INTEGRATED NUTRITION PROGRAMME

1. Ensure that 25% of all health facilities are baby friendly.

2. Increase the proportion of mothers who breastfeed their babies exclusively for at least six months of age and who breastfeed their babies for at least 12 months of age.

3. Contribute to the reduction of mortality due to infectious diseases particularly diarrhoea, measles, and acute respiratory infections in children <5 years of age by 50%, 70% and 30% respectively, through nutritional support and counseling.

4. Contribute to the prevalence of low birth weight to 10% of all live births.

5. Increase regular growth monitoring to reach 85% of children <2 years of age.

6. Reduce the prevalence of under weight (weight-for-age) among children <5 years of age to 10%.

7. Reduce the prevalence of severe underweight (weight-for-age) among children <5 years of age to 1%.

8. Reduce the prevalence of stunting (height-for-weight) among children <5 years to 20%.

9. Reduce the prevalence of wasting (weight-for-height) among children <5 years of age to 2%.

10. Eliminate micro nutrient malnutrition:

• Reduction of Vitamin A deficiency in children under 5 years of age with serum retinol <20ug/dl,

• Reduction of Iron deficiency anaemia rates in children and women.

• Reduction of Iodine deficiency rates.

11. Reduce disease of lifestyle related to over-nutrition.

1.1 The South African Breastfeeding Guidelines for Health Workers.
1.2 Policy Guidelines and Protocols on Vitamin A Supplementation.
1.3 Vitamin A Brochures for Health Workers.
1.4 Guidelines for Health Facility Based Nutrition Interventions to Prevent Malnutrition in South Africa.
1.5 Integrated Management of Childhood Illnesses Manuals (Nutrition Module in the IMCI Manuals).
1.6 Integrated Nutrition Programme for South Africa. Broad Guidelines for Implementation- Draft Document 5 January 1998 (Being Reviewed).
1.7 National Food Service Management Guidelines (Draft)
1.8 National Guidelines on Nutrition for People Living with HIV|AIDS (Draft)
1.9 Growth Monitoring and promotion guidelines and manuals (draft)

2.1 Road-to-Health Charts
2.2 Weighing scales
2.3 Non-stretch tape measures
2.4 Dolls for demonstration purposes.
2.5 Nutrition Education tools.

3.1 Vitamin A capsules.
3.2 Iron and folate capsules
3.3 Nutrition supplements. ("PEM" scheme)

4.1 Staff working at the district level have the following competencies, particularly applied to community- based, integrated nutrition (the competencies listed below are applicable to health workers other than dieticians and nutritioninst):

4.1.1. An understanding of the principles of nutrition.
4.1.2 An understanding of the conceptual framework for the analysis of nutrition problems in communities.
4.1.3.The ability to design, implement and evaluate intersectoral programmes.
4.1.4.The capacity for project management and application of innovative approaches to nutrition issues.
4.1.5.The ability to communicate with a target group, analyse its needs and make appropriate choices of communication media and materials.
4.1.6.The ability to train at community and other levels using good educational practice.
4.1.7.The ability to follow-up and monitor the growth of children using the Road to Health Chart
4.1.8.The ability to recognise under-nutrition, micronutrients deficiency and obesity, and appropriately counsel and advise clients.

4.2. The ability to give basic nutrition advise and counseling particularly on the following:

• Nutrition during pregnancy, breast feeding and complementary feeding
• Infant feeding options for HIV positive mothers
• Feeding during illness such as diarrhoea and other infections
• Young child feeding practices
• Importance of micro-nutrients and choice of micro-nutrient rich foods
• Food hygiene

4.3.The ability to recognise severe signs of malnutrition and take appropriate action

There is effective and efficient referral and counter referral system between district health facilities and community based services.

5.1. Mothers are referred to breastfeeding support groups
5.2. Clients on the Supplementation Programme are referred to the next level of care.
5.3. Severe cases of malnutrition are referred to the next level of care.
5.4. Patients with a need for additional health and social services are referred as appropriate.

6.1 Appropriately counsel and advise clients on under-nutrition, micronutrient deficiency and overnutrition.
6.2 Appropriately counsel and advise clients on breastfeeding and complementary feeding.
6.3 Appropriately counsel and advise clients on infant feeding options for HIV positive mothers.
6.4 Counselling and support of current coping strategies.
6.5 Counseling on growth promotion
6.6 Counseling on nutrition during the life cycle as appropriate.

7.1 Children’s weight and height is recorded and graphed accurately on the Road to Health Chart.
7.2 Charting of weight and other appropriate parameters by the client on a home monitoring programme.
7.3 Supplement provided recorded on statistical returns

8.1 The active participation of households, community leaders and structures, NGOs, CBOs and other community role players are mobilised in the district.
8.2 Household coping strategies already in place are supported.
8.3 Communities are empowered with the necessary skills and knowledge to become self-reliant with regard to their food and nutrition needs and to be in control of factors affecting their nutritional well being.
8.4 Community health workers are utilised to initiate community growth monitoring and identification of nutrition problems.

9.1 Intersectoral collaboration of line departments and other sectors are mobilised at all levels to ensure joint action to ensure nutrition problems are addressed
9.2 Collaboration between health-facilities and community-based programmes to implement the community component of the Integrated Management of Childhood Illness.