Overview

Malnutrition in all its forms is closely linked, either directly or indirectly, to major causes of death and disability worldwide. The causes of malnutrition are directly related to inadequate dietary intake as well as disease, but indirectly to many factors, among others household food security, maternal and child care, health services and the environment. While most nutrition interventions are delivered through the health sector, non-health interventions can also be critical. Actions should target the different causes to reach sustainable change, which requires a multisectoral approach.

This document provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Focusing on this package of essential nutrition actions (ENA), policy-makers could reduce infant and child mortality, improve physical and mental growth and development, and improve productivity.

Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions required to implement them. The document uses a life course approach, from pre-conception throughout the first 2 years of life.

Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the ENAs described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities.

Contents

• Abbreviations
• Acknowledgements
• Preface
• Executive Summary
• Global nutrition challenges
• Part I. Recommendations, rationale and evidence for nutrition actions
  • 1. Interventions targeted at young infants (0–5 months)
    • 1.1 Early initiation of breastfeeding
    • 1.2 Exclusive breastfeeding
    • 1.3 Counselling and support for appropriate feeding of low-birth-weight infants
    • 1.4 Infant feeding in the context of human immunodeficiency virus (HIV)
  • 2. Interventions targeted at infants and young children (6–23 months of age)
    • 2.1 Continued breastfeeding
    • 2.2 Complementary feeding
    • 2.3 Use of multiple micronutrient powders (MNPs) for home fortification of foods consumed by infants and young children 6–23 months of age
    • 2.4 Vitamin A supplementation for children under five years of age
    • 2.5 Vitamin A supplementation in children with measles
    • 2.6 Daily iron supplementation for children 6 to 23 months old
    • 2.7 Zinc supplementation for diarrhoea management
    • 2.8 Reaching optimal iodine nutrition in young children
    • 2.9 Management of children with severe acute malnutrition (SAM)
    • 2.10 Management of children with moderate acute malnutrition
    • 2.11 Nutritional care and support of HIV-infected children 6 months to 14 years old
    • 2.12 Nutritional care and support during emergencies
  • 3. Intervention targeted at women of reproductive age
    • 3.1 Intermittent iron and folic acid supplementation in menstruating women
  • 4. Interventions targeted at pregnant women
    • 4.1 Daily supplementation with iron and folic acid for women during pregnancy
    • 4.2 Intermittent iron and folic acid supplementation for non-anaemic pregnant women
    • 4.3 Vitamin A supplementation in pregnant women
    • 4.4 Calcium supplements in pregnant women
    • 4.5 Reaching optimal iodine nutrition in pregnant and lactating women
    • 4.6 Nutrition care and support for pregnant women during emergencies
  • 5. Global intervention
    • 5.1 Wheat and maize flour fortification
  • Other interventions with an impact on nutrition
  • References
• Part II. Effectiveness of large-scale nutrition programmes: evidence and implications
  • 1. The evolution of evidence for the effects of nutrition interventions, 1960–2010
  • 2. What do we need to know?
  • 3. The impact on whom is being estimated?
  • 4. Shape of response curve
  • 5. Which components via what routes/platforms are included in effective programmes?
  • 6. Estimating nutrition improvement achieved and associated resources
    • 6.1 Data sources and calculations
    • 6.2 Do levels of resources relate to rates of improvement?
  • 7. Implications
    • 7.1 Implications for programmes: limitations and caveats
    • 7.2 Specific implications for designing future programmes and sustaining existing ones
  • 8. Cash Transfer Programmes
    • 8.1 Mechanisms, demand and supply-side
    • 8.2 Coverage and resource intensities
    • 8.3 Effect on nutrition outcomes
    • 8.4 Linkage to direct nutrition programmes
  • References
• Annexes
  • Annex 1 Components and platforms for 32 nutrition programmes with comparative data
  • Annex 2 Summary of CT/CCT programmes
  • Annex 3 Nutrition Programme Case Studies

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