Public Health Nutrition Intervention

Public health nutrition intervention can be defined as interventions focus on the adjustment of
personal practices and habits. It includes adding nutrients to staple foods which is termed by
fortification, while supplementation offers to the provision of individuals or mixtures of nutrients
separately from the diet.

Nutrition intervention, is defined as purposefully planned actions intended to positively change a

nutrition – related behavior, environmental condition or aspect of health status for an individual
target group, or the community at large. It consists of two components, planning and
implementation.

The purpose of nutrition intervention is to resolve or improve the nutrition diagnosis or nutrition
problem by provision of advice, education or delivery of the components, or a specific diet or meal
plan tailored to the patients/client’s needs.

Example of nutrition intervention include: National Education Campaigns to improve knowledge

and attitudes e.g., campaign and Traffic light food labeling, also collaboration with food
manufacturer to fortify foods, or reduce the salt, sugar or fat contents of food.

The main focus of nutrition intervention includes nutrition education, modification of food services
nutrition labelling to facilitate food changes, and behavior changes through multiple component
programs with focus on a supportive environment for weight loss.

v Examples of general nutrition intervention of public health concern are

ü Daily iron and folic acid supplementation during pregnancy.
ü Daily iron and folic acid supplementation during pregnancy in malaria endemic areas.
ü 1000 days of child’s life
ü Fortification of cereal with vitamin A

v Also, in Nigeria. (NNHS) National Nutrition and Health survey 2018

ü National Nutrition and Health Survey 2015
ü Exclusive Breastfeeding Programs
ü SDG2 Goals

USAID nutrition strategies supplementary program

Nutrition Intervention Strategies in Nigeria

UNICEF’s program supports the government to implement the national plan of Action on food and
Nutrition by strengthening health and community system and fully integrating nutrition cuts all
aspect of primary health care (PHC) system with a particular focus on community management of
acute, malnutrition (CMAM), infant and young child feeding (IYCF) intervention and micronutrient
supplementation.

The UNICEF’s nutrition interventions are also aligned and convergent with other sector
interventions, including those related to antenatal case, the prevention and control of pneumonias
and diarrhea immunization, deworming, distribution of insecticide, treated mosquito nets and
adolescent girls and material nutrition

Nutrition Intervention Strategies in Nigeria

Also, since 2009, UNICEF has been supporting Nigeria’s community-based programme for
treatment of severe acute malnutrition (SAM)

UNICEF works to prevent malnutrition by supporting the education and counselling of mothers and
caregivers on how to adequately feed their children, and by providing also micronutrient
supplement to children and pregnant women.

Also detecting geographical differences in the north of the country, including humanitarian
nutrition assistance, while also provide policy advice at the federal and state level, helping to
increase the ability of the government and partners to coordinate the nutrition sector, proactively,
identify risk factors for the nutrition status of the population.

SDG 2 Goals on Nutrition

In September 2015, the United Nation adopted the Sustainable Development Goals (SDGS) – a set
of 17 goals with specific targets aimed at ending poverty, protecting the planets and ensuring
prosperity for all by 2030.

SDG2, was a global commitment to tackle under nutrition and hunger, the need for better nutrition
was recognized in SDG2, with aims, to end hunger, achieve food seeding and improved nutrition
and promote sustainable agriculture.

1000 Days window of Opportunity

The first 1000days refers to a child’s life from the moment they are conceived until they have
reached 2 years of age (24 months). This is the time when the brain and immune systems grows and
develop significantly.

Infant and young child feeding {IYCF}

According to the convention on the rights of the child; every infant and the child has the right to
good nutrition.

It is believed and proved that under nutrition is associated with 45% of child death. Globally in
2020, 149 million children under 5 were estimated to be stunted {too short for age} 45 million were
estimated to be wasted {two thin for height} and 38.9 million were overweight or obese.

Under nutrition is estimate to be associated with 2.7 million child deaths annually or 45% of child
death. The first 2yrs of child’s life are particularly important, as optimal nutritional during this
period lowers morbidity and mortality reduces the risk of chronic disease foster better development
overall.

Optimal breath feeding is so critical that it could save the lives of over 820,000 children under the
age of 5 years each year.

WHO and UNICEF recommend that early initiation of breast feeding within one hour of birth.

- Exclusive breast feeding for the first month of life, and

- Introduction of nutritionally adequate and safe complimentary {solid} foods, at 6months
together with continued, breast feeding up to 2 years of age or beyond.
Nutrition intervention in Nigeria.

Community Management of acute Malnutrition (CMAM)

The CMAM approach is comprised of four components

1. Community outreach and mobilization

2. Outpatient management of SAM without medical complications and
3. Inpatient management of SAM with medical complications
4. Services or programs to manage moderate acute malnutrition (MAM)

Also, implementation of the various component of CMAM can vary across geographical areas and
implementers, but all CMAM programs include the outpatient management of SAM without
medical complications and are designed with a community component. There is also consideration
for people living with HIV and or / tuberculosis (TB).

The management of acute malnutrition in infants under 6 months, a highly vulnerable group with an
increased risk of mortality, is generally included in national protocols.

The national treatment for the management under CMAM includes medical treatment such as
antibiotics, Vitamin A supplements, malaria prophylaxis, deworming treatment, measles,
vaccination, and iron or folic acid supplements.

Also, amongst the interventions are the use of RUTF, RUSF RIBF, F75, and F100, rehydration
solution for malnutrition combined mineral and vitamin mix.

1. RUTF: It is a lipid-based, energy dense mineral and vitamin-enriched food specifically

designed to treat SAM in children 6 – 59 months. RUTF has a similar nutrient composition
of F100, does not require cooking, and safe for in-home consumption.
2. RUSF: It has a similar properties RUTF but one of its formulations is specifically designed
to treat MAM in children 6 – 59 months.
3. FBF are blends of partially precooked and milled cereals, soya beans, and pulses fortified
with vitamins, and minerals, and may contain vegetable oil with milk powder.
4. F-75 and F-100, are therapeutic milks used in inpatient treatment of SAM. They provide 75
and 100 kilocalories for every 100 millimeters, respectively.
5. Rehydration for solution for malnutrition (ReSoMal) is oral hydration solution specifically
for severely malnourished children.
6. Combined Mineral and Vitamin Mix: is used to make F-75 and F-100 therapeautic milks
from local ingredients (milk, oil and sugar) and ReSoMal from the commonly- available
oral rehydration solution.

Control of Micro nutrient deficiencies

Another intervention strategy of managing, malnutrition also in control of micronutrient

deficiencies, micronutrient malnutrition particularly (VAD) Vitamin A deficiency, iron deficiency
anemia (IDA) and Iodine deficiency disorder (IDD).

Dietary inadequacy is the primary cause of VAD and IDA, while poor iodine content of soil and
water due to environmental iodine deficiency is the main determinant of IDD.

Three main intervention strategies employed for the control of micronutrient malnutrition are
 • Supplementation of the specific micronutrients
• Fortification of foods with micronutrient
• Horticulture intervention to increase production and nutrition education to ensure regular
consumption of micronutrients rich foods.

Supplementation Programmes

Supplementation programmes across country are also part of nutrition intervention strategies severe
among them are

v VAS (Vitamin A Supplementation programme.)

(WHO) world health organization recommends Vitamin A supplementation (VAS) programme for
children 6-59 months where vitamin A deficiency is a public health problem. Coverage of vitamin
A supplementation programme is a key intervention for child survival.

Also, VAS programme remains a critical child intervention especially in countries with high levels
of child mortality.

Also, lower coverage has been discovered in VAS, coverage database, this is high developing
countries such as part of west and central Africa. The reason for this includes shift in financing
around supplementary programmes.

FeFol (Iron Folic Acid) Intervention Strategies

Also, part of nutrition intervention strategies is daily oral iron and folic acid supplementation with
30mg to 60mg of elemental iron and 400ug (0.4mg) folic acid. It is recommended for pregnant
women to prevent maternal anemia, puerperal Sepsis, low birth weight and preterm birth. Also, the
equivalent of 60mg of element iron is 300mg ferrous sulfate heptahydrate, 180mg ferrous fumarate
or 500mg ferrous gluconate.

Home Micronutrient Powder fortification (MNP) Interventions

Micronutrient powder (MNP) interventions are often integrated within infant and young feeding
(IYCF) programmes to improve micronutrient in take from complementary foods. Micronutrient
powder (MNP) sachets contains a dry powder with micronutrients that can be added to any
semi-solid or solid foods that were first developed as an alternative iron syrup for treating
nutritional anemia in young children.
The World Health Organization (W.H.O) recommends home fortification of foods with MNP
among infants and children programming guidance for MNP interventions has been provided by the
home fortification Technical Advising Group (HF-TAG, 2011)

MNP delivery through routine health services, community-based outreach, market-based models,
and other platforms has the potential to increase awareness of important IYCF practices.

Food Fortification Intervention Strategies

Food fortification is the process whereby nutrients are added to food to maintain or improve the
quality of diet of a group, community or population food fortification is of great importance due to
insufficient intake of vitamins and minerals, due to consumption of predominantly processed foods.

The main methods of food fortification include

v Commercial fortification
v Industrial fortification
v Bio fortification
v Home fortification

1. Commercial and industrial fortification include: wheat flour, corn meal, cooking oils.
2. Bio fortification involves breeding crops to increase their nutritional value, which include both
conventional selective breeding and genetic engineering.
3. Home fortification examples is Vitamin D crops.

Also, under fortification of foods examples of intervention strategies include salt iodization,
Vitamin A.

National Policies Intervention Strategies

National food and Nutrition Policy.

The national food and nutrition policy is a document that provides the framework for addressing the
problems of food and nutrition insecurity in Nigeria, from the individual household, community and
up to the national level. It guides the identification, design and implementation or of intervention
activities across different relevant sectors.
Nigeria developed policies and strategies to address the nutrition perspective of their mandates.
These documents include.

i. National Health Policy and Guidelines.

ii. The national agricultural Policy
iii. The agricultural Transformation Agenda
iv. Science Technology, and innovation Policy e.t.c

Maternal Newborn and Child Health (MNCH) week is a biannual event. The week aims to
deliver a package of basic intervention that are highly effective in reducing child mortality and
improving mother and child health

Also, the evaluation of the programme shared that Nigeria has successfully reduced the maternal
mortality ratio. In Nigeria, the maternal mortality ratio was estimated at 1,200 per 100,000 live
births in 19905 and at 576 per 100,000 live births in 2013.

Nutrition Assessment Counseling and Support (NACS) across Lifecycle.

The nutrition assessment, counselling and support (NACS) approach is aimed to improve the
nutritional status of individuals and population by integrating nutrition into policies, programs, and
the health services delivery infrastructure nutrition assessment include Anthropometric,
biochemical clinical and Dietary.

Also, there are few steps to the process, they are

i. Nutrition Assessment
ii. Nutrition Diagnostics
iii. Nutrition Intervention
iv. Nutrition Monitoring and Evaluation

MODES OF EDUCATIONAL VISIT TO COMMUNITIES FOR NUTRITION

INTERVENTION STRATEGY

Ø Strategies to change nutritional knowledge and behavior could be more effective if community
members’ ability to make decisions and solve problems were enhanced. To mobilize social
energy in grassroots community development, several health and nutrition education
programmes have applied an active-participatory democratic, empowering and problem-posing
“approach based on concepts of the Brazilian Pedagogue.
STAGES INVOLVED IN PARTICIPATORY NUTRITION EDUCATION PROGRAMME
FOR INTERVENTION STRATEGY

1) Identifying and Assessing issues of greatest interest to the community is the first stage of a
participatory programme.

The nutrition educator visits all the households with children under five years of age and meet their
parents in order to develop a programme to improve infant and child nutrition. Group discussion are
organized with the community members and the participatory approaches applied. The nutrition
education listens to the community members and lists the major issues such as breast feeding,
weaning practices, access to healthcare, mothers’ employment and household income.

Facilities Dialogue about social, economic and cultural conditions. These explains, nutrition
educator facilities dialogue about the social, economic and culture conditional underlying the
nutrition problems. The critical is can be presented by is of photographs, role-play surfer or
puppets.

Community members describe the problems they see in health and nutrition of infants and children
and discuss what they feel about them. They are asked to describe income, job and resources
problems as well as the political situation and to relate this to the condition of health of children.

Also, discussion about food habits and belief is encouraged. They are allowed to share their
experiences about food insecurity (e.g., hunger, not enough money to buy food or little land to grow
food child malnutrition, infection and diseases e.g., diarrhea) and death. They are also asked the
vulnerable group in the community.

This method of critical reflexive thinking and analysis, community members and educators will set
nutritional health aims and objectives. Small groups of community members of organize
nutrition-related activities and there is increased decision-making by community members.

The third stage involves decisions made about actions to solve the needs and problems in both the
personal and the social arenas. The community groups continue their learning interaction by
organizing activities of meet goals and to overcome obstacles to achieve the health and nutrition
situation envisioned.

The groups make decisions about actions, set time frames and designate individuals to be
responsible for coordinating the activities and making progress reports.
Also, a group should be elected with the local medical and inform them of activities. Radio, spots,
billboards, theatre group announcement etc. can be used to give recognition of extraordinary
participation and result of activities.