Nutrition Education and Rehabilitation Sessions (NERS)

Dr. M. Homayoun Ludin

Ministry of Public Health Afghanistan

December 10, 2014

Nutrition Education Rehabilitation Session is a community-based approach to successful and sustainable reduction of malnutrition in resource-poor settings. It is based on positive deviance model.

This approach is combined with CMAM for the treatment of children with moderate acute malnutrition (MAM) and prevent further deterioration of nutritional status.

What is NERS?

To raise awareness of optimal IYCF (Exc. breastfeeding and complementary feeding) practices in the community;

To sustainably prevent malnutrition and common diseases in children in the community;

To Promote healthy feeding, cooking, health-seeking and hygiene practices;

To Rehabilitate malnourished children especially MAM

NERS Objectives

In this approach the community will be mobilized volunteers from the community will be

trained to conduct (NERS) in which caregivers and

volunteer facilitators meet to learn and practice cooking energy dense meals and feeding them to their malnourished children;

Caregivers at these sessions also learn about breastfeeding, danger signs in ill children, health seeking and maternal health;

NERS Approach

Caretakers of identified malnourished children are invited to participate in NERS for a duration of 12 days.

NERS is implemented by volunteer – they help mothers prepare/cook and feed energy rich/calorie dense meals to their children.

Caregivers bring a fist full of food to the sessions and a piece of wood.

NERS Approach

Days 1Every child is weighed on the first dayPreparing energy dense meals based

on menus Education (one topic each day)Feeding children

Days 2 to 6: Feeding Preparing energy dense meals based

on menusEducationFeeding children

How does 12 day-NERS look like?

Day 7: Home Alone DayParticipants stay home and

practice the new behaviors. CHW/volunteers visits families

and counsel

Day 8: Feedback Preparing energy dense meals

based on menus Feeding children

EducationDiscussion around the

experiences the caregivers faced at home and assist them

Cont’d…

Day 9 and 10: at home

Day 11: Next-to-last day of the SessionPreparing energy dense meals based on

menusFeeding childrenEducationDiscussion – problems faced at home

Day 12: Last day of the SessionPreparing energy dense meals based on

menus EducationFeeding children All children will be weighed againCaregivers counseled

Cont’d…

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The approach provides a solution that can quickly address an immediate problem.

Supervised feeding is held during the session.

Caregivers learn and implement the same practices at home and report on their experiences at the sessions.

NERS is the source of learning about what positive and unique behaviors people themselves practice in the community

Knowledge and doing something empowers community

Advantages of NERS

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Lessons Learnt

building the capacity of Community Health Workers (CHW) and Family Health Action Group (FHAG) strengthens feeding babies and breastfeeding practices and participatory cooking sessions in the community level

Establishment and training of FHAG reduce load of working at community level and improved maternal and newborn care services

Close supervision of Female CHWs and FHAG has great affect on follow up of pregnant and lactating women by CHWs and FHAG

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Challenges

o Some parts of community not ready to accept women as volunteers

o some areas do not have CHWs, making it difficult to reach lactating mothers

o Gaining approval from IRB takes too much time

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Expansion to other ethnic areas and in rural areasIntegration of community-based NERS approach into BPHSIntegration of pictorial materials and guidelines of the project

into MoPH MNC guidelinesExpansion of FHAGs establishment national wideInclusion of one Female staff for supervision and support of

Female CHWs and FHAG is essential for effective and successful implementation of community based maternal and newborn care

Recommendations

Affordable NERS is affordable and families are not dependent on

outside help or resources to practice the new behaviors. NERS is much more cost effective

Sustainable The positive behaviors continue after the NERS sessions

end. The skills practiced at the session become habitual behaviors – they are sustained over life and passed from one generation to another

NERS not only changes the behaviors of individual families, but also changes how a community perceives malnutrition and their ability to change the situation.

Advantages of NERS

NERS focuses on the treatment of under weight, MAM and its prevention.

Promotes long-term self-sustaining solutions to malnutrition (solutions are within the community)

Can demonstrate achieving results in a very short amount of time.

NERS can be linked to facility based GMP and CMAM especially as a way to address MAM appropriately and comprehensively.

Conclusions

Thank You

Any Questions?