From Addis to Delhi, accelerating progress in adolescent nutrition through cross continent learning

At Nutrition International, we know that generating the greatest impact for the people we serve comes with days, months, and even years of learning and some trial and error, and that every lesson along the way is invaluable.

Across our ten country offices in Africa and Asia, we are constantly exchanging ideas, lessons learned, and best practices, with the goal of reaching the full potential of our current programs and stimulating growth in our newer ones.

Adolescent nutrition, a key focus area of Nutrition International’s Right Start programs, is increasingly gaining global attention – especially where girls are concerned, as they are often one of the most vulnerable groups when it comes to poverty and malnutrition. Yet there is still more that needs to be done.

Looking to foster progress within this space, our India and Ethiopia offices have recently collaborated to exchange learnings from our Right Start initiative, which among many objectives, aims to improve the health and nutrition of adolescent girls through WHO-recommended weekly iron and folic acid supplementation (WIFAS) and nutrition counselling and education.

India is home to the world’s largest national WIFAS program, through several state programs, and has a lot of knowledge and wisdom to offer Ethiopia as they develop their new adolescent nutrition program. In fact, its success and depth of experience has sparked inspiration among our adolescent nutrition team in Ethiopia, particularly for Ermias Mekuria, who has been given the opportunity to visit India’s WIFAS program and transfer his newfound knowledge back to Ethiopia, where their adolescent nutrition program has just recently been launched through Right Start.

‘’Visiting India’s programs was like walking into Ethiopia’s future,’’ said Ermias. ‘’While Right Start Ethiopia is still in an early phase of its development, it aims to reach nearly one million adolescent girls with WIFAS and nutrition education by 2019.’’

Reporting on this knowledge exchange initiative, Ermias, Senior Project Officer for adolescent nutrition, Ethiopia, shares his main lessons:

1 – Tracking school attendance for maximum coverage

Although located in different parts of the world, Ethiopia and India share similar challenges when it comes to cultural norms.

In both countries, a common gendered-barrier faced by adolescent girls is in accessing schools and attending on a regular basis. This can often be related to a lack of good nutrition, poor sanitation in schools, insufficient finances for families, early marriage, pregnancy and overall gender discrimination.

Attending school is essential for girls’ long term nutrition. Since our WIFAS program works directly in and with schools, missing school often means that girls do not receive the supplements they need to benefit in anaemia reduction and therefore lack potential to do better in their studies. To help monitor their IFA consumption, it is crucial to track school attendance to have the most up-to-date data and consequently better understand where the gaps are in preventing anaemia among adolescent girls.

2 – Taking into account the importance of gender-disaggregated data availability

A notable difference in India’s adolescent nutrition program is that its interventions, particularly IFA supplementation and nutrition education, reach both adolescent boys and girls in school, whereas Ethiopia’s program only includes boys in the education component.

Anaemia is higher among girls and women in India, at 53 percent, but still a concern with over 23 percent in boys and men.

On the other hand, data for adolescents in Ethiopia is lacking. In fact, there is currently no country-wide evidence on the magnitude of anaemia among school-going boys between the ages of 10 to 19, and even data on girls is limited, often only including adolescents from ages 15 to 19 when they are surveyed as part of ‘’women of reproductive age’’ – omitting girls from ages 10 to 14.

Although it is generally understood that boys biologically have lower needs for iron than girls during adolescence due to menstruation, the lack of data can hinder decision-makers and program officers’ ability to understand the true need of IFA supplementation among target groups, and consequently prevent the design of programs that properly respond to those needs.

3 – Working in a enabling policy environment

Finally, visiting India’s nation-wide WIFAS program confirmed the importance of working in an enabling policy environment for the successful implementation of adolescent nutrition programs.

The Government of India takes anaemia very seriously, and has taken concrete steps towards tackling the issue such as by launching its national ‘’Anaemia Free India’’ program, for which reducing anaemia among adolescents is a key priority area through the distribution of WIFAS. In fact, India’s WIFAS program started out as a state-level demonstration project in Chhattisgarh in 2010, and has since grown to reach a total of 108 million adolescents across all states.

Similarly, Ethiopia has demonstrated its commitment to eradicating anaemia by launching its second National Nutrition Programme (NNP II) in 2016, which specifically endorses iron and folic acid supplementation for adolescent girls as part of its first strategic objective – to improve the nutritional status of women from ages 20 to 49 and adolescent girls ages 10 to 19.

The success of India’s national WIFAS program demonstrates the significance of having a government who supports and champions adolescent health, and reinforces hope for Ethiopia’s anaemia-specific interventions to become just as accomplished in the future.

‘’Coming back to Ethiopia with a new wealth of knowledge will allow our team to apply new learnings, such as tracking school attendance, and guide us in the right direction to help Right Start grow and allow more girls to reach their full potential,’’ said Ermias.

Globally, there is great potential to accelerate improvements in adolescent health and nutrition – especially with the dedication of adolescent nutrition champions such as Ermias, enhanced by opportunities for additional cross-pollination.

Learn more about the Right Start Initiative
 

11th World Congress on Adolescent Health

Ermias was also in India to attend the 11th World Congress on Adolescent Health – Investing in Adolescent Health – the Future is Now, where he shared his experiences with early implementation of new adolescent nutrition projects in Ethiopia, such as Right Start. The Congress provided a global stage for attendees to present new approaches and best practices that can contribute to accelerated action for adolescent health and rights, both globally and with specific reference to India and the sub-region.

Abanti Zakaria

Junior Program Officer, Adolescent and Women's Health and Nutrition

Abanti Zakaria, Junior Program Officer, is a part of the Adolescent and Women's Health and Nutrition sub-unit within Nutrition International's Global Technical Services team. Working under the supervision and mentorship of Dr. Marion Roche, Abanti contributes to the design, monitoring, implementation and dissemination of Nutrition International’s Adolescent Nutrition programs. Abanti is passionate about girls and women’s empowerment, and is pleased to see that interest in adolescent nutrition interventions is growing globally, complemented with growing investment. She has a BScH in Life Sciences and an MSc in Human Nutrition. Abanti joined Nutrition International in 2014.

Roche Marion headshot

Marion Roche

Senior Technical Advisor, Adolescent and Women's Health and Nutrition

Marion Roche, Senior Technical Advisor, Adolescent and Women's Health and Nutrition, supports and provides strategic direction to Nutrition International’s programs that advocate, build capacity and generate evidence to improve adolescent girls’ and women’s health and nutrition. Marion has expertise in behaviour change communication, community and global nutrition, infant and young child feeding, intervention design and evaluation, implementation research, qualitative research and social marketing. She has a PhD in Nutrition, a MPH in Global Health and a MSc Nutrition. Marion joined Nutrition International in 2011.