TSHWANE DISTRICT HEALTH

NUTRITION:
Strategy and Targets
Erika Spaumer RD(SA)
CHIEF DIETICIAN: TSHWANE DISTRICT HEALTH SERVICES
Purpose of the Session
Provide information to students on
Tshwane District Health Service’s (TDHS) Nutrition
Strategy and Targets
❖District Background
❖Key Priority Areas and related
Policies and Guidelines
❖Nutrition Indicators and Targets
District Background
Tshwane District Health Services
Within Gauteng, Tshwane’s Public
Healthcare service is delivered
through:
▪ 63 Primary Healthcare Clinics
(25 of which fall under City of
Tshwane; 1 satellite clinic)
▪ 7 Community Health Centres
(CHCs)
▪ 9 Hospitals
(4 District Hospitals; 3 Tertiary
Hospitals; 2 other Government
Hospitals)
Tshwane District Health Services: Nutrition
Tshwane AD: Dietetics Lindi Be Bruyn
Sub-district Chief dietician Dietician Admin (ECD subsidy)
Maryfrancis Omeh
1a Vulani Chabane Thina Mushadu
Lerato Zitha
Tintswalo Baloyi
1b Zelda Kgomo -
Nothando Mbatha
Reabetswe Rankune
2&4 Danielle Reyneke Itumeleng Sello -
Kabelo Ntisi (Community Service)
Kamogelo Nkoana
Tumelo Nkhuna
3&6 Erika Spaumer Violet Ndlovu
Bongi Nkondo
Boipelo Mere (Community Service)
Rhulani Chauke
5&7 Mavis Siquela Happy Khubana Johannes Kganyago
Maphuti Moabelo
Tshwane District Health Services alignment
The United Nations developed the 2030 Agenda
comprising of Sustainable Development Goals (SDGs)
= 17 goals with 169 targets that UN Member States
have agreed to work towards achieving by the year
2030.
▪ Vision for a world free from poverty, hunger and
disease
▪ Health: SDG 3 “Ensure healthy lives and promote
well-being for all at all ages”, with 13 targets in line
with World Health Organization's (WHO) work.
▪ Almost all of the other 16 SDGs are related to
health or their achievement will contribute to health
indirectly.
Tshwane District Health Services alignment
The National Development Plan (NDP): Vision
2030 “Our future, make it work”, was adopted in
2012, as South Africa`s development roadmap.

All Departments have

their own separate
Strategic Plans aligned
to the NDP; Provinces
and Districts adapt
these to compile their
Annual Performance
Plans (APPs) with own
Key Performance Areas
(KPAs).
Tshwane District Health Services alignment
Focus on scaling up high-impact nutrition
interventions:
▪ Micronutrient and/or nutritional supplementation
for pregnant and lactating women,
undernourished children and people living with
HIV and/or TB
▪ Breastfeeding and complementary feeding
counselling
▪ Growth monitoring and promotion services
▪ Vitamin A supplements and deworming
▪ Anthropometric screening of school learners
▪ Improving health workers’ capacity to provide
nutrition support and counselling.
Key Priority Areas (KPAs)
and related
Policies and Guidelines
Key Performance Areas (KPAs)
1. Disease specific, nutrition support, treatment and
counselling
2. Nutrition education, promotion and advocacy
3. Implementing quality assurance measures
4. Data validation and verification at facility level
 1. Disease specific, nutrition support, treatment and counseling
FOCUS AREAS:
▪ Nutrition Assessment, Counselling and Support
(NACS)

Nutrition Nutrition
▪
Assessment Counseling
utrition Assessment Nutrition
and and Support
classification education

Based on clients’ nutritional status and

diseases (HIV, AIDS, TB & debilitating
conditions, Chronic diseases of lifestyle
and Acute Malnutrition)
Nutrition Assessment Counselling and Support (NACS) Tools
Nutrition Assessment Counselling and Support (NACS) Tools

Tshwane Nutritional Supplementation Guidelines

Based on RT9 tender 2020:
1 June 2020 – 31 May 2024
NDOH Guidelines for Healthy Eating 2012

Enjoy a variety of foods

Make starchy food part of most meals

Fish, chicken, lean meat or eggs could be eaten daily

Have milk, maas or yoghurt every day

Eat plenty of vegetables & fruit every day

Eat dry beans, split-peas, lentils & soya regularly

Use salt & foods high in salt sparingly

Use fats sparingly; choose veg oils rather than hard fats

Use sugar AND food & drinks high in sugar sparingly

Drink lots of clean, safe water

Be Active!
NDOH Management of Chronic Conditions
2. Nutrition education, promotion and advocacy

FOCUS AREAS:
▪ Trainings
• Acute Malnutrition, Breastfeeding/ Mother Baby Friendly Initiative (MBFI),
Infant and Young Child Feeding (IYCF), Vitamin A, NACS and Nutrition data
elements and indicators for clinic staff and community structures e.g. Early
Childhood Development Centres (ECDs), Mental Health facilities, etc.
▪ Community awareness and campaigns
• Health awareness events
• Outreach plans to improve vitamin A coverage to children aged 12 to 59 m
▪ Promotional material
• Develop / update Nutrition Information Education and Communication (IEC)
and Training materials in line with guidelines and communicate to relevant
sections
Integrated Management of Acute Malnutrition (IMAM)
 Integrated Management of Acute Malnutrition (IMAM)
Acute Malnutrition: Prevention Continuum

Inpatient Care
SAM with Medical Emergencies

Management of ACUTE
MALNUTRITION
SAM with Medical Complications

OTP SAM without Medical Complications

Outpatient Care
OSP MAM with/out Medical Complications

Growth Monitoring
& Promotion
GMP NAM with Growth Faltering / At risk

NAM and Growing well

GMP

Kauchali S. NDOH.
 Integrated Management of Acute Malnutrition (IMAM)

Late Versus Early Presentation

SAM without MAM NAM / NAM at risk

SAM with medical medical Outpatient Outpatient
complications complications
Inpatient In or Outpatient
Growth Monitoring &
Management of ACUTE MALNUTRITION Promotion
 Classification of Acute Malnutrition – WEIGHT FOR LENGTH

Standard
Length/Height for age Weight for age Weight for Length/Height
deviation
Child very tall - rarely Maybe growth problem.
>3 Obese
endocrine disorder Assess Lt/Ht for age
Maybe growth problem.
>2 Normal Overweight
Assess Lt/Ht for age
>1 Normal Normal Possible risk of overweight
0 = Median Normal Normal Normal
Normal
<–1 Normal Normal

Stunted Wasted
<–2 Underweight
MAM
Severely wasted
<–3 Severely stunted Severely underweight
SAM
 Classification of Acute Malnutrition – MUAC & OEDEMA
▪ Most facilities have Ward Based Outreach Teams (WBOT)
with Community Health Workers (CHWs)
▪ CHWs have been assigned households to monitor
▪ Trained to do MUAC AND check for Bilateral Pitting
Oedema

Age Group NAM MAM SAM

6 - 59 months old ≥ 12.5 cm ≥ 11.5 to < 12.5 cm < 11.5 cm
Infant and Young Child Feeding (IYCF)

Exclusive breastfeeding
for the first six months;
where after complementary
feeding starts,
while breastfeeding continues
for 2 years and beyond

Recommendation is the same

for all mothers,
regardless of HIV status
MBFI (Mother Baby Friendly Initiative)
PMTCT (Prevention of Mother-to-Child Transmission)
PMTCT (Prevention of Mother-to-Child Transmission)
PMTCT (Prevention of Mother-to-Child Transmission)
Growth Monitoring & Promotion (GMP)

▪ First 1000 days

▪ Mother and Child seen as
one unit
▪ Training for School Health
Nurses
 Maternal Nutrition

▪ Mother and Child seen as one unit

▪ Nutrition for pregnant & lactating
women
▪ Nutrition & congenital
abnormalities
Early Childhood Development (ECD) guidelines

Tshwane District Nutrition ECD

subsidy for creches meeting set
requirements
Nutrition IEC/training materials
3. Implementing quality assurance measures

FOCUS AREA:
Monitoring and Evaluation of Nutrition
policy implementation in various
facilities:
▪ Primary Health Care Facilities
▪ ECD centres
▪ Mental Health NGOs
▪ Hospitals
▪ Old age homes / other Community
structures
4. Data validation and verification at facility level

FOCUS AREA:
▪ Validation and Verification of
Nutrition Data in Primary Health
Care Facilities and Hospitals
 Nutrition
Indicators and Targets
Nutrition Data Indicators 2023/24

Nutrition Data Indicator Collection point

Infants exclusively breastfed Hex 3 rate Clinic level
Vitamin A 12-59m coverage Clinic level
MAM <5 incidence Clinic and Hospital level
SAM <5 incidence Clinic and Hospital level
Child <5 food supplementation coverage Clinic level
Overweight or obese <5 incidence Clinic level
MAM fatality <5 rate Hospital level
SAM fatality <5 rate Hospital level
SAM death <5 rate Hospital level
Early Breastfeeding initiation rate MOU – Clinic and Hospital level
Nutrition Indicators

Targets
Nutrition Data Indicator
2023/24
Infants exclusively breastfed Hex 3 rate 55%
Vitamin A 12-59m coverage 55%
MAM <5 incidence 5/1000
SAM <5 incidence 5/1000
Child <5 food supplementation coverage 5/1000
Overweight or obese <5 incidence 50/1000
MAM fatality <5 rate 5,0%
SAM fatality <5 rate 7,0%
Early Breastfeeding initiation rate 70%
Nutrition Data Elements 2023/24
Nutrition Data Elements 2023/24
Nutrition Data Elements 2023/24
Infant exclusively breastfed at DTaP-IPV-Hib-HBV 3rd dose rate
Infant exclusively breastfed at DTaP-IPV-Hib-
Element
HBV (Hexavalent) 3rd dose
• Infant reported to be exclusively breastfed at
DTaP-IPV-HepB-HBV (Hexavalent) 3rd dose
immunisation (preferably 14 weeks after birth)
• Only record as exclusively breastfed if the
Definition
child received breastmilk ONLY
• A child who has received ANY solids, milk
(other than breastmilk) or other liquids
(including water) should not be counted
Infant exclusively breastfed at Hexavalent
Indicator
3rd dose rate
• Monitors infants on exclusively breastfeeding
Use
up till the age of 14 weeks after birth
Target • 55% (2023/24)
Vitamin A dose 12-59 months coverage
Vitamin A dose 12-59 months coverage
Element Vitamin A dose 12-59 months
• Children 12-59 months who received Vitamin
Definition A 200,000 units, every six months as a
proportion of population 12-59 months
Indicator Vitamin A dose 12-59 months coverage
• Monitors Vitamin A supplementation to
children aged 12-59 months
Use
• Each child should receive supplementation
twice a year
Target • 55% (2023/24)
Vitamin A dose 12-59 months coverage

Additional elements captured to calculate Vitamin A

coverage:
• COS (Community Outreach Services) Vitamin
A dose 12-59 months
• Child from 12-59 months provided with
Vitamin A in community/household by CHW
• Vitamin A dose 12-59 months (campaign)
• Vitamin A dose given to a child 12-59 months
(under 5 years) of age during a mass
vaccination campaign.
Child under 5 years Moderate Acute Malnutrition (MAM) incidence
Moderate acute malnutrition in child under 5
Element
years new
• Child under 5 years with a weight-for-height
Z-score (WHZ) between -2 and -3 and or
child has a mid-upper arm circumference
Definition
(MUAC) from 11.5 to 12.4 cm and no oedema
• Only record new cases, not those coming for
follow-up
Child under 5 years moderate acute
Indicator
malnutrition incidence
• Monitors prevention and diagnosis of MAM in
Use
children under 5 years
Target • 5 per 1,000 (2023/24)
Child under 5 years Severe Acute Malnutrition (SAM) incidence
Severe acute malnutrition in child under 5
Element
years new
• Child under 5 years with WHZ <-3 OR with
Definition MUAC <11.5 cm OR nutritional oedema of
both feet
Child under 5 years severe acute
Indicator
malnutrition incidence
• Monitors prevention and diagnosis of SAM in
Use
children under 5 years
Target • 5 per 1,000 (2023/24)
Child under 5 years food nutritional supplementation coverage
Child under 5 years on food supplementation
Element
new
• Child under 5 years newly started on a food
supplementation program for SAM cases in
Definition
rehabilitation, all MAM cases OR children
with growth faltering
Child under 5 years food nutritional
Indicator
supplementation coverage
• Monitors access to and efficient use of food
Use supplementation in children under 5 years of
age
Target • 5 per 1,000 (2023/24)
Nutritional supplementation guideline
Nutritional supplementation guideline
Nutritional supplementation guideline
Overweight or obese in child under 5 years incidence
Element Child under 5 years overweight or obese new
• Child under 5 years identified as being above
+2 (overweight) and or above +3 (obese)
weight-for-length/height
Definition
• Only record children presenting for the first
time as overweight/obese for age (i.e. new
cases), not those coming for follow-up.
Overweight or obese in child under 5 years
Indicator
incidence
• Monitors prevention and diagnoses of
Use
overweight/obesity in children under 5 years.
Target • 50 per 1,000 (2023/24)
 Child under 5 years moderate acute malnutrition case fatality rate
Element Moderate acute malnutrition death under 5 years
• Death in child under 5 years with MAM (MUAC 11.5-12.4cm, if over
6 months, OR WHZ between -2 and -3 and no oedema)
Definition • All children under 5 years who were assessed as having MAM on
admission must be reported here, irrespective of the cause of death
(it does not imply that the child died from MAM).
Indicator Child under 5 years moderate acute malnutrition case fatality rate
• Monitors treatment outcome for children under 5 years who were
Use
separated with MAM
Target • 5.0% (2023/24)
 Child under 5 years severe acute malnutrition case fatality rate
Element Severe acute malnutrition death under 5 years
• Death in child under 5 years with SAM (MUAC<11.5cm, if over 6
months, OR WHZ<-3SD and/or presence of bilateral pitting oedema)
• All children under 5 years who were assessed as having SAM on
Definition
admission must be reported here, irrespective of the main final
diagnosis or cause of death (it does not imply that the child died from
SAM).
Indicator Child under 5 years severe acute malnutrition case fatality rate
• Monitors treatment outcome for children under 5 years who were
Use
separated with SAM
Target • 7.0% (2023/24)
 Breastfeeding early start within 1 hour after birth rate
Element Term infant put to the breast within 1 hour after birth
• The percentage of term infants who were put to the
breast within 1 hour after birth
• Includes term or live birth with birth weight above 2500g
Definition • This indicator does not imply that those preterm babies
who can be put on the breast should be denied the
opportunity to do so (this is for counting and reporting
purposes)
Indicator Breastfeeding early start within 1 hour after birth rate Skin to skin keeps baby
• Monitors implementation of evidence based key clinical warm and calm,
practices for the protection, promotion and support of promotes bonding,
Use
breastfeeding (The mother baby friendly initiative) as a helps breastfeeding get
standard of care in all facilities rendering deliveries. started.
Target • 70% (2023/24)
 Nutrition Indicators

Nutrition Data Indicator Collection point Targets

Infants exclusively breastfed Hex 3 rate Clinic level 55%
Vitamin A 12-59m coverage Clinic level 55%
MAM <5 incidence Clinic and Hospital level 5/1000
SAM <5 incidence Clinic and Hospital level 5/1000
Child <5 food supplementation coverage Clinic level 5/1000
Overweight or obese <5 incidence Clinic level 50/1000
MAM fatality <5 rate Hospital level 5,0%
SAM fatality <5 rate Hospital level 7,0%
Early Breastfeeding initiation rate MOU – Clinic and Hospital level 70%
Tshwane District Health Services: Nutrition
▪ Assistant Director: Dietetics:
▪ Lindi de Bruyn, 079 529 4675, Lindi.DeBruyn@gauteng.gov.za
▪ Chief dietician: Sub-district 1a (DGMAH cluster):
▪ Vulani Chabane Khosa, 072 783 7981, Vulani.Chabane@gauteng.gov.za
▪ Chief dietician: Sub-district 1b (Odi hospital cluster):
▪ Zelda Kgomo, 082 414 1996, Zelda.Kgomo@gauteng.gov.za
▪ Chief dietician: Sub-district 2 and 4:
▪ Danielle Reyneke, 082 737 7490, Danielle.Reyneke@gauteng.gov.za
▪ Chief dietician: Sub-district 3 and 6:
▪ Erika Spaumer, 082 303 9775, Erika.Spaumer@gauteng.gov.za
▪ Chief dietician: Sub-district 5 and 7:
▪ Mavis Siquela, 079 696 8542, Mavis.Siquela@gauteng.gov.za
Thank You