Fact sheet: Achieving Nutritional Impact and Food Security through Agriculture

This four-page fact sheet summarizes ways that agriculture projects can maximize nutrition and food security of women, children, and other vulnerable groups. It offers examples of what works and what does not and recommends design strategies that can increase nutritional benefits.

Download the fact sheet.

Nutrition and Food Security Impacts of Agriculture Projects: A Review of Experience

This document summarizes IYCN’s review of more than 30 years of studies examining food security and nutrition impacts of agricultural projects in low-income countries. Findings revealed that it is possible to anticipate food security and nutrition impacts and that agricultural projects can be oriented in ways that maximize positive outcomes. 

Download the literature review.

Nutritional Impact Assessment Tool and Guidance

This tool aims to assist project designers in assessing an agriculture project’s likely impacts on the nutrition of vulnerable groups. When it is not possible to include nutrition objectives in the design of a project, conducting a nutritional impact assessment during the planning process can help to avoid unintended negative impacts. 

Download the tool and guidance.

Integrating Household Nutrition and Food Security Objectives into Proposed Agriculture Projects: Illustrative Guidance

This guidance helps agriculture project designers build nutrition and food security objectives into their projects rather than leave positive impacts to chance. By following this guidance during the initial planning stages, project designers can enhance nutritional impact and food security of vulnerable groups. 

Download the illustrative guidance.

IYCN created a collection of tools and resources for use by community-based nutrition programs. The collection includes literature reviews, social and behavior change communication resources for reaching a wide range of community members, and monitoring and evaluation tools. Informed by IYCN’s experience implementing community approaches in eight countries, the tools fill specific program needs but can be adapted for use in other country settings. The resources described below can be used together or separately and modified based on findings from formative research.

Overview

Strengthening community nutrition programming: Tools for reaching caregivers, households, and communities. Provides an overview of IYCN’s collection of tools for community-based nutrition programming, including a summary of the project’s community approaches and methods used to develop the materials. Download the overview.

Literature reviews on community-based nutrition programs

The roles and influence of grandmothers and men: Evidence supporting a family-focused approach to optimal infant and young child nutrition. Reviews evidence of the roles and influence of grandmothers and men on childhood nutrition and offers recommendations for how program implementers can strengthen community approaches for addressing malnutrition and improving results. Download the literature review.

Behavior change interventions and child nutritional status: Evidence from the promotion of improved complementary feeding practices. Analyzes behavior change interventions aiming to improve complementary feeding practices and children’s nutritional status and provides recommendations for designing and implementing these interventions. Download the literature review.

Community interventions to promote optimal breastfeeding: Evidence on early initiation, any breastfeeding, exclusive breastfeeding, and continued breastfeeding. Examines evidence on community interventions—including health facility outreach, community-mobilized programming, and national social marketing—to promote optimal breastfeeding and offers recommendations to inform policy and program planning. Download the literature review.

Tools for reaching mothers and caregivers

Mother-to-Mother Support Groups: Trainer’s Manual and Facilitator’s Manual with Discussion Guide. A tool for training mother-to-mother support group facilitators to lead participatory discussions on maternal, infant, and young child nutrition. Provides detailed information on potential support group topics and answers to questions that may arise during support group sessions. Download the trainer’s manual and facilitator’s manual with discussion guide.

Infant Feeding and HIV: Trainer’s guide and participant’s manual for training community-based workers and volunteers. A tool for training peer educators to incorporate nutrition into current community-based HIV prevention, care, and treatment activities. Download the trainer’s guide and participant’s manual.

 Tools for reaching household members

Infant and Young Child Feeding and Gender: A training manual and participant manual for male group leaders. A tool for training male group leaders to share information and encourage discussions on gender roles related to optimal infant and young child feeding practices. Download the training manual and participant manual.

Engaging Grandmothers to Improve Nutrition: A training manual and guide for dialogue group mentors. A tool for training grandmothers to serve as dialogue group mentors. Offers information and techniques for facilitating discussions on family care and maternal and child nutrition. Download the training manual and guide.

Tools for reaching community members

Strengthening Health Talks: Training Manual. Offers step-by-step instructions for facilitating a half-day workshop with health workers or community workers to improve the quality of group counseling sessions and health talks. Download the training manual.

Mobilizing communities for improved nutrition: A manual and guide for training community leaders. Provides step-by-step instructions for facilitating a one-day workshop with community leaders (including religious leaders, business leaders, and government officials) to support and improve children’s health and well-being through improved maternal, infant, and young child nutrition. Download the training manual and participant manual.

Community theater for improved nutrition: A guide for program managers and theater groups. Offers recommendations for program managers and community theater groups to integrate maternal, infant, and young child nutrition content into existing community theater activities. Download the guide.

Bushes that Grow Are the Future Forest: Using radio to improve infant and young child feeding in Zambia. Describes IYCN’s experience developing a radio series on infant and young child feeding and provides key steps and tips for replicating the process in a variety of settings. Download this document.

Monitoring and evaluation tools

Infant and Young Child Feeding Practices Monitoring Tool and Guide. A tool to help programs monitor progress in achieving key behaviors related to infant and young child feeding. The tool is designed for community workers to track individual behaviors during each counseling session or contact point with a caregiver, thereby providing a record of progress toward reaching an optimal mix of practices for the child. The guidance provides step-by-step instructions for using the tool in different program settings. Download the tool and guide.

Counseling Supervision Checklist and Guidelines. A tool for health worker supervisors to measure health workers’ knowledge and record their behaviors during counseling sessions. Periodic use of the checklist can help programs identify gaps, implement solutions, and measure changes over time. Download the tool.

Exit Interview Questionnaire and Guidelines. Assists program managers in assessing the quality of counseling services and client satisfaction. The Guidelines provide detailed instructions for using the Questionnaire. Download the tool.

Referral Tracking Form and Register. A tool to track referrals of caregivers from community volunteers to health centers. Download the tool.

Altrena Mukuria at the congressional briefing on May 25, 2010.

May 2010

The Infant & Young Child Nutrition (IYCN) Project’s Altrena Mukuria educated lawmakers, policymakers, and global health colleagues on the role of health systems strengthening in reducing maternal and child mortality and morbidity in low-income countries during a May 25 congressional briefing in Washington, DC. The briefing—“Is Health Systems Strengthening the Answer to Improving Maternal Health?”—is the first in a new policy discussion series organized by PATH, the Global Health Council (GHC), and Management Sciences for Health (MSH).

Dr. Mukuria highlighted the important work being done by the IYCN Project to improve health systems and increase the capacity of health workers, as well as how health systems are integral to improving the health of women and children throughout the world. Panelists joining Dr. Mukuria for the discussion included Congresswoman Gwen Moore (D-WI), Richard Greene of the US Agency for International Development, and Dr. Paul Waibale of MSH. Dr. Jeff Sturchio, the GHC’s president and CEO, moderated the discussion. Speakers discussed how health systems strengthening not only creates better health programs but also increases utilization of health services at community, regional, and national levels.

Visit the PATH website to learn more about the briefing and the policy series.

• Breastfeeding is the safest feeding option for infants during an emergency. Every effort should be made to support mothers to breastfeed and avoid the use of breastmilk substitutes, which should be a last resort only after fully exploring safer options.
• Relactation should be prioritized for infants younger than six months of age who are no longer breastfed. When this is not possible (e.g., for orphans), or when skilled personnel identify a need for artificial feeding, breastmilk substitutes must be accompanied by training for caregivers on hygienic preparation and use. Liquid ready-to-use breastmilk substitutes are preferred over powder mixes.
• In an emergency, the use of breastmilk substitutes can endanger children’s lives and, in accordance with international guidelines, they should not be donated. UNICEF is the coordinating agency in Haiti for the appropriate use of breastmilk substitutes and can provide guidance to organizations.
• Children older than six months of age require nutritious, age-appropriate, and safe complementary foods in addition to breastmilk. Priority should be given to providing local, culturally acceptable foods. When cooking facilities are unavailable, ready-to-use fortified foods are an option. However, once cooking facilities have been set up, fortified blended food is recommended. 

Download the statement. Please share this information with colleagues working on relief efforts for Haiti.

New research on extending antiretroviral (ARV) prophylaxis through six months of breastfeeding shows great promise for the prevention of mother-to-child transmission of HIV. In July, researchers announced findings from three highly anticipated randomized, controlled trials at the International AIDS Society Conference (IAS) in Cape Town, South Africa. The results added to a significant body of evidence showing that that giving ARV prophylaxis to infants or Highly Active Antiretroviral Therapy (HAART) to women who do not qualify for treatment during breastfeeding can significantly reduce transmission of HIV to infants. 

The findings are significant for HIV-positive mothers who are faced with making difficult decisions about the safest way to feed their babies. Mothers may choose to avoid breastfeeding or stop early to avoid passing the virus through breastmilk, yet the danger of common diseases such as diarrhea and pneumonia, malnutrition, and infant and young child deaths associated with formula feeding is well known. If giving HAART to women who do not qualify for treatment can greatly reduce the HIV transmission risk of breastfeeding, more infants and children of HIV-positive mothers will be able to benefit from the health and nutrition benefits of breastfeeding.

According to Tim Quick, Senior Technical Advisor for HIV and Nutrition and Co-chair of the US President’s Emergency Plan for AIDS Relief Food and Nutrition Technical Working Group at the US Agency for International Development’s Office of HIV/AIDS, the new research means that more HIV-positive mothers may choose to breastfeed their babies and breastfeed for longer periods—ensuring that they get the nutrients they need to prevent malnutrition and infections.

“As long as there is still a risk of transmission through breastfeeding, we will continue to support mothers to make informed choices about infant feeding and help them balance the risks of breastfeeding and formula feeding,” said Quick. “These new findings may dramatically shift that balance in favor of breastfeeding.”

The current World Health Organization (WHO) HIV treatment guidelines recommend that stage one and two HIV-positive people, including pregnant women, begin ARV treatment if their CD4 cell count is less than 200 cells/μL. Later in the year, a WHO expert committee will meet to consider the available evidence on treatment for pregnant and breastfeeding women with higher CD4 counts and consider updating current guidelines to support temporary administration of ARVs to pregnant and lactating women who do not qualify for treatment.

As WHO considers how the new evidence should impact international recommendations, it will also consider the limitations of the evidence that leave many unanswered questions. The long-term health effects of giving HAART to women who do not qualify for treatment and infants are still unclear. Moreover, the feasibility of ensuring drug adherence among a population that looks and feels healthy is uncertain. And while these studies only provided drugs through six months, many women are unable to meet AFASS criteria (acceptable, feasible, affordable, sustainable, and safe) to stop breastfeeding until much later, so the efficacy and safety of continuing prophylaxis through the entire breastfeeding period is an urgent research need. The cost and human resources implications of providing ARVs to a much bigger population must also be modeled. Effectiveness trials are needed to determine the overall feasibility of implementing long-term prophylaxis in real-life settings.

Read summaries of the studies:

• Kesho Bora study
• Mma Bana study
• Breastfeeding, Antiretroviral, and Nutrition study

Linked below is a Call for Letters of Interest for the Alive & Thrive (A&T) Small Grants Program. Letters of Interest are due September 14, 2009.

The A&T Small Grants Program aims to fund operational research projects that will identify novel approaches and overcome key barriers to improving infant and young child feeding at scale in low-income countries. Awards for small grants are generally in the range of US$50,000-$100,000. 

View the Call for Letters of Interest for the A&T Small Grants Program

View community-based approaches

• Child feeding bowl: a simple tool to improve nutrition
• Grandmothers improve their approach to treating sick children in Laos
• Safer Breastfeeding Programme protects babies from HIV in South Africa
• Harnessing the power of mother-to-mother support groups in Kenya’s refugee camps
• Enhancing community-based child growth promotion in Zambia

A new report from PATH includes optimal breastfeeding and complementary feeding practices as part of a broad array of lifesaving prevention and treatment solutions for addressing diarrheal disease in the developing world. Diarrheal Disease: Solutions to Defeat a Global Killer presents scientific evidence to support strategies to scale up use of interventions to control diarrheal disease. 

In tandem with the new report, a Call to Action is bringing together partners from the health, water and sanitation, and environmental sectors to raise awareness and catalyze momentum on programs that address diarrheal disease control.

Visit PATH’s Resources for Diarrheal Disease Control website to download the report, view case studies from organizations making a real impact, submit a case study from your own organization, and sign the Call to Action. 

After flooding caused by a hurricane in Cabaret, Haiti, IYCN helped educate mothers about good breastfeeding practices at a community event in December 2008.

The theme for this year’s World Breastfeeding Week, August 1–7, 2009, is Breastfeeding: A Vital Emergency Response. Are you ready? The World Alliance for Breastfeeding Action’s (WABA) annual campaign will highlight the vital role of breastfeeding before and during emergencies worldwide.

The IYCN Project supports WABA’s call for increased efforts to protect, promote, and support breastfeeding in emergencies. During earthquakes, floods, conflicts, and other crises, good breastfeeding and complementary feeding practices save lives and prevent malnutrition and childhood illnesses.

Check back for updates on IYCN’s World Breastfeeding Week activities in the field.

Visit the World Breastfeeding Week website.