Box 2.

Recommendations for integration of findings at the provincial/health zone levels

Disseminate the new national iCCM/nutrition policies and guidelines to strengthen IYCF counselling, management of MAM, as well as strengthen the capacity of community health workers and health providers in the management of MAM and SAM.

Strengthen health provider capacity (including that of relais communautaires or RECOs) through training on IYCF, and IMCI/iCCM and treatment of MAM and SAM.

Equip health workers with updated SBCC materials, including key culturally relevant messages and illustrated counselling cards on IYCF practices, including feeding during and after illness.

Strengthen the preventative components of nutrition with iCCM, using the adapted counselling cards to assure facility‐ and community‐based health workers are well equipped and trained to

Avoid separation of mother and baby after delivery, and assure early initiation of breastfeeding;

Counsel on early introduction of foods prior to 6 months of age and how it disrupts exclusive breastfeeding practices;

Counsel and provide support on breastfeeding challenges, including counselling on perceptions of insufficient breastmilk linked to child/maternal illness, counsel on maintaining breastmilk supply, and expression of breastmilk, during periods the mother is away;

Counsel on appropriate complementary feeding practices with an emphasis on quantity, diversity, and frequency of foods to provide for children 6–23 months of age; and

Counsel caregivers on feeding children during and after illness.

Develop or collect local complementary feeding recipes to improve practices based on readily available local foods and cultural beliefs around these foods, to increase dietary diversity, quantity of food consumed, and frequency of meals, as well as increased protein intake. Use recipes during cooking demonstration sessions conducted through mother‐to‐mother support groups.

Strengthen the quality of services and improve counselling on IYCF practices during contacts with care givers, from well child visits to visits for sick children (within the context of case management) to community‐level contact points (including home visits).

Strengthen and maintain the skills of facility‐ (nurses) and community‐based providers (RECOs) through supportive supervisions, and updated curricula.

Target and strengthen engagement with key influencers—grandmothers, fathers, traditional healers, and other influential members of the community—to encourage good IYCF practices. Capitalize on/use existing community groups or establish mother‐to‐mother and community support groups to maximize community reach. Work with and support community organizations to create or strengthen community groups.

Explore innovative ways to work alongside traditional healers. Health management teams should explore how they can facilitate and rationalize referral, encourage the dispensing of ORS/zinc for simple cases of diarrhoea, and provide nutrition advice for certain key IYCF practices (such as breastfeeding messages).

Ensure consistent supply of supplementary foods for treatment of MAM and SAM by liaising with PRONANUT and other implementing partners and advocating for a steady supply at facility and community levels.