1. NUTRITION AND PRIMARY HEALTH CARE
NUT THREE SLIDES 2005
May2005
NUTRITION AND PRIMARY HEALTH CARE
PHN 804
January 2012
Nutrition matters throughout life, but it matters most when it affects growth and development. Most growth faltering, as indicated by being underweight or stunted, occurs from birth until about 2 years of age and it may already start during the gestation period

2. Causes of and strategies for under-nutrition throughout the life cycle
NUT THREE SLIDES 2005
May2005
Causes of and strategies for under-nutrition throughout the life cycle
Nutrition matters throughout life, but it matters most when it affects growth and development. Most growth faltering, as indicated by being underweight or stunted, occurs from birth until about 2 years of age and it may already start during the gestation period

3. Nutrition and the life cycle
NUT THREE SLIDES 2005
Nutrition and the life cycle
May2005
Optimal nutrition at different stages of the life cycle
The close interrelationships among selected stages of the life cycle- periconception, pregnancy, lactation, infancy and adulthood are presented schematically in Figure 1
Good nutrition at each of these stages of the life cycle contributes to optimal growth and development of infants and children and a healthier adult population.
Fig 1. Relationship among the life stages

4. Learning Objectives
By the end of this module the learner should be able to:
Describe importance of nutrition for all ages of the life cycle
Outline the effects of malnutrition through the lifecycle
Discuss strategies to break the malnutrition cycle.

5. The Cycle of Under-nutrition
NUT THREE SLIDES 2005
May2005
The Cycle of Under-nutrition
Child growth failure
Low birth
weight babies
Early
pregnancy
Low weight and
height in teens
Slide 12 The Intergenerational Cycle of Malnutrition
Intergenerational links drive the cycle of malnutrition: small maternal size leads to low birth weight and subsequent growth failure in children, leading to small adult women. This diagram also illustrates the effects of early pregnancy, which causes low birth weight in the current pregnancy and in future pregnancies by inducing the mother’s premature cessation of growth.
Small adult women
ACC/SCN, 1992

6. The cycle of under-nutrition
NUT THREE SLIDES 2005
The cycle of under-nutrition
May2005
Under nutrition that occurs during childhood, adolescent and pregnancy has as additive negative impact on the birth weight of infants.
Intrauterine growth retardation (IUGR) leads to a far higher risk of dying in the neonatal period or later infancy.
A low –birth weight infant is thus more likely to be underweight or stunted in early life.
Effects of under nutrition through out the life cycle
Low-birth weight (LBW) infants who have suffered intrauterine growth retardation (IUGR) as fetuses are born
undernourished and are at a far higher risk of dying in the neonatal period or later infancy.
If they survive, they are unlikely to significantly catch up on this lost growth later and are more likely to experience a variety of developmental deficits.
A low –birth weight infant is thus more likely to be underweight or stunted in early life.

7. Causes of Under-nutrition

8. Life time consequences of being born undernourished
NUT THREE SLIDES 2005
May2005
Life time consequences of being born undernourished
Life time consequences of being born undernourished
As depicted in Figure 2. Poor nutrition often starts in utero and extends, particularly for girls and women, well into adolescent and adult life.
It also spans generations.
Low-birth weight (LBW) infants who have suffered intrauterine growth retardation (IUGR) as fetuses are born undernourished and are at a far higher risk of dying in the neonatal period or later infancy.
If they survive, they are unlikely to significantly catch up on this lost growth later and are more likely to experience a variety of developmental deficits.
Figure 2. Effects of malnutrition throughout the life cycle

9. Biological and Social risk factors for under-nutrition
NUT THREE SLIDES 2005
May2005
Biological and Social risk factors for under-nutrition
Infancy and early childhood (0-24 months)
Suboptimal breastfeeding practices
Inadequate complementary foods
Infrequent feeding
Frequent infections
Slide 8: Maternal Malnutrition: A Life-Cycle Issue (one)
Women are vulnerable to malnutrition throughout the life cycle for both biological and social reasons.
Infancy and early childhood (0–24 months). Most young girls living in poor environments are suboptimally breastfed in infancy and early childhood, receive infrequent and poor complementary foods (both in quantity and/or quality), and suffer frequent infections. Such nutritional neglect during the first two years of life has immediate and long-term negative consequences on women’s survival, growth, development, and productivity.

10. Biological and Social risk factors for under-nutrition
NUT THREE SLIDES 2005
May2005
Biological and Social risk factors for under-nutrition
Childhood (2-9 years)
Poor diets
Poor health care
Poor maternal education
Childhood (two to nine years). At two years of age, many of the girls who survive under such nutritional stress are stunted with little chance of recovery. Moreover, in some parts of the world, girls are discriminated against in access to food, health care, and education throughout childhood.

11. Biological and social risk factors for under-nutrition
NUT THREE SLIDES 2005
May2005
Biological and social risk factors for under-nutrition
Adolescence (10-19 years)
Increased nutritional demands
Greater iron needs
Early pregnancies
Life time risk factors for under nutrition
Adolescence (10–19 years). During adolescence, girls experience rapid physical growth and sexual maturation which significantly increases their needs for macronutrients and micronutrients (especially iron).
Adolescent girls’ growth spurt occurs before menarche (first menstruation). Adolescent girls continue to grow in height long after menarche. Linear growth, particularly of the long bones, is not complete until the age of 18, and peak bone mass is not achieved until the age of 25.
A malnourished adolescent girl whose menarche has been delayed may achieve full height as late as 23 years and will, therefore, be capable of conceiving before her body size is fully developed. Moreover, the development of the birth canal is slower than that of height and does not reach mature size until about two to three years after the growth in height has ceased.
Pregnancy puts adolescent women at increased risk of malnutrition (diverting nutrients from the mother to the fetus), pregnancy complications, and poor pregnancy outcomes (including death).
Early pregnancy contributes to the cycle of maternal malnutrition in two ways:
Indirectly, through the premature cessation of the mother’s growth.
Directly, through the increased risk of delivering a low birth weight baby.

12. Biological and social risk factors for under-nutrition
NUT THREE SLIDES 2005
May2005
Biological and social risk factors for under-nutrition
Pregnancy and lactation
Higher nutritional requirements
Increased micronutrient needs
Closely-spaced reproductive cycles
Pregnancy and lactation. In most developing countries, women spend a large proportion of their reproductive years pregnant, lactating or pregnant and lactating. McGuire and Popkin (1990) estimate that on average, African and Asian women between the ages of 15 and 45 are pregnant or lactating 30–48 percent of their time. The nutritional demands during pregnancy and lactation are multiple to support fetal growth and breastmilk production. These added nutritional requirements specific to pregnancy and lactation manifest themselves both at the macronutrient and the micronutrient level.
More calories are needed to achieve adequate pregnancy weight gain and build stores for lactation.
More iron is needed because of the growth of the fetus and placenta and the expansion of plasma volume. More vitamin A may be needed to ensure adequate vitamin A concentration in breast milk.
Closely spaced reproductive cycles, negative energy balance, and micronutrient deficiencies can lead to a condition known as “maternal depletion syndrome”. Nutritional stress is greatest when an adolescent woman is pregnant and lactating.

13. Strategies to break the malnutrition cycle
NUT THREE SLIDES 2005
May2005
Strategies to break the malnutrition cycle
Solve economic and social problems
Space pregnancies
Reduce workloads
Micronutrient deficiencies

14. Strategies to break the malnutrition cycle
NUT THREE SLIDES 2005
May2005
Strategies to break the malnutrition cycle
Infancy through adolescence.
Infancy and early childhood (0–24 months old)
Childhood (2–9 years old)
Adolescence (10–19 years old)

15. Strategies to break the malnutrition cycle
NUT THREE SLIDES 2005
May2005
Strategies to break the malnutrition cycle
Improve nutrition and health
For all women
For pregnant women
For lactating women

16. Contact points for nutrition action
NUT THREE SLIDES 2005
May2005
Contact points for nutrition action
Contact points
Prenatal
At delivery
At immediate post-partum
Postnatal
Outputs should be implemented at the following contact times
Prenatal
Delivery
Immediate post-partum
Postnatal

17. Nutrition actions During prenatal visits
NUT THREE SLIDES 2005
May2005
Nutrition actions
During prenatal visits
Counsel on increasing food intake.
Distribute iron/folic acid tablets.
Screen for severe anemia.
Complete 5 antitetanus immunizations for pregnant women.
Monitor weight gain.
Deworm during 3rd trimester.
During prenatal visits
Counsel on increasing food intake.
Distribute iron/folic acid tablets.
Screen for severe anemia.
Complete 5 antitetanus immunizations for pregnant women.
Monitor weight gain.
Deworm during 3rd trimester.
Encourage family consumption of iodized salt.
Counsel to use treated bed-nets to reduce malaria infection.
Educate on STIs and HIV and AIDS transmission and prevention.
Counsel on breastfeeding following WHO guidelines .
Counsel on reducing workload.

18. Nutrition actions During prenatal visits
NUT THREE SLIDES 2005
May2005
Nutrition actions
During prenatal visits
Encourage family consumption of iodized salt.
Counsel to use treated bed-nets to reduce malaria infection.
Educate on STIs and HIV and AIDS transmission and prevention.
Counsel on breastfeeding following WHO guidelines .
Counsel on reducing workload
Outputs should be implemented at the following contact times
Prenatal
Delivery
Immediate post-partum
Postnatal

19. Nutrition actions At delivery and immediate post partum period
NUT THREE SLIDES 2005
May2005
Nutrition actions
At delivery and immediate post partum period
Initiate skin-to-skin contact immediately after delivery.
Counsel to breastfeed within 1 hour of delivery, checking positioning and attachment and following WHO guidelines .
Give the mother vitamin A.
At delivery and immediate post partum period
Initiate skin-to-skin contact immediately after delivery.
Counsel to breastfeed within 1 hour of delivery, checking positioning and attachment and following WHO guidelines .
Give the mother vitamin A.

20. Nutrition actions During post natal visits
NUT THREE SLIDES 2005
May2005
Nutrition actions
During post natal visits
Counsel on increasing food intake.
Check iron/folic acid supplementation and continue supplementation for mother to complete 6 months.
Educate on STIs and HIV and AIDS transmission and prevention.
Counsel on breastfeeding following WHO guidelines .
Encourage family consumption of iodized salt.
Counsel to use treated bed-nets to reduce malaria infection.
During postnatal visits.
Counsel on increasing food intake.
Check iron/folic acid supplementation and continue supplementation for mother to complete 6 months.
Educate on STIs and HIV and AIDS transmission and prevention.
Counsel on breastfeeding following WHO guidelines .
Encourage family consumption of iodized salt.
Counsel to use treated bed-nets to reduce malaria infection.

21. Nutrition impact indicators
NUT THREE SLIDES 2005
May2005
Nutrition impact indicators
Birth weight
Mother’s height
Mother’s pre-pregnancy weight:
Body mass index
Mid-upper-arm circumference (MUAC)
Weight gain during pregnancy
Rate of weight gain during pregnancy
Weight loss during lactation