MINISTRY OF HEALTH Guidelines on Maternal Nutrition in Uganda

[Pages:37]MINISTRY OF HEALTH

Guidelines on Maternal Nutrition in Uganda

1st EDITION DECEMBER 2010

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ACKNOWLEDGEMENTS The Ministry of Health would like to acknowledge the valuable contribution of partners, groups, and individuals at various stages of the development of these guidelines. Ministry of Health is indebted to A2Z: The USAID Micronutrient and Child Blindness Project/AED and UNICEF for technical and financial support that made the development and finalization process of the guidelines possible. Ministry of Health is grateful to the technical working group: Dr. Alfred Boyo (A2Z/AED), Annet Kyarimpa Mugabe (A2Z/AED), Dr. E. Madraa (MOH), Tim Mateeba (MOH), Rebecca Mirembe (MOH), Dr. Jacinta Sabiiti (MOH), Sheila Katurebe (MOH), Dr. G. Bisomborwa (WHO), Dr. Miriam Mutabazi (MSH-Strides). Special thanks and appreciation is extended to Dr. Alfred Boyo, Annet Kyarimpa Mugabe and Tim Mateeba for coordinating the entire process.

Dr. Anthony. K. Mbonye Commissioner Community Health Ministry of Health

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TABLE OF CONTENTS ACRONYMS .............................................................................................................................................. 5 FOREWARD............................................................................................... Error! Bookmark not defined. 1. INTRODUCTION................................................................................................................................ 9

1.1. Overview............................................................................................................................................ 9 1.2. Situation analysis .............................................................................................................................. 11 1.3. Justification ....................................................................................................................................... 11 1.4. Purpose of the guidelines................................................................................................................. 12 1.5. Goal and objectives of the guidelines .............................................................................................. 12 1.6. Target audience................................................................................................................................ 12 2. MATERNAL NUTRITION INTERVENTIONS........................................................................... 13 2.1. Maternal nutrition interventions during preconception.................................................................. 13

2.1.1. Nutritional assessment during preconception.......................................................................... 13 2.1.2. Micronutrient deficiencies prevention and control through diet and supplementation........... 14 2.1.3 Nutrition education/counseling during preconception.............................................................. 16 2.2. Maternal nutrition interventions during antenatal care ................................................................... 17 2.2.1. Nutritional assessment .............................................................................................................. 17 2.2.2. Nutritional requirements of pregnant women.......................................................................... 22 2.2.3. Nutrition education/counseling during antenatal care .............................................................. 23 2.2.4. Common physiological disturbances during pregnancy............................................................ 23 2.3. Maternal nutrition interventions during postnatal care................................................................... 24 2.3.1. Nutritional assessment of lactating women .............................................................................. 24 2.3.3. Nutritional requirements during lactation ................................................................................ 25 3. MATERNAL NUTRITION UNDER SPECIAL CIRCUMSTANCES ...................................... 26 3.1 Diseases ............................................................................................................................................ 26

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3.2. Social factors, local practices, and environmental issues affecting maternal nutrition .................... 27 3.2.1. Child spacing.............................................................................................................................. 27 3.2.2. Myths, local practices, and gender issues that affect maternal nutrition ................................. 28 3.2.3. Substance abuse........................................................................................................................ 28 3.2.4. Maternal nutrition in emergencies ............................................................................................ 29 3.2.5. Nutritional care for adolescent pregnancy ............................................................................... 29 3.2.6. Community support for maternal nutrition.............................................................................. 29 3.2.7. Water, sanitation, and hygiene.................................................................................................. 30

4. IMPLEMENTATION ........................................................................................................................ 31 5. MONITORING AND EVALUATION......................................................................................... 34 ANNEX I: Counseling Job aid for Health Workers on Prevention and Control of Anemia .................. 35 ANNEX 2: Protocols for Interventions to Prevent and/or Treat Maternal Anemia............................... 36

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ACRONYMS

AED ANC BFHI BMI DHT DOT FP HIMS IDD IEC IFA IPT ITNs LBW MDG MOH MUAC NDP NGO NTD PEM PMTCT PNC RCT TB UDHS VAD VHT WHO YCC

Academy for Education Development Antenatal Care Baby-friendly hospital initiative Body Mass Index District Health Team Direct observed Therapy Family planning Health Information Management Service Iodine deficiency disorders Information Education and Communication Iron and Folic Acid Intermittent Presumptive treatment Insecticide Treated Nets Low birth weight baby Millennium Development Goals Ministry of Health Mid-Upper Arm Circumference National Development Plan Non-Governmental Organization Neglected Tropical Diseases Protein energy malnutrition Prevention of mother-to-child transmission Prenatal care Routine Counseling and Testing Tuberculosis Uganda Demographic Health Survey Vitamin A deficiency Village health teams World Health Organization Young Child Clinic

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FOREWARD

Maternal nutrition plays a critical role in the reduction of maternal morbidity and mortality. This document provides guidance on nutrition for women of reproductive age. During periods of pregnancy and lactation, women's nutrition becomes particularly vulnerable. Maternal malnutrition in Uganda is cyclical: mothers give birth to low birth-weight babies who were undernourished in utero, and these children are then stunted during childhood, pregnant during adolescence, underfed and overworked during pregnancy and lactation, and ultimately give birth to low birth weight babies of their own. This report provides guidance on how to break this intergeneration cycle of maternal malnutrition by outlining special nutritional interventions at preconception, pregnancy, and lactation that enable safer and more optimal birth outcomes. These guidelines should be implemented in conjunction with the existing Infant and Young Child Feeding policy guidelines to improve the health of babies, which will ultimately result in healthier adolescents and adults.

It is important that all maternal health stakeholders in Uganda utilize these guidelines by integrating the recommendations for implementation into their programs and supporting and/or funding the interventions, thus contributing to a reduction of maternal malnutrition as well as the associated morbidity and mortality.

These maternal nutrition guidelines have been developed to improve the knowledge and skills necessary for service providers at all levels to adequately respond to maternal and child nutritional needs; improve provision of quality maternal and child nutritional services at the community and health facility level; to provide a basis for advocacy efforts that garner support for maternal nutrition interventions at all levels, to facilitate workshops for health care providers and other stakeholders on interpersonal nutrition education and counseling, community dialogue, development of IEC materials, and health education for improved maternal nutrition; and to strengthen integration of nutrition interventions for adolescent, pregnant, and lactating women within existing health services.

These recommendations set forth by the Ministry of Health aim to ensure the provision of optimal maternal nutrition services. MOH will continue to coordinate and monitor the implementation of the guidelines.

The following recommendations can be followed to improve the provision of maternal health and nutrition services in Uganda:

Recommendation 1: Folic acid at preconception Folic acid should be provided as a supplement, in addition to adequate intake of foods rich in folic acid, to women prior to conception to prevent neural tube defects in newborns.

Recommendation 2: Proper weight gain during pregnancy i. Based on BMI results, women who are underweight, overweight, or obese should receive counseling regarding appropriate diet for adequate weight gain during pregnancy. ii. A woman at preconception is considered to be underweight when her MUAC reading is less than 21.0cm.

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iii. A pregnant or lactating woman is considered to be underweight when her MUAC reading is less than 23.5cm.

Recommendation 3: Antenatal care and iron and folic acid supplementation i. All pregnant women should be screened for anemia and corrective action taken. ii. All pregnant women should be encouraged to attend at least four ANC sessions at health facilities during which they receive iron and folic acid supplementation according to nationally accepted protocols to prevent anemia. iii. Pregnant women should be counseled to ensure compliance with the recommended iron and folic acid supplementation intake of at least 90+ tablets.

Recommendation 4: Malaria and worm control to prevent anemia i. All expectant mothers should be given preventive doses of fansidar and dewormers during the second and third trimesters. ii. Women should be advised to sleep under ITNs and practice adequate personal and environmental hygiene.

Recommendation 5: Diet during pregnancy and lactation In addition to the regular three meals, women should be counseled to eat at least one extra meal (snack) per day while pregnant and two extra meals per day while lactating, to meet the daily energy requirements of pregnancy and lactation respectively.

Recommendation 6: Vitamin A supplementation i. Women should be counseled and given a one-time dose of 200,000IU of vitamin A within eight weeks of giving birth. ii. For mothers who have opted NOT to breast feed their infants, a one-time, low dose of 50,000IU should be given to the infant to help boost immunity.

Recommendation 7: Postnatal care and iron and folic acid supplementation All postnatal women should be given routine iron and folic acid supplementation within six weeks of delivery and be counseled to ensure compliance with the recommended dosage of one tablet per day for three months.

Recommendation 8: Iodine supplementation All women of reproductive age should be counseled on the daily intake of iodine by using iodized salt.

Recommendation 9: Nutrition counseling and education All women of reproductive age should be given sufficient nutritional counseling and education to promote improved nutritional status on the following topics:

i. Intake of foods rich in iron, folate, vitamin A, and iodine. ii. Intake of variety of foods that includes protein, energy, vitamin and mineral rich foods. i. Clean and safe drinking water and personal and environmental hygiene.

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Recommendation 10: Breastfeeding and family planning Women should be counseled on the role of, and conditions for, exclusive breastfeeding as a method of family planning in addition to other family planning methods. Recommendation 11: Education regarding local practices that negatively affect maternal nutrition Health care providers should educate and counsel mothers and family members regarding all forms of myths, taboos, or local practices that affect the nutritional status of women before, during, and after pregnancy. Recommendation 12: Nutrition during emergencies During emergency situations, humanitarian aid programs should prioritize vulnerable groups that include children, pregnant women, and lactating mothers in their nutrition outreach to meet their energy and other nutrient needs.

Dr. Nathan Kenya-Mugisha For Director General of Health Services

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