Here we are showing you some of the nutrition reports from Nepal, malnutrition and how it is a serious obstacle to child survival and overall goal.

1 BACKGROUND

Malnutrition remains a serious obstacle to child survival, growth, and development in Nepal. The most common forms are protein-energy malnutrition (PEM) and micronutrient deficiency states (iodine, iron, and vitamin A deficiency).  Each type of malnutrition wrecks its own particular havoc on the human body, and to make matters worse, they often appear in combination.

There is wide variation in the state of malnutrition throughout Nepal, both ecologically and regionally. Stunting is more common in the mountain areas than in the Terai, but underweight and wasting are more common in the Terai area than in the mountain areas.  There are many causes of PEM.  An important cause of PEM in Nepal is low birth weight.  Low birth weight also leads to an intergenerational cycle of malnutrition.

Iodine deficiency disorder was another most endemic problem in Nepal, especially in the western mountains and mid-hills during the 1970s. To overcome this public health problem, Government of Nepal, Ministry of Health and Population adopted a policy in 1973 to fortify all edible common salt with iodine under the ‘Universal Salt Iodization (USI) Program’. Later in 1998, the Ministry of Health and Population issued a ‘two-child logo’ for quality certification of iodized packet salt with 50 ppm iodine at the production level.

Since fiscal year (2060/61), Child Health Division decided to celebrate February as the month to create general awareness about the use of iodized salt by conducting different activities with the help of different partner agencies like UNICEF, WHO and Salt Trading Corporation Ltd. This advocacy campaign is expected to further contribute to the prevention of Iodine Deficiency Disorders (IDD).

In order to assure proper usage and storage of iodized salt at the household level, the Child Health Division is also co-ordinating with the Curriculum Development Centre under the Ministry of Education to update the current curriculum on iodine.

Micronutrient Initiative (MI), in 2005 conducted the survey to track the progress towards elimination of IDD in Nepal. Two main indicators of the IDD- urinary iodine excretion and salt iodine at the household level were assessed in the survey. The survey also explored the knowledge, attitude and behavior patterns of consumers towards procurement and consumption of iodized salt in the country. This  survey has revealed improved iodine status in Nepal as the median Urinary Iodine Excretion (UIE) among school-aged children increased from 144 micrograms/liter in 1998 to 188 microgram/liter in 2005, both of the levels being over the minimum level designated by WHO to indicate the adequacy of iodine intake i.e. 100 microgram/liter. Nepal has however yet to achieve the goal of Universal Salt Iodization, which requires that at least 90% of households should be consuming adequately iodized salt.

Vitamin A deficiency still remains to be a public health problem among school-aged children and women. Rates of night blindness increase with age in both children and women. Furthermore, rates are higher in rural areas. Among preschool children, no cases of night blindness are reported in urban areas. The highest rate of night blindness is seen in the eastern and central Terai.

Low dose vitamin A program has been piloted in Sunsari, Parsa and Chitawan to treat night blind pregnant women with 25000 IU vitamin A capsule, 4 weekly doses.

The prevalence of worm infestation in Nepal is very high. Worm infestation in children leads to decreased resistance to infection, induces malnutrition, and also, leads to anemia and also impairs cognitive function in children.

The deworming impact survey conducted in 2003/04 noted that children below the age of 2 years also are severely affected by worm infestation. Because of this and in accordance with recent WHO recommendation, the MoHP in 2004 lowered the age limit for deworming from one year to five years of age.  Therefore deworming of one to five years of age into the National biannual vitamin A supplementation is implemented in the entire country.

Similarly, de-worming of all pregnant women with a single dose of albendazole tablet after the first trimester of pregnancy in order to prevent anemia in them is being routinely practiced through all health facilities in Nepal.

Anemia caused by iron deficiency is a major public health problem in Nepal affecting all segments of the population. The prevalence of anemia was higher in preschool children (78 percent) than in pregnant women (75 percent). Moreover, astonishingly high rate of 90 percent was found in infants 6-11 months old (NMSS, 1998).

Recognizing the severe consequences of iron deficiency anemia, and its effects on health, learning capacity, productivity, and maternal and neonatal survival, Ministry of Health and Population has approved a five year Anemia Control Plan of action developed by Child Health Division, DoHS.

Iron supplementation during pregnancy has been a key health initiative in Nepal since 1980. According to the government policy, all pregnant women are supplied with an iron tablet containing 60 mg. of elemental iron, free of cost. It is provided to all pregnant women since the beginning of the second trimester of pregnancy and continued up to 45 days postpartum (225 days in total).

In order to increase coverage and compliance of iron tablets among pregnant and postnatal mothers, the Nutrition Section of the Child Health Division has been implementing the Intensification of Maternal and Neonatal Micronutrient Program (IMNMP)™ since 206061. IMNMP is operated through the existing health facilities as well as through community-based outlets like FCHVs. IMNMP is an integrated approach as it includes the promotion of antenatal check-ups, deworming during pregnancy, consumption of adequately iodized salt, postpartum vitamin A supplementation, promotion of nutritious foods and rest during pregnancy.

Phase one of IMNMP was launched in five priority districts in 2003 with support from MI. Nepali Technical Assistance Group (NTAG) was entrusted with the task of providing initial training and logistics support. Evaluation of the program has revealed a significant increase in coverage and compliance of iron tablet supplementation among pregnant and postpartum women. As for example, coverage among third trimester pregnant women rose from 47 percent at baseline at 2003 to 85 percent in 2005. Similarly, compliance increased from 28 percent at baseline to 73 percent by the end of the second year.

These achievements have resulted in the phase-wise expansion of this program to 22 districts by July 2006. The MI, UNICEF and other organizations are replicating the program in additional districts in the year 2006/2007. The DoHS has planned nationwide program implementation by on 2009-10.

Food fortification with iron is a low-cost intervention for providing iron-rich nutrients to a larger population without changing their food consumption patterns. In Nepal, the most appropriate fortification vehicle to reduce iron deficiency anemia is wheat flour.  Fortification is now underway at few flour mills.

Realizing a need for a comprehensive document on nutrition policy and strategy for generating support and effective implementation of the program, A National Nutrition Policy and Strategy was compiled and approved in a single document form in FY 2061/62. During the development of this document, several new areas like household food security, improved dietary habit, life cycle-related diseases, school health and nutrition, nutrition in exceptionally difficult circumstances and analyzing, monitoring and evaluation of nutrition situation for future activity were also identified.

School-aged children, especially in the government-run schools are also one of the vulnerable groups to suffer from PEM problems. This leads to an undernutrition situation in them and thus they suffer from PEM, vitamin ‘A’ deficiency and iron deficiency anemia. To address these issue, a ‘National School Health and Nutrition Strategy’ has also been approved by MoHP as an integral part of the comprehensive National Nutrition Policy and Strategy.

Overall goal:

Achieving nutritional well being of all people in Nepal so that they can maintain a healthy life and contribute to the socio-economic development of the country in collaboration with relevant sectors.

Achieving nutritional well being of all people in Nepal so that they can maintain a healthy life and contribute to the socio-economic development of the country in collaboration with relevant sectors.

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