Table 1.

Summary of actions documented in Mauritania with respect to key infant and young child feeding practices and documents reviewed (explanations found at the end of the table)

Key practice †	Summarized findings by type of document reviewed, with selected national‐level findings*
	Policies	Formative research	Training/curricula	Programmes	Intended programme coverage	Actual programme coverage	Programme monitoring	Survey/evaluation
Promotion of optimal feeding practices
Timely introduction BF 1 h	✓	✓	✓	✓	National	Sub‐national	(✓)	44% ‡
EBF to 6 months	✓	✓	✓/–✓	✓/–✓	National	Sub‐national	(✓)	11% §
Continued BF to 24 months	✓	N/I	✓	✓	National	Sub‐national	(✓)	33% ¶
								50%**
Introduce CF at 6 months	✓	(✓)	✓/–✓	✓/–✓	National	Sub‐national	(✓)	40% ††
Nutrient‐dense CF	✓	N/I	✓	(✓)	National	Sub‐national	(✓)	30% ‡‡
Responsive feeding	✓	N/I	✓	✓	National	N/I	(✓)	N/I
Appropriate frequency/consistency	(✓)	N/I	✓	✓	N/I	Sub‐national	(✓)	8% §§
Dietary assessments to evaluate consumption	N/I	N/I	N/I	N/I	N/I	N/I	N/I	Food groups ¶¶
Micronutrients
Vitamin A supplements young children	✓	✓	✓	✓	National	56%***	MICS	N/I
Post‐partum maternal vitamin A supplementation	✓	N/I	(✓)	(✓)	National	30% †††	27% increase ‡‡‡ , (7)	N/I
Zinc to treat diarrhoea	None	N/I	N/I	N/I	N/I	N/I	N/I	N/I
Prevention of zinc deficiency	(Fortify)	N/I	N/I	N/I	N/I	N/I	N/I	N/I
Anaemia prevention (malaria, parasites)	✓	(✓)	✓	✓	(National)	Sub‐national	12% §§§	85%
								<11 g dL−1 ¶¶¶ , (8)
Anaemia prevention (iron/folic acid in pregnancy)	✓	N/I	✓	✓	National	Sub‐national	N/I	N/I
Assessment of iron‐deficiency anaemia	(✓)	(✓)	✓	N/I	N/I	N/I	N/I	N/I
Iodine programmes	✓	N/I	✓	✓	National	23% homes****, (8)	(✓)	MICS
Other nutrition support
Management of malnutrition	✓	N/I	✓	✓	N/I	Sub‐national	(✓)	13% WHZ
								25% WAZ
								32% HAZ ††††
Prevention MTCT HIV/AFASS	✓	N/I	(✓)	(✓)	N/I	N/I	53% ‡‡‡‡
Food security	✓	N/I	N/I	✓	N/I	N/I	(✓)	✓
Hygiene and food safety	(✓)	✓	✓	✓	N/I	N/I	20%	N/I
							38%HH §§§§
Related tasks
IEC/BCC in programmes	✓	N/I	✓	N/I	N/I	N/I	N/I	N/I

EXPLANATION OF TABLE HEADERS AND MARKINGS:

Confirmed documentation of actions specific to these key practices.

N/I

No documentation of the activity was provided or identified.

(✓)

Actions more generally related to the key practices, but without referencing the practice specifically.

Practice that is addressed but that is not specifically consistent with international norms – e.g. in case of anaemia: haemoglobin assessments are used and these cannot distinguish the cause of the anaemia, but treatments only address iron‐deficiency anaemia.

n/a

Not applicable.

^† KEY PRACTICES AND RELATED ACTIVITIES AS OUTLINED IN WUEHLER ET AL., 2011 (9) , TEXT BOX 1.

Timely Introduction of BF, 1 h: commencement of breastfeeding within the first hour after birth.

EBF to 6 Months: with no other food or drink other than required medications, until the infant is 6 months of age.

Continued BF to 24 Months: continuation of any breastfeeding until at least 24 months of age as CFs are consumed.

Initiation of CFs at 6 Months: gradual commencement of CFs at 6 months of age.

Nutrient‐Dense CF: promotion of CFs that are high in nutrient density, particularly animal source foods and other foods high in vitamin A, iron, and zinc.

Responsive Feeding: encouragement to assist the infant or child to eat and to feed in response to hunger cues.

Appropriate Frequency/Consistency: encouragement to increase the frequency of CF meals or snack as the child ages (two meals for breastfed infants 6–8 months, three meals for breastfed children 9–23 months, four meals for non‐breastfed children 6–23 months, ‘meals’ include both meals and snacks, other than trivial amounts and breast milk) and to increase the consistency as their teeth emerge and eating abilities improve.

Dietary Assessments to Evaluate Consumption: indicates whether dietary assessments are being conducted, particularly those that move beyond food frequency questionnaires.

Vitamin A supplements young children: commencement of vitamin A supplementation at 6 months of age and repeated doses every 6 months.

Post‐partum maternal vitamin A: vitamin A supplement to mothers within 6 weeks of birth.

Zinc to treat diarrhoea: 10 mg/day for 10–14 days for infants and 20 mg/day for 10–14 days for children 12–59 months.

Prevention of zinc deficiency: provision of fortified foods or zinc supplements to prevent the development of zinc deficiency among children >6 months.

Anaemia prevention (malaria, parasites): iron/folate supplementation during pregnancy, insecticide‐treated bed nets for children and women of child‐bearing years, anti‐parasite treatments for children and women of child‐bearing years.

Assessment of iron‐deficiency anaemia: any programme to go beyond the basic assessment of haemoglobin or haematocrit to assess actual type of anaemia, such as use of serum ferritin or transferrin receptor to assess iron‐deficiency anaemia.

Iodine programmes: promotion of the use of iodized salt; universal salt iodization or other universal method of providing iodine with programmes to control the production and distribution of these products.

Management of malnutrition: diagnosis of the degree of malnutrition, treatment at reference centres/hospitals for severe acute malnutrition and appropriate follow‐up in the community, or local health centre; or community‐based treatment programmes for moderately malnourished children.

Prevention MTCT HIV/AFASS MTCT‐Mother‐to‐child‐transmission, HIV‐Human immuno deficiency virus AFASS: appropriate anti‐retroviral treatments for HIV‐positive women during and following pregnancy to avoid transmission to the infant, exclusive breastfeeding to 6 months, breast milk substitutes only when exclusive breastfeeding is not possible, and AFASS alternatives to breast milk are available, followed by gradual weaning or continued partial breastfeeding depending on the risk factors (see Text Box 4 of Wuehler et al., 2011 (9)).

Food security: programmatic activities with impact on infant and young child nutrition, including agency response to crises, tracking markers of food security, and food aid distributions.

Hygiene and food safety: all aspects of appropriate hand washing with soap, proper storage of food to prevent contamination, and environmental cleanliness, particularly appropriate disposal of human wastes (latrines, toilets, burial).

* CATEGORIES OF ACTIONS UNDER WHICH THE KEY PRACTICES WERE CORRECTLY ADDRESSED.

Policies: nationally written and ratified policies, strategies, or plans of action.

Formative research: Studies that specifically assess barriers and beliefs among the target population regarding each topic, and bibliographic survey of published studies identified through PubMed search of ‘nutrition’ plus either ‘child’ or ‘woman’ plus the name of the country and/or by key informant.

Training/curricula: programme protocols, university or vocational school curricula, or other related curricula that specifically and correctly addresses each desired practice, these include pre‐ and in‐service training manuals.

Programmes: documented programmes that are functioning at some level that are intended to specifically address each key practice listed.

Intended programme coverage: the level at which the programme is meant to be implemented, according to programme roll‐out plans.

Actual programme coverage: the extent of programme implementation that was confirmed in one of the received documents.

Programme monitoring: monitoring activities that are conducted for a given programme that specifically quantify programme coverage, training, activities implemented, whether messages are retained by caregivers and result in change.

Surveys and evaluations: studies that have been conducted to evaluate changes in specific population indicators in response to a programme and/or cross‐sectional surveys.

ADDITIONAL INFORMATION

BF, breastfeeding; EBF, exclusive breastfeeding; CFs, complementary foods; IEC, information education communication; BCC, behaviour change communication; MTCT HIV, Mother to child transmission of human immunodeficiency virus; AFASS, acceptable, feasible, affordable, sustainable and safe; MICS, multiple Indicator Cluster Survey; NCHS, National Center for Health Statistics; DHS, Demographic and Health Survey; MS‐UNICEF, Ministry of Health‐UNICEF United Nations Children's Fund; WHO, World Health Organization. ^‡Percentage of women who commenced breastfeeding within 1 h of birth, MICS 2007. ^§Percentage of infants 0–5 months consuming exclusively breast milk, MICS 2007. ^¶Percentage of infants 20–23 months consuming breast milk, MICS 2007.**Percentage of infants 20–23 months consuming breast milk, MS‐UNICEF December 2008 rapid assessment report. ^††Percentage of infants 6–9 months receiving CFs in addition to breast milk, MICS 2007. ^‡‡Percentage of infants 6–36 months consuming meat, fish, and poultry the day prior to the study, DHS 2000; vitamin A‐rich foods not reported. ^§§Percentage of breastfed infants 9–11 months who also consumed CFs at least three times in the 24 h prior to the survey (age‐appropriate frequency, MICS 2007). ^¶¶Dietary data collected in MICS 2007 include consumption of food groups, but no quantities of these foods.***Percentage of children reportedly receiving vitamin A supplements in the 6 months prior to the survey, MICS 2007. ^†††Percentage of women (15–49 years) reportedly receiving vitamin A supplements in the 2 months post‐partum during the last pregnancy occurring during the previous 5 years, MICS 2007. ^‡‡‡Percentage of increase in women reportedly consuming vitamin A supplements early post‐partum. ^§§§Percentage of households in which insecticide treated bed nets are reportedly available, MICS 2007. ^¶¶¶Percentage of children 6–59 months with whole blood haemoglobin concentration <11 g dL⁻¹ Hb, 2008 rapid nutrition survey.****Percentage of homes with adequately iodized salt (≥15 ppm iodine) available; this is up from MICS 2007 of 1.6%. ^††††Percentage of children <5 years with z‐scores <−2, weight‐for‐height (WHZ), weight‐for‐age (WAZ), height‐for‐age (HAZ), by WHO Growth Standards, as reported in MICS 2007 (also reported data according to NCHS references). ^‡‡‡‡Percentage of women 15–49 years reporting knowledge that HIV can be passed mother‐to‐child through breast milk, MICS 2007. ^§§§§Percentage of households in which a child's (<2 years) human wastes are disposed of in toilets, latrines, or buried and percentage of households (HH) with access to appropriate method of disposing of human wastes (toilet, latrine), MICS 2007.