National Nutrition Situation, Policies, Priorities and Programs

Dr. Shyam Raj UpretiChild Health DivisionDepartment of Health Services

NHSP II(Impact Indicators)

NFHS 1996 NDHS 2006

MMMS 2008

Lancet 2010

WHO 2012 MDG 20150

100

200

300

400

500

600539

281229 240

170134

Maternal Mortality Ratio(per 100,000 live births)

U5MR IMR NMR0

20

40

60

80

100

120

140

160139

93

58

91

64

38

6148

33

5446

3338 32

16

U5MR, IMR and NMR Trend

NFHS 1996 NDHS 2001 NDHS 2006 NDHS 2011 MDG 2015

NHSP II

OUTCOME INDICATORSTARGET

2010 2013 2015% of diarrhea cases among under -5 children treated with zinc (and ORS)

7% 25% 40%

% of children exclusively breastfed in the first 6 months 35% 48% 60%

% Vit A coverage maintained for children aged6 -59 months 90% 90% 90%

% of low birth weight (or small) babies 32% 27% 25%

NDHS 2001 NDHS 2006 NDHS 2011 MDG 20150

10

20

30

40

50

60 57

49

41

28

43 39

29

27

11 13 11

5

Stunting Underweight Wasting

Changes in nutritional status of children under 5 years of age

Source: NDHS 2011

Stunting by Sub-region

Percent of children under age 5 who are too short for

their age (based on WHO standards)

Eastern terai31%

Central terai41%

Western mountain 60%

Mid-western terai 44%

Far-westernhill 58%

Eastern hill 46%

Centralhill 31%

Western hill 36%

Mid-western hill 52%

Far-western terai32%

Western terai 40%

Central mountain 46%

Eastern mountain 45%

41%

Disparity by wealth quintile exists….

Fig 24: Stunting (-2SD) Trend for children between 6-23 months, by Wealth Index

0%

10%

20%

30%

40%

50%

60%

1996 2001 2006

Poorest

P oorer

Middle

Richer

Richest

Total

65% reduction in richest quintile!

12% increase in poorest quintile!

14% reduction overall

High Inequity

Ref: DHS 2001 and 2006. Adapted from Ramu Bishwakarma. Social Inequalities in Child Nutrition in Nepal. August 2009 (Background paper for Nepal Nutrition Assessment and Gap Analysis, November 2009)

Sustained High Vitamin A Supplementation and De-worming to Children (Focus needed: 6-11 months - 55% and Urban below 80%)

Mid Western

Hill

Far Western

Hill

Eastern Terai

Central Terai

Western Terai

Mid Western

Terai

Far Western

Terai

0

10

20

30

40

50

60

70

80

90

100

68.1

42.8

82.9 83.9

92.3

63.2 65.5

Percentage with adequately iodized salt

Percentage with adequately iodized salt

Perc

ent

Iodized salt social marketing campaign will be planned for expansion in a phase wise manner to the districts having low consumption of adequately iodized salt

NMSS 1998

NDHS 2006

NDHS 2011

Urban

Rural

Easte

rn M

ountain

Centra

l Mountai

n

West

ern M

ountain

Easte

rn Hill

Centra

l Hill

West

ern Hill

Mid-west

ern Hill

Far-w

estern

Hill

Easte

rn Te

rai

Centra

l Tera

i

West

ern Te

rai

Mid-west

ern Te

rai

Far-w

estern

Terai

0

10

20

30

40

50

60

70

8078

48 46.2

41.2

46.7

51.3

33.1

52.7

42.340.2

43.6

36

40.9

49.546.7

48.8

56.960.4

Prevalence of anaemia in 6-59 months children

Axis Title

NDHS 2011

% of children aged 6-59 months with anemia NDHS 2011

6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total0

10

20

30

40

50

60

70

80

9078

74 72

57

4438

25

46

Age in months

68.6%

IYCF practices among 6-23 months children

National EDR CDR WDR MWDR FWDR0

20

40

60

80

100

120

24 29.117.9

33.3

1925.7

76 70.982.1

66.7

8174.3

IYCF 3 practices Series2

0-1 months 2-3 months 4-5 months 0-5 months0

10

20

30

40

50

60

70

80

90

100

88

74

53

70

Exclusive breastfeeding by age

NFHS 1996 NDHS 2001 NDHS 2006 NDHS 20110

5

10

15

20

25

30

28.3

26.7

24.4

18.2

6.5 8.6

13.5

Maternal Nutritional Status

Maternal Under-nutrition Maternal Overnutrition

NDHS 2011

42%

NMSS 1998

NDHS 2006

NDHS 2011

Urban

Rural

Pregnan

t

Breastf

eeding

Neither

Easte

rn M

ountain

Centra

l Mountai

n

West

ern M

ountain

Easte

rn Hill

Centra

l Hill

West

ern Hill

Mid-west

ern Hill

Far-w

estern

Hill

Easte

rn Te

rai

Centra

l Tera

i

West

ern Te

rai

Mid-west

ern Te

rai

Far-w

estern

Terai

0

10

20

30

40

50

60

70 67.7

36.2 35

27.6

36.2

47.6

38.9

33

26.5

19.2

33.1

26.1

19.5

35.9

22.5

28.8

44.942.6

32.7

49

41.9

Prevalence of Anemia in 15-49 Years aged Women

National Nutrition PolicyOverall Objective:• To reduce child and maternal mortality through nutritional interventions

Specific Objectives:• Reduce general malnutrition among children and women, i.e. stunting,

underweight, wasting, low BMI• Reduce Iron Deficiency Anemia among children, children under age 2

year and pregnant women• Maintain and sustain Iodine Deficiency Disorders and Vitamin A

Deficiency control activities.• Improve maternal nutrition• Align with multi-sectoral nutrition initiative.• Improve Nutrition related behavior change and communication• Improve Monitoring of Nutrition related programs/activities

National Nutrition Strategy• Protect, promote and support optimal feeding practice of children

through IYCF scale up, increasing coverage of GM• Expansion of Community Management of Acute Malnutrition linked to

expansion of Nutrition Rehabilitation Homes• Reduce IDA through

– iron tablet supplementation to pregnant, adolescents– MNPs distribution liked to IYCF to children under 2 years – Deworming (Preschool, school and pregnant) and flour fortification

• Increase accessibility and Social Marketing of 2-Child Logo iodized packet salt

• Bi-annual mass supplementation of VA to under 5 years children• Gradual expansion of the School Health and Nutrition activities in all

districts • BCC for changing dietary practices for improved maternal and child

nutrition practices

Nutrition InterventionsNationwide

1. Growth Monitoring and counseling

2. Prevention and control of Iron Deficiency Anemia (IDA)

3. Prevention, Control and Treatment of Vitamin A deficiency (VAD)

4. Prevention of Iodine Deficiency Disorders (IDD)

5. Control of Parasitic Infestation by deworming

6. Emergency Nutrition

At scale

1. Infant and Young Child Feeding (IYCF)

2. Community Management of Acute Malnutrition (CMAM)

3. Micronutrient Powder (MNP) distribution link with IYCF

4. School Health and Nutrition Program – 14 districts+15 district under process in this FY

Piloting / small scale

1. Maternal and Child Health Care (MCHC) Program – 9 districts

2. Food supplementation

3. Vitamin A Supplementation to address the low coverage in 6-11 months children (Jumla, Chitwan & Kavre)

4. Piloting New Growth Chart (Rukum)

5. Multi-sectoral Nutrition Plan (MSNP) – (6 Districts: Bajura, Achham, Jumla, Nawalparasi , Kapilvastu & Parsa)

Nutrition Problem Current StatusGeneral Malnutrition among children under 5 years of age (Macronutrients)

Underweight - “On track” Stunting and Wasting – “Not on track”

Inequity in increasing

Vitamin A Deficiency No longer a public health problem Iodine Deficiency Disorders

“On track” (MDG Target-90%)(80% HHs Consuming adequately Iodized Salt)

Iron Deficiency Anaemia “On track”

Current Progress in Nutrition

Children 6-59 months Children 6-23 months Women 15-49 years0

10

20

30

40

50

60

70

80

90

7875

4842

46.2

68.6

36

NMSS 1998 NDHS 2006 NDHS 2011

New Initiatives

• Multi-sectoral Nutrition Plan has recently been approved by the Council of Ministers

• Strategy for IYCF, Maternal Nutrition and detailed Communication Plan for MIYCF is under development process

• Priorities programmes such as IYCF, MNP, CMAM and NRH are gradually being scaled up in different districts

• MCHC Programme review (national as well as regional) has been carried out.

Issues and Challenges

Sustained and predictable financing for scaling up priority programmes viz. IYCF, CMAM etc.

Institutional strengthening for nutrition and capacity building of HWs including management capacity at central level

Sluggish procurement process for commodities and services Weak monitoring and supervision at all levels with poor use of

available data Good progress of micronutrient deficiency control program but

maintenance and sustainability is a challenge Implementation of nutrition activities through multi-sectoral

approach

Future Priorities in Nutrition • Sustained financing for program scale-up, i.e. Infant and

Young Child Feeding Counseling (IYCF), Multiple Micronutrient Powders (MNPs) distribution linked with IYCF, Community Management of Acute Malnutrition (CMAM)

• Impact assessment of targeted food supplementation and cash grant

• Support to maintain and sustain micronutrients deficiency control programs (IDA, IDD, VAD)

• Institutional strengthening of nutrition program with institutional arrangements and capacity building of community health workers and volunteers in nutrition

• Technical and financial support to implement multi-sectoral nutrition interventions.

Thank you