Pharmacy Level III

Learning Guide -17

Unit of Competence: Provide Information on Nutritional Supplement
Module Title: Providing Information on Nutritional Supplement

LG Code: HLT PHS3 M04 LO3- LG17

TTLM Code: HLT PHS3 TTLM 0919

LO 3: Advising on health and nutritional services.

Learning Guide #-1

Instruction Sheet
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This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
Identifying nutritional services needed
Methods of nutritional intervention
Essential nutrition actions
Role of pharmacy technicians on nutrition services
This guide will also assist you to attain the learning outcome stated in the cover page.
Specifically, upon completion of this Learning Guide, you will be able to:
Identify nutritional services needed
Know Methods of nutritional intervention
Specify Essential nutrition actions
Know Role of pharmacy technicians on nutrition services

Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Read the information written in the information Sheet
3. Accomplish the Self-check

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 Advising on health and nutritional services
Learning Guide #17
INFORMATION
SHEET #1
Topic
3.1 Identifying nutritional services
needed

From a nutrition perspective, there are six main components of a balanced diet:

carbohydrates, fats, protein, vitamins, minerals and water. It is important that all six are
consumed regularly.

Advising on health and nutritional services

Learning Guide #17

INFORMATION
SHEET #2 3.2. Methods of nutritional intervention
Topic

Nutritional intervention is corrective measure that is undertaken to rectify the

occurrence of overall malnutrition or specific nutrient deficiency or excess. In the
Ethiopian context, the commonest nutritional problems are deficiency diseases.
Therefore, the focus this topic is on the interventions against deficiency states.

General principles of nutrition intervention

• Should consider the conceptual framework

• Should integrate long term and short-term intervention

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 • Should target the different layers of causes

• Every sector is responsible (the concept of Nutrition lense)- multisectoral

intervention

• Should focus on the life cycle

• Should consider sustainability and participation of the beneficiaries

• Promote food-based approaches

Causal model-based approaches to Nutrition Intervention

This approach gives due attention to the effect of nutrition intervention on the different
causes. The major intervention categories include:

 DIETARY MODIFICATION-- Targets the immediate causes) ---for diet deficient

of nutrients
 DIETARY DIVERSIFICATION ---for poor dietary practices due to lack of
knowledge OR lack of access to food
 ECONOMIC APPROACHES (Targets Basic causes of Malnutrition) ---lack of
access to food and money to buy foods

3.2.1. Dietary modification

This approached focuses on improving the nutrient content of the diet through various
mechanisms. It involves either adding a nutrient in to a food(sprinkles) or giving the
nutrient in the form of a tablet.

Methods used for dietary modification

• Adding a nutrient in to a food (Fortification, Enrichment,

Standardization)

• Adding a food in to another food (Omega 3 and Omega 6 fatty

acids, milk, butter, sugar, Dried and powdered meat (Quanta))

• Processing the food to improve nutrient bioavailability eg.

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  Fermentation-increases absorption of Fe, Zn, Mg

 Germination- Amylase Rich Flour (Power flour)

• Giving the nutrient in the form of a drug (Supplementation)

• Biofortification (enriching the nutrition contribution of staple crops

through plant breeding)

• Home Fortification (Sprinkles)

• In Ethiopia the most common dietary modification methods used are

• Fortification (Iodine, Infant formulas)

• Supplementation

• Vitamin A (Targets children 6-59 months, Lactating mothers)

• Iron (Pregnant, lactating women, adolescents, and Children

U5)

• Folic acid (Pregnant women)

• Zinc (Children < 5 years with diarrhea)

• Germination, fermentation

• Cooking in Iron pots (adds iron to the food)

• Using clay pots for water storage (Decreases fluoride Level in water)

Widely Used Fortified Foods in the world

Food Vehicle Fortifying agent

Salt Iodine, iron

Wheat and corn flours, bread. pasta, Vitamin B complex, iron, folic acid, Vitamin
rice B12

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 Milk, margarine, yoghurts, soft cheeses Vitamins A and D

Sugar, monosodium glutamate, tea Vitamin A

Iron, vitamins B1, B2, niacin, vitamin K, folic

Infant formulas, cookies
acid, zinc

Vegetable mixtures amino acids,

Vitamins, minerals
proteins

Soy milk, orange juice Calcium

Juices and substitute drinks Vitamin C

Ready-to-eat breakfast cereals Vitamins and minerals

Diet beverages Vitamins and minerals

Enteral and parenteral solutions Vitamins, minerals

Source: http://dietary-supplements.

3.2.2. Dietary diversification

This approached works in areas where people consume undiversified monotonous diet
that is poor in nutrient contents. It assumes lack of knowledge or inadequate access to
diverse source food is the cause of this problem. Behavior change communication
(BCC) on the importance of diversified production and diversified consumption is
recommended. Diversified production (e.g. Backyard gardening, Nutrition garden, horticulture,
Animal farm eg. poultry, shots)

• Diversified consumption

 Keeping diet diversified by taking nutrients from the seven

food groups

 Healthy eating (balancing)

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3.2.3. Formula milk

Formula milk, also known as baby formula or infant formula, is usually made from cows'
milk that has been treated to make it more suitable for babies. F-75 is the "starter"
formula used during initial management of malnutrition, beginning as soon as possible
and continuing for 2-7 days until the child is stabilized. Severely malnourished children
cannot tolerate normal amounts of protein and sodium or high amounts of fat. They may
die if given too much protein or sodium. They also need glucose, so they must be given
a diet that is low in protein and sodium and high in carbohydrate. F-75 has is specially
mixed to meet the child's needs without overwhelming the body's systems in the initial
stage of treatment. Use of F-75 prevents deaths. F-75 contains 75 kcal and 0.9 g
protein per 100 ml. As soon as the child is stabilized on F-75, F-100 is used as a
"catch-up" formula to rebuild wasted tissues. F-100 contains more calories and protein:
100 kcal and 2.9g protein per 100 ml.

 F75 Preparation
Add either one large packet of F75 to 2 liters of water or one small packet to 500
ml of water. Where very few children are being treated smaller volumes can be
mixed using the red scoop (20 ml water per red scoop or F75 powder).

 F100 Preparation
It is made up from one large package of F100 diluted into 2 litres of water or one small
package diluted into 500 ml of water. In all cases, breast-fed children should always get
the breast-milk beforeF100 and on demand.

Warning: F100 should never be given to be used at home. F100 is always prepared and
distributed in an in-patient unit. F100 should not be kept in liquid form at room
temperature for more than a few hours before it is consumed: if there is a refrigerator
and a very clean kitchen/ utensils, then it can be kept (cold) for up to 12 hours. A whole
day’s amount should never be made up at one time. RUTF can be used both in in-
patient and out-patient programs.

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Self-Check
1. List all types of nutritional interventions and identify their differences
2. Give example for dietary diversification
3. Define formula milk
4. How you can prepare F75 and F100?

Advising on health and nutritional services

Learning Guide #17
INFORMATION
SHEET #3 3.3. Essential nutrition actions (ENA)
Topic

 Essential nutrition actions Based on proven behaviors.

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 3.3.1.Optimal breast feeding
 Breast feeding(BF) for the 6 first months of life.

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 3.3.2.Optimal complementary feeding behavior

3.3.3.Women’s Nutrition

3.3.4.Feeding sick child during and after treatment

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 3.3.5. Feeding in special situation
A. Control of Vitamin A Deficiency

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 B. Control of Anemia

C. Control of Iodine Deficiency Disorders

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Self-check

1. What are Optimal complementary feeding behaviors

2. List Feeding in special situation

Advising on health and nutritional services

Learning Guide #17

INFORMATION
SHEET #4 3.4. Role of pharmacy technicians on
Topic nutrition services

Pharmacists have diverse roles in relation to Parenteral nutrition (PN) therapy including
the assessment of patients’ nutritional needs; the design, compounding, dispensing,
and quality management of PN formulations; developing and implementing of an
individualized nutrition care plan and monitoring patients’ response to PN therapy. Other
areas of pharmacists’ practice in relation to PN include supervision of HPN (home
parenteral nutrition) programs; education of patients, caregivers, and other health care
professionals on nutrition support; and conducting PN-related research and quality
improvement activities.

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References

 American Dietetic Association and Dietitians of Canada. Manual of Clinical

Dietetics. 6th edition. Chicago, Illinois: American Dietetic Association, 2000
 Food and Nutrition Technical Assistance III Project (FANTA). 2016. Nutrition
Assessment, Counseling, and Support (NACS): A User’s Guide—Module 3:
Nutrition Education and Counseling, Version 2. Washington, DC: FHI
360/FANTA.
 Human Nutrition A Health Prospective, Mary E. Barasi, Second Edition in 2003
Hodder Arnold, 338 Euston Road, Landon NW1 3BH.
 Nutrition A Health Promotion Approach, Geoffrey P Webb. Third Edition, in 2008
Hodder Arnold, UK, 338 Euston Road, Landon NW1 3BH.
 Essentials of Human Nutrition, Jim Mann and A. Stewart Trus well, Second
Edition in 2002, Oxford University Press.
 Human Nutrition for Health science students, Tefera Belachew, Jimma
University, 2007.
 Gibson, Principles of nutritional assessment oxford 1990.

 FMOH, protocol for the management of severe acute malnutrition 2004, 2007
and 2013.
 FMOH, National guideline for control and prevention of micronutrient deficiency,
2004

Prepared By
Educational Phaone
No Name LEVEL Region College Email
Background Number

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 1 Debisa Taressa Pharmacy B Oromia Nagelle HSC deebisaaseenaa12@gmail.com 0921798728
2 Tamene Galchu Pharmacy B Oromia Nagelle HSC maatigelchu@gmail.com 0930675055
3
Ebrahim Dawud Pharmacy A Somali Jigjiga HSC ebraadaa@yahoo.com 0910480186
4 Alemseged Workneh Pharmacy A Harari Harar HSC yealemwerk@gmail.com 0913739792
5
Habtamu Tarekegn Pharmacy B BGRS Pawi HSC htarekegn25@.gmail.com 0917504094

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