The Somali women are also have problems in their life, including homelessness, lack of water and food, so we would like to support them

Dear expert reply on this topic please

It depends on her nutritional status. If her nutritional status is degrading she must be included in the program.
There are criteria to consider with the MUAC

Dear Patrick Shabani i am from Pakistan and in National Guideline protocol said that enrolled in TSFP program only 2nd and 3rd trimester pregnant woman not 1st trimester my question is that why not we admit pregnant women in first trimester any reason?

Hi Amanullah,
we normally use the "2nd or 3rd Trimester" criterion since this is typically when the pregnancy is verifiable by observation.

Some programmes / guidelines have also included "or confirmation of the pregnancy by a doctor or midwife" (sorry I can't recall the reference for that).

To my knowledge there is no reason a woman in the first trimester of pregnancy shouldn't be included. Indeed in the early stages of embryo development this would be ideal especially if the woman is malnourished herself. The key from a programmatic perspective is that the pregnancy is verifiable.

I hope this helps,

Paul

I agree with Paul
Just to add, it's during the 1st tremester that organs are formed, and adequate nutrition is essential. By all means if they fit the inclusion criteria they should be added to the program.Lactating women have increased physiologic needs and should be included likewise.My experience is from a humanitarian setting, I don't know what obtains in other national nutrition programes

In my opinion there is no scientific reason. However in the health system I know, women begin the 1st antenatal consultation (ANC) after the 1st trimester, which provides an opportunity for the health worker to check the health of the mother, confirm the presence of a pregnancy and verify her nutritional status.
It is only now that if the woman meets the admission criteria that she would be enrolled in the program. It should also be pointed out that certain products for the systematic treatment of the malnourished pregnant woman cannot be given in the first trimester of pregnancy.

Dear Adamou,

Please could you elaborate on which products you consider should not be given to a pregnant woman in the first trimester and substantiate your response? This contradicts the advice of others that it is safe, and advisable, to enrol pregnant women in a programme as early as possible.

Many thanks,
Tamsin

Hi Tamsin,
I suspect that by 'systematic treatment' Adamou is referring to medications. Mebendazole is contraindicated for pregnant women in the first trimester. As far as I am aware this remains the current guidance from WHO and the manufacturers,

I hope this helps,

Paul

Many thanks for the clarification, Paul.

Many thanks all experts

dear colleageus in nutrition

the idea of the prevention of malnutrition starting from the first 1000 days of life of the neonate (window of opportunity according to the nutrition in emergency guideline) means to start the prevention from the time of conception to the end of the 2 year of age ,i.e the first trimester should be included in prevention and of course in management. the problem in our country was in how to detect that the mother is pregnant because even the non-pregnant women want to have a ration, so they take a sample of urine from a pregnant woman and take the ration. This results in an increase in the need of foods and costs the donor a lot. So it has been decided to admit the mother in the 2nd trimester in which the belly will appear and the health worker could know if she is pregnant or not.