COMMUNITY

COMMUNITY MANAGEMENT
MANAGEMENT
OF ACUTE
OF ACUTE MALNUTRITION
MALNUTRITION
(CMAM)
(CMAM)

MODULE EIGHT
Improving Micronutrient
Status of Complementary
Foods with Micronutrient
Powder

COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM)

1
COMMUNITY
COMMUNITY MANAGEMENT
MANAGEMENT
OF ACUTE
OF ACUTE MALNUTRITION
MALNUTRITION
(CMAM)

Module 8c. Learning Objectives

(CMAM)

Participants will be able to :

1. explain why children need MN during Complementary feeding
2. explain the strategies Nigeria uses to improve the MN status of HH
meals
3. Why MNP in children 6-23months is critical
4. when to give and when not to give
5. MNP Dosage to give and how long
6. Data management process for MNP in health system

COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM)

2
COMMUNITY
COMMUNITY MANAGEMENT
MANAGEMENT
OF ACUTE
OF ACUTE MALNUTRITION
MALNUTRITION
(CMAM)

Module 8c. Learning Objectives

(CMAM)

Participants will be able to :

1. explain why children need MN during Complementary feeding
2. explain the strategies Nigeria uses to improve the MN status of HH
meals
3. Why MNP in children 6-23months is critical
4. when to give and when not to give
5. MNP Dosage to give and how long
6. Data management process for MNP in health system

COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM)

3
 Why Micronutrients matter?
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

Micronutrients are vitamins and minerals

They are important for good health and development

Different micronutrients are contained in different kinds of

foods

A shortage of micronutrients often occurs when people

suffer from chronic malnutrition
 Children 6-23months are most at risk because of the
demand for growth & Dev'pt.

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 Micronutrient Deficiencies
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

Extreme shortage of vitamins and minerals is

a serious health risk and can lead to:

Blindness VAD Rickets, Vitamin

Goitre, IDD D Deficiency
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 Micronutrient Deficiencies
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

Less extreme cases are hard to detect but are

very common and negatively impact health

Weak
immune Poor brain
system developm
ent
Tiredness Vision
problem
s
Lack of
appetite
Growth failure
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 Micronutrient Deficiencies
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

For every single case, there are many

undetected case

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 Why Micronutrient Powder?
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

The role of Children's

Vita-Min Powder in
young child feeding

8
 Why Micronutrient Powder?
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

Single-serving sachets
containing a powdered
mixture of 15 vitamins
and minerals

Caregivers mix the MNP

into their child’s meal to
provide their child with
all the micronutrients
essential for good health

In Nigeria, MNP is called

Children's Vita-Min
Powder or Sinadarin
Bitamin Don Yara in
Hausa
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 Micronutrient
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
Amount
(CMAM)
Vitamin A 400 µg RE
Vitamin C 30 mg
• Single-serving
Vitamin D sachets5.0 µg
containing
Vitamin E a mix of powdered
5 mg a-TE
Vitamin B1 and minerals
vitamins 0.5 mg
Vitamin B2 0.5 mg
Vitamin B6 0.5 mg Iron is an important
• Caregivers
Vitamin B12 mix the MNP 0.9 µg into
their child’s meal to 150
Folic Acid provide
µg
mineral in preventing
their
Niacin child with all the
6 mg anaemia
micronutrients
Iron essential
10 mg for
Zinc
good health 4.1 mg
Copper 0.56 mg
Iodine 90 µg
• In Nigeria, MNP has 17.0
Selenium been µg
branded as Children's Vita-
Min Powder
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM) Benefits of Children's Vita-Min
Powder
• Makes children strong and
active

• Prevents anaemia and

other vitamin and mineral
deficiencies

• Helps prevents illness

• Improves children’s
appetite
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)
Benefits of Children's Vita-Min Powder
Cont’d
•Easy to use, can be added to any
soft or mashed foods

•Contains all vitamins and

minerals essential for the healthy
development of young children

•Helps to promote the

introduction of nutritious
complementary foods at 6
months of age
 Steps of Use
COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)

Wash your hands with soap and

clean, running water before

preparing food for your child.

COMMUNITY MANAGEMENT
OF ACUTE MALNUTRITION
(CMAM)
Steps of Use Cont’d

Prepare soft or mashed

food.

Do not mix with hot Do not mix with liquids

foods. or liquid foods.
Steps of Use Cont’d

Pour and mix an entire

sachet of Children's Vita-
Min Powder into a small
portion (2-3 spoonfuls)
of your child's meal.
Steps of Use Cont’d

Wash your hands and your

child's hands with soap
and clean, running water
before feeding your child.
Steps of Use Cont’d

Feed the small portion

with Children's Vita-
Min Powder to your
child immediately.
Continue to feed your
child the rest of their
meal.
 Important Warning
• Do NOT add Children's Vita-Min Powder to liquids (e.g.
water, tea, milk)

• Do NOT add Children's Vita-Min Powder to hot food

• Do NOT split the contents of 1 sachet over several

meals

• Do NOT share food with Children's Vita-Min Powder

• DO store Children's Vita-Min Powder in a cool, dry and

clean place within the home
 Why is Children's Vita-Min Powder for
children 6 to 23 months?
• From birth to 2 years of age is the period of
greatest growth in a person’s life
• Breastmilk has all the necessary nutrients for
children in the first 6 months of life
• 6 to 23 months is when
children need vitamins
and minerals the most!

0 months 23 months
 Who should temporarily not use Children's
Vita-Min Powder?
• Children suffering from severe acute malnutrition (SAM)
• Children enrolled in CMAM or other therapeutic feeding programme
• Children with fever or confirmed malaria

Why?
• Children suffering from SAM should be enrolled in a CMAM programme
• Therapeutic foods (RUTF) contain the necessary vitamins and minerals
• During fever or confirmed malaria, the iron in Children's Vita-Min
Powder will likely not be absorbed well

After completion of treatment (discharge from CMAM or malaria

treatment), children should be given Children's Vita-Min Powder as usual
 Dosage/Mixing Children's Vita-Min Powder

• Each pack of Children's Vita-Min

Powder contains 30 sachets
• Once sachet should be used each
day by adding the entire sachet into
a small portion of one of the child’s
meals
• If a caregiver forgets to add
Children's Vita-Min Powder, she
does not need to worry, she can
continue adding the next day
 Possible Side Effects of Children's Vita-Min
Powder

• Children's stools may become darker

• Children's Vita-Min Powder contains iron

and iron darkens the stool

• This is normal and shows it is working!

 Possible Side Effects of CVMP Cont’d

• During the first days of feeding with

Children's Vita-Min Powder, a child may
develop loose stools or mild diarrhoea

• Severe or prolonged diarrhoea (more than

3 days) is NOT caused by Children's Vita-
Min Powder and caregivers should take
their child to the health centre for
treatment
 Possible Side Effects of CVMP Cont’d

• It is very important to
tell caregivers about
these possible side
effects during initial
counselling, so they
know it is normal and
do not get alarmed
 Who should receive Children's Vita-Min
Powder?

Children 6 to 23 months

Except…
If they are suffering from severe acute malnutrition and/or
enrolled in a CMAM programme, or have fever or
confirmed malaria.
They are eligible for Children's Vita-Min Powder once
CMAM or malaria treatment is over
 Service Delivery Points
Children's Vita-Min Powder can be distributed
through three platforms:

1. Primary Health Facilities (PHC)

2. Community IYCF support groups

3. Special outreaches in hard-to-reach areas

 Primary Health Facilities

• Mothers of children 6 to 23
months will attend health
facilities distributing Children's
Vita-Min Powder

• The child will be given a

routine health check to see if
they are eligible for Children's
Vita-Min Powder
Community IYCF-Support Groups

• Mothers of children 6 to 23
months will be present at
community meetings (IYCF
groups, religious groups)

• Mothers will be asked

questions about the health
of their child to ensure they
are eligible for Children's
Vita-Min Powder
 Community IYCF-Support Groups Cont’d

• The child will be registered

for the Children's Vita-Min
Powder programme and
provided with 3 packs (90
sachets) of Children's Vita-
Min Powder to be used over
6 months
 Special Outreach in Hard-to-Reach Areas

• In areas where outreach activities take

place, Children's Vita-Min Powder can
also be included in the package of
interventions every three months in
pre-identified communities

• Eligible children should be registered

for the Children’s Vita-Min Powder
programme and provided with 3 packs
(90 sachets) of Children’s Vita-Min
Powder to be used over 6 months
 Supply Management
• In all three distributions
methods, the PHC will be in
charge of managing the supply of
Children's Vita-Min Powder
• IYCF support group leaders will
pick up their supply of Children's
Vita-Min Powder from the PHC
• Children’s Vita-Min Powder will
be delivered quarterly to each
PHC
Monitoring for Children’s Vita-Min Powder
Programme:
We want to know:

1. How many children have received Children's

Vita-Min Powder and counselling

2. How many packs of Children's Vita-Min

Powder have been distributed

3. How many packs of Children's Vita-Min

Powder are still at the PHC
 Benefits of Monitoring
Regular reporting of
programme data
• Helps identify key
challenges and obstacles
• Good monitoring leads
to challenges being
identified and
improvements being
made
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 Monitoring Tools:

1. Children's Vita-Min Powder Ration Card

2. Children's Vita-Min Powder Distribution

Register

3. Rapid-Pro for reporting

Children's Vita-Min Powder Ration Card:
Asign a registration number to the Card

Multiple Micronutrie nt (MN P) Ratio n Card

Registration No.

Age
Visits Date Name of the mother:
(months)
Visit 1
Visit 2
Visit 3 Name of the child:

Place of issuance:

Date of 1st distribution:

Age at 1st distribution:

Child’s age in months at each visit

Children's Vita-Min Powder Register:
Visit numbe r (tick the corre ct bo x)
Fo r c hild 6 -8
mont hs
Is child currently
Age Se x Visit 1 Visit 2 Visit 3
Name o f mot he r Name o f child Mo nth Date receiving any
(mo nt hs ) (M/ F)
solid-semi
foods?
Cross if 'NO'
6-1 1 mt h 1 2-18 mt h 1 9 -2 3 mth 12 -1 8 mth 1 9 -2 3 mt h 1 9 -2 3 mth

To tal

Cross the box if child is between ages 6 to 8

months and NOT receiving any
complementary foods Tick box corresponding to
child’s age at each visit
 Rapid-Pro
• You will send programme data
every week using your mobile
phone

• This will not cost any money

• Reporting week starts on Monday

and ends on Sunday

• Programme data will be texted

each Monday for the week
previous
 IT IS IMPORTANT TO NOTE.
• The frequency and duration of using MNP should be such
that it contributes enough of required micronutrients so
that the combination of the diet and the MNP’s satisfy the
RNI for all micronutrients.
• Each sachet must contain one RNI for each micronutrient
giving.
• Example: 90 sachets for a 6 months period would result in
an average dose of 50% of the RNI/day. 60 sachets for a
period of 6 months would result in an average dose of 33%
of the RNI/day. While 120 sachets for the same period of 6
months will result in an average dose of 67% of RNI/day.