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Liebig’s Law of the
                    Minimum


 Yield is proportional to the
amount of the most limiting
nutrient, whichever nutrient
           it may be.
Nutrition Assessment, Counseling & Support



         S
         C
         A
         N
     N                             N
     A           NACS
                                   A
     C                             C
     S                             S
         S
         C
         A
         N
  Establishing a Nutrition Standard of Care
GOAL: Improved health and quality of life


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



                                                  Economic
  Nutrition care      HIV-Free Survival        strengthening,    Health system
   & support                                livelihoods & food   strengthening
                                                   security


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




          NACS
Linearizing the Life Cycle as a
                           Continuum of Care

Pregnancy Birth   Infancy    Childhood   Adolescence    Adulthood
C&T
ART & ARV
Prophylaxis
   Tx of
Malnutrition
 Maternal
Nutrition &
   IYCF
Counseling


                                          Photos: Wendy Hammond
                                                                  Photo: Wendy
                                                                  Hammond



Pregnancy   Birth   Infancy   Childhood         Adolescence          Adulthood
ART & ARV
       Prophylaxis
      Peri-/Postnatal
            Care
         Maternal
       Nutrition &
     IYCF Counseling          Photo: Wendy Hammond




Pregnancy   Birth   Infancy            Childhood     Adolescence   Adulthood
Postnatal Care
                 Deworming
               Micronutrients
                  IYCF/GMP
                    CMAM
            Tracking/Follow-Up of
             Mother-Infant Pairs




                                                              Photos: Save the Children Federation




Pregnancy   Birth   Infancy         Childhood   Adolescence               Adulthood
Pediatric Care
                                   Nutrition
                              Surveillance/GMP &
                                    Referral
                                Micronutrients
                                     CMAM
                                                                   Photo of Plumpy’nut® from
                                                                   Valid International; all others:
                                                                   Save the Children Federation




Pregnancy   Birth   Infancy        Childhood       Adolescence   Adulthood
Nutrition
                                                                               Nutrition
                                                      Surveillance,
                                                                             Surveillance,
                                                  Referral, Assessment
                                                                         Referral, Assessment
                                                     & Counseling
                                                                            & Counseling
                                                      Deworming
                                                                            Micronutrients
                                                     Micronutrients
                                                                          Tx of malnutrition
                                                         CMAM


  Photo: LINKAGES Project




Pregnancy         Birth     Infancy   Childhood         Adolescence          Adulthood
Why NACS??

• 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
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 Plans
3. Optimal diet
4. Dietary management of symptoms
5. Dietary management of drug side-effects
6. Adherence to medications & clinical visits
7. Chronic disease management
8. Exercise
9. Water, sanitation, and hygiene (WASH)
10. Referral to community services, including household
    ES/L/FS support
Nutrition Support

Treatment of        Prevention of       Economic            Water, Sanitation, &
Malnutrition        Malnutrition        Strengthening,      Hygiene (WASH)
                                        Livelihood & Food
                                        Security Support
• Corrective        • Routine Medical   • Savings           • Distribution of
  Medical Care &      Care & Tx         • Microcredit         POU water
  Tx                • Provision of MN   • Income-             treatment
• Food by             Supplements         generating          products or
  Prescription      • Provision of        activities          vouchers
• Provision of MN     Complementary     • Household food    • Latrine
  Supplements         Foods/Dietary       production          construction
                      Supplements       • Food assistance
Enabling Environment
             Policies, Strategies &
                                                 Supply Chain Management
SUN/               Guidelines         Training
1000                                                  Funding/Financing       PEPFAR
Days          Research/M&E
                                                         Community
 Feed        Mapping/Stre                                 Demand
                                                                              Title II
  the         ngthening
Future                                                     Referral Links &
               Services
                                                              Tracking

 Global                                NACS
 Health
Initiative


             Human Resources                       Quality Improvement
NUTRITION
                                                SUPPORT

                                               NUTRITION
                                              COUNSELING
                                                                     Exercise
                                                IYCF/GMP
                                            Maternal Nutrition

                          Nutrition            NUTRITION                                    Household
                          Care Plan           ASSESSMENT                                      food
                                                                                Support
                                                                                             rations
Clinic       Food by        Prompt              Anthropometry                   Groups                     Community
           Prescription: treatment of               Clinical
           Therapeutic,                            Dietary         Community Health Workers
                           infections
         Supplementary &                  Biochemical    Food
          Complementary Adherence to                    security                          Economic
              Foods        medications                                                    Strengthening,
                                                                                          Livelihoods &
                                            Dietary management                            Food Security
                                              of symptoms, drug
                                            side-effects and drug-
                                               food interactions
                                                  WASH
                                         Point-of-use water treatment
                                          Micronutrient supplements
                                                                                                              17

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Tim Quick 2

  • 1. Liebig’s Law of the Minimum Yield is proportional to the amount of the most limiting nutrient, whichever nutrient it may be.
  • 2.
  • 3. Nutrition Assessment, Counseling & Support S C A N N N A NACS A C C S S S C A N Establishing a Nutrition Standard of Care
  • 4. GOAL: Improved health and quality of life OBJECTIVES: • Improve nutritional status • Improve infant survival • Reduce food insecurity • Strengthen health systems Economic Nutrition care HIV-Free Survival strengthening, Health system & support livelihoods & food strengthening security NACS: A platform for integrating nutrition into the continuum of care
  • 5. NACS: A Life Cycle Approach NACS
  • 6. Linearizing the Life Cycle as a Continuum of Care Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 7. C&T ART & ARV Prophylaxis Tx of Malnutrition Maternal Nutrition & IYCF Counseling Photos: Wendy Hammond Photo: Wendy Hammond Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 8. ART & ARV Prophylaxis Peri-/Postnatal Care Maternal Nutrition & IYCF Counseling Photo: Wendy Hammond Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 9. Postnatal Care Deworming Micronutrients IYCF/GMP CMAM Tracking/Follow-Up of Mother-Infant Pairs Photos: Save the Children Federation Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 10. Pediatric Care Nutrition Surveillance/GMP & Referral Micronutrients CMAM Photo of Plumpy’nut® from Valid International; all others: Save the Children Federation Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 11. Nutrition Nutrition Surveillance, Surveillance, Referral, Assessment Referral, Assessment & Counseling & Counseling Deworming Micronutrients Micronutrients Tx of malnutrition CMAM Photo: LINKAGES Project Pregnancy Birth Infancy Childhood Adolescence Adulthood
  • 12. Why NACS?? • 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
  • 13. 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
  • 14. Nutrition Counseling 1. Understanding of client preferences, constraints & options 2. Nutrition Care Plans 3. Optimal diet 4. Dietary management of symptoms 5. Dietary management of drug side-effects 6. Adherence to medications & clinical visits 7. Chronic disease management 8. Exercise 9. Water, sanitation, and hygiene (WASH) 10. Referral to community services, including household ES/L/FS support
  • 15. Nutrition Support Treatment of Prevention of Economic Water, Sanitation, & Malnutrition Malnutrition Strengthening, Hygiene (WASH) Livelihood & Food Security Support • Corrective • Routine Medical • Savings • Distribution of Medical Care & Care & Tx • Microcredit POU water Tx • Provision of MN • Income- treatment • Food by Supplements generating products or Prescription • Provision of activities vouchers • Provision of MN Complementary • Household food • Latrine Supplements Foods/Dietary production construction Supplements • Food assistance
  • 16. Enabling Environment Policies, Strategies & Supply Chain Management SUN/ Guidelines Training 1000 Funding/Financing PEPFAR Days Research/M&E Community Feed Mapping/Stre Demand Title II the ngthening Future Referral Links & Services Tracking Global NACS Health Initiative Human Resources Quality Improvement
  • 17. NUTRITION SUPPORT NUTRITION COUNSELING Exercise IYCF/GMP Maternal Nutrition Nutrition NUTRITION Household Care Plan ASSESSMENT food Support rations Clinic Food by Prompt Anthropometry Groups Community Prescription: treatment of Clinical Therapeutic, Dietary Community Health Workers infections Supplementary & Biochemical Food Complementary Adherence to security Economic Foods medications Strengthening, Livelihoods & Dietary management Food Security of symptoms, drug side-effects and drug- food interactions WASH Point-of-use water treatment Micronutrient supplements 17