Essential Nutrition Actions

The Essential Nutrition Actions (ENA) framework delivers an integrated package of cost-effective nutrition actions proven to reduce maternal and child undernutrition and associated mortality and morbidity. The target groups include children younger than two and pregnant and lactating women since the highest risk period for malnutrition-related mortality or reduced physical, cognitive and human potential is during gestation and the first two years of life. To achieve high coverage levels, the ENA framework emphasizes reaching children and women through existing programs in multiple sectors such as health, agriculture and education. 

A key strategy of the ENA framework is to build a broad coalition of advocates to promote messages and services for seven essential nutrition and child health interventions to achieve lasting public health impact.  Situational analysis and research  is done as well as extensive consultations with the Ministry of Health and local partners to effectively tailor the ENA approach to the local context.

To disseminate key messages and services, HKI builds upon and strengthens the capacities of existing health staff and selected community members. Short, skills-based training programs teach health personnel and selected community members the importance of the seven elements together with techniques for determining behavior change goals with pregnant women, mothers of young children, and their families. These actions are promoted at health facilities, in the communities and through other relevant programs such as homestead food production and village gardens, primary education and microcredit programs.  (For more information about HKI’s gardening programs, click here.)

Messages are conveyed through multiple channels including interpersonal communications, women’s and community group discussions, educational talks at heath centers, community events and mass media, especially radio. The seven elements of ENA are: 

Support for optimal breastfeeding of infants during the first 6 months of life which entails the initiation of breastfeeding within one hour of birth and exclusive breastfeeding for the first 6 months. (To learn more about optimal breastfeeding, click here.);

Improved complementary feeding including appropriate quality, frequency, diversity and food hygiene of young children from 6 months of age with continued breastfeeding to 24 months and beyond. Point-of-use products such as micronutrient powders or lipid-based nutrient supplements may be used to improve the nutrient quality of the local diet for children from 6 months of age. (For more information about the point-of-use supplement Sprinkles®, click here.);

Appropriate nutritional care of sick and malnourished children including “kangaroo mother” care for low birth weight infants, increased feeding during/after illness, treatment of diarrhea with oral rehydration solution and supplements of zinc and vitamin A, and integration, where appropriate, of community-based therapeutic care for treatment of moderate and severe acute malnutrition;

Improved nutrition for pregnant and lactating women  including increased caloric and protein intake, dietary changes to increase iron absorption and intake of other micronutrients, rest during pregnancy, and iron-folic acid supplementation;

Integrated control of anemia in pregnant women and children including improved iron nutrition and supplementation for pregnant women; intermittent preventive treatment for malaria during pregnancy; promotion of insecticide-treated bed nets; de-worming during pregnancy and for children starting at 12 months of age; and delayed cord clamping;

Control of vitamin A deficiency, including breastfeeding, supplementation of women post-partum and of children, dietary diversification and promotion of the consumption of fortified foods (to learn more about HKI's efforts to combat vitamin A deficiency click here); and

Promoting the use of iodized salt.

The ENA framework also addresses HIV/ AIDs by preventing mother to child transmission of HIV through optimal infant feeding and supporting nutritional care of people living with HIV/ AIDS. (For more information about HKI’s HIV/AIDS programs, click here.)