Food supplemt smita - Copy (3).pptx

Presented By
SMITA PANDEY
2019 Batch
Food supplement

Contents
 Introduction of food supplement
 Food supplements for several groups
 Preservation of nutritive values
 Socio-cultural aspects of nutrition
 Role of community Health Nursing in
Nutrition
 National Nutritional Programme

Food supplement
Food supplements’ are defined as foodstuffs that
are meant to supplement the normal diet and
which are concentrated sources of nutrients or
other substances with a nutritional or physiological
effect, alone or in combination, marketed in dose
form (e.g. pills, tablets, capsules, liquids in
measured doses).

Food supplements for several groups…
The idea behind food supplements, also called dietary
or nutritional supplements, is to deliver nutrients that
may not be consumed in sufficient quantities.
Supplements are not a substitute for a balanced healthy
diet. A diet that includes plenty of fruits, vegetables,
whole grains, adequate protein, and healthy fats should
normally provide all the nutrients needed for good
health.

Food supplements for several groups…
Most European countries agree that messages aimed
atthe general public should focus on food-based dietary
guidelines.
Supplements do not feature in these guidelines, but
there are certain population groups or individuals who
may need advice about supplements, even when they
eat a healthy balanced diet.

Population group Nutrients
People over age 50 Vitamin D, Vitamin B12, folate
Women of child bearing age Folic acid, vitamin D, calcium
Children under 5 Vitamin A, vitamin C, vitamin D, although children with a
good appetite who eat a wide variety of food may not need
them.
Breastfeeding women Vitamin D, iron
People who cover their skin, are dark-skinned, or are
housebound
Vitamin D
Vegans Vitamin D, B12

Preservation of nutritive values
The various vitamins and minerals are susceptible to destruction
by air, light, water, heat, time and the action of enzymes in the
foods themselves. However, you can cut losses and significantly
increase your nutrient intake by the care you taken in choosing,
storing and cooking foods.
 Dark green leafy vegetables and deep yellow vegetables have
more vitamin A lighter than coloured ones.
 Fresh or frozen fruits and vegetables have more nutrients than
canned ones .
.

 Cooked vegetables that are reheated after being kept
in the refrigerator for two or three days lose more than
half their vitamin C.
 The sooner you eat the food, the less chance of
nutrient loss. The water-soluble vitamins, especially
thiamin, folic acid and vitamin C, can be destroyed
during improper storage and excessive cooking
 Heat, light, exposure to air, cooking in water and
alkalinity are all factors that can destroy vitamins.

There are three R`s for nutrient preservation.
The three R`s for nutrient preservation are to
reduce the amount of water used in cooking,
reduce the cooking time and reduce the surface
area of the food that is exposed.

Tips to preserve nutritive value of food
Farm to Table
As soon as vegetables are picked, their nutrient clock
beings to tick away. The more time it spends off the
plant, the more vitamins will be lost.
For this reason, seeking out local produce when
possible is never a bad idea -- the less time it takes for
the veggies to get to your plate, the more nutrients
they'll retain.

Tips to preserve nutritive value of food
Home Storage
Once you get those fresh vegetables home, minimize
additional nutrient loss by eating them right away or
storing in the refrigerator or freezer. Cold temperatures
will limit the degradation of vitamins so use the
vegetable drawer in your fridge (where humidity is
higher) and store in an air-tight bag or container.

Tips to preserve nutritive value of food…
Avoid trimming and chopping prior to storage
too, this will limit surface area and help lock
more of the vitamins inside.

Tips to preserve nutritive value of
food…
Holding on
Cooking veggies can further diminish the content of
various water-soluble vitamins including
folate, thiamin, B6 and vitamin C, especially in foods
that sit out heated for more than 2 hours. Quick
cooking will maximize nutrients.

Tips to preserve nutritive value of food…
Take advantage of as many vitamins as possible by
following these tips:
 Keep skins on when possible
 Avoid continuous reheating of food
 Use a minimal amount of cooking liquid
 When you do boil, retain the cooking liquid for a future
use (like soups and stocks)

Tips to preserve nutritive value of
food…
 Use the microwave
 Use a pressure cooker when possible
 Avoid using baking soda to retain color
 Cut veggies into large chunks to reduce surface area

Research Article
Research Trends on Food Preservation: A Scientometric
Analysis
Abstract
The present study is aimed at analysing the global
publication trends on food preservation using Scopus
database for the period 1998-2012. The database
contained 17511 publications on food preservation. The
study analysed the broad features of literature on food
preservation focusing on year-wise distribution of
publications, highly productive countries, international
collaboration, activity index, highly productive
institutes, methods of food preservation, preservation
by food types, and channels of communication.

Research Article
To ensure food and nutrition security of more than
nine billion people is a daunting task for the entire
world. To feed humanity, it requires increased
production of grains, pulses, oilseeds, vegetables,
fruits, milk, poultry, fish, meat, etc. Preservation of
food is equally important to deal with the increased
production as both animal and plant products are
exposed to decomposition through biochemical
changes, decay, fermentation by microorganisms,
and destruction by pests. It is believed that insects
and pests destroy more grain in storage than is
distributed. This calls for better storage and
preservation facilitie

Research Article
The present study attempted to highlight the growth
and development of research publication on food
preservation. A total of 17511 publications were
published during 1998-2012. There was a steady growth
of publications during 1998-2012. Out of the total
publications, ‘microbial’ method of food preservation
accounted for the highest percentage 30 %) of
publications, followed by ‘chemical’ with 27 % of
publications. Out of the total publications, ‘meat’ food
type accounted for the highest percentage (20 %) of
publications, followed by fruits’ and ‘oil seeds’ with 18
% of population

Socio-cultural aspects of nutrition
Man is a social being, deeply‐rooted food habits have
developed within a culture and they vary widely from
one society to another.
Food means not only proteins, fat, minerals ,vitamins
but much more;it is part of security and civilisation.
Nation and civilisation are linked together not only
ideas,but also by bread.

Socio-cultural aspects of nutrition…
It is no wonder that the growing incidence of
hunger and malnutrition should have come to
infront of international concern.
Instead, here is a sample of some ways in which
various religious groups include food as a vital
part of their faith.

Understanding the role of food in cultural and religious
practice is an important part of showing respect and
responding to the needs of people from a range of
Religious communities.
However, it is important to avoid assumptions about a
person’s culture and beliefs.

Food habits are one of the most complex aspects of
human behavior, being determined by multiple motives
and directed and controlled by multiple stimuli. For
most people food is cultural, not nutritional. A plant or
animal may be considered edible in one society and
inedible in another. Probably one of the most
important things to remember in connection with the
cultural factors involved in food habits is that there are
many combination of food which will give same
nutritional results.

In the Nepali context, household access to sufficient
food does not ensure that all household members are
well-nourished. Cultural beliefs about food
consumption can lead to low nutritional status,
particularly for highly-sensitive groups such as pregnant
and lactating women and young children.

Some of the examples of food beliefs in Nepal
A common cultural practice that affects nutrition in
Nepal is the categorization of foods into ‘hot’ or
‘cold’. During critical periods such as pregnancy,
lactation and illness, it is common practice to avoid
eating foods classified as ‘cold’ in order to protect
the body in its vulnerable state.

Some of the examples of food beliefs in Nepal…
 One widely held belief is that if a woman eats more
during pregnancy she will have a bigger baby which can
cause problems during labour.
 Foods of animal sources are considered good for
pregnant women.
 Social factors also influence the diet of pregnant
women: women and girls usually eat after male
members and children have eaten and have less access
to food from animal sources and other special foods.

Some of the examples of food beliefs in Nepal…
 Colostrum is regarded as a form of pus, toxic, and a
harmful substance by society.
 Baby boys are commonly exclusively breastfed
until six months of age, while baby girls are
generally offered their first solid food earlier, at five
months of age.
 In some cultures, it is believed that a connection
between stomach and womb exists and womb and
stomach are rested together by not giving food to
the mothers.

Role of community health nurse in nutrition
 Community Health nurse (CHN) often serves as bridge
between community residents and health care system.
Nurses are concerned about the nutritional status of
the people in the community.
 The community health nurse will have to study about
all people in community regarding their food habits
and factors affecting their health.
 CHN have excellent opportunities to provide
information and counseling about role of nutrition in
health promotion and prevention of illness
 CHN needs to impart knowledge about good nutrition
without hurting their cultural habits.

Role of community health nurse in nutrition…
 Nutrition problems are usually the result of
multiple factors, so the nurse must follow an
epidemiologic approach while taking nutritional
histories and developing care plan for the patients
with nutritional inadequacies.
 The community health nurse needs to identify the
malnourished children and refer them to
rehabilitation center as per the need.
 She needs to use media of health education in
nutrition education.

Role of community health nurse in nutrition…
 CHN demonstrate the recipes which are affordable and
locally available.
 CHN should assist in nutritional rehabilitation program
 CHN should organize, plan, conduct or take part in
research activites to promote health of the people in the
community.

NATIONAL
NUTRITIONAL
PROGRAMME

Background
Nutrition section under Family Welfare Division
(FWD) is responsible for national nutrition
program for improving the nutritional status of
children, pregnant women and adolescents. Its goal
is to achieve nutritional well-being of all people to
maintain a healthy life to contribute in the socio-
economic development of the country, through
improved nutrition program implementation in
collaboration with relevant sectors.

Background…
Nutrition interventions are cost effective investments
for attaining many of the Sustainable Development
Goals. In alignment with international and national
declarations and national health policies, the
Government of Nepal is committed to ensuring that its
citizens have adequate food, health and nutrition. The
Constitution (2015) ensures the right to food, health
and nutrition to all citizens.

Background…
Focus on nutrition — Nutrition is a globally
recognized development agenda. Since the year
2000, several global movements have advocated
nutrition for development. The Scaling-Up-
Nutrition (SUN) initiative calls for multi-sectoral
action for improved nutrition during the first 1,000
days of life. The Government of Nepal as an early
member of SUN, adopted the Multi-sector
Nutrition Plan (MSNP) in 2012 to reduce chronic
nutrition. Recently, the UN General Assembly
declared the 2016–2025 period as the Decade of
Action on Nutrition

Background…
Policy initiatives — The National Nutrition
Policy and Strategy was officially endorsed in
2004 to address all forms of malnutrition
including under-nutrition and over-nutrition.
This policy provides the strategic and
programmatic directions in the health sector
while the MSNP provides a broader policy
framework within and beyond the health
sector under a Food and Nutrition Security
Secretariat of the National Planning
Commission that coordinates its
implementation.

Background…
The National Health Policy, 2071 highlights
improved nutrition via the use and promotion
of quality and nutritious foods generated locally
to fight malnutrition. The Nutrition Technical
Committee was established in then Child
Health Division now FWD in 2011 to support
multi-sectoral coordination for developing
nutrition programme.

Malnutrition in NepaL
Despite a steady decline in recent years, child
under-nutrition is still unacceptable in Nepal.
Maternal malnutrition is also a problem with 17
per-cent of mothers suffering from chronic
energy deficiency alongside the increasing
trend of overweight mothers 22 % (NDHS,
2016).

Malnutrition in Nepal…
Forty-one percent of women of reproductive age and 46
percen tof pregnant women are anaemic. About 68
percent (NDHS 2016) of children aged 6-23 months are
anaemic while the prevalence of that among adolescent
women (15-19) has been increased from 38.5 percent in
2011 to 43.6 percent in 2016 (NDHS).

Nutrition programmes implemented by FWD
Nutrition Section (1993–2018)
Nationwide programmes:
• Growth monitoring and counseling
• Prevention and control of iron deficiency anaemia
(IDA
• Prevention, control and treatment of vitamin A
deficiency (VAD)
• Prevention of iodine deficiency disorders (IDD)

 Control of parasitic infestation by deworming
 Mandatory flour fortification in large roller
mills.
 Maternal, Infant, and Young Children Nutrition
(MIYCN) programme.

Scale-up programmes:
 Comprehensive Nutrition Specific Interventions
 Integrated Management of Acute Malnutrition
(IMAM)
 Micronutrient Powder (MNP) distribution linked with
infant and young child feeding(IYCF)
 School Health and Nutrition Programme
 Vitamin A supplementation to address the low
coverage in 6–11month olds • Multi-sector Nutrition
Plan (MSNP)

OBJECTIVES OF NATIONAL
NUTRITION PROGRAMME
The overall objective of the national nutrition
programme undertaken by nutrition section is to
enhance nutritional well-being, reduce child and
maternal mortality and contribute to equitable
human development.
The specific objectives of the programme are as
follows:
 To reduce protein-energy malnutrition in children
under 5 years of age and women of reproductive
age.

OBJECTIVES OF NATIONAL NUTRITION
PROGRAMME…
 To improve maternal nutrition
 To reduce the prevalence of anaemia among adolescent
girls, women and children
 To eliminate iodine deficiency disorders and vitamin A
deficiency

PROGRAMME…
 To reduce the critical risk of malnutrition and life
during very difficult circumstances
 To strengthen the system for analysing, monitoring
and evaluating the nutrition situation
 Behaviour change communication and nutrition
education at community levels
 To align health sector programmes on nutrition
with the Multi-Sectoral Nutrition Initiative

PROGRAMME…
• To reduce the critical risk of malnutrition and life
during very difficult circumstances
• To strengthen the system for analysing, monitoring
and evaluating the nutrition situation
• Behaviour change communication and nutrition
education at community levels
• To align health sector programmes on nutrition
with the Multi-Sectoral Nutrition Initiative

PROGRAMME…
• To promote the practice of good dietary habits to
improve the nutritional status of all people
• To prevent and control infectious diseases to improve
nutritional status and reduce child mortality
 To control lifestyle related diseases including coronary
disease, hypertension, tobacco related diseases, cancer
and diabetes
• To improve the health and nutritional status of
schoolchildren

Targets
Current Global Nutrition Targets
a. Sustainable Development Goal
Goal — End hunger, achieve food security and improved
nutrition and promote sustainable agriculture
• By 2030, end hunger and ensure access by all people, in
particular the poor and people in vulnerable situations,
including infants, to safe nutritious and sufficient food all
year round;
• By 2030, end all forms of malnutrition, including achieving,
by 2025, the internationally agreed targets on stunting and
wasting in children under 5 years of age, and address the
nutritional needs of adolescent girls, pregnant and
lactating women and older persons;

Targets…
 By 2030, double the agricultural productivity and
incomes of small-scale food producers, in particular
women, indigenous peoples, family farmers,
pastoralists and fishers, including through secure and
equal access to land, other productive resources and
inputs, knowledge, financial services, markets and
opportunities for value addition and non-farm
employment

Targets
b. Global Nutrition Target by 2025 (World Health
Assembly [WHA])
• Reduce the global number of children under five who
are stunted by 40 percent
• Reduce anaemia in women of reproductive age by 50
percent
• Reduce low birth weight by 30 percent
• No increase in childhood overweight
• Increase the rate of exclusive breastfeeding in the first
six months up to at least 50 percent
• Reduce and maintain childhood wasting to less than 5
percent.

STRATGIES OF NATIONAL NUTRITION
PROGRAMME
Specific strategies to improve nutrition in Nepal
Control of protein energy malnutrition (PEM)
Control of protein Energy malnutrition
• Promote breastfeeding within one hour of birth and
avoid pre-lacteal feeding.
• Promote exclusive breastfeeding for first six months and
the timely introduction of complementary food.
• Ensure continuation of breastfeeding for at least 2 years
and the introduction of appropriate complementary
feeding after 6 months.
• Strengthen the capacity of health workers and medical
professionals for nutrition and breastfeeding
management and councelling.

PROGRAMME…
 Improve skills and knowledge of health workers on
growth monitoring and nutrition councelling
 Strengthen the system of growth monitoring and its
supervision and monitoring.
 Promote the use of appropriate locally available
complementary foods such as jaulo and SarBottam
Pitho.
 Increase awareness on the importance of appropriate
and adequate nutrition for children and pregnant and
lactating mothers.

PROGRAMME…
• Distribute fortified foods to pregnant and lactating
women and children aged 6 to 23 months in food
deficient areas.
• Improve maternal and adolescent nutrition and low
birth weight through improved maternal nutrition.
• Create awareness of the importance of additional dietary
intake during pregnancy and lactation.
• Strengthen nutrition education and nutrition
counselling

PROGRAMME…
Control of iron deficiency anaemia (IDA)
• Advocate to policy makers to promote dietary diversity.
• Iron folic acid supplementation for pregnant and post-
partum mothers.
• Iron fortification of wheat flour at roller mills

STRATGIESOF NATIONAL NUTRITIONPROGRAMME…
Household food security
• Promote kitchen garden and agricultural skills.
• Promote the raising of poultry, fish and livestock
for household consumption.
• Inform community people how to store and
preserve food.
• Improve technical knowledge of food processing
and preservation.
• Promote women’s group income generation
activities.

STRATGIESOF NATIONAL NUTRITIONPROGRAMME…
Improved dietary practices
• Conduct a study to clarify the problems of
culturally-related dietary habits
• Promote nutrition education and advocate for good
diets and dietary habits.
• Develop and strengthen programmes for behaviour
change to improve dietary habits.
• Strengthen nutritional education and advocacy
activities to eliminate food taboos that affect
nutritional status.
• Promote the household food security programme.

PROGRAMME…
Infectious disease prevention and control
• Promote knowledge, attitudes and practices that
will prevent infectious diseases.
• Ensure access to appropriate health services.
• Improve nutritional status to increase resistance
against infectious disease
• Improve safe water supplies, sanitation and housing
conditions.
• Improve food hygiene.

PROGRAMME…
School Health and Nutrition Programme
• Build capacity of policy and working level
stakeholders.
• The biannual distribution of deworming tablets to
grade 1 to 10 school children.
• Celebrate School Health and Nutrition (SHN) week
each June to raise awareness on malnutrition at the
community level through school children and
health worker
• Multiple micronutrient supplementation for
children aged 6-23 months.

PROGRAMME…
• Create awareness of importance of iron in
nutrition, promote consumption of iron rich
foods and promote diverse daily diets.
• Control parasitic infestation among
nutritionally vulnerable groups through
deworming pregnant women and children aged
12-23 months.

PROGRAMME…
 Control of iodine deficiency disorders
 • The universal iodization of salt.
 • Strengthen implementation of the Iodized Salt Act,
2055 to ensure that all edible salt is iodized.
 • The social marketing of certified two-child logo
iodized salt.
 • Ensure the systematic monitoring of iodized salt

PROGRAMME…
 . • Increase the accessibility and market share of
iodized packet salt with the two-child logo.
 • Create awareness about the importance of using
iodized salt to control iodine deficiency disorder
(IDD) through social marketing campaign

STRATGIES OF NATIONAL
NUTRITION PROGRAMME…
Control of vitamin A deficiency
• The biannual supplementation of high dose vitamin A
capsules to 6-59 month olds.
• Post-partum vitamin A supplementation for mothers
within 42 days of delivery.
• Strengthen implementation of vitamin A treatment
protocol for severe malnutrition, persistent diarrhoea,
measles and xerophthalmia.

PROGRAMME…
• Advocate for increased home production, consumption and
preservation of vitamin A rich foods.
• Strengthen the use of the vitamin A Treatment protocol.
• Distribute first aid kits to public schools.
• Introduce child-to-child and child-to-parent approaches

PROGRAMME…
• Nutrition education to promote dietary diversification
and consumption of vitamin A rich foods.
• Ensuring the availability of vitamin A capsules at health
facilities.
• Increase awareness of importance of vitamin A
supplementation.
• The biannual distribution of vitamin A capsules to 6 to
59-month olds through FCHVs

PROGRAMME…
Integrated management of acute malnutrition
• Build capacity of health workers on managing acute
malnutrition and of other community workers on
screening and the referral of cases.
• Establish and implement the key parts of the
IMAM programme: community mobilization,
inpatient therapeutic care, outpatient therapeutic
care and management of IMAM.
• Implement the IMAM programme based on
maximum coverage & access, timeliness of service
provision, appropriate care and care as long as it is
needed.

PROGRAMME…
• Integrate the management of acute malnutrition
across sectors to ensure that treatment is linked to
support for rehabilitating cases and to wider
malnutrition prevention programme and services.
• Support and promote IYCF, water, sanitation and
hygiene (WASH), early childhood development,
social protection and child health and care along
with the management of acute malnutrition.
• Promote the IMAM programme as the bridge
between emergency and development
programmes.

PROGRAMME…
• The supportive supervision and monitoring of IMAM
programme activities.
• Harmonize the community and facility-based
management of acute malnutrition.
• Strengthen the coordination and capacity of nutrition
rehabilitation homes

PROGRAMME…
Nutrition in emergencies
• Develop adequate capacity and predictable leadership
in the nutrition sector for managing humanitarian
responses.
• Formulate an emergency nutrition in emergency
preparedness and response contingency plans.
• Establish and strengthen stronger partnerships and
coordination mechanisms between government, UN
and non-UN agencies

PROGRAMME…
• Agencies to respond in emergencies through the
activated nutrition cluster.
 Promote the consumption of vitamin A rich foods and
a balanced diet through nutrition education
• Provide vitamin A capsules (200,000 IU) to postpartum
mothers through healthcare facilities and community
volunteers.

PROGRAMME…
Low birth weight
• Reduce maternal malnutrition by preventing PEM,
VAD, IDD and IDA.
• Reduce the workloads of pregnant women.
• Increase awareness of the risks of smoking and
alcohol to pregnant women.
• Increase awareness of risks of early pregnancy to
infant and maternal health.
• Promote activities for nutrition monitoring and
counselling at antenatal clinics

STRATGIES OF NATIONAL
NUTRITION PROGRAMME…
 • The supportive supervision and monitoring of
IMAM programme activities.
 • Harmonize the community and facility-based
management of acute malnutrition.
 • Strengthen the coordination and capacity of
nutrition rehabilitation homes

PROGRAMME…
Lifestyle related diseases
• Create awareness among adults about the
importance of maintaining good dietary habits.
• Develop the capacity for nutritional counselling at
health facilities.
• Create awareness among adolescents and adults
about the importance of controlling smoking and
body weight.
• Create awareness to increase physical activity and
improve stress management

MAJOR ACHIEVEMNETS
Growth Monitoring
 In FY 2074/75, the percentage of new-born with
low birth weight (<2.5 kg) was increased to 11.9
% at national level from 9% in FY 2072/73.
 Similar increased was seen across the provinces
except for Gandaki Province and Province 1 still
contributed highest percentage of low birth weight
among new-borns (14.9 percent) in national data.
 Karnali province had least.

MAJOR ACHIEVEMNETS
 Nationally, there was an average of 3 visits per
child in FY 2074/75, similar to that of FY 2073/74
but slightly low than of FY 2072/73.
 The Province 1, Gandaki Province, Province 5
and Sudurpachim province had average visits
more than that of the national average whereas
the province 2 had the lowest average visits
across the provinces .

MAJOR ACHIEVEMNETS…
 The percentage of children aged 0 to 23 months
registered for growth monitoring in 2074/75 (69.9
per cents) was increased sluggishly from the
previous fiscal years.
 The Karnali province had the highest percentage
(106%) while province 3 had the lowest
percentage (54.7%).
 In 2074/75, among 69.9 percent,4.3 percent of 0-
23month olds were reported as underweight at
national level.
 The highest proportion (8.1%) of underweight
children were from the Karnali provinces followed
by Province 2 (7.7%) while the least was from

.2 Infant and young child feeding
 Improving care and practices related to IYCF is a
priority strategy of MOHP. The IYCF programme
was scaled-up in all 77 districts from FY 2072/73.
 IYCF is also linked with the distribution of micro-
nutrient powder (Baal Vita) in 42 districts and with
child cash grants (CCG) in Huma, Mugu, Jumla,
Dolpa, Kalikot Karnali districts.

MAJOR ACHIEVEMNETS
 The proportion of 6-8 months old children
registered for growth monitoring who received
complementary foods varied in FY 2074/75 from
about 7.4 percent of these children in the
province 2 to 46.9 percent in the province 3 (
 Nationally, only 30.8 percent of these children
received complementary food which is much
lower than the NDHS 2016 figure of 84 percent.

Integrated management of acute malnutrition
 The Integrated Management of Acute Malnutrition
(IMAM) Programme (previously known as
Community based Management of Acute
Malnutrition [CMAM] programme) manage Severe
Acute Malnutrition (SAM) in children aged 0-59
months through inpatient and outpatient services
at facility and community level.
 This programme was being implemented in 11
districts (Achham, Kanchanpur, Bardiya, Jajarkot,
Jumla, Mugu, Kapilbastu, Sarlahi, Dhanusha,
Saptari and Okhaldhunga) untilFY 2072/073 and
was scaled-up in 10 districts in FY 2073/074.

 The scaled-up districts were Kalikot, Humla,
Dolpa, Dadeldhura, Bajhang, Bajura, Baitadi,
Panchthar, Khotang, and Parsa, (10 Districts) In
Chitwan, the program was implemented in only
few VDCs covering the Chepang population.
 A IMAM aims to integrate nutrition support across
health, early childhood development, WASH and
social protection sectors for the continued
rehabilitation of cases and to widen malnutrition
prevention programme and services.

 In FY 2074/75, total 26984children of 6 months to
5 years with SAM admitted in outpatient
therapeutic centres of 55 districts. Among them,
25682 were discharged with 19441 with complete
recovery.
 Among all discharged SAM cases, 75.7 percent
were recovered, less than 1 percent died and
14.4 percent were defaulter, which were within
the SPHERE standards of effectiveness of IMAM
Program: recovery rate >75 percent, defaulter
rate <15 percent and death rate <10 percent.
However, few provinces, including province 3 and
province 5 achieved substantially below average

Nutrition rehabilitation homes
 The first Nutrition Rehabilitation Home (NRH)
was established in 1998 in Kathmandu aiming to
reduction of child mortality caused by malnutrition
through inpatient rehabilitation of acute
malnutrition among the children.
 NRH has been scaled-up in 19 districts across
Nepal.

 In FY 2074/75, total 2250 children were provided
with nutritional care through 17 NRH; and among
them 2152 children were more than of 5 years
and 98 were less than or equal to five.
 Those not recovered were referred to the tertiary
health facilities for advance treatment. Along with
the treatment of children, 6215 mothers were
counseled in the NRH and in hospital OPD.

 Nutritional Rehabilitation Homes restore severely
malnourished children to good health while
educating their mothers about nutrition and child
care.
 This program is very effective which involves the
mothers in the process for built-in sustainability to
bring back children’s optimal health.

MAJOR ACHIEVEMNETS
Prevention and control of iron deficiency anaemia
 MOHP has been providing supplementary iron folic
acid (IFA) to pregnant and post-partum women since
1998 to reduce maternal anaemia.
 The protocol is to provide 60 mg elemental iron and
400 microgram folic acid to pregnant women for 225
days from their second trimester.
 To improve access, in 2003, the Intensification of
Maternal and Neonatal Micronutrient Programme
(IMNMP) began IFA supplementation through female
community health volunteers (FCHVs).
 This programme covered all 75 districts by 2014.

 The coverage of first-time iron distribution is high
at 73 percent nationally with the highest coverage
in Karnali province and Province 5 (101 percent
and 100 percent respectively), but the compliance
of taking 180 tablets throughout the pregnancy
(45 percent) and 45 days post-partum (38
percent) is substantially low.
 Province 3 has the lowest coverage amongst all
for all three indicators

 IFA distribution as percentage of expected live
births in Nepal in last three years
 Nationally the trend of first time, 180 days and 45
days post-partum IFA distribution has been
declining slightly over the periods .
 Frequent shortage of IFA tablets has further
deteriorated the coverage.

Integrated Infant and Young Child Feeding and
Micro-Nutrient Powder Community Promotion
Programme
 The NDHS 2006 found that 78 percent of 6-23
months old children were anaemic, mostly due to
poor IYCF practices. A Plan of Action
subsequently endorsed Sprinkles as the key
intervention to address anaemia in young
children.
 In 2007, the National Nutrition Priority Workshop
endorsed the piloting of sprinkles
supplementation as a preventive measure

 . In June 2009, MOH piloted the home fortification
of complementary food with MNPs for 6-23
months olds in six districts integrated with the
Community IYCF Programme. The successful
pilot programme led to MOH expanding it to an
additional nine districts in 2012.

 A feasibility study of the programme in 2008/09
found strong community acceptance with a very
high coverage and compliance on the use of
MNP.
 The linking of IYCF with MNPs has contributed to
significant improvement in IYCF practices.
 The prevalence of anemia among children age 6-
23 months has decreased to 68% (NDHS, 2016)
from 78 percent. However, it still calls for
continuous effort as the coverage of the program
is not very promising

Control of vitamin A deficiency disorders
 The government initiated the National Vitamin A
Programme in 1993 to improve the vitamin A
status of children aged 6-59 months and reduce
child mortality.
 This programme is recognized as a global public
health success story. It initially covered 8 districts
and was scaled up nationwide by 2002.
 FCHVs distribute the capsules to the targeted
children twice a year through a campaign-style
activity.

 The overall national achievement is around 80
percent among the children aged 6-59 months
which is slightly lower than last year (i.e 82.8
percent).
 The coverage by provinces varies with Karnali
province with higher proportion of children
receiving vitamin A supplementation while
Province 3 has the lowest coverage of 67.7
percentage.
 If we compare the trend from last year, this year
the coverage seems to declined slightly

 Coverage of vitamin A supplementation to
children aged 6-59 months by Distribution Round
 Vitamin A supplementation is presented by 1st
Round (Kartik) and 2nd Round (Baishak).
 The overall national achievement is more than 75
percent among the children aged 6-59 months
with 83.4 percent in Kartik and 76.1 percent in
Baishak.
 This is however less than that of last year (85
percent in Kartik and 81 percent in Baishak).

 Furthermore, the coverage by provinces varies
with Karnali province and Province 5 with higher
proportion of children receiving vitamin A
supplementation and lower proportions of
children receiving it in Province 3.

MAJOR ACHIEVEMNETS
School Health and Nutrition Programme
 The School Health and Nutrition Strategy (SHNS)
was developed jointly in 2006 by Ministry of
Health and Ministry of Education to address the
high burden of diseases in school age children.
 In 2008, a five- year Joint Action Plan (JAP) was
endorsed to implement School Health and
Nutrition (SHN) Program.

The current Joint Action Plan (2071/072 to 2075/76)
calls for:
• annual health screening
• biannual deworming of Grade 1–10 school children
• a first aid kit box with refilling mechanism in all
primary schools
• hand washing facilities with soap in all schools
• toilets in all schools
• the use of the new attendance registers in all schools
• orient school management committees on facilitating
health and nutrition activities
• child club mobilization on health and nutrition issues.

 Until FY 72/73, progress in this regard has not
been reported in the annual report due to the very
poor, almost no reporting to the system.
 In FY 2074/75 As reflected, national coverage of
school deworming is 38.4 percent for girls and
34.1 percent for boys with the highest in
Province(83.3 percent for girls and 79.4 percent
for boys) and with lowest in province 2 (only 8.5
percent for girls and 6.4 percent for boys).

Nutrition in emergencies
 When an emergency caused by any reasons
such as natural disasters (earthquake, flood,
drought, etc.), conflicts or any other cause occurs
affecting the overall health, nutrition, and
livelihoods of all the population either in any are
of the country or nationwide, Nutrition in
Emergencies (NiE) services is provided to the
affected areas.

 NiE interventions focus on the pregnant and
lactating women (PLWs) and children under five
years of age as they are nutritionally most
vulnerable during any emergency.

Under NiE interventions following Five Building
Blocks of nutrition interventions are implemented
in the affected areas of the country.
• Promotion, protection and support to breast
feeding of infant and young children aged 0-23
months.
• Promotion of proper complemetary feeding to
the infant and young children aged 6-23 months.
• Management of moderate acute malnutrition
(MAM) among the children aged 6-59 months and
among PLWs through targeted supplementary
feeding program (TSFP).

• Management of severe acute malnutrition among
the children aged 6-59 months through
therapeutic feeding.
• Intensification of Micronutrient supplementation
for children and women including MNP and
vitamin A for children aged 6-59 months, IFA for
pregnant and postnatal

 In 2074/75, response for the floods was done.
 Nutrition cluster reached 1,400,772 children aged
6-59 months and 160,950 pregnant and lactating
women in 18 flood affected districts namely;
Jhapa, Morang, Sunsari, Saptari, Siraha,
Dhanusha, Mahottari, Sarlahi, Rautahat, Bara,
Parsa, Nawalparasi, Rupendehi, Kapilvastu,
Dang, Banke, Bardiya and Kailali.

 In these districts, the progress was as; Vitamin A
supplemented to 1,400,772 children aged 6-59
months, counselling of breast feeding and
complementary feeding to the caretakers of 0-23
months children (297,281), screening of children
aged 6-59 months (630,976), treatment of Severe
Acute Malnutrition (15,201), deworming of 12-59
months children (1,209,568), iron and folic acid
tablets to Pregnant and Lactating women
(160,950)

Small Scale Flood Response:
 On the evening of 27 August 2018, the
Saptakoshi river flooded entered to six wards of
Hanumannagar Kankalini Municipality (ward no.
5, 6, 7, 9, 11 and 12) and two wards of Tilathi
Koiladi Rural Municipality (ward no. 4 and 5)
inundating about 540 households.
 After the flood, UNICEF provided a joint
sanitation, clean water and nutrition response to
the affected areas.

In case of nutrition, the interventions were as
follows:
• Assessed/screened the nutrition situation of
children aged 6-59 months and pregnant &
lactating women
• Oriented Female Community Health Volunteers
and health workers to address the nutrition issues
in the affected areas
• Distributed of Multiple Micro-nutrient powder
(MNP) to the children aged 6-23 months in the
affected areas by FCHVs
• Treated the children aged 6-59 months with

SMART nutrition survey in 6 flood affected districts:
 As a part of monitoring progress, an assessment
of the nutritional status and feeding behavior of
children, adolescent, pregnant and lactating
women were measured through Standardized
Monitoring and Assessment in Relief and
Transition (SMART) nutrition survey in six flood
affected districts (Rautahat, Sarlahi, Mahottari,
Saptari, Jhapa and Siraha.

MAJOR ACHIEVEMNETS….
 In order to smooth implementation of SMART
survey, study protocols and questionnaires were
developed.
 The data collection of the survey started from the
third week of April 2018 because of a delay in
getting ethical clearance from Nepal Heath
Research Council (NHRC).

 As per this guideline, the 6 districts in terms of
incidence of wasting show that the situation
ranges from “Serious” to “Critical”.
 Regarding the MUAC assessment, the situation
is quite different. The findings show the
differences between rapid nutrition assessment
after 10 days of flood emergencies i.e. last week
of August 2017 was 28.3 per cent and MUAC
assessment during SMART nutrition survey done
in during end of nutrition in flood emergency
response in March 2018 was 7.7 per cent.

Cluster coordination
 In nutrition cluster, more than 25 members agencies
have been organized.
 In 2018, 9 nutrition cluster meetings were organized
by UNICEF and MOHP jointly.
 In 2018, through the nutrition cluster meeting
following technical working group have been formed
and activated to provide technical assistance on
different aspects of nutrition programme in
emergencies:
• IYCF working group
• IMAM working group
• Micro-nutrient working group
• Information management working group

Similarly, following documents have been
revised/prepared by nutrition cluster in 2018:
 TOR of nutrition cluster
 TOR of five nutrition cluster working groups
 Revised nutrition cluster operation guideline
 Prepared/revised three contingency plans to
address the issues of nutrition in flood,
earthquake and cold wave emergencies
 4W mapping
 Update the nutrition cluster roster

References
 Ghimire B, A text Book of Community Health Nursing,
2nd edition, Heritage Publishers & Distributors P. Ltd
 Dr swaminathan M, Handbook of Food and Nutrition,
5th edition, The Banglore Printing &Publishing Co. Ltd
 Clement I,Mannual of Community Health Nursing, 1st
edition, Jaypee Brothers Medical Publishers,2012
 https://www.nytimes.com/1982/07/07/garden/preservi
ng-the-nutrients-of-food-with-proper-care.html
 https://www.foodnetwork.com/healthyeats/healthy-
tips/2013/04/how-to-prevent-vitamin-loss-when-
cooking-vegetables
 http://dohs.gov.np/wp4content/uploads/2018
/06/DoHS_Annual_Report_2072/_75.pdf

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