National Conference on Rice Fortification in Nepal

Kathmandu
18-19 December

Nutritional Status and Interventions in Nepal:

Progress and Current Status

Raj Kumar Pokharel

Chief, Nutrition Section
Child Health Division
 Introduction

• Malnutrition is a serious problem in Nepal, as in other countries of South

Asia, and is a major threat to the health of infants, adolescent girls and
pregnant & lactating mothers.

• 82% of all deaths among children under age 5 in Nepal take place before a
child’s first birthday, with 54% occurring during the first month of life

• Although child mortality has reduced in recent years, malnutrition

amongst the increased number of surviving children remains unacceptably
high.
 Protein Energy Malnutrition (PEM)

• Apart from the immediate and long-term impact on children’s

health, this malnutrition also reduces the population’s
educational achievements, labour productivity and economic
growth.
 REDUCING CHILD MORTALITY

Pneumonia
Other 20%
29%

Deaths associated with

under-nutrition
Diarrhoea
At - min 35% 12%

Malaria
8%
Perinatal Measles
22% HIV/AIDS 5%
4%
Without Improvement in
Nutrition, Further Child
Mortality Reduction is less likely
Sources:
EIP/WHO. Black et al, 2008. The Lancet Series on Maternal and
Child Under-nutrition.
Trends in Nutritional Status of Children

Percent of children under 5, based on 2006 WHO Child Growth Standards

Stunting

Underweight

Wasting
 Child Stunting by Province
Percent of children under 5 stunted, based on 2006 WHO Child Growth Standards

Nepal
Province 7 36%
36% Province 6
55%

Province 4
29%
Province 5
39% Province 3
29%
Province 1
33%

Province 2
37%
Nepal Demographic and Health Survey 2016
Child Stunting Regional Comparison
Percent of children under 5 who are stunted, based on 2006 WHO Child Growth Standards
Trends in Nutritional Status of Women
Percent of women age 15-49

This is related to low energy intake versus

heavy physical workload, inadequate
nutrition knowledge, and lack of extra food
intake during pregnant and lactating

Thinness (BMI<18.5)

Overweight/Obese
 Micronutrient Deficiencies

• Micronutrient malnutrition encompasses a multitude of

micronutrient deficiencies which affect all aspects of
human development and particularly impact on maternal
mortality, birth outcome, child morbidity & mortality, and
childhood development
• Key health problems caused by micronutrient deficiencies
include anemia, night blindness, iodine deficiency
disorders, neural tube defects etc.
 Trends in Anemia among
Children and Women
Percent of children age 6-59 months and women age 15-49 with any anemia

Children

Women
 Anemia in Children by Province
Percent of children age 6-59 months with any anemia

Nepal
Province 7 53%
50% Province 6
48%

Province 4
46%
Province 5
53% Province 3
43%
Province 1
55%

Province 2
59%
 Anemia in Women by Province
Percent of women age 15-49 with anemia

Nepal
Province 7 41%
39% Province 6
35%

Province 4
28%
Province 5
44% Province 3
29%
Province 1
43%

Province 2
58%
IFA Supplementation during Pregnancy in Nepal
 Iodine Deficiency Disorders (IDD)

• Nepal government launched Salt Iodization

Program in 1973
• Ministry of Health also initiated Iodized Oil
Injection/Capsule Programme in Hilly and
Mountainous districts
1979- 1998
• Universal Salt Iodization adopted as sole strategy
to control IDD in Nepal since 1998
 Universal Salt Iodization

Increment in Household Coverage of Iodized

Salt
 Impact of Universal Salt Iodization

IDD No Longer a Public

Health Problem in Nepal as
Median UIC is above the
WHO Cut-Off Point

Sources:
1.Ministry of Health/HMG, UNICEF, WHO, Micronutrient Initiatives, New Era. Nepal Micronutrient Status Survey 1998.
2.Ministry of Health and Population, Micronutrient Initiatives, New Era. Nepal Iodine Deficiency Disorders Status Survey 2005.
 Vitamin A Deficiency (VAD)

• National Vitamin A Supplementation Program started

in 1993 and scaled up to all 75 districts by 2002
Impact
Trend in Under-five Mortality

• Drastic reduction in Under-

five Mortality achieving the
goals of MDG and World Fit for
Children.

• Vitamin A supplementation is
one of the major
contributors.*

S Thapa, MK Choe, RD Retherford. Effect of Vitamin A Supplementation on Child Mortality: evidence from Nepal’s 2001 Demographic and Health Survey. Tropical Medicine
and International Health. August 2005: 8; 782-789..
Major Nutrition Programs: Health
Nationwide At scale up
1. Maternal Infant and Young Child Nutrition (MIYCN) 1. Integrated Management of Acute
Malnutrition (IMAM) – 32 districts
2. Growth Monitoring and Counseling
2. Micronutrient Powder (MNP) distribution
3. Prevention and control of Iron Deficiency Anemia (IDA) linked with IYCF – 26 districts (including 11
earthquake districts)
4. Prevention, Control and Treatment of Vitamin A deficiency
3. School Health and Nutrition Program (56
5. Prevention of Iodine Deficiency Disorders (IDD)
districts)
6. Control of Parasitic Infestation by deworming
4. Adolescent Girls Iron Folic Acid
7. Flour fortification via large roller mills Supplementation Program – 10 districts

8. Community based integrated management of newborn and5. Multi-sectoral Nutrition Plan (MSNP)–(28
childhood illnesses Districts)

9. Maternal health (ANC, skilled delivery and PNC) 6. Golden 1000 Day Communication Campaign

10. Promotion of National Dietary Guidelines

At small scale
1. Maternal and Child Health Nutrition (MCHN) Program– 7 districts (Karnali, Bajura and Solu)
2. IYCF Linked with Child Cash Grant ( 5 Districts of Karnali, Achham, Bajhang and Rautahat)
3. Fully nourished village/wards initiative (campaign)
4. Emergency Nutrition Program – 14 districts during Eqs
 Nepal’s Status Against WHA Global Nutrition Targets

SN World Health Assembly (WHA) 2025 Status WHA Target for Nepal’s Current
Global Targets (Base year Nepal Status
(Not Set Yet Nationally)
2011)
1 Achieve a 40% reduction in the number of 40.5% 25% 35.8% (NDHS 2016)
children under - 5 who are stunted

3 Achieve a 30% reduction in low birth weight 12.1% 8% 24.2 % (MICS 2014)

4 Ensure that there is no increase in childhood 1.4% ≤1.4% 1.2 % (NDHS 2016)
overweight

5 Increase the rate of exclusive breastfeeding 69.6% >50% 66.1 % (NDHS 2016)
in the first 6 months up to at least 50%

6 Reduce and maintain childhood wasting to 10.9% 5% 9.8% (NDHS 2016)

less than 5%

NMICS: Nepal Multiple Indicator Cluster Survey, 2014; NDHS: Nepal Demographic and Health Survey, 2016
Thank You