Overview of Child Nutrition in Nepal

Speaker: Dr. Ramesh Kant Adhikari Professor,Kathmandu Medical College Former Dean, Institute of Medicine, Kathmandu Presented at: Nestlé Nutrition Institute, Kathmandu, Nepal

Summary

Nepal has a population of 26.6 mn with one of the lowest GNI US$1147. It has its share of nutritional problems. More than 40% of children under five years of age are stunted, almost one third are under weight and more than 10% are wasted. Anaemia is a significant public health problem, more the one third of children and 40 % of their mothers are anaemic. Some of the immediate causes are poor infant and maternal feeding, inadequate household food security and poor maternal and child care practices. The determinants of nutritional health are feeding which is done through breast feeding and complementary feeding. Infections like diarrhoea and ARI prevalence rates, child care practices and women’s workload, maternal dietary practices etc. Rural children living in mountains, born to illiterate mothers from the poorest section are more likely to become stunted. Rural children living in terai, born to illiterate mothers from poorest section are most likely to be wasted.

Breast feeding is universal in Nepal, 98% of children start with human milk as their first meal. Initiation of breastfeeding less than one hour of birth is showing an increasing trend from 35% in 2006 to 45% in 2011. Complementary foods are initiated in 75% of infants in 6 to 7 months in 2011 up from 63 % in 2006. Grains are the most fed food item. Overall 64% of children less than 3 years in age were fed Vitamin A rich food. Overall 24% of children under 3 years of age received iron rich food. Cereal grains (97%), tubers (72%), legumes (54%), meat, fish and poultry (30%), oils/fats (21%) and sugary food (12%) are the types of food consumed in order of frequency. Vitamin A rich vegetables and fruits were consumed by 65% of mothers. Prevalence of deficiency of Vitamin A, E and D is 7, 25 and 33% respectively. Pregnant and lactating women allowed rest during non-monsoon season compared to NPNL women and had higher total energy expenditure but no such difference during monsoon season which demanded work from all. De-worming since 2004 reduced the prevalence of anaemia both among women and children. Mortality trends show a decreasing trend throughout the years while morbidity rates show that the prevalence of diseases like ARI, fever and diarrhoea are reducing in Nepal.

There have been various national programmes that are being implemented in Nepal like iron and folic acid supplementation for pregnant and lactating mothers. Infant and young child feeding (IYCF) counselling that includes early initiation and exclusive breast feeding up to 6 months of age and optimal complementary feeding. There are multiple micronutrient powder supplementations for children 6-23 months of age in some districts. National Vitamin A supplementation programme has also been implemented.

A Multi sectorial nutrition plan was implemented which focused on reduction of maternal and child under nutrition. Poor growth in first 1000 days of life has far reaching consequences like poor brain development and immune system, reduced cognitive development, and reduced world performance, decreased resistance to disease, onset of degenerative disease. The plan scaled up both nutrition specific and nutrition sensitive approaches. The nutrition specific interventions through ministry of health, targeted at individual level of causality.