HS 346: exam 1 study guide (lecture 4-the AAMA project, Nepal MSNP, Micronutrient Interventions, UNICEF Child Malnutrition)

What is exclusive breastfeeding and who is it recommended for?

Infants (AGED 0-6 MONTHS) only receive breast milk, no other food or drinks.

What is colostrum and why is it important?

"First milk", rich in antibodies and nutrients for newborn immunity.

What are the key goals in complementary feeding?

• introduce family foods at 6 months

• dietary diversity > 4 food groups

• age-appropriate meals per day

• diverse/frequent diet

When and where was the AAMA (action against malnutrition) project implemented?

Nepal in (2016?)

What was the context in which the intervention was developed?

High childhood malnutrition

What were the 2 core components of the AAMA project?

• BEHAVIOR CHANGE COMMUNICATION (moms with a little bit of land and had young kids needed to farm more often, and farm more dietarily diverse foods)

• COMMUNITY MOBILIZATION (female community health workers to hold meetings with mothers monthly to check up on them).

Who did the AAMA project target and why?

Mothers of young children with a bit of land because they could implement the behavior changes and they have control over their land and therefore, some aspects of their health.

What is an FCHV

• Female Community Health Volunteers.

• The AMMA project utilized this kind of workers because they serve the communities that they are from.

• They are trusted sources of information and service, and can provide important, basic services like immunizations and vitamin supplication.

What is formative research?

research conducted at the beginning of the planning process, or during the implementation of a plan, to understand BEHAVIORS and BARRIERS before designing interventions.

What are the 8 determinants of action in AAMA's barrier analysis?

• perceived susceptibility

• perceived severity

• perceived benefits

• perceived barriers

• cues to action

• self-efficacy

• social norms

• positive/negative reinforcement

What behavior change theories informed AAMA?

• Health belief model

• Theory of planned behavior.

What methods were used in AAMA's impact evaluation?

Mixed methods:

• surveys

• interviews

• focus groups

Key finds of AAMA and how did Suaahara build on it?

• Improved feeding practices.

• Suaahara scaled up with broader multi-sectoral strategies.

Trends in infants <5 and neonatal mortality in Nepal over 30 years?

Significant decline due to improved health interventions

Trends in stunting, wasting, and underweight

• stunting declined

• wasting and underweight remain challenges.

When did Nepal develop its first multi-sectoral nutrition plan? How has it evolved over time?

It was launched in 2013, expanded to MSNP-III with broader sectors and targets

Nutrition specific interventions

Direct (ex: supplementation)

Nutrition sensitive interventions

Indirect (ex: agriculture, education)

Examples of MSNP-III nutrition specific interventions

• Vitamin A

• iron-folic acids

Examples of MSNP-III nutrition sensitive interventions

• school meals

• sanitation programs

What are some other categories for strategic intervention in MSNP III?

• sustainable food systems

• resilience to crisis

• GENDER EQUALITY

Maternal and child nutrition targets being measured as part of the MSNP III

reduce STUNTING, anemia, and improve dietary diversity

Out of the estimated USD 1.5 billion required to implement MSNP-III, what percentage is paid for by the government of Nepal?

~15%

What is hidden hunger

micronutrient deficiencies without visible signs

What are the 5 approaches to address micronutrient deficiencies

• supplementation

• fortification

• dietary diversification

• biofortification

• public health measures

What is supplementation?

addition of nutrients to the diet through pills (think of a vitamin A supplement, like a GUMMY, individual)

Supplementation vs point-of-use fortification?

Supplementation: Pills or syrups. Point-of-use: nutrient powders added to food

What is fortification?

Adding extra nutrients to foods that wouldn't have them naturally in a MASSIVE way like in agriculture. For the GENERAL POPULATION, targeted for vulnerable groups, as its commercially driven by markets.

When is fortification appropriate (or not)?

Appropriate when infrastructure for it exists (like tech and factories), not when access is limited.

What is dietary diversification?

expand production, processing, marketing, and consumption of a wide variety of foods

What is biofortification?

The development of crops with enhanced nutritional profiles to combat nutrient deficiencies.

What are public health measures?

Measures that contribute most to people being healthier today than they were a century ago :

• Sanitation

• Better nutrition

• occupational safety

What is the triple burden of child malnutrition?

Undernutrition (stunting/wasting)

micronutrient deficient

overweight/obesity

How does UNICEF assess children's diets?

Using MDD (minimum dietary diversity); compares to recall-based methods

UNICEF framework determinants of malnutrition

Immediate

• inadequate diet

• disease

Underlying:

• food insecurity

• care practices

Enabling:

• policies

• systems

Primary outcomes UNICEF aims to influence?

Improved maternal and child malnutrition

reduced stunting and wasting

Perceived susceptibility in AAMA

mothers recognized that poor feeding could lead to weakness/illness in their kids → helped motivate early breastfeeding and interest in dietary diversity to prevent malnutrition

Perceived severity in AAMA

Focus groups revealed awareness that undernutrition could stunt growth and affect future success → reinforced urgency to adopt recommended feeding practices

Perceived benefits in AAMA

Mothers believed that breast milk made children strong and healthy → supported promotion of exclusive breastfeeding and colostrum feeding

Perceived barriers in AAMA

Many moms feared that they couldn’t produce enough milk due to poor diets, some discarded colostrum due to cultural beliefs → informed messaging to reassure moms abt milk adequacy and educate on colostrum’s value

Cues to action AAMA project

Flip charts, crop calendars, and home visits by trained volunteers served as visual and interpersonal prompts → triggered behavioral change by linking nutrition messages to agriculture and daily routine

Self efficacy in AAMA

mothers lacked confidence in preparing diverse meals or feeding animal-source foods → AAMA provided hands-on training in homestead food production and cooking demos to build skills

Social norms in AAMA

Grandmothers were often primary caregivers and influenced feeding decisions, some discouraged colostrum → strategy targeted influential family members with tailored education and group discussions

Positive/negative reinforcement in AAMA

Mothers saw visible improvements in child health when feeding practices improved, group leaders praised progress → reinforced continued adoption of behaviors like timely breastfeeding and diverse complementary feeding