Nutrition and maternal and child health

by Rop DC
Lecturer : Dr Ngatia
 Introduction
The nutrient needs for pregnant women and women
who are breastfeeding are generally greater than those
of other women.
Pregnant and breastfeeding women can meet their
needs for many, but not all, nutrients by having the
amount and type of food recommended for them.
 The amount of some nutrients required by pregnant
women is difficult to obtain from food.

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 Introduction
Two important ones are folate (folic acid) and iron.
To obtain enough of these essential nutrients, it is
recommended that women of childbearing age take a
multivitamin containing folic acid every day.
 Pregnant women should ensure their multivitamin
contains sufficient iron.
Pregnant and breastfeeding women should eat a little
more food, equal to two or three servings, each day.

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 ENERGY NEEDS OF PREGNANCY
Pregnant women’s energy needs increase during their
second and third trimesters.
Women who have a normal body weight at the start of
their pregnancy need about 350 extra calories a day in
their second trimester and 450 extra calories a day in
their third trimester.
These extra calories help them gain the amount of
weight needed to support the baby's growth and
development.

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 Estimated energy requirements

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 Weight gain
1st trimester -2.3-3.2kg
2nd trimester 4.5-6.4kg
3d trimester 4.2-5.4kg

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 NUTRIENT NEEDS OF
BREASTFEEDING WOMEN
Women who are breastfeeding also have different
nutritional needs.
 For example, breastfeeding women need more vitamin
A, vitamin C and zinc, and less iron than pregnant
women.
They also need to eat one more serving from each of the
four food groups:
• Vegetables and Fruit (an orange vegetable),
• Grain Products,
• Milk and Alternatives, and
• Meat and Alternatives.

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 Recommended Dietary Allowances

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 ENERGY NEEDS OF BREASTFEEDING
WOMEN
Breastfeeding women also have higher energy
requirements than non-pregnant women.
How much they need depends on how much milk they
produce and how quickly they lose their pregnancy
weight.
Women need about 350 to 400 extra calories each day
for the first year of breastfeeding.
Women who are breastfeeding and who have gained an
appropriate amount of weight during pregnancy need to
eat about the same amount of food as they did during
their pregnancy
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 SPECIFIC NUTRIENT NEEDS FOR
PREGNANT TEENAGERS
All teens need more calcium than adult women.
 However calcium needs are the same for pregnant and
non-pregnant teens
Other nutrients (like zinc) are needed in greater
amounts by pregnant teens than by other teenagers.
 However, teenagers can easily meet these nutrient
needs by taking a daily multivitamin.

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 In reality, there is a similar increase in energy needs
during pregnancy and breastfeeding.

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 Consequences of malnutrition among
women
Low birth-weight babies
Inability to sustain work: low productivity due to low
energy (BM<18.5)
Reduced capacity to care for the family
The problem of over- nutrition is also becoming a
public problem not only among urban women, but in
rural women as well.

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 NEWBORN GROWTH AND
NUTRITION
The consequence of being born underweight often extend into
adulthood- studies now suggest a link between foetal under-
nutrition and risk of various adult chronic diseases.
During infancy, nutrient needs are high due to rapid growth
and development.
For the first 4-6 months, exclusive breastfeeding is
recommended. The breast milk is adequate in most nutrients
except Vit. D.
Frequent or prolonged infections and inadequate dietary
intake (proteins, energy, Vit A, Zinc & Iron) exacerbate the
effects of growth retardation causing growth faltering from
birth to 2 years of age.

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 Nutritional requirements in infancy

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 Weight gain

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 Recommendation for infants
The WHO recommends human milk as the exclusive
nutrient source for feeding full-term infants during the
first 6 months after birth
 Regardless of when complementary foods are
introduced, breastfeeding should be continued through
the first 12 months

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 HIV and Infant Feeding
All mothers supported to B/F unless tested +ve
Replacement feeding
Guidance and support to feed child

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 Who is at Great Risk of Poor Child
feeding practices?
Greatest risk is at 6-24 months
Children recovering from illness especially diarrhoea,
malaria, measles, ARI
Children of mothers with peak seasons of employment
– long working hours
Communities where the girl child is discriminated and
given inferior food
Poor maternal access to resources
Low maternal education

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 Nutrition in childhood

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 Nutrient needs in childhood

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 Common nutritional problems during
childhood and school age
Severe malnutrition, Protein Energy Malnutrition (PEM)
common among infants and young children, and is
commonly associated with infections.
 Also common are mild to moderate forms of malnutrition
mainly stunting (undernutrition) and obesity (overnutrition).
 Obesity levels are however higher in urban areas. Currently
globally, 37% (226 million) under fives are stunted.
 In Kenya the number of stunted children has remained high
over the years, the current rate of stunting is 35%.
Micronutrient deficiencies of Vit A, iron and iodine are also
common.

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 Causes of malnutrition in children
Poverty leading to long term reduction in dietary
intake
Repeated episodes of illnesses
Poor quality diets over a long time
Poor care practices
Poor environment

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 Nutrition interventions in child health
services
Individual counselling of mothers on feeding practices
(breastfeeding and complementary feeding)
Preventive doses of Vitamin A every 4-6 months to all
children 6-59 months where anaemia is a risk
Growth monitoring of all children to check if their growth
is adequate
Screen, treat and refer children for severe malnutrition,
severe anaemia and clinical signs of Vitamin A deficiency
Ensure all children are immunized against all immunisable
childhood illnesses.
Counsel mothers on spacing of children (family planning)

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 Thank you

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