Imroving Nutrition Practices through the Essential Nutrition Actions (ENA) Framework IN Southern Ethiopia

The Essential Nutrition Actions (ENA) framework was applied to provide improved nutrition support through advocacy, capacity building, interpersonal communication, and community mobilization. Emphasis is given to the programmatic integration of these nutrition actions so that they do not operate in isolation from one another and from other child survival programs. Changes in practices were assessed through a comparison from representative cross-sectional household surveys for children <2 years collected at baseline in 2003 (1789) and at end of program implementation in 2006 (1200). The surveys were conducted in one region in southerner Ethiopia (population 15 million). Iron folic acid supplementation during pregnancy increased from 28% to 39%, initiation of breastfeeding within 1 hour of birth increased from 64% to 72%, exclusive breastfeeding of infants <6 months from 54% to 66%, , and postpartum vitamin A supplementation from 5% to 19%, Vitamin A for children 6-23 months from 24% to 61%, , all with significant p values. Improvement was also achieved in women dietary practices from 8% to 50% during pregnancy and breastfeeding during illness from 6% to 47%. No improvements were reported in increasing food intake during pregnancy. The ENA framework promotes key nutrition actions to be taken at key contact points in the life cycle. Maximizing contacts through multiple program opportunities within existing health systems, the health extension programs and existing community structures can achieve large-scale coverage of nutrition actions known to have a public health impact in reducing under-five mortality and morbidity.