Tim Quick 2

Liebig’s Law of the Minimum

Yield is proportional to the amount of the most limiting nutrient, whichever nutrient

it may be.

Fortification

CMAM

Zinc Supplementation

Growth

monitoring

&

Promotion

Universal

Salt

Iodization

PD Hearth

Vitamin A

Supplementation

Infant &Young Child Feeding

Iron/FA

Supplementation

Maternal Nutrition

NACS

NACS

NACS

NACS

NACS

Nutrition Assessment, Counseling & Support

Establishing a Nutrition Standard of Care

NACS: A platform for integrating nutrition into the continuum of care

Nutrition care & support

Economic strengthening,

livelihoods & food security

Health system strengthening

HIV-Free Survival

OBJECTIVES:• Improve nutritional status• Improve infant survival• Reduce food insecurity• Strengthen health systems

GOAL: Improved health and quality of life

NACS: A Life Cycle Approach

Adul

thoo

d

Birth

Pregnancy

Infancy

ChildhoodAdolescence

NACS

BirthPregnancy Infancy Childhood Adolescence Adulthood

Linearizing the Life Cycle as a Continuum of Care


C & TART & ARV Prophylaxis

Tx of Malnutrition

Maternal Nutrition &

IYCF Counseling

Photo: Wendy Hammond

Photos: Wendy Hammond


ART & ARV Prophylaxis

Peri-/Postnatal Care

Maternal Nutrition &

IYCF Counseling Photo: Wendy Hammond


Photos: Save the Children Federation

Postnatal CareDeworming

MicronutrientsIYCF/GMP

CMAMTracking/Follow-Up of

Mother-Infant Pairs


Photo of Plumpy’nut® from Valid International; all others: Save the Children Federation

Pediatric CareNutrition

Surveillance/GMP & Referral

MicronutrientsCMAM


Photo: LINKAGES Project

Nutrition Surveillance,

Referral, Assessment & CounselingDeworming

MicronutrientsCMAM

Nutrition Surveillance,

Referral, Assessment & Counseling

MicronutrientsTx of malnutrition

• Links vulnerable to clinical services -- reciprocal impact between health & nutrition -- most powerful nutrition intervention for AIDS patients is ART

• Corrective chronic nutrition mgmt -- continuum of care

• Link patients to support groups & community services

• Referrals for economic strengthening, livelihood & food security (ES/L/FS) support

• Health system strengthening -- NACS for general population, not just HIV-patients & families

Why NACS??

NACS Hinges on Nutrition Assessment

1. Routine Comprehensive Assessment• Anthropometry• Biochemical• Clinical• Dietary• Household Food security

2. Analyze/interpret data using evidence-based standards

3. Identify nutrition problems

4. Determine causes/contributing risk factors

5. Cluster signs/symptoms and defining characteristics

6. Determine an appropriate Nutrition Care Plan

Nutrition Counseling

1. Understanding of client preferences, constraints & options

2. Nutrition Care Plans3. Optimal diet4. Dietary management of symptoms5. Dietary management of drug side-effects6. Adherence to medications & clinical visits7. Chronic disease management8. Exercise9. Water, sanitation, and hygiene (WASH)10. Referral to community services, including household

ES/L/FS support

Nutrition Support

Treatment of Malnutrition

Prevention of Malnutrition

Economic Strengthening, Livelihood & Food Security Support

Water, Sanitation, & Hygiene (WASH)

• Corrective Medical Care & Tx• Food by

Prescription• Provision of MN

Supplements

• Routine Medical Care & Tx• Provision of MN

Supplements• Provision of

Complementary Foods/Dietary Supplements

• Savings• Microcredit• Income-

generating activities• Household food

production• Food assistance

• Distribution of POU water treatment products or vouchers• Latrine

construction

Enabling Environment

SUN/1000 Days

Feed the

Future

Global Health

Initiative

Policies, Strategies & Guidelines Training

Research/M&E

Supply Chain Management

Quality ImprovementHuman Resources

Funding/Financing

Referral Links & Tracking

Mapping/Strengthening

Services

NACS

PEPFAR

Title II

Community Demand

17

NUTRITION ASSESSMENT

NUTRITION SUPPORT

NUTRITION COUNSELING

Biochemical

WASH

IYCF/GMP

Nutrition Care Plan

Adherence to medications

Dietary management of symptoms, drug

side-effects and drug-food interactions

Maternal Nutrition

Exercise

Prompt treatment of

infections

Household food

rations

Referrals

Referrals

CommunityFood by Prescription: Therapeutic,

Supplementary & Complementary

Foods

Micronutrient supplements

Point-of-use water treatment

Food

security

AnthropometryClinicalDietary

Referrals

Referrals

ClinicSupport Groups

Community Health Workers

Economic Strengthening, Livelihoods & Food Security

Health & Medicine

Tim Quick 2