Growth Monitoring and Promotion

Growth monitoring of children less than 5 years of age has been one of the major strategy for prevention and control of protein energy malnutrition. It is recognized as an effective means of detecting growth faltering early, providing a critical opportunity for taking the preventive or curative actions needed.

Based on the assumption that community based growth monitoring and promotion activities are relevant where there is low awareness of the causes of malnutrition and where families do not have the necessary information to help them protect and promote their children’s health and nutritional status.

Currently, health workers of all public health facilities monitor the growth of children once a month by taking their weight in 75 districts. Based on the WHO new growth standard, MoHP has revised and developed a new growth monitoring card. Currently, the operational feasibility of the new growth card is being done in 4 districts viz. Dang, Jumla, Rukum and Udaypur. The growth monitoring coverage of mid-western development region has the highest among all five regions.

 

Infant and Young Child Feeding

Appropriate feeding practices are essential for enhancement of nutrition, survival, growth and development of infants and young children. These feeding practices, collectively known as IYCF practices, include breastfeeding and complementary feeding (with age appropriate frequency and with sufficient nutrient density and diversity).

Improving care and practices related to infant and young child feeding (IYCF) is a key priority of MoH. With support from the partners, the program is being expanded in different districts, however, lack of an effective monitoring mechanism is a challenge.

Integrated Management of Acute Malnutrition

In line with Multi Sector Nutrition Plan (MSNP), Integrated Management of Acute Malnutrition (IMAM) Programme (previously CMAM-Community based Management of Acute Malnutrition) manages acute malnutrition in children age 6-59 months through inpatient and outpatient services at the community level.

In Nepal, this programme was piloted from 2008 in 5 districts viz. Achham, Bardiya, Jajarkot, Kanchanpur and Mugu which was later evaluated and expanded to 6 additional districts namely Dhanusa, Jumla, Kapilvastu, Okhaldhunga, Saptari and Sarlahi.

Along with the IYCF promotion and support, it aims to integrate the programme across the sectors (Health, ECD, WASH, Social protection) to ensure that the treatment is linked to support for continued rehabilitation of cases and to wider malnutrition prevention programme and services.

The programme also acts as a bridge between emergency and development i.e. more DRR (Disaster Risk Reduction). The main goal of this program is to prevent mortality and morbidity due to acute malnutrition among 6-59 months children at the community level.

 

Prevention and Control of Iron Deficiency Anemia        

Since 1998, the MoH has been providing iron foliate (IFA) at “no cost” to pregnant women and breastfeeding mothers through the network of government health system as part of antenatal care (ANC) and postnatal care (PNC) services.

Pregnant women are provided with 180 tablets during antenatal visits and are advised to take one tablet a day. An additional 45 tablets are provided after childbirth to cover the post-natal period. In addition to providing IFA tablets, the policy recommends education on nutrition, health and hygiene with special focus on consuming adequate iron rich foods throughout pregnancy and the postpartum period; however, the implementation of this component is comparatively weak.

The maternal IFA supplementation programme in Nepal faces several constraints including limited coverage, stock out of IFA tablets at the community level and low intake. The government, in collaboration with the Micronutrient Initiative and other programme stakeholders piloted the Maternal and Neonatal Micronutrient Programme (IMNMP) in 2003, an initiative that focused on intensifying programme activities in a few selected districts to identify potential strategies to improve the coverage and compliance.

The IMNMP focused on intensive advocacy activities and building awareness through public media and training health workers and volunteers. Currently, the programme is implemented in 74 of the country’s 75 districts. The programme evaluation shows improved coverage and compliance as a result of community-based delivery involving FCHVs.

 

Micronutrient Powder (MNP) Supplementation

Micronutrient Supplementation is a home based fortification intervention which has shown to reduce anemia significantly. As per the decision by the Government of Nepal, MNP/Baal Vita is supplemented to children 6-23 months of age by linking it with the community based promotion of Infant and Young Child Feeding (IYCF) as one of the strategies to address anemia among children under 2 years of age.

MNP Supplementation program was started in 2009 with a feasibility study done in two districts – Parsa and Makwanpur. The overall objective of the study was to reduce anemia and use the MNPs as a motivation to change infant, and especially, young child feeding practices i.e. complementary feeding practices. MNP distribution program has currently been implemented in 15 districts of Nepal viz. Makwanpur, Parsa, Rupandehi, Gorkha, Rasuwa, Palpa, Sankhuwasabha, Sunsari, Morang, Kapilvastu, Dang, Bardiya, Rukum, Achham and Dadeldhura.

 

Prevention and Control of Iodine Deficiency Disorder

A policy to fortify all edible salt with iodine in Nepal was adopted by MoH in 1973. A social marketing campaign along with celebration of the month of February as “Iodine Month” continues to raise awareness about the government endorsed “two-child-logo” packaged salt for consumption of adequately iodized salt at household level.

The Five Year National Plan of Action to achieve optimal Iodine Nutrition in Nepal: 2013- 2017 prioritized Universal Salt Iodization (USI) as the primary intervention to improve iodine status while reducing reliance on iodine supplementation, which had been in place earlier. The plan focused on creating the necessary infrastructure that could provide a foundation for sustaining achievements. The plan outlines the key successes, further strengthening critical program elements and incorporating lessons from other countries where USI programs are maturing.

The major activities carried out includes: Iodine tests in those VDCs, orientation to FCHVs, and conduction of IDD classes, street drama show, and community level orientation.

 

Control of Vitamin A Deficiency

The Nepal Vitamin A Supplementation (VAS) programme for young children is held up as a global success story. It was started in 1993 in 8 districts following a meeting in Kathmandu that considered three major research projects in Nepal in the late 1980s which all concluded that periodic dosing of children 6-59 months with high dose vitamin A resulted in significant reductions in child mortality. By the end of 1997 the programme was implemented in 32 districts and by 2002 it had expanded to all 75 districts. FCHVs distribute the capsules to young children twice a year through a ‘campaign-style’ activity.

School Health and Nutrition

With the School Health and Nutrition Strategy came in action in 2006, the program was piloted in in 2 districts, Syangja and Sindhupalchowk. Based on the evaluation of the program, some of the cost effective components were expanded in other parts of the country.

The training on school de-worming and First Aid Kit has been expanded in 31 districts. In addition, Save the Children has been supporting for the comprehensive package on SHN in three districts namely Kapilvastu, Pyuthan and Siraha.

 

Nutrition in Emergency (NiE)

With the aim to strengthen and ensure system-wide preparedness and technical capacity in strategic planning, partnership, coordination, situation analysis, response and monitoring of nutritional needs during humanitarian emergencies, a nutrition cluster was established jointly led by Child Health Division and UNICEF. The main focus areas of the nutrition cluster are: preparedness, assessment and monitoring; coordination; capacity building; supply of emergency nutrition commodities; emergency response; and disaster risk reduction.

Training on a SMART (Standardized Monitoring & Assessment of Relief & Transitions) training for survey managers and enumerators, and Nutrition Emergency training was conducted.

The nutrition cluster has prepared NiE guideline in relation in the districts of Mid and Far Western Regions. The nutrition cluster distributed fortified blended flour, Vitamin A, Ready to Use Therapeutic Food (RUTF) and Iron Folic Acid tablet to pregnant & breastfeeding women and children under 5 years along with Maternal, Infant and Young Child Nutrition counseling services.

Source: Annual Report 2072