The period from birth to two years of age is a critical period in early childhood development including the promotion of optimal growth, health, and development (Stemberg, 1997).

Suboptimal care and feeding practices, and inadequate access to nutrient rich foods, as well as frequent infections, are the primary causes of malnutrition and mortality among children under 2 years of age (Shrimptom, 2001 and Black et. al., 2008). Micronutrient malnutrition in infants and young children results primarily from diets lacking essential vitamins and minerals, such as iron, vitamin A, and zinc. Due to micronutrient deficiencies, one million children die before the age of five and 100,000 infants are born with preventable physical defects each year around the world (MI, 2009). While significant progress has been made in reducing the prevalence and consequences of iodine and vitamin A deficiencies through improved household use of iodized salt and the periodic provision of high-dose vitamin A supplements to young children, there has been limited success in reducing the burden of other micronutrient deficiencies and iron deficiency anemia in particular.

In the light of this fact, micronutrient powders (MNP) were developed in 1996, in single-dose sachets for household use (Nestle et. al., 1996). MNP are easy to use, require no literacy and the sachets are light-weight, easy to transport, and do not require any extra caution for storage. Any semi-solid food can be instantly fortified by mixing in MNP, which is virtually tasteless and should not change the color, smell, or taste of the food if prepared and used correctly. MNP are appropriate for vulnerable populations at risk of deficiency, especially young children 6 to 23 months of age starting complementary feeding.

WHO recommends the use of MNP for children 6 to 23 months of age to prevent anemia and iron deficiency (WHO, 2011). The efficacy, safety, and acceptability of MNP for infants and young children have been demonstrated through randomized control trials in multiple countries across the world, and MNP have proven to be as effective as the standard iron drops in treating and preventing anemia in young children, with cure rates ranging from 55-90%. Additionally, MNP may have advantages over iron drops and syrups in terms of convenience, acceptability, and incorporation of other micronutrients (WHO, 2011 and HF-TAG, 2011).

As part of a strategy to address the high burden of malnutrition among children, Nepal Government in collaboration with UNICEF and an implementing organization designed and launched an intervention project of an “Integrated IYCF and MNP project” among children 6-23 months. In Nepal, the MNP product has been locally branded as “Baal Vita,” and packaging has been developed specifically for the local context.

Contents of Micronutrient Powder – Baal Vita (in One Gram Sachet)

Micronutrient Amount
Vitamin A 400 gg
Vitamin C 60.0 mg
Vitamin D 5.0 gg
Vitamin E 5.0 mg
Vitamin B1 0.5 mg
Vitamin B2 0.5 mg
Niacin 6.0 mg
Vitamin B6 0.9 gg
Vitamin B12 0.5 mg
Folic acid 150 gg
Iron 10.0 mg
Zinc 4.1 mg
Copper 0.56 mg
Selenium 17.0 mg
Iodine 90.0 gg

The IYCF/MNP intervention includes the distribution of 60 sachets of Baal Vita to all children aged 6-23 months of age every six months with the suggestion to feed the child one sachet of Baal Vita every day mixed into food for two months. Every six months the families should come back and pick up a new batch of 60 sachets so that the child should consume 180 sachets over the eligible period of 18 months. Baal Vita is provided free of charge to families with children 6-23 months through local health institutions or through female community health volunteers (FCHVs).

The project has been carried out in phases, including:

  • Feasibility survey of IYCF promotion and Baal Vita distribution in 4 Village Development Committee (VDCs) in Makwanpur and Parsa.
  • Evaluation of three potential distribution models during a pilot in six districts.
  • Expansion of the IYCF/MNP project to an additional nine districts (and continuing in the six pilot districts), and potentially scaling up to all 75 districts eventually. The project is currently in place in 15 districts total.

UNICEF and the European Union (EU) have partnered in a project to improve nutrition security of women and young children in Asia. The 4-year Maternal and Young Child Nutrition Security Initiative in Asia (MYCNSIA) is being implemented in five countries, including Nepal. The initiative aims to achieve two goals: reducing stunting rates by 5% points from baseline in four years, and reducing anemia in pregnant women and children by one-third from baseline in the same period. A key component of MYCNSIA is scaling up the IYCF/MNP Baal Vita intervention, including implementing an impact evaluation in two of the nine new IYCF/MNP districts. MYCNSIA supported a baseline impact survey among young children 6 to 23 months that collected anthropometry and anemia/micronutrient status data in Kapilvastu and Achham districts.