This ante-natal nutrition (ANC) pilot project will expand GHIs efforts to target a critical population: pregnant women. In this pilot project, GHI will apply its innovative model, providing families with the knowledge and support to fight malnutrition in their homes, at an earlier point in the continuum of care. This intervention emphasizes proper antenatal care, care during the course of a womans pregnancy, and the provision of essential micronutrient supplementation. The pilot will be focused in Musanze District in northern Rwanda, and will involve a three-pronged effort:
1. GHI will employ its proven community-focused design methodology to develop a training curriculum on the importance of antenatal care as part of efforts to improve nutrition in the first 1,000 days. The training will be incorporated into GHIs Health Center Program, and will be delivered by peer leaders at GHIs 18 partner Health Centers, reaching an estimated 1,440 women of reproductive age in the pilot year. This will leverage GHIs training platform to improve ANC knowledge and reinforce the importance of ANC visits.
2. GHIs training team will train 60 local nurses, nutritionists, and Lead Community Health Workers in maternal nutrition, improving the districts capacity to provide quality clinical care. GHIs training team will partner with the District of Musanze to conduct a training course for local healthcare workers who are tasked with delivering antenatal care, including nurses and Lead Community Health Workers, as well as district nutritionists. The training will leverage GHIs nutrition expertise, and will include units on pregnancy, breastfeeding, and complimentary feeding.
3. GHI will develop training materials specifically designed to improve maternal nutrition, and leverage existing Health Center partnerships to ensure their dissemination to an estimated 160 pregnant women. GHI will work directly with four of its existing partner Health Centers, where nurses will provide GHIs training materials as part of standard ANC visits. GHI estimates that approximately 40 women will receive ANC visits at each partner Health Center as part of this pilot project.
This pilot will leverage the strong relationships GHI currently has at the Health Centers and district government in Musanze, and will leverage GHIs expertise and scale to reach pregnant women as a new target demographic.
The ANC pilot project will begin in September 2015 and will last one year. Building upon successes in the pilot, GHI will use this pilot as a starting point for an expanded ANC program.
1. Baseline Assessment: September November 2015
GHI will conduct a comprehensive needs assessment in Musanze District to ensure that the pilot reflects and responds to the realities of the mothers it will work with, and to share with government partners.
2. Curriculum Development: December 2015 January 2016
GHI will apply the same principles of human centered design that have guided the development of its entire training curriculum to design new training materials tailored to provide nutrition education to pregnant women as part of ANC visits. Topics covered will include: nutrition, malnutrition, pregnancy, breastfeeding, and complementary feeding.
Nurses at four partner health centers will distribute these materials following comprehensive training by the team.
3. Introduction of ANC unit into curriculum: January 2016 to April 2016
GHI will incorporate a unit focused specifically on ANC into its health center program, reaching approximately 1,440 women of childbearing age during Seasons B and C (January to April 2016, and May to July 2016). This unit will focus on the importance of seeking ANC at health centers as well as re-enforce lessons it already provides around maternal nutrition during pregnancy and breastfeeding.
4. ANC nutrition training for nurses, nutritionists, and lead community health workers: May to June 2016
GHI will lead two sets of trainings designed to build the capacity of Musanze District to include nutrition education as a component of ANC.
-5 day ANC nutrition workshop for 60 nurses, nutritionists, and lead CHWs from all sectors in Musanze District
-5 day workshop with the 8 nurses who will disseminate nutrition training materials as part of standard ANC visits across 4 partner health centers. The workshop will focus on technical ANC information and strategies for behavior change education.
5. Introduction of GHI training materials as part of standard ANC visits at 4 partner health centers: July 2016
GHI will work closely with 8 nurses at 4 partner health centers in Musanze who will begin to provide training materials as part of standard ANC visits. GHI expects that in July and August 2016 these nurses will see approximately 40 women each, reaching a total of 160 pregnant women.
According to World Food Program estimates, 795 million people around the world are undernourished. Malnutrition is a contributing factor in 45% of deaths of children under the age of five, claiming the lives of 3.1 million children a year. While the loss of life is overwhelming, the loss of human capital is also sobering. Children who lack adequate nutrition are less likely to attend school, and when they do, they are less likely to succeed. On average, these children earn less and die at a younger age than their peers.
Chronic malnutrition can begin in utero with fetal undernutrition. Evidence shows that babies born to stunted (a common measure of chronic malnutrition) or underweight women are more likely to be stunted or underweight themselves. Maternal undernutrition contributes to 800,000 neonatal deaths annually and is a risk factor for fetal growth restriction, which is associated with an increased risk of stunting at 24 months of age.
The 1,000 days between conception and a childs second birthday offer a critical window of opportunity to establish a lasting foundation for health through adequate nutrition. Given the linkages between maternal and child undernutrition, it is essential that health interventions help pregnant women achieve optimum nutrition as early as possible during pregnancy.
In Rwanda, malnutrition is a pervasive challenge that undermines the nation's health and economic growth. Despite the fact that 85% of Rwandas population engages in agriculture, a staggering 38% of children under five are chronically malnourished.
For too long, malnutrition has been treated as purely a public health challenge while, at its core, it is also a challenge of failing food systems. To solve malnutrition, it is not only important to target nutrition interventions to pregnant women, it is also critical to design interventions that incorporate nutrition-sensitive agriculture into the prevention and treatment of chronic malnutrition.
Gardens for Health International (GHI) partners with existing government health centers in Rwanda to provide lasting agricultural solutions to chronic childhood malnutrition. Its work targets families for whom agriculture has the potential to be a catalyst for improved food and nutrient security. By addressing the root causes of malnutrition and investing in the productivity of these families, GHI provides a compelling solution for achieving long-term health and nutrition outcomes.