Malnutrition in all its forms is closely linked, either directly or indirectly, to major causes of death and disability worldwide. Worldwide, in 2011 about 101 million children under 5 years of age were underweight and 165 million stunted. At the same time, about 43 million children under 5 were overweight or obese.
The causes of malnutrition are directly related to inadequate dietary intake as well as disease, but indirectly to many factors, among others household food security, maternal and child care, health services and the environment. While most nutrition interventions are delivered through the health sector, non-health interventions can also be critical. Actions should target the different causes to reach sustainable change, which requires a
This document provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Focusing on this package of essential nutrition actions, policymakers could reduce infant and child mortality, improve physical and mental growth and development, and improve productivity.
Part I presents the interventions currently recommended by WHO (see table on pages 8 to 9), summarizes the rationale and the evidence for each, and describes the actions required to implement them. The document uses a life-course approach, from pre-conception throughout the first two years of life.
Some interventions require adequate behaviours, such as initiating breastfeeding soon after delivery, breastfeeding exclusively for six months and then continuing breastfeeding until two years and beyond. In order for those interventions to be successfully established
action is needed to promote healthy behaviors; to create a supportive environment, such as a conducive hospital environment, skilled health workers, support in the community and the workplace; and protection from commercial and other negative influences.
Other interventions require the provision of supplies in adequate amounts for all those in need of them: iron and folic acid supplements, vitamin A supplements, multiple micronutrient powders and ready-to-use therapeutic foods.
The document highlights the circumstances in which the interventions have to be delivered, such as the prevalence of different nutrition conditions, or the occurrence of special situations, such as the presence of underlying disease (HIV infection, measles, diarrhoea) and emergency circumstances
The document deals with interventions delivered through the health sector while recognizing that other interventions delivered through a variety of sectors (agriculture, water and sanitation, education, etc.) also have important impacts on nutrition. A special mention is made of food fortification, an intervention that requires the involvement of the health sector and actors in the food system.
Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the ENAs described in the first part have been implemented in large-scale programmes
in various settings, what the outcomes have been, and examine the evidence for attribution of changes in nutritional outcomes to programme activities. Some background on the evolution of programmatic evidence is given, and implications for the future are drawn.