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WHO recommendations on antenatal care for a positive pregnancy experience: Summary. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations for Routine Antenatal Care.
Geneva, Switzerland, WHO, 2018 Jan. 10 p. (WHO/RHR/18.02; USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief highlights the WHO’s 2016 ANC recommendations and offers countries policy and program considerations for adopting and implementing the recommendations. The recommendations include universal and context-specific interventions. The recommended interventions span five categories: routine antenatal nutrition, maternal and fetal assessment, preventive measures, interventions for the management of common physiologic symptoms in pregnancy, and health system-level interventions to improve the utilization and quality of ANC.
Maternal and Child Nutrition. 2017 Dec 22; 1-9.The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a “Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes,” which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programs. Currently, global surveillance and monitoring data show that overall IFA supplementation programs suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programs-include weak supply chains, low access to antenatal care services, low-quality behavior change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programs. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programs, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programs. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews.
Guideline: use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women.
Geneva, Switzerland, WHO, 2016. 32 p.The guideline is intended for a wide audience, including governments, nongovernmental organizations, healthcare workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services and their integration into national and subnational public health strategies and programmes. This WHO guideline states that routine use of multiple micronutrient powders during pregnancy is not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes.
Breastmilk Output in a Disadvantaged Community with High HIV Prevalence as Determined by the Deuterium Oxide Dose-to-Mother Technique.
Breastfeeding Medicine. 2016 Mar; 11(2):64-9.INTRODUCTION: World Health Organization breastfeeding guidelines for HIV-infected mothers are exclusive breastfeeding for 6 months and then continued breastfeeding for 12 months, provided the mother is receiving antiretroviral prophylaxis. Many African women perceive that breastmilk alone is not sufficient for their infant's nutritional requirements for the first 6 months of life, and mixed feeding is a common practice. METHODOLOGY: A stable isotope technique was used to determine breastmilk output volumes and maternal body composition objectively at five different time points in the first year of the infant's life. RESULTS: Breastmilk output volumes were high for HIV-infected mothers: 831 +/- 185 g/day at 6 weeks; 899 +/- 188 g/day at 3 months; 871 +/- 293 g/day at 6 months; 679 +/- 281 g/day at 9 months; and 755 +/- 287 g/day at 12 months. These high output volumes had no negative impact on the mother's fat-free mass. The breastmilk output volumes for HIV-uninfected mothers were not significantly different to the outputs for HIV-infected mothers at any of the time points (p > 0.05): 948 +/- 223 g/day at 6 weeks; 925 +/- 227 g/day at 3 months; 902 +/- 286 g/day at 6 months; 746 +/- 263 g/day at 9 months; and 713 +/- 264 g/day at 12 months. CONCLUSION: This study using objective methodology shows that breastmilk outputs of HIV-infected mothers were relatively high (and within published reference ranges), and mothers are able to provide sufficient breastmilk for their infants without compromising their own fat-free mass.
Geneva, Switzerland, WHO, 2016. 172 p.The World Health Organization has released a new set of antenatal care (ANC) recommendations to improve maternal and perinatal health worldwide. The guidelines seek to reduce the global burden of stillbirths, reduce pregnancy complications and provide all women and adolescents with a positive pregnancy experience. High quality health care during pregnancy and childbirth can prevent deaths from pregnancy complications, perinatal deaths and stillbirths, yet globally, less than two-thirds of women receive antenatal care at least four times throughout their pregnancy. The new ANC model raises the recommended number of ANC visits from four to eight, thereby increasing the number of opportunities providers have to detect and address preventable complications related to pregnancy and childbirth. The guidelines provide 49 recommendations for routine and context-specific ANC visits, including nutritional interventions, maternal / fetal assessments, preventive measures, interventions for common physiological symptoms and health system interventions. Given that women around the world experience maternal care in a wide range of settings, the recommendations also outline several context-specific service delivery options, including midwife-led care, group care and community-based interventions.
Washington, D.C., World Bank, 2004 May.  p. (Health, Nutrition and Population (HNP) Discussion Paper; World Bank Report No. 69106)This paper argues for more nuance in the interpretation of progress towards the Nutrition Millennium Development Goal indicator (halving the prevalence of underweight children, under 5 years old, by 2015). Interpretation of a country's performance based on trends alone is ambiguous, and can lead to erroneous prioritization of countries in need of donor assistance. For instance, a country may halve the prevalence by 2015, but will still have unacceptable high malnutrition rates. This paper analyses which countries are showing satisfactory and unsatisfactory progress using the Annual Rate of Change (ARC), and then introduces the World Health Organization-classification of severity of malnutrition in the analysis to provide more nuance. It highlights that a little less than half of the Bank's client population is likely to halve underweight by 2015. Although the paper uses national data only, it flags the risks and recommends that countries take regional disparities into their needs-analysis. The paper also argues for more attention to the other important nutrition indicators, stunting and micronutrient deficiencies, which remain enormous problems, and briefly discusses solutions to reducing underweight malnutrition.
Maternal and Child Nutrition. 2016 May; 12 Suppl 1:12-26.Childhood stunting is the best overall indicator of children's well-being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below -2 SD from the length-for-age/height-for-age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length-for-age/height-for-age z-score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post-natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.
World Health Organization. Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition. Geneva, Switzerland, 2014.
Advances In Nutrition. 2015 Jan; 6(1):134-5.Add to my documents.
Systematic review of integration between maternal, neonatal, and child health and nutrition and family planning. Final report.
Washington, D.C., Global Health Technical Assistance Project, 2011 May. 284 p. (Report No. 11-01-303-03; USAID Contract No. GHS-I-00-05-00005-00)This reveiw seeks to focus on the MNCHN and FP components of SRH to examine the evidence for MNCHN-FP integration, review the most up-to-date factors that promote or inhibit program effectiveness, discuss best practices and lessons learned, and identify recommendations for program planners, policymakers, and researchers. The objective was to address these key questions: 1) What are the key integration models that are available in the literature and have been evaluated?; 2) What are the key outcomes of these integration approaches?; 3) Do integrated services increase or improve service coverage, cost, quality, use, effectiveness, and health?; 4) What is the quality of the evaluation study designs and the quality of the data from these evaluations?; 5) What types of integration are effective in what context?; 6) What are the best practices, processes, and tools that lead to effective, integrated services? What are the barriers to effective integration?; 7) What are the evidence/research and program gaps? What more do we need to know?; and 8) How can future policies and programs be strengthened?
Guardian. 2015 Mar 9;  p.A growing body of evidence documents the importance of multiple micronutrient supplements during pregnancy to improve the health and survival of newborns and their mothers. When mothers take micronutrient supplements during pregnancy -- instead of iron-folic acid alone -- their babies are born later and born bigger, giving them a stronger start in life. We call on the WHO to update their guidelines.
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.2)Recognizing that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition, in 2012 the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to: achieve a 40% reduction in the number of children under-5 who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; reduce and maintain childhood wasting to less than 5%. As part of its efforts, the World Health Organization (WHO) has developed a series of six policy briefs, linked to each of the global targets, to guide national and local policy-makers on what actions should be taken at scale, in order to achieve the targets. Recognizing that the six targets are interlinked, many evidence-based, effective interventions can help make progress toward multiple targets. The purpose of these briefs is to consolidate the evidence around which interventions and areas of investment need to be scaled up, and to guide decision-makers on what actions need to be taken in order to achieve real progress toward improving maternal, infant and young child nutrition. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.3)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the first target: a 40% reduction in the number of children under-5 who are stunted. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing stunting rates among children aged under 5 years. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.7)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the fifth target: Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in improving exclusive breastfeeding rates among infants less than six months. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.6)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan for maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the fourth target: No increase in childhood overweight. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners prevent continued increases in overweight in children and ensure that the target is met. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.5)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the third target: a 30% reduction in low birth weight. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing rates of low birth weight. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.4)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025 . This policy brief covers the second target: a 50% reduction of anaemia in women of reproductive age. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing the rates of anaemia among women of reproductive age. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.8)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the sixth target: reduce and maintain childhood wasting to less than 5%. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners to reduce and maintain the rate of childhood wasting. (Excerpts)
Maternal and Child Nutrition. 2013; 9 Suppl 2:27-45.An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.
The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions.
Maternal and Child Nutrition. 2013; 9 Suppl 2:6-26.In 2012, the World Health Organization adopted a resolution on maternal, infant and young child nutrition that included a global target to reduce by 40% the number of stunted under-five children by 2025. The target was based on analyses of time series data from 148 countries and national success stories in tackling undernutrition. The global target translates to a 3.9% reduction per year and implies decreasing the number of stunted children from 171 million in 2010 to about 100 million in 2025. However, at current rates of progress, there will be 127 million stunted children by 2025, that is, 27 million more than the target or a reduction of only 26%. The translation of the global target into national targets needs to consider nutrition profiles, risk factor trends, demographic changes, experience with developing and implementing nutrition policies, and health system development.This paper presents a methodology to set individual country targets, without precluding the use of others. Any method applied will be influenced by country-specific population growth rates. A key question is what countries should do to meet the target. Nutrition interventions alone are almost certainly insufficient, hence the importance of ongoing efforts to foster nutrition-sensitive development and encourage development of evidence-based, multisectoral plans to address stunting at national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, and other factors that affect the risk of stunting. In addition, an accountability framework needs to be developed and surveillance systems strengthened to monitor the achievement of commitments and targets.
Essential nutrition actions: Improving maternal, newborn, infant and young child health and nutrition.
Geneva, Switzerland, WHO, 2013.  p.This document provides a compact summary of WHO guidance on nutrition interventions targeting the first 1000 days of life. Focusing on this package of essential nutrition actions, policy-makers 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, 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. 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 to 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. (Excerpts)
Geneva, Switzerland, WHO, 2013.  p.This guideline provides global, evidence-informed recommendations on the use of calcium supplements as a public health intervention for the purpose of improving pregnancy outcomes. Poor maternal and newborn health and nutrition remain significant contributors to the burden of disease and mortality. Calcium supplementation has the potential to reduce adverse gestational outcomes, in particular, by decreasing the risk of developing hypertensive disorders during pregnancy, which are associated with a significant number of maternal deaths and considerable risk of preterm birth, the leading cause of early neonatal and infant mortality. Member States have requested guidance from the World Health Organization (WHO) on the efficacy and safety of calcium supplementation in pregnant women as a public health strategy, in support of their efforts to achieve the Millennium Development Goals and the global targets set in the maternal, infant and child nutrition comprehensive implementation plan. The guideline is intended for a wide audience including policy-makers, their expert advisers, and technical and programme staff at organizations involved in the design, implementation and scaling-up of nutrition actions for public health.
Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?
Paediatric and Perinatal Epidemiology. 2012 Jul; 26 Suppl 1:315-25.Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and Development of WHO through the Nutrition Guidance Expert Advisory Group processes. How and if programme guidance, as well as policy commitment for improved maternal nutrition, will be strengthened through the Nutrition Guidance Expert Advisory Group process is as yet unclear. The global movement to increase investment in programmes aimed at maternal and child undernutrition called Scaling Up Nutrition offers an opportunity to build developing country experience with efforts to improve nutrition during pregnancy and lactation. All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries. (c) 2012 Blackwell Publishing Ltd.
Washington, D.C., World Bank, 2013 Jan.  p.This report provides operational guidance to maximize the impact of investments on nutrition outcomes for women and young children. The recommendations in this document build on evidence to date on issues of malnutrition, with the aim of providing concrete guidance on how to mainstream nutrition into agriculture, social protection, and health. The document is composed of five modules, including an introduction, an economic analysis of the relationship between poverty, economic growth and nutrition, and one module for each of the aforementioned focus sectors.
[Geneva, Switzerland], WHO, 2011.  p.As part of its "Making Pregnancy Safer" series, the World Health Organization answers the following questions about skilled birth attendants: Who is a skilled birth attendant? In how many births do skilled attendants assist? How do skilled attendants care for mothers and babies? How does skilled birth care impact on maternal mortality? How can the coverage be increased? What does WHO do to increase skilled care at birth?
Lancet. 2007 Sep 22; 370(9592):1030-1031.Young Kwang Chae and Jeong Hyun Yun query whether data from our randomised controlled trial of early, high-dose vitamin A supplementation (50 000 I given with the three diphtheria-tetanus-pertussis [DPT] vaccinations at 6, 10, and 14 weeks) in Gambian infants can contribute to the ongoing controversy about whether there might be harmful interactions between vitamin A supplementation and killed vaccines, particularly in girls. Several notes of caution are necessary. The observations by Benn and colleagues that have raised the concerns relate to excess mortality. Our trial is greatly underpowered for this endpoint. There were two postneonatal deaths in the high-dose group (n=99) and none in the standard WHO dose group (n=98). One male infant died of pneumonia and septicaemia at 7 months and one female of unknown causes at 3 months. This overall post-neonatal infant mortality rate equates to 10 in 1000, which is exceptionally low for this region and reflects the high level of monitoring and clinical care offered to the study participants. This point reduces the usefulness of our data in contributing to the debate. In response to Chae and Yun's query as to whether the vitamin A might have exacerbated DTP-related side-effects, we have reanalysed our data in an attempt to identify potentially life-threatening illnesses. In our original paper we restricted the analyses to clinic visits that elicited a treatment. Numerous non-critical conditions such as colds and skin rashes remained. We have now excluded these and repeated the analysis of potentially life-threatening events for the time window between the first DPT vaccination and vitamin A dose at 6 weeks and the first live vaccine (measles at 9 months). We analysed four diseases (malaria, diarrhoea, pneumonia, and septicaemia) separately and combined. There were 73 events in the high-dose group and 79 events in the WHO group. Owing to small numbers of events there were wide confidence intervals and no differences were significant. The closest to significance (pneumonia) was, if anything, lower in the high-dose group. In summary, our trial is under powered to contribute to this important debate, but we will be happy to contribute the data to future meta-analyses. (full text)