This document outlines strategies and interventions to tackle stunting in children under 2 years old. It recommends preventive and early interventions at the community level through empowerment and improved healthcare services. The key is to assure sustainability through ongoing quality improvement processes. It describes screening children under 2 to identify nutritional needs and providing evidence-based interventions. Interventions discussed include delayed cord clamping, early breastfeeding, dietary diversity, facility-based management of severe and moderate acute malnutrition, community-based management, identifying at-risk children, fortified supplements, deworming, zinc therapy, multivitamin supplements, and vitamin A supplementation. Metrics include decreasing malnutrition and assuring regular quality improvement team meetings.

1. Recomend a strategy for
tackling stunting U2
PREVENTIVE & EARLY INTERVENTION
COMMUNITY EMPOWERMENT
IMPROVEMENT HEALTH CARE SERVICES
ASSURE SUSTAINABILITY THROUGH QUALITY
IMPROVEMENT PROCESS

2. Exposición de la visión

3. Metas y objetivos

4. Today’s Situation
 CENSUS OF CHILDREN UNDER TWO:
Localization. Age. Nutritional status. Interventions
for.
 SCREENING OF CHILDREN IN NEEDS
(underweight for age + stunted)

5. What we do
 Quality improvement
 Maintain the screening for children needs
 Close the gaps providing nutritional interventions
evidence based
 Assure that the proved interventions reach the
children with needs and keeps them exactly

6. Líneas de intervención
CORD CLAMP DELAY: In term neonates
led to significant increase in newborn
haemoglobin and higher serum ferritin
concentration at 6 months of age. In
preterm neonates was associated with
39% reduction in need for blood
transfusion and a lower risk of
complications after birth
McDonald SJ, Middleton P. Eff ect of timing of umbilical cord clamping of term infants on maternal and neonatal
outcomes.Cochrane Database Syst Rev 2009; 2: CD004074.
Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Eff ect of timing of umbilical cord clamping and other strategies to
infl uence placental transfusion at preterm birth on maternal and infant outcomes.Cochrane Database Syst Rev
2011; 8: CD00324

7. Líneas de intervención
Breast feeding initiation within 24 h of birth
is associated with a 44–45% reduction in
all-cause and infection-related neonatal
mortality, and is thought to mainly operate
through the effects of exclusive
breastfeeding. Counselling or educational
interventions increase exclusive
breastfeeding by 43% at day 1, by 30% till
1 month, and by 90% from 1–5 months
Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality
and morbidity: a systematic review. BMC Public Health (submitted).
Imdad A, Yakoob MY, Bhutta ZA. Eff ect on breastfeeding promotion interventions on breastfeeding rates, with
special focus on developing countries. BMC Public Health 2011; 11 (suppl 3): S24.

8. Líneas de intervención
Promotion of dietary diversity and
complementary feeding:14 Demographic
Health Survey datasets from low-income
countries; consumption of a mínimum
acceptable diet with dietary diversity
reduced the risk of both stunting and
under weight whereas mínimum meal
frequency was associated with lower risk
of underweight only
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young
child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 2012;
8: 354–70

9. Líneas de intervención
Facility-based management of SAM and
MAM according to the WHO protocol:
Following the WHO protocol, would lead to
a 55% reduction in deaths; SAM treated in
hospitals or rehabilitation units, shows
mortality rates higher specially for
oedematous malnutrition (50–60%). WHO
recommends inpatient treatment
forchildren with complicated SAM, with
stabilisation and appro priate treatment of
infections, fluid management and dietary
therapy
WHO. Guideline update: technical aspects of the management of severe acute malnutrition in infants and
children. Geneva: World Health Organization, 2013

10. Líneas de intervención
Community-based management of SAM /
MAM: Facility-based treatment of SAM
remains important, community manage
ment of SAM continues to grow rapidly
globally.This shift in treatment norms from
centralised, inpatient care towards
community-based models allows more aff
ected children to be reached and is cost
eff ective
Collins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe
malnutrition.
Food Nutr Bull 2006; 27: S49–82

11. Líneas de intervención
Identification of children at risk for
undernutrition or undernourished: The
need to focus on the crucial period of the
1000 days from conception to a child’s
second birthday during which good
nutrition and healthy growth have lasting
benefi ts throughout life. Almost all
stunting takes place in the fi rst 1000 days.
The few randomised controlled trials that
included nutritional status outcomes show
effects on the weight or length of infants
Bhutta ZA, Das JK, Rizvi A, et al, The Lancet Nutrition Interventions Review Group and the Maternal and Child
Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be
done and at what cost? Lancet 2013; published online June 6. http://dx.doi.org/10.1016/S0140-6736(13)60996-4

12. Líneas de intervención
Fortified food supplements:
Micronutrient powders significantly
improved haemoglobin concentration
and reduced IDA by 57% and retinol
defi ciency by 21%.
Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children. BMC
Public Health (in press)

13. Líneas de intervención
Deworming in children (for soil-
transmitted intestinal worms):
Significant effects: Reduced
anaemia,reduced iron defi ciency
anaemia Reduced retinol deficiency.
Improved haemoglobin concentrations.
Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children.
BMC Public Health (in press)

14. Líneas de intervención
Zinc therapy for diarrhea: Preventive
zinc supplementation in populations at
risk of zinc deficiency reduces the risk
of morbidity from childhood diarrhoea
and acute lower respiratory infections
and might increase linear growth and
weight gain in infants and young
children
Yakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on
mortality and morbidity due to diarrhea, pneumonia and malaria.
BMC Public Health 2011; 11 (suppl 3): S23

15. Líneas de intervención
MMN supplementation including iron in
children [multivitamins tablets with iron]:
MMN supplementation: Significant
effects: increased length, increased
weight. MMN might be associated with
marginal increase in fluid intelligence
and academic performance in healthy
school children
Allen LH, Peerson JM, Olney DK. Provision of multiple rather tan two or fewer micronutrients more eff ectively improves
growth and other outcomes in micronutrient-defi cient children and adults J Nutr 2009; 139: 1022–30

16. Líneas de intervención
Vitamin A supplementation reduced all-
cause mortality by 24% and diarrhoea-
related mortality by 28% in children
aged 6–59 months
Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA.Vitamin A supplementation for preventing morbidity and
mortality
in children from 6 months to 5 years of age.Cochrane Database Syst Rev 2010; 12: CD008524

17. Metas y objetivos
Assure nutritional evaluation of every children
under two in the community and in health facilities
Assure evidence based nutritional interventions
of every children under two, in risk of malnutrition
or malnourished in the community and in health
facilities
Decrease Malnutrition in children under two
Assure monthly meetings of QI Team in district
and regional levels

18. Recommendations
 Apply the census once, and update it annually
 Monthly, alternatively to ambulatory visit to health
facility, visit the children under two, specially those in risk
or undernourished
 Refer the children under two in risk of malnutrition or
undernourished, for treatment in the health facility
 Monitor accomplish of interventions at home
 Keep the surveillance health system in function
 Monthly, without any exception, do the meeting of QI
team at district and regional levels