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NATIONAL NUTRITION PROGRAMME

The National Nutrition Program under Department of Health Services has laid the vision as
All Nepali people should live with adequate

nutrition, food safety and food security for adequate physical, mental and social growth and development and survival To improve the overall nutritional status of children, women of child bearing age, pregnant women, and all ages through the control of general malnutrition and the prevention and control of micronutrient deficiency disorders having a broader inter and intra-sectoral collaboration and coordination, partnership among different stakeholders and high level of awareness and cooperation of population in general.

Malnutrition remains a serious obstacle to child

survival, growth and development in Nepal. The most common forms of malnutrition is protein-energy malnutrition (PEM) .The other form of malnutrition are 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.
Even moderately acute and severely acute

malnourished children are more likely to die from common childhood illness than those adequately nourished.

In addition, malnutrition constitutes a serious

threat especially to young child survival and is associated with one third of child mortality.
One of the important causes of PEM in Nepal is

low birth weight of below 2.5 kg, a sign of poor maternal nutrition leading to an intergenerational cycle of malnutrition.

As of the Nepal Demographic and Health Survey

(NDHS) 2006, 49% of children below 5 years of age are stunted. The survey also showed that 39% of the children are underweight and 13 % of the children below 5 years are wasted.
Malnutrition is not evenly distributed throughout

Nepal; it varies both ecologically and regionally. Stunting, underweight and wasting are more common in mid and far west hills and mountain areas than other part of the country.

All three indicators are poor in the central Terai

Iodine deficiency disorder was another endemic problem in Nepal, especially in the western mountains and mid hills for which Ministry of Health and Population adopted a policy to fortify all edible common salt with iodine and decided to celebrate February as the month to create general awareness about the use of iodized salt through mass campaign to contribute in the prevention of Iodine Deficiency Disorders (IDD).Well-equipped modern warehouses have been constructed in various parts of the country for safeguarding buffer stock.

Another problem among school-aged children

and women is the Vitamin A deficiency leading to night blindness both in children and women. No cases of night blindness are reported due to a regular semiannual supplementation of high dose (200,000 I.U.) Vitamin A supplementation to preschool children.
The National Vitamin A Supplementation

Program with community support is considered as the one of the internationally recognized successful program.

As cases of night blindness is seen in the

eastern and central Terai regions among school going children and pregnant women low dose vitamin A program is being piloted in Sunsari, Parsa and Chitwan.
The prevalence of worm infestation in Nepal is

very high leading to decreased resistance to infection, induces malnutrition, and also, leads to anaemia and also impairs cognitive function in children

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 single dose of albendazole tablet after first trimester of pregnancy is being routinely practiced through all health facilities in Nepal.

Anaemia caused by iron deficiency is a major public

health problem in Nepal affecting all segments of the population. The survey has shown a remarkable amount of anaemia, i.e., 81 percent among children aged 6-11 months and 71% among 12-23 months of age. This calls for launching of most appropriate interventions to address anaemia in this age group.
As of the government policy all pregnant women

and postpartum mothers are supplied with iron tablet (225 days in total) free of cost. In order to increase coverage and compliance of iron tablets among pregnant and postnatal mothers .

Intensification of Maternal and Neonatal Micronutrient

Program (IMNMP) is being implemented through the existing health facilities and community-based outlets like FCHVs.. By the end of fiscal years, the program has been introduced in 68 districts. And within next year all the 75 districts will be covered .

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 view of this, wheat flour fortification program has been launched with support from MI (Micronutrient Initiative).
Similarly, a pilot project has also been launched in

a VDC of Lalitpur with MI support where cereal flours (mainly maize) are being fortified with iron, folic acid and vitamin A at small water mills.

Likewise, Government of Nepal has launched social

marketing of low cost fortified blended complementary food under brand name Champion targeting the children aged 6-23 months in partnership with Population Services International, World Food Program and MI.

In order to reduce the prevalence of low weight

among young children, Anaemia among the pregnant women, nursing mothers and young children MOHP along with other EDPs has implemented the Mother and Child Health Care (MCHC) activity in remote food deficit districts of Nepal in Dadeldhura, Doti, Darchula, Baitadi, Bajhang, Bajura, Achham and Salyan districts through the existing health facilities such as HP, SHP and PHC- ORC clinics.

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 formulated and approved in a single document form in FY 2061/62 by the help of JICA.
The Nepal Nutrition Assessment and Gap Analysis

(NAGA) was undertaken to provide the synthesis of information necessary to develop a detailed multisector Nutrition Action Plan for the next five years.
After the endorsement of NAGA by MoHP,

implementation of NAGA recommendation is a high priority of GoN.

School Health and Nutrition Program


School aged children, especially in the government

run schools are also one of the vulnerable groups to suffer from PEM problems.
To address this issue, a 'National School Health

and Nutrition Strategy has also been jointly approved by MoHP and MoE and piloted in 2 districts namely Sindhupalchowk and Syangja from June 2008 and will continue up to May 2012.

The main goal of the SHNP is to develop physical, mental, emotional and educational status of the school children with following objectives, which are as following: 1. Improve use of SHN services by school children 2. Improve healthy school environment 3. Improve health and nutrition behaviours and habits 4. Improve and strengthen community support system and policy environment n

In the FY 2066/67, GoN has implemented following activities with the support of various EDPs. They are given below; Piloting New born Vitamin 'A' dosing in 4 districts (Nawalparasi, Tanahu, Banke, and Sindhuli) Piloting Micronutrient Sprinkles: (i) Pre piloting feasibility study for acceptance, compliance and distribution modality in 2 districts (Makwanpur and Parsa), and (ii) Program in 6 districts Syangja, Tanahu, Banke, Surkhet, Makwanpur and Dhading Piloting Community based management of acute Malnutrition in 5 districts (Bardiya, Achham, Mugu, Kanchanpur and Jajarkot) Iodized salt Social Marketing ExpansioN.

GOAL Overall Goal National Nutrition Program Achieving nutritional well being of all people in Nepal to maintain a healthy life to contribute in the socioeconomic development of the country, through improved nutrition program implementation in collaboration with relevant sectors to achieve the following national goals: To reduce IMR to 34.4/1,000 LB and<5 mortality rate to 62.5/1,000 LB by the end of 2017 as of second long term health plan; and IMR 36/1,000 ; <5 mortality rate 54/1,000 and Maternal Mortality Ratio (MMR) 250/100,000 live births by 2015 (MDGs)

Nutrition Specific MDGs Goal The following Nutrition Specific Goals are to be achieved by the end of 2015 (MDGs): Reduce sub-clinical VAD to 7% Reduce anaemia in pregnant women to 43% Reduce anaemia in all age women to 42% Reduce anaemia in children to 43% Increase consumption of adequately iodized salt ( 15 PPM) at HHs level to 88% Reduce prevalence of night blindness in pregnant women to 1% Reduce prevalence of underweight in <5 years children to 27%

Reduce prevalence of stunting in <5 years children to 28% Reduce prevalence of wasting in <5 years children to 5% Increase exclusive breast-feeding in <6 months children to 88% Reduce prevalence of thinness (BMI 18.5 below 25) in women to 15%

Nutrition Objectives To reduce PEM in children under 5 years of age and reproductive aged women to half of the 2000 level by the year 2017 To reduce the prevalence of anaemia among women and children less than 40% by 2017. To virtually eliminate IDD and sustain the elimination by 2017 To virtually eliminate vitamin A deficiency and sustain the elimination by 2017 To reduce the infestation of intestinal worms among children and pregnant women to less than 10% by 2017 g the nutrition situation

To reduce the prevalence of low birth weight to 12% by the year 2017 To improve household food security to ensure that all people can have adequate access, availability and utilization of food needed for healthy life in order to reduce the percentage of people with inadequate energy intake to 25% by 2017 To improve health and overall nutritional status of school children through the implementation of School Health and Nutrition Program. To reduce the critical risk of malnutrition and life during exceptionally difficult circumstances To strengthen the system for analyzing, monitoring and evaluation.

NUTRITION PROGRAM COMPONENTS Program Specific Objectives In order to improve the overall nutritional status of children and pregnant women, the national nutrition program has set the following objectives: Control of Protein Energy Malnutrition To reduce protein-energy malnutrition (PEM) in children less than five years of age and Reproductive aged Women to half of the 2000 level by the year 2017 through a multi-sectoral approach;

Control of Iodine Deficiency Disorders To virtually eliminate iodine deficiencies disorders and sustain the elimination by the year 2017;
Control of Vitamin a Deficiency Disorders To virtually eliminate vitamin A deficiency and sustain the elimination by the year 2017; Control of Anaemia To reduce the prevalence of Anaemia among Women and Children less than 40% by the year 2017;

Low Birth Weight To reduce the prevalence of low birth-weight to 12 percent of all births by the year 2017; Protection and Promotion of Breastfeeding To promote exclusive breastfeeding till the age of six completed months. Thereafter, introduce complementary foods along with breast milk till the child completes 2 years or more. To reduce the Infestation of intestinal worm among Children and Pregnant Women to Less than 10% by 2017;

TARGETS
Reduce severe and moderate malnutrition

among children under Five years of age at 40 percent by the year 2017; Reduce iron deficiency in pregnant women to 43 percent by the year 2015; Reduce sub clinical vitamin A deficiency among children under five years of age to 7 percent by preventive measures by the year 2015; Reduce nutritional blindness caused by vitamin A deficiency among pregnant women to 1 percent by the year 2015.

STRATEGIES
The following general strategies have been pursued to address the nutritional situation in Nepal: Promote, facilitate and utilize community participation and involvement for all nutrition activities; Develop understanding and effective co-ordination between various concerned Sections, Divisions and Centers within the Department of Health Services;

Maintain and strengthen co-ordination among other agencies involved in nutrition activities, i.e., the Ministries of Agriculture, Education, Local Development and the National Planning Commission, as well as with EDPs, NGOs, INGOs and private sector; Decentralise authority to the region, district, Health Post, Sub Health Post and community for needs assessment, planning, implementation, and monitoring; Conduct national advocacy and social mobilization campaigns;

Integrate/incorporate activities (such as Expanded


Programme on Immunization, Integrated Management of Childhood Illness, Maternal and Family Health and other concern program etc.) into nutrition plans; Develop a systematic approach for Monitoring and Evaluation of all nutrition program activities; Celebrate School Health and Nutrition Week (Poush 10-16) to raise awareness about the importance of Nutrition; Implement School Health and Nutrition Program as per National Strategy; and Growth monitoring will be used as a screening tool to assess the general malnutrition status of children under less than five years.

Specific strategies are as follows:


Control of Protein Energy Malnutrition (PEM) Create awareness regarding the importance of growth monitoring and exclusive Breast Feeding up to 6 month of age and timely introduction of complementary foods. Provide growth-monitoring services, ANC checkups, de-worming during Pregnancy and Nutritious food supply to 6 to 36 months age of children and to expectant & nursing mothers through outreach clinics, Sub Health Posts, Health Posts/PHC .

Protect, Promote & Support Optimal Feeding Practice


for Infant & Young Children. Increase awareness among medical professionals through advocacy efforts, such as by including sessions on breastfeeding on seminars/workshops held by various associations; BCC for Changing the Dietary Practices Celebrate Breastfeeding Week (August 1-7) as an advocacy for the protection and promotion of breastfeeding. Strengthen Nutrition Rehabilitation Home. Improve Maternal Nutrition & Low Birth Weight Baby Through improved Maternal Nutrition Practices.

Control of IDD
Strengthen the implementation of Iodized Salt Act, 2055 for regulation and monitoring of iodized salt trade to ensure that all edible salt is iodized; Increase the accessibility and market share of iodized packet salt with two-child logo; Create awareness about the importance of use of iodized salt for the control of IDD; through Social Marketing Campaign; Explore the possibility of progress evaluation system in IDD control program on a rotational basis in all 5 development regions;

Control of Vitamin A Deficiency (VAD)


Distribute high-dose vitamin A capsules to children between 6 and 59 months biannually through FCHVs; Advocate for increased home production, consumption and preservation of Vitamin A rich foods at the community level; Explore the fortification of suitable foods (such as sugar and cooking oil) with Vitamin A; Strengthen the usage of Vitamin A Treatment protocol; Supplementation of Vitamin A capsule (200,000 IU) to postpartum mothers through healthcare facilities and community volunteers;

Control of Anaemia
Increase coverage and compliance of iron/folate supplementation for pregnant women; Reduce the burden of parasitic infestations (helminths, malaria and Kalazar); Identify and implement food fortification to increase the dietary iron intake focusing on commercial as well as small-scale community based fortification initiatives; Promote dietary diversification to improve the quality of food consumed with an emphasis on bioavailable iron;

Promote maternal care practices and services to improve health and nutritional status of mother and babies; Identify and implement the effective modalities to address iron deficiency in young children, adolescents and non-pregnant women of reproductive age;

De-worming
De-worming of pregnant women through health facilities with single dose tablet (Albendazole 400 mg) starting from 2nd trimester (4 months) of the pregnancy; Distribute Bi-annual de-worming tablet to Primary School Children in 43 districts (Government schools); Follow up the comprehensive de-worming work plan