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Ravi K Mishra
Public Health Officer
Central Regional Health Directorate, Hetauda
Neonatal mortality
Low birth weight
Medical Birth injuries and difficulty in labor
causes of Congenital anomalies
1 BCG TB At Birth
Source: http://www.who.int/nutgrowthdb/about/introduction/en/index5.html
Prevalence of anemia in under 5 years children
90 NATIONAL
80 AVERAGE
70
60
50 46%
40
30
20
Problem of 10
0
deficiencies is 67.7
70
still serious 60
Prevalence of anemia in women (15-49 years)
47.6 49
50 44.9 42.6 41.9
38.9
36.2 35 36.2 33 35.9
40 33.1 32.7
27.6 26.5 28.8
30 26.1
22.5
19.2 19.5
20
10
Infant &
Young Child
Feeding (IYCF)
practices in
Nepal –
Breastfeeding
Source: DHS 2011 – Tables 11.3 & 11.6 and DHS 2006 – Tables 12.2 &
12.5 and WHO recalculation of 2006 data based on new IYCF
indicators, published in WHO “Indicators for assessing infant
and young child feeding practices. Part 3: Country Profiles
Infant & Young
Child Feeding
(IYCF) practices
in Nepal –
Complementary
feeding
Global
initiatives in
nutrition –
SUN and Scaling up of evidence-based-cost-
effective interventions to prevent and
REACH treat under-nutrition with special focus
on 1000 days “window of opportunity’
Adopting multi-sector approach which
includes integrating nutrition in relevant
sectors
REACH focuses on scaling-up
nutrition (SUN) actions
Overall objective:
To reduce child and maternal mortality through nutritional interventions
Specific objectives:
Reduce general malnutrition among children and women, i.e. stunting,
underweight, wasting, low BMI
National Reduce Iron Deficiency Anemia among children, children under age 2 year
nutrition and pregnant women
Maintain and sustain Iodine Deficiency Disorders and Vitamin A Deficiency
policy and control activities
strategy Improve maternal nutrition
Align with multi-sectoral nutrition initiative
Improve Nutrition related behavior change and communication
Improve Monitoring and Evaluation for Nutrition related
Programmes/Activities
Need of multi-sector
approach
Need of a nutrition
architecture
Identify information and
HR gaps
Multi-Sector
Nutrition Plan
Framework
National
nutrition
programmes
Section II
Infant and Young Child
Feeding (IYCF) programme
1. Basic IYCF package training to HWs
and FCHVs (7)
2. Integrated IYCF and Baal Vita
Community Promotion Programme
National (15)
3. IYCF linked with Child Cash Grant
nutrition Programme (5)
programmes 4. SUAAHARA/USAID promoting ENA
and EHA (20)
5. Agriculture and Food Security
Project (AFSP) (20)
6. Knowledge-based Integrated
Sustainable Agriculture and
Nutrition (KISAN) (19)
7. Sunaula Hazar Din (15)
1. IYCF
practices:
Breastfeeding
and
Complementary
feeding F = Frequency
Age specific
A = Amount
T = Texture
V = Variety
A = Active feeding
H = Hygiene
IMAM manages
acute
2. Integrated malnutrition in
Management children age 6-59
months through
of Acute inpatient and
Malnutrition outpatient
services at the
(IMAM) community level.
programme
Previously known as
Community based
Management of Acute
Malnutrition (CMAM)
Programme
IMAM Program began in
2007/8 and in 2012/13 the
program covered 11 districts.
Recording & reporting
IMAM programme service model in district SHP / HP
Hospital
Region / Centre
Ilaka HF / PHC
DHO / DPHO
Hospital / SC &/ OTP
Community SHP / HP
FCHV
Ilaka HF / PHC
PHC
Supply
Recording of new
cases, referral,
follow up
(6-59 months)
3. Nutrition
Rehabilitation
Homes (NRHs)
Management of
acute malnutrition
in the facility
Hospital
NRH
1. National Vitamin A
Programme
2. Intensification of Maternal
4. & Neonatal Micronutrient
Programme (IMNMP)
Micronutrient 3. Iodine Deficiency Disorder
deficiencies (IDD) Control Programme
control 4. IYCF and Baal Vita
programmes Community Promotion
Programme
5. Flour fortification
Programme
6. Fortified flour distribution
programme
12-23 months: ½ tab i.e. 200 mg
24-59 months: 1 tab i.e. 400 mg
Health
Facility DHO / DPHO
1. National Vitamin A Programme
VAS piloting
Region / Centre to reach the
unreached:
Reporting
Supply
6-11 months
De-worming tablet
Vitamin A capsule
Recording
House
180
tablets
Recording & reporting
Region / Centre
Supply
45 Once 1 tab
tablets i.e. 400 mg
of de-
worming
table to
pregnant
Dose: 1 IFA tab i.e. 60 mg iron + 400 µg folic acid women after
1st trimester
3. Iodine Deficiency Disorder (IDD) Control World fit for children target on micronutrients
Programme • 90% HH use adequately iodized salt
Recording &
Programme
reporting
Community
Supply
Region / Centre
Karnali &
Solukhumbu
6-23 months
Growth monitoring in
health facility
Grade 1 - 10
Adolescent
iron
Region / Centre
Recording &
reporting
Supply
Private & Public
Grade 1 - 10
Recording
& Private & Public
Grade 1 - 10
Supply reporting
RC
Supply Supply
Based The major causes of neonatal deaths in Nepal are infection, birth
asphyxia, preterm birth, and hypothermia.
Newborn Care Hence, reduction of high neonatal mortality is an urgent priority
Program for achieving MDG 4.
(CB‐NCP) MoHP has binitiated integrated newborn health care package
called “Community Based Newborn Care Program (CBNCP)” based
on the National Neonatal Health Strategy 2004.
The program was implemented as a pilot in 10 districts in FY
2065/66 and further expanded covering 39 districts by the end of
FY 2069/70. The plan is to cover all 75 districts by 2015.
The goal of CBNCP is to reduce neonatal
mortality (NMR) through the sustained high
coverage of effective community based
interventions.
The specific objectives of CBNCP include:
To prevent and manage newborn infection
To prevent and manage hypothermia and LBW
GOAL AND babies
OBJECTIVE OF To manage post-delivery asphyxia, and
CB‐NCP To develop an effective system of referral of
sick newborns
Expansion of CB-NCP in new 5 districts (Bajura, Pyuthan,
Rupandehi, Udayapur and Dadeldhura)
Intensive monitoring of CB-NCP program districts (in low
performing districts)
Capacity Building Training for New-born Care for health
MAJOR service providers (30 persons)
ACTIVITIES Orientation training on CB-IMCI, CB-NCP and Zinc, CHX to
the HWs of private sectors (CBNCP Program Districts)
CB-NCP training to newly recruited medical doctors and
HWs
Construction/renovation of newborn care facilities in 37 sites
Thank you