MAMA HistoryDr. Priscilla Benner MD

MAMA Director

The construction begins

The main building at the Nutritional Center

Building the dining room

One of the first mission teams

Dr. Benner talking with

the people in the

community about the Nutrition Center.

Making new contacts

The moms are working in the garden at the Nutrition Center.

The harvest is ready.

Importance of Vitamin A

Dr. Benner

Focus on Vitamin A Vitamin A distribution and food fortification

has become a standard part of Child Survival efforts around the world.

Vitamin A saves children's lives, eyes and faces.

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Vitamin A Functions Vision (night, day, colour) Epithelial cell integrity against

infections Immune response Haemopoiesis Skeletal growth Fertility (male and female) Embryogenesis

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Severe Vitamin A deficiency is a wide spread problem in Nigeria, especially in the Northwest, and is one of the reasons that children suffer so many infections.

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Why do children become vitamin A deficient?

• Mothers of poor children often have Vitamin A Deficiency and produce deficient breast milk.

• Children’s diets provide too little vitamin A.• Children spend a large part of their childhood

being sick.Provitamin A carotenoids in vegetables and fruits are less readily bio-available than previously thought.

• Early weaning is often onto foods low in vitamin A.

• Growth velocity, and therefore vitamin A requirement, is higher during pre-school age than at any other time postnatally.

Humphrey, Katz et al, 2002

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is distributed every 4-6 months to infants, children, and new mothers according to established protocols

is part of child survival programs all over the world

prevents infections and improves growth

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Vitamin A distribution…

Vitamin A Mega-Dose Capsules 200,000 International Units/Capsule

Prevention & Treatment DosesRepeat this dose as recommended for emergency indications

Age: UNITS /Dose Capsule Notes:Infants less than 6 months:Non-breast-fed, or breast-fed if mother

has not received supplemental vitamin A

 

50,000 ¼(2 drops)

Breast milkprovides

Vitamin A

Infants 6 to 12 months:Every 4-6 months

  

100,000  ½(4 drops)

Give eggs, milk, greens,

fruits, colored vegetables

Children over 12 months:Every 4-6 months

 

200,000 1 Not safe forgirls or women

who maybecome

pregnant!Mothers within 6 weeks

after delivery  

200,000  1 16

Revised Recommendations 2002 IVACG

Population Amount of Vitamin A to be administered

Time of Administration

Infants 0-5 months 3 doses of 50,000 IU each with at least 1 month interval between doses

At each DTP contact (6,10, and 14 weeks) otherwise at other opportunities

Infants 6-11 months 100,000 IU as a single dose every 4-6 months

At any opportunity (e.g., measles immunization)

Children 12 months and older

200,000 IU as a single dose every 4-6 months

At any opportunity

Postpartum Women 2 doses of 200,000 IU at least 1 day apart

As soon after delivery as possible and not more than 6 weeks later.

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In acute emergencies such as measles, pneumonia, TB, malaria, meningitis, severe diarrhea, severe malnutrition, or when signs impeding loss of vision from nutritional blindness, or risk of mouth infection leading to noma are detected, -use the

Vitamin A Emergency Triple Dose Treatment

This will replenish acutely depleted Vitamin A sores and can be life SAVING!

Also, use all other appropriate treatments for the conditions. SEEK CONSULTATION!

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Emergency Triple Dose Treatment: For noma, malaria,

measles, pneumonia or any life-threatening infection in malnourished children

Give the age appropriate Vitamin A mega dose: One dose today One dose tomorrow One dose in 2 weeks

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Vitamin A Single (Extra) Dose Treatment for Malnourished Children with Moderate Infections

In addition to other appropriate treatments, when a malnourished child presents with a serious, but not acutely life-threatening condition such as: Ear infection Diarrhea Tonsillitis Respiratory infection Parasites Worsening malnutrition

Give one extra dose of Vitamin A but do not repeat more often than once per month in the absence of severe infection.

See Chart.20

Nutritional Blindness

Bitot Spots

Very Dangerous!

Permanent blindness may occur if Vitamin A is not given immediately – following the protocol.

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Nutritional Blindness

Keratomalacia:Hazy Dry Cornea

Poor Quality

Now the cornea is becoming soft – very critical danger!

Megadose vitamin A according to the International Norms but be given now!

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Nutritional Blindness

Gelatinous cornea Bulging, about ready to

rupture. If that happens, the eye

will be permanently blind.

There is still a chance that this eye can be saved by 3 doses of Vitamin A.

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Nutritional Blindness Same eye, healed by

timely Vitamin A capsules. Scar remains, but vision is good. This eye was saved by 3 Vitamin A capsules!

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Nutritional Blindness:

Xerophthalmia Dry Eye

Bitot Spots

Hazy dry cornea poor

quality — Keratomalacia

Gelatinous cornea, bulging, about ready to rupture. If that

happens, the eye will be

permanently blind.

Same eye, healed by

timely Vitamin A capsules.

Scar remains, but vision is

good.25

Essential Micronutrients Besides Vitamin A, there are many other

essential micronutrients (vitamins and minerals) that are found to be lacking in children who get noma, nutritional blindness, and other deadly infections (“Hidden Hunger”).

Improving nutrition by better diet in pregnancy, exclusive breast feeding early in life, and food fortification with COMPLETE ESSENTIAL MICRONUTRIENTS will prevent many deaths from childhood infections.

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INTESTINAL PARASITES

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Intestinal parasites-The Scope of the Problem

Most common infection worldwide Prevalence rates in resource poor communities can

be over 90%. In 2008, 3.5 billion people (mostly children) were

estimated to be infested with intestinal parasites. From: Tropical Medicine Institute of Sao Paulo Brazil.

Estimated over 300 million suffer severe impairments because of high worm burdens.

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Intestinal parasites cause illness and death from:

AnemiaMalnutrition Impairment of physical growth-both

stunting and wastingPoor intellectual development Infections

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WHERE DO INTESTINAL PARASITES COME FROM?

They enter the body through food and water that has been contaminated by human or fecal waste, or through skin if the person steps (or sits) in mud that contains human or animal feces.

Many people infested with intestinal parasites are not clinically ill but can still spread the disease by not using latrines or toilets.

Children with swollen bellies usually have:

Severe malnutrition

A large burden of intestinal parasites

Parasites compete with children for food!

Children with heavy worm burdens may be forced to share ¼ or more of their daily nutrients with their parasites.

Deworming promotes child survival. Therefore, national level mass deworming campaigns

been implemented in many developing countries. One tablet of deworming medicine, usually

Albendazole, is given every 6 months according to standardized protocols to everyone in the community.

This is effective in controlling the worm burden and usually well accepted by communities.

Deworming can be integrated into Child Health Day Events along with immunizations, vitamin A distribution, bed net distribution and growth monitoring.

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Albendazole targets the three major intestinal parasites:

Ascaris lumbricoides-Round worm Trichuris-Whipworm Anclostoma duodenale (Africa)or Necantor

americanus (Western Hemisphere)-Hookworm

Other medicines that may be used:

MEBENDAZOLE 500mg tablets can also be used as single dose treatments of intestinal parasites

LEVAMISOLE 80mg can be used for school age children

PYRANTEL 10mg/kg If Shistosomiasis is a problem in the region,

PRAZIQUANTEL is used. Instructions may be added to this seminar if there is need for this medication in the target population.

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Each parasite produces a different set of problems:

Ascaris is the large roundworm with a voracious appetite for calories and vitamins.

Hookworm is the parasite that attaches itself to the intestinal lining and dines on the blood of its victim.

Whipworm is the one which attaches to the rectum, causing prolapse and bleeding.

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Notice the size of the parasite in centimeters.

Ascaris

Ascaris at surgery

The entire community should be

dewormed.41

Correct Practices of Albendazole

Administration

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Children over age 1 and all adults can be dewormed.

Follow the recommendation of the Ministry of Health regarding pregnant women.

Albendazole is safe in lactation but the woman can save her pill to take after the first 3 months of pregnancy.

Note: Follow norms of MOH in country for children age 12-24 months and pregnant women.

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Always include the children not enrolled in school in the

deworming.

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Albendazole 400mg Chewable Tablets

International Norms for Treatment of Intestinal Parasites in Community Deworming Campaigns Given with Megadose Vitamin A

CapsulesInfants under 1 year No treatment with

AlbendazoleChildren 1-2 years (12-24months)

200mg (1/2 tablet) (Crushed and suspended in water)

Children over 2 years and Adults

400mg (1 tablet)(Crushed and suspended in water up to age 3, or as long as needed)

Pregnant Woman? Safe in pregnancy after the first 3 months

1. Wash your hands with soap and water if you touch the child’s mouth.

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2. Ask all mothers to help you by washing their hands first, then you give the pill to the mother, who places it in her child’s mouth after reassuring the child.

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3. Never put pill in the mouth of a crying child.

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4. Do not coerce, threaten, or unnecessarily frighten the child. Treat him or her gently and with patience.

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A child that is regularly treated for worms: is more active in school. grows and learns better. is more resistant to other infections.

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Do not give to infants less than 1 year

old.51

For Children From 1-3 Years Old:

Crush the tablet. Mix with water. Have mother help child to drink. Give with Vitamin A capsule at the same time. Don’t risk aspiration by forcing a child to take

the medicine until they are calm.

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For Children Older Than 3 Years Old:

Have the child chew the tablet and swallow with water. Ask the child to show you that he or she has swallowed

the tablet and has the residue in his or her mouth. Children may not want to take their medicine.

It is also okay to crush the tablet for any child or adult and mix with water that has been boiled and cooled.

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Teach hygiene! The community needs to learn to protect the water that is used for drinking and bathing, to wear shoes, dispose of human waste properly, keep animals away from homes and children, and much more! When habits change, deworming programs will not be needed.