Health and Nutrition

Empowering vulnerable families and communities to manage their health needs through information on best health and nutrition practices and connecting them to health care and social services.

Health and Nutrition

Empowering vulnerable families and communities to manage their health needs through information on best health and nutrition practices and connecting them to health care and social services.
Sector at a Glance

As children grow, their health and nutrition care needs vary. Factors also play a role in the overall health of vulnerable children and their families, including caregiver behaviors; access to education, safe water, and hygiene facilities; and the proximity of health services. Expectant mothers— especially those who learn they are HIV-positive during a routine prenatal visit—require additional support.

The first 1,000 days of life from conception to age 2 years is a critical window for both child and mother. Studies have shown that a child who suffers from chronic malnutrition during this vital period may be at increased risk of living in poverty and having lower cognitive skills than typically developing peers, and, among girls, may face a higher risk of maternal death in adulthood. Furthermore, approximately half of all deaths among children under age 5 years worldwide results from malnutrition.

Addressing these issues at the individual and household levels is a challenge because a many factors affect the ability of mothers and caregivers to adopt optimal health- and nutrition-related behaviors. Caregivers may know little about appropriate feeding or health-seeking practices and have limited decision-making ability in their households. Households also may have limited resources. Moreover, community norms, HIV-stigma and discrimination, and the quality of care available through the local health system can hamper mothers and caregivers from adopting healthy behaviors, such as exclusive breastfeeding for the infant’s first 6 months, hand-washing, appropriate use of long-lasting insecticidal nets, complete immunization, HIV testing, and treatment adherence among HIV-positive adults and children.

Programming for vulnerable households and communities can help erode barriers to health and nutritional support by linking families to quality health and social services through wide-scale community events and providing them with information through clinics and home-based visits. Community-based interventions strive to transform norms so that communities can manage their own health needs.

Catholic Relief Services recognizes that, to improve access to quality health and nutrition services for vulnerable children and their caregivers, working on multiple levels—individual, household, community, civil society, and government—and with faith-based and private service providers is key.

CRS health and nutrition interventions promote long-term development by incorporating approaches that recognize and respond to the needs and realities of vulnerable populations, organizations, and local systems. Our programs are designed to address inequities, support universal access to health care, and foster sustainable outcomes.

Household dynamics, parenting skills, cultural norms, socioeconomic status, access to sanitation and education, and other factors may influence child health and nutritional outcomes. So, whenever possible, CRS takes a multisectoral approach to create an empowering environment that positively influences child and caregiver nutrition and health outcomes.

With support, caregivers are more likely to practice health and nutrition behaviors that benefit the entire family. Communities find local solutions and resources for improving care. Public and private providers improve the quality of the services they offer through improved management and organizational oversight. An increase in sectoral and organizational linkages means improved communication and coordination so that even those people living in remote areas can access services.

Highlights of our work in Health and Nutrition

CRS country programs
Zambia
Lesotho
Uganda
Malawi
Kenya
Case studies

Preventing Malnutrition in Children Under Age 2 Years in Zambia Through Community-Led Complementary Feeding and Learning Sessions

Photo by Sara A. Fajardo

How children are fed during their first 2 years of life shapes their future. Through the Feed the Future Zambia Mawa project, CRS is helping to safeguard those futures by bolstering nutrition during the critical first 1,000 days—beginning from a woman’s pregnancy to the first 2 years of her infant’s life. Nearly 960 trained nutrition volunteers educate more than 10,000 women with children under age 2years on how to best feed their growing babies.

During monthly home visits, volunteers monitor children’s growth and expectant mothers’ nutritional status. Those showing signs of faltering growth are enrolled in an intensive 12-day course on community-led complementary feeding and learning.

During the course, the mothers engage in drama, talks, and songs to build their knowledge on the importance of prolonged breastfeeding, how critical hygiene is, and ways to optimally feed and care for their children. The group setting creates a support network that helps the mothers remember their lessons. Through hands-on cooking demonstrations, they learn to create menus and prepare food while preserving the maximum nutritional value. Ingredients are locally produced, seasonally available, and high-nutrient value crops. By practicing together, program participants are able to build the necessary skills to cook the same meals at home.

After the mothers have completed the course, volunteers conduct follow-up home visits to answer questions, monitor children’s growth, and encourage caregivers to continue their new nutrition practices. On average, 3 months following their mother’s participation in the program, children will have gained 2.2 pounds; 6 months later, 3.7 pounds. Children who are not showing improvement are referred to local health facilities for follow-up assessment and counseling.

By 2017, Mawa will reach 19,000 children younger than age 2 years. The goal is to reduce stunting by 20 percent in the project area.

Preventing Malnutrition in Children Under Age 2 Years in Zambia Through Community-Led Complementary Feeding and Learning Sessions

How children are fed during their first 2 years of life shapes their future. Through the Feed the Future Zambia Mawa project, CRS is helping to safeguard those futures by bolstering nutrition during the critical first 1,000 days—beginning from a woman’s pregnancy to the first 2 years of her infant’s life. Nearly 960 trained nutrition volunteers educate more than 10,000 women with children under age 2years on how to best feed their growing babies.

Read more

Bolstering Nutrition With Keyhole Gardens for Vulnerable Households in Lesotho

Photo by Sara A. Fajardo

In the mountainous regions of Lesotho, stunting and chronic malnutrition can affect up to 51 percent of children. To help reverse this trend, CRS introduced keyhole gardens, raised bed plots that produce harvestable crops within 3 months of completion.

Their compact size means they can be built where farmland is scarce: in urban areas, at schools, and even at refugee camps. Because they are located near the home, keyhole gardens are a good source of food for elderly and chronically ill people, and for families caring for vulnerable children.

Highly adaptable, keyhole gardens are suited for arid and semi-arid zones, and yield harvests during periods of biting frost. Their design allows for moisture retention, and they keep the soil warm. Constructed with locally available resources, these gardens reduce the need for costly materials purchased on the market.

Year-round production means families can rely on well-rounded diets, even in the lean season. During peak times, some households have sold their surplus at a profit of up to $8.44 per month at the time of sale. For these households, which typically receive an average income of $46.22 a month, this profit represented an 18 percent increase in monthly income.

A CRS-sponsored learning event in Lesotho in 2011 worked to adapt keyhole gardens to local conditions in 16 sub-Saharan African countries, Afghanistan, and Haiti. A follow-up event in 2012 revealed that the methodology was versatile and adaptive to different environments. In Burundi, keyhole gardeners used local timber products to construct the garden walls. In Haiti, keyhole gardens resulted in greater vegetable yields. In the water-scarce regions of Madagascar, the gardens improved access to vegetables.

Today, poor families worldwide are reaping the benefits of keyhole and other homestead gardening practices. Timor Leste, Syria, and Turkey have begun adopting the practice.

Bolstering Nutrition With Keyhole Gardens for Vulnerable Households in Lesotho

In the mountainous regions of Lesotho, stunting and chronic malnutrition can affect up to 51 percent of children. To help reverse this trend, CRS introduced keyhole gardens, raised bed plots that produce harvestable crops within 3 months of completion.

Read more

Dramatically Improving School Attendance in Uganda With Latrines, Safe Water, and School Health Clubs

Photo by Sara A. Fajardo

What does access to safe water and sanitation have to do with school success? For children living where latrines and drinking water are unavailable, such access can often be the deciding factor between academic achievement, dropping out, or repeating a year. Waterborne illnesses routinely keep children out of school: An estimated 443 million schoolchildren miss school days each year for this reason.

Some children report losing vital instructional hours so they can search for water to drink while in school. To keep children in the classrooms, CRS Uganda improved the water supply infrastructure and built hand-washing stations and latrines equipped with an extra changing room for menstrual hygiene in 13 primary schools. These changes now benefit 6,723 children.

Through health clubs, CRS Uganda encourages students to become catalysts for change. Each of the 30- to 40-member clubs comprises an equal number of boys and girls. Led by teachers trained in hygiene promotion, members meet regularly to design activities and messages on hygiene and safe water usage. They take the lead on cleaning the school compound, classrooms, and latrines. And they write skits and songs, and choreograph dances to convey good hygiene practices at school and community functions.

CRS has found that kid-centered clubs effectively boost social awareness and create safe spaces for children to engage with one another, share information, and learn about topics that improve the quality of their lives and communities.

The results of the project have been remarkable. In just 3 years, attendance among girls in the targeted areas rose from 46 percent at the start of the project to 75 percent, and overall attendance increased from 67 percent to 85 percent.

Dramatically Improving School Attendance in Uganda With Latrines, Safe Water, and School Health Clubs

What does access to safe water and sanitation have to do with school success? For children living where latrines and drinking water are unavailable, such access can often be the deciding factor between academic achievement, dropping out, or repeating a year. Waterborne illnesses routinely keep children out of school: An estimated 443 million schoolchildren miss school days each year for this reason.

Read more

Bringing Health Services to Vulnerable Children and Their Families in Malawi and Kenya Through Community Health Days

Photo by Sara A. Fajardo

Families arrive in droves for Community Health Day—held in villages across Malawi—to access a range of services, from growth monitoring and deworming to birth registration and school enrollment assistance. These services are provided in collaboration with the Ministry of Health and other providers to support healthy families. On-site health workers treat people with minor ailments and refer undernourished children, hypertensive adults, and other complicated cases for further services. Individuals found to be HIV-positive receive on-site counseling and a referral to a health facility for testing to confirm the diagnosis and to assess whether they are eligible for antiretroviral therapy.

Speeches and dramas keep people entertained as they wait their turn for services. Such health days are one CRS approach to ensuring that children and their caregivers receive vital health services and information. To date, more than 95,937 Malawians have benefitted from health days, and 41.5 percent of attendees have been children under age 15 years.

In just 1 year, similar events in Kenya have reached more than 7,050 through the Conrad N. Hilton Foundation funded THRIVE program. The Kenya program also uses these health days as a platform to keep children’s immunizations up to date and to follow-up on birth registration—a critical document to ensure that children are guaranteed their legal rights as citizens. As a result of this program, more than 2,853 Kenyan children have acquired their birth certificates.

Health days provide a platform for improving access to vital health, nutrition, and other social services to rural communities. Information collected during health days helps to inform Ministry of Health officials and other entities of gaps in service delivery so they can address those gaps through other means, such as scaled-up mosquito net distribution. 

Bringing Health Services to Vulnerable Children and Their Families in Malawi and Kenya Through Community Health Days

Families arrive in droves for Community Health Day—held in villages across Malawi—to access a range of services, from growth monitoring and deworming to birth registration and school enrollment assistance. These services are provided in collaboration with the Ministry of Health and other providers to support healthy families. On-site health workers treat people with minor ailments and refer undernourished children, hypertensive adults, and other complicated cases for further services.

Read more

Providing a Critical Link Between Vulnerable Households in Kenya and Needed Services Through Community Health Workers

Photo by Sara A. Fajardo

Mary Onyango is a community social service connector. Each day, she wears deep grooves into the dirt roads of her western Kenyan community visiting vulnerable households as a CRS-trained community health worker, or CHW.

Like all CHWs, Mary deciphers what households need most: medical referrals, nutritional support, referrals to financial services, parenting advice, or simply a sympathetic ear. In one case, she accompanied a woman through her pregnancy and taught her about prevention-of-mother-to-child transmission of HIV. When it came time for the birth, Mary took the woman to the clinic and ensured that the baby received the required medicine immediately after delivery. The child is thriving and has been declared HIV-free.

CHWs also are taught to target specific health concerns. In eastern Kenya, where the doctor–patient ratio is 1:100,000, CHWs received training through the project Community Integrated Management of Childhood Illnesses, funded by the U.S. Agency for International Development, to identify and treat basic cases of five childhood illnesses: acute respiratory infection, malaria, diarrhea, fever, and malnutrition. They referred more complicated cases to 23 target health facilities.

The results were impressive: The percentage of children younger than age 5 years who were now sleeping under bed nets increased from 10 percent to 96 percent. Furthermore, cases of pneumonia now are assessed and referred within 24 hours, and the percentage of people hand-washing before food preparation jumped from 29 percent to 57 percent. The Kenyan Ministry of Health has adopted the project modules as a national protocol.

CHWs like Mary are at the heart of vulnerable household programming. As members of the community with links to social services and medical providers, CHWs are an effective way to help identify problems, provide just-in-time messaging, individualize care, and connect vulnerable households with the right services. 

Providing a Critical Link Between Vulnerable Households in Kenya and Needed Services Through Community Health Workers

Mary Onyango is a community social service connector. Each day, she wears deep grooves into the dirt roads of her western Kenyan community visiting vulnerable households as a CRS-trained community health worker, or CHW.

Read more

Creating Support Systems in Malawi to Help Prevent Mother-to-Child-Transmission of HIV

Photo by Sara A. Fajardo

Receiving an HIV-positive diagnosis during an otherwise healthy pregnancy can be terrifying for an expectant mother. In Malawi, opt-out HIV testing means many mothers learn their status during their first prenatal visits. To protect mothers’ health and prevent HIV transmission to babies, Malawian government policy requires that pregnant, HIV-positive women begin antiretroviral therapy, or ART, as quickly as possible. Many mothers start therapy without having fully absorbed the news of their HIV status or without disclosing their diagnosis to their partners and families.

Two tools provided through the IMPACT project, funded by USAID and the President’s Emergency Plan for AIDS Relief, support these women: a mobile phone application that assists government health surveillance assistants, or HSAs, to provide information and counseling during routine home visits and formal  that invite fathers to attend prenatal appointments.

The app translates the often misunderstood paper manual used by HSAs into an easily navigable handheld mobile resource to provide timely clinical information and psychosocial support. HSAs use the app from the earliest contact during pregnancy until HIV-exposed infants are 24 months old to keep mothers current on their child’s development and how to prevent HIV transmission throughout pregnancy and breastfeeding.

After introducing the love letters, clinics saw a 26 percent increase in husbands who joined their wives for appointments. During those visits, fathers were encouraged to get an HIV test and also learned about proper nutrition for mother and baby, fetal development, and how to help their wives who are HIV-positive to adhere to an ART regimen.

By improving on HSA in-home care and spousal support, the IMPACT project helped mothers living with HIV to better cope with their status, thus increasing the likelihood that they will follow the proper steps to decrease transmission of HIV to the next generation. 

Creating Support Systems in Malawi to Help Prevent Mother-to-Child-Transmission of HIV

Receiving an HIV-positive diagnosis during an otherwise healthy pregnancy can be terrifying for an expectant mother. In Malawi, opt-out HIV testing means many mothers learn their status during their first prenatal visits. To protect mothers’ health and prevent HIV transmission to babies, Malawian government policy requires that pregnant, HIV-positive women begin antiretroviral therapy, or ART, as quickly as possible. Many mothers start therapy without having fully absorbed the news of their HIV status or without disclosing their diagnosis to their partners and families.

Read more