Implementing an Integrated Nutrition Package at Large Scale in Madagascar: The Essential Nutrition Actions Framework

• Published in: Food and nutrition bulletin 2009-09, Vol.30 (3), p.233-244
• Main Authors: Guyon, Agnès B., Quinn, Victoria J., Hainsworth, Michael, Ravonimanantsoa, Priscilla, Ravelojoana, Voahirana, Rambeloson, Zo, Martin, Luann
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aging; Breast Feeding - statistics & numerical data; Diet - statistics & numerical data; Dietary Supplements - statistics & numerical data; Female; Health Promotion - methods; Health Surveys; Humans; Infant; Infant Nutrition Disorders - prevention & control; Infant, Newborn; Madagascar; Male; Maternal Nutritional Physiological Phenomena; Maternal-Child Health Centers - organization & administration; Nutrition Policy; Pregnancy; Program Development; Young Adult
• ISSN: 1564-8265; 0379-5721; 1564-8265
• DOI: 10.1177/156482650903000304

Background Madagascar has some of the highest rates of child stunting, maternal malnutrition, and infant mortality in sub-Saharan Africa. Objective To improve infant and young child feeding practices, increase uptake of micronutrient supplements, and improve women's dietary practices through implementation of a nutrition project based on the Essential Nutrition Actions (ENA) framework. Methods Interventions included training, interpersonal communication, community mobilization, and mass media. Changes in practices were assessed through a comparison of data for children under 2 years of age from representative cross-sectional household surveys collected at baseline in 2000 (n = 1,200) and at the end of program implementation in 2005 (n = 1,760). The surveys were conducted in six districts with a population of 1.4 million. Results The rate of initiation of breastfeeding within 1 hour of birth increased from 32% to 68%, the rate of exclusive breastfeeding of infants under 6 months of age increased from 42% to 70%, the rate of continuation of breastfeeding at 20 to 23 months increased from 43% to 73%, the rate of feeding children the minimum recommended number of meals per day at 6 to 23 months increased from 87% to 93%, the rate of iron–folic acid supplementation during pregnancy increased from 32% to 76%, and the rate of postpartum vitamin A supplementation increased from 17% to 54% (p