food demonstrations and promote backyard gardening and other income generating activities. The groups are supported by the creation of “baby friendly communities” and are closely linked to the health facilities and to community health workers. At the same time, the community health workers conduct active screening for malnutrition and refer malnourished children to facilities for treatment. 279. The community based support groups are run by volunteers drawn from the communities who are then trained by local partners. The use of local community members is a key strategy to ensure that services reach into, and are accepted by marginalized communities. Acceptance of the messenger is important in addressing harmful local practices and beliefs that prevent parents from seeking out and making use of available nutritional services. For example, in some communities, the symptoms of malnutrition are associated with witchcraft and affected children are at risk of not being reported or neglected by their parents. Similarly, some women are reluctant to present their malnourished children at facilities for nutritional support for fear of accusations that they caused the condition because of their transgression against the taboo of sexual intercourse whilst breastfeeding. Overcoming such harmful attitudes and practices requires advocacy by trusted community workers. 280. In addition to community interventions, Vitamin A supplementation, growth monitoring and feeding counselling is integrated into routine mother-child facility-based services such as the Expanded Programme on Immunization programme at primary care Peripheral Health Units (PHUs). At birth, each child’s mother is provided with a yellow “Under-Fives Card” which is used to monitor growth, general development progress, Vitamin A and immunization coverage, and most recently, the child’s HIV status and treatment. Children are meant to receive 2 doses of Vitamin A in the first 12 months of life. In 2013, 73 percent of children had their “Under-five” card (Statistics Sierra Leone, 2014). 281. In addition, Sierra Leone has institutionalized bi-annual Maternal and Child Health Weeks (MCHW) which deliver an integrated package of health and nutrition interventions, including Vitamin A supplementation, deworming, immunizations and screening for acute malnutrition. In order to ensure that all children are reached, especially those in hard-to-reach areas, interventions are preceded by micro-planning involving community members to identify and ensure events cover hard-to-reach areas. During 2012, approximately one million children aged 9-59 months received a measles vaccination in addition to Vitamin A and de-worming tablets during the MCHW. 282. The Integrated Management of Acute Malnutrition (IMAM) Programme was introduced in 2007 to address the high rates of severe acute malnutrition (SAM). The programme comprises a community based screening and identification component using a simple measuring of the Mid-Upper Arm Circumference. Malnourished children receive Ready-to-Use Therapeutic Food and other essential medicines, plus hospitalization if necessary through the PHUs and inpatient facilities in government and faith-based hospital using therapeutic milk. By 2012, 36% of total PHUs (50 percent of PHUs in 7 districts) (UNICEF Sierra Leone, 2012). 283. In addition, children with Moderate Acute Malnutrition receive support through a partnership with the World Food Programme’s (WFP) Supplementary Feeding Programme. 7. Health and Welfare  77