EDEN INSTITUTE

DEPARTMENT OF
CLINICAL MEDICINE
LECTURE NOTES: THE FIRST 1000 MCDP
Current situation
• Over one million children under the age of five years and 10% of
women of reproductive age are malnourished.
• Common nutrition issues include chronic malnutrition (45%),
Underweight (15%), wasting (5%) and low birth weight (10%)
• Micronutrient deficiencies in children under five years include vitamin
A (54%) and iron deficiency anaemia (53%).
• The impact of chronic malnutrition (stunting) on child cognitive,
physical and mental development, irreversible long term effect on
health and child mortality is well documented in the 2008 Lancet
Series.
What is the first 1000 MCDP?
• Overwhelming evidence suggests that the first two years of life provides a
window of opportunity which, when proper nutrition and maternal care is
ensured, long term irreversible complications (i.e. reduced cognitive
ability, lack of organ development, susceptible to illness and premature
death) can be avoided.
• Maternal and child undernutrition are caused by multiple factors, and
addressing the problems therefore requires the collaboration between a
wide range of actors from different sectors, working at all levels from
community to national level
• The first 1000 MCDP aims to strengthen and scale up selected priority
interventions from different sectors based on global and national
evidence of cost effectiveness thereby, reducing stunting in children
Five strategic areas that were set-out
• Strategic area 1: Policy and coordination for robust stewardship,
harmonisation and coordination of the programme. The three ones
concept similar to the one used for HIV/AIDS programmes (i.e. one
agreed policy framework; one coordinating authority; and one agreed
monitoring and evaluation system).
• Strategic area 2: Priority interventions across sectors to reduce
stunting. Promote integrated high-impact maternal and child nutrition
interventions to be complemented by strong advocacy and
communication messages and a comprehensive monitoring and
evaluation plan.
• Strategic area 3: Institutional, organisational and human resource
capacity building
• Strategic area 4: communications and advocacy
• Strategic area 5: Monitoring, evaluation and research
Framework of the causes of maternal and
child undernutrition

Immediate causes

Underlying causes

Basic causes
Interventions in line with strategic areas
• Strategic area 1; Intervention 1: Create strong leadership and effective
harmonisation and coordination of the 1st 1000 MCDP
• Strategic area 2; intervention 2: incorporate it into disease prevention
programmes for mothers, infants and children; Improving nutrition 0-
6 months infancy (i.e. exclusive breastfeeding for the 1st 6 months of
life, growth monitoring, vitamin A supplementation-6-59 months,
promotion of food based interventions, promote early detection of
acute malnutrition and treatment)
• Strategic area 3; intervention 3: building institutional and human
capacity for effective delivery of nutrition services
• Strategic area 4; intervention 4: increase nationwide knowledge,
awareness, ownership, participation and support around the first
1000 MCDP
• Strategic area 5; intervention 5: measure progress against the targets,
assess effectiveness of interventions and document and disseminate
lessons learned
Pregnancy Maternal and adolescent Social protection
nutrition: programmes:
extra meals; diverse  livelihood support at community & households
diet aimed at improving food and nutrition security of
 Iron and folic acid supplements, iodised salt, multiple vulnerable households
micronutrients, Breastfeeding counselling Mother and Baby  Homestead gardening
Friendly Hospital Initiative  Community supportive/nutrition groups/
 Fortified staples and specialised nutritional products Mothers’ groups
 Family planning  Household food security
 Promote Production, accessibility and utilization
of diverse foods (crops and livestock)
 Promote food processing, preservation and
storage Provision of Safe water, hygiene and
sanitation
0-6 months  Immediate initiation of exclusive breastfeeding Maternal and  Maternal and adolescent education and male
adolescent nutrition involvement
 Exclusive breastfeeding  School Health and Nutrition/Home grown school
 Growth monitoring & Promotion feeding Strategies/legislation/policies for bio-
fortification

7-24 months  Maternal and adolescent nutrition

 Appropriate complementary local foods for baby
 Continued breastfeeding
 Community growth monitoring
 and promotion
 Clinic-based GM and promotion
 6 monthly de-worming and Vitamin A supplementation for baby
 Appropriate and timely management of severely and moderately
malnourished children
 Correct feeding of sick child Fortified staples and specialised
nutritional products
 Provision of additional iron through Micronutrient Powders
(MNP)