-
specific national strategies and guidelines, which should
serve as the basis for the counseling and information
given to mothers. The global guidance recommends that
lactating mothers living with HIV should:
• Exclusively breastfeed their children for the first 6
months
• Continue breastfeeding, with complementary foods, for
at least 12 months
• Continue breastfeeding until a nutritionally adequate
and safe diet can be provided without breastmilk
• Antiretroviral therapy (ART) greatly reduces the
risk of postnatal HIV transmission from a mother to
her child, even if the infant is exclusively breastfed.
WHO recommendations released in 2015 state that
all pregnant women living with HIV should receive
lifelong ART.
• Skilled counseling and support for appropriate
infant feeding practices and antiretroviral (ARV)
drug interventions to promote the HIV-free survival
 of infants should also be available to all pregnant
women and mothers during antenatal care, delivery,
and postnatal services.
 Did You Know?
• Consumption of junk food is increasing among children
around the world, and has led to rising rates of
overweight and obesity. Young children in many
countries, especially among urban populations, are
often given junk foods as snacks.
• To address this, health care providers and families need
to be made aware of heathy versus unhealthy weight
gain in children and how junk foods can be detrimental
to children’s growth.
• Counseling parents on healthy nutrition, advocating for
appropriate food labeling, and regulating the marketing
of junk food and sweetened beverages to children are
strategies for reducing its consumption. 
2. Micronutrient Interventions

• Micronutrient deficiencies, including deficiencies of vitamin A,

iron, iodine, zinc, and folic acid are common among women
and children, particularly in low- and middle-income countries.
Ensuring adequate micronutrient status in women of
reproductive age and children under 5 improves the health of
expectant mothers, the growth and development of children in
the first 1,000 days, and the survival and physical and mental
development of children.
Strategies to improve micronutrient status mainly fall into four
categories:
a. Promotion of foods that are rich in nutrients: For example,
increased consumption of orange-fleshed sweet potatoes has
been shown to reduce vitamin A deficiency.
b.Preventive supplementation: Large-scale
supplementation is usually administered
through public health programs to meet the
micronutrient needs of a population, or specific
sub-groups such as pregnant women and
children under 5.
c. Supplements can be for individual nutrients, or
a formula that includes multiple micronutrients.
For example, folic acid is given to women
before and during pregnancy to prevent birth
defects in their newborn children. 
d. Fortification of foods that are commonly consumed by
households: This involves the addition of micronutrients to staple foods
that are consumed regularly by the target population. For example, salt is
often fortified with iodine, vitamin A is added to oil and sugar, and
multiple micronutrients are added to wheat and maize flour.

Treatment of micronutrient deficiencies:

•  Micronutrient deficiencies can be diagnosed through blood testing, and
treatment usually consists of high-dose supplements. Case-finding and
treatment should be integrated within health services and within food
security interventions when feasible.
• It is not enough to supply missing micronutrients;
micronutrient interventions must be complemented
by strategies that help ensure the body’s ability to
absorb the nutrients it receives. Some examples of
interventions to improve nutrient absorption
include
– promoting exclusive breastfeeding, effective delivery of
health interventions, and
– using cooking techniques that preserve nutrients.
3. Micronutrient Supplementation for Children
• The micronutrient interventions that have been
shown to improve the health and nutrition of
children include:
a. Micronutrient powders: Multiple micronutrient
powders (MNP) are single-dose sachets of
vitamins and minerals in powder form that can be
mixed into foods. Iron delivered through MNP
has been shown to reduce the risk of iron
deficiency and anemia in children, and is
recommended in locations where the prevalence
of iron deficiency in children under the age of 5 is
greater than 20%.
b. Vitamin A supplementation for children: WHO recommends
that in settings where vitamin A deficiency is a public health
problem, high-dose vitamin A be given to infants and children 6-
59 months of age. For a child 6-59 months of age, one high-dose
vitamin A capsule taken twice a year can reduce mortality
from all causes by around 24%. Interventions to provide vitamin
A to children are often organized around National Immunization
Days and Child Health Weeks, or through other outreach
strategies.

c. Zinc supplementation can reduce the incidence of diarrhea and

pneumonia in children. When provided for 10-14 days to a child
with diarrhea, zinc supplementation, alongside oral rehydration
therapy, will reduce the duration of acute diarrhea up to 25%
and is also associated with a 42% reduction in treatment failure
and death. 
 IV. Maternal Nutrition Interventions

• A healthy pregnancy requires a diet that includes an adequate and

balanced intake of energy, protein, vitamins, and minerals to meet
maternal and fetal needs.
• However, for many pregnant women, dietary intake of vegetables,
meat, dairy products, and fruit is often insufficient to meet these
needs. In much of sub-Saharan Africa and Asia, maternal
undernutrition is a key determinant of poor pregnancy and birth
outcomes. However, obesity and overweight, as well as excessive
weight gain during pregnancy, are also associated with poor
pregnancy outcomes.
• WHO recommends counseling during reproductive and antenatal
care about healthy eating and physical activity to promote healthy
weight gain during pregnancy.
In addition, a range of micronutrient interventions seek
to improve maternal nutrition:
a. Iron-folic acid supplementation: Neural tube
defects are birth defects in the brain, spine, or spinal
cord. They often occur before a woman is even aware
that she is pregnant. Folic acid supplementation
before and during pregnancy can reduce these defects
by 72%. Folic acid is often provided in conjunction
with iron, to meet the additional needs of the mother
in pregnancy and to treat anemia. Iron-folic acid
tablets are part of the standard antenatal care package
according to national policies. The dosage is 60 mg
per day of iron and 400 mcg per day of folic acid.
Prevention and Control of Anemia
1. Anemia and undernutrition share many common causes,
including poor health, hygiene, and micronutrient
deficiencies.. The two most common causes of anemia
are micronutrient deficiency and infection and
inflammation due to malaria and worm infestation.
2. Among pregnant women, supplementation with iron-
folic acid tablets can reduce the risk of anemia among
infants at birth by 73%. Supplementation with iron-
folic acid is recommended throughout pregnancy
(typically, this begins as soon as pregnancy is confirmed
or is planned) and for an additional 3 months postpartum
in areas with anemia prevalence above 40%.
3. Delayed clamping of the umbilical cord (waiting 1-
3 minutes after delivery to clamp the cord) is
recommended to improve the infant's iron stores
during the first six months of life.
4. Deworming is a simple intervention, and its
importance is often overlooked. Treating helminth
 infections can reduce anemia by up to 12.4% in
adults. Wherever prevalence of hookworm is 20-
30%, provision of deworming medication should be
part of antenatal care. 
5. Malaria is a common cause of anemia in pregnant
women.
– Sleeping under an insecticide-treated net during
pregnancy has been associated with a 47% reduction of
severe malarial anemia and a 23% reduction in the risk
of low birthweight. 
– Intermittent preventive treatment in
pregnancy (providing preventive antimalarial medicines
to mothers starting in the second trimester) is associated
with a 12% reduction in maternal anemia (during the third
trimester or at delivery) as well as a reduction in low
birthweight. As part of antenatal services, at least 3 doses
of antimalarial should be given “presumptively” to a
pregnant woman (in areas of stable malaria transmission),
though the number of minimum doses required varies
from country to country.
b. Maternal calcium supplementation: WHO
recommends daily calcium supplementation
for pregnant women in places where there is
low calcium intake in the diet. Calcium
supplementation has been found to lower the
risk of preeclampsia in pregnancy, one of the
leading causes of maternal deaths and preterm
births.
c. Balanced energy protein supplementation (that
is, nutritional supplements that provide less than
25% of energy from protein) can help promote
appropriate weight gain during pregnancy, as well as
fetal growth. Evidence suggests that this
supplementation reduces the incidence of 
small for gestational age by 32% and the risk of 
stillbirths by 45%. Given the cost of
supplementation, more information is needed on
implementation approaches for this intervention.