Unit 9 Nutration Supplimantation in NEPALpptx

ppt

1. Unit 9 Nutration Supplementation

2. Introduction Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as diabetes and cardiovascular disease), and longevity .

3. Cont …. Nutrition section under Family Welfare Division 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

4. Cont… Nutrition interventions are cost effective investments for attaining many of the Sustainable Development Goals • 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

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7. Cont… Current Global Nutrition Targets Sustainable Development Goal • Goal 2 — 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

8. Nutrition supplementation in Nepal Vitamin A programme Iodized salt programme Distribution of iron tablet Promotion of breastfeeding or exclusive breast feeding Dewormimg

9. Vitamin A Supplementation Vitamin A First recognized fat soluble vitamin Generally found in 2 forms:- Retinol :found only in animal sources. Beta- carotene :found mainly in plant sources About 90% of Vit.A is stored in liver and is used when there is no Vit.A in the diet. Is not utilized without protein.  

10. Cont… Vitamin A deficiency One of the main nutritional problems in most of the developing countries as it is considered to be the most significant cause of blindness. Deficiency of Vit.A depends upon its store in liver A healthy adult,if doesnot take vit.A for few months, deficiency is not clinically apparent until stored Vit.A starts reducing. However in case of young children,this period is shortened.  

11. Cont.. Epidemiology Age: Vit.A deficiency is preponderant in chidren, rare during infancy, greater risk in preschool children . There is progressive increase in prevalence up to age of 12-13 years. Sex: Xerophthalmia is more frequent in boys than in girls though the incidence of keratomalacia is similar in both sexes Socioeconomic status: Children from rural and tribal families belonging to low socioeconomic group Seasonal effects: Appears to be peak in May-June and also in November and December. Drought: More during drought due to non-availability of carotene rich foods like leafy vegetables because of shortage of rainfall

12. Cont … Causes Poor diets: Inadequate intake of Vit.A or its precursor(beta-carotene) is the primary cause of vit.A deficiency. Inadequate intake of dietary fat and protein can also hamper the absorption of vit.A Secondary causes: Malabsorption syndrome,liver disease, PEM, zinc deficiency Poverty and ignorance: Lack of knowledge and poor purchasing power Traditional wrong beliefs Eg : Papaya,which is a good source of Vit.A is not given to pregnant women because it is believed to cause abortions

13. Cont… Infections: Common childhood infections like measles, diarrhoea , respiratory tract infections, and infestations like ascariasis and giardiasis interfere with absorption of Vit.A Association with PEM: About 25-50% of hospitalized children of kwashiorkor or marasmus have xerophthlmia . Studies shows that protein deficiency may cause impaired synthesis of retinol binding protein (RBP),the protein that carries retinol leading to Vit.A deficiency.

14. Major Vit.A deficiency problems 1)Vision Xerophthalmia (dryness of eyes)-It is the term for all Vit.A deficiencies that affects structure or function. of eyes. Night blindness or nyctalopia :occurs if sufficient Vit.A is not available and even the liver reserve is diminished, to rapidly regenerate visual purple(rhodopsin).People with night blindness may not be able to see in dim light or twilight

15. Cont… Conjunctial xerosis: Conjunctiva becomes dull and dry.Characteristics features include dryness,loss of transparency,thickening,wrinkling and pigmentation. Bitot’s spot: As the disease progress,dirty,foamy and raised spots are formed on the conjunctiva Corneal xerosis: Corneal surface becomes rough and lacks glistening appearance and photophobia occurs in children

16. Cont… Corneal ulcers: Occurs due to infection . Initially cornea is shallow,but if becomes deep can lead to perforation and ultimately prolapse of content of eyeball Keratomalacia : Cornea softens. Rapid destruction of full thickness of cornea leads to prolapse of iris and ultimately permanent blindness occurs. Corneal scar: Occurs after keratomalacia and finally loss of sight

17. 2)Epithelial changes Epithelial cells become dry and flat and eventually hardens to form keratin(a kind of protein which forms tissues like nails and hairs 3)Respiratory tract Affects the mucus membrane of nasal passage ,it dries up and its cilia are lost. Similarly throat, trachea and bronchi become rough and dry.

18. Control of vitamin A deficiency

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21. Treatment

22. Cont… In case of women in reproductive age with either night blindness and/or Bitots spot, a daily oral dose of Vit.A not exceeding 10,000IU is recommended for 2 weeks. In case of pregnant women with nightblindness ,Vit.A ,never exceeding 10,000IU per day until cure can be given. [ Note :High dose Vit.A should be avoided during pregnancy-particularly in 1 st trimester because of possible risk of teretogenesis ]

23. Prevention

24. Cont… Infections :any underlying infections must be treated to prevent further progression of disease.The secondary causes must also be treated. Behavioural changes through effective communcation are also useful. It include aspects like utilization of available primary health care services to control PEM,infections and infestations.Traditional misconceptions and myths must be dealt carefully.  

25. Iodized salt programme

26. Cont… "iodized salt" means the iodized salt in granular or powder form with minimum 96 percent sodium chloride, white, pale pink or light grey in colour , free from visible contamination with clay, grit and other extraneous adulterant and impurities and with quality standard .

27. NATIONAL NUTRITION POLICY 2004 IDD Objective 3: To virtually eliminate iodine deficiency disorders and sustain the elimination. Target 1: To virtually eliminate iodine deficiency disorders by the year 2017.

28. Cont… Since 1973 and under universal salt iodization program, Ministry of health also implemented iodized oil supplementation program under goitre and cretenismeradication project as a short term strategy during the period of 1979/80 – 1998.This program was especially targeted to the people in hilly and mountain districts.

29. Cont… Strategies for Control of Iodine Deficiency Disorders (National Nutrition Program) Strengthen the implementation of Iodized Salt Act, 2055 for regulation and monitoring of iodized salt trade to ensure that all edible salt is iodized Encourage better storage practices to prevent iodine loss Ensure systematic monitoring of iodized salt

30. Cont.. Increase the accessibility and market share of iodized packet salt with ‘two‐child’ logo Create awareness about the importance of use of iodized salt for the control of IDD through social marketing campaign Develop IDD monitoring system and implement the monitoring survey at national level

31. Cont… Iodine is a micronutrient essential for thyroid function. Iodized salt prevents goiter, brain damage, and other health problems among children and adults. In line with food and drug regulations, household salt should be fortified with iodine to at least 15 parts per million ( ppm ) at the consumption level.

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33. Distribution off iron tablet Objectives: To increase coverage and compliance of iron/ folate supplementation for pregnant women To reduce burden of parasitic infections ( helminth and malaria) among women and children To control vitamin A deficiency in children and pregnant women (written as women only). To identify and implement food fortification to increase dietary iron intake, focusing on commercial as well as small-scale community-based fortification initiatives

34. Cont… 5.To promote dietary modification to improve the quality and diversity of food consumed with an emphasis on bio available iron[S2] 6. To promote maternal care practices and services to improve health and nutritional status of mothers and their babies

35. Cont… 7. To identify and implement effective modalities to address iron deficiency in young children, adolescent and non-pregnant reproductive aged women 8. To develop a systematic approach to the monitoring and evaluation of anemia control programme activitie

36. Cont… Since 1998, the MoHP has been providing iron foliate (IFA) at “no cost” to pregnant women and breastfeeding mothers through the network of government health system as part of antenatal care(ANC) and postnatal care (PNC) services

37. Cont… Pregnant women are provided with 180 tablets during antenatal visits and are advised to take one tablet a day. An additional 45 tablets are provided after childbirth to cover the post natal period.

38. Cont … National Protocol on Iron Supplementation for Pregnant Women Dose: 60 mg iron + 400 µg folic acid, daily Duration: From the beginning of the second trimester in pregnancy (6 months) till 45 days of postpartum (total 225 days). Note : It is also globally recommended that if 6 months duration cannot be achieved in pregnancy, continue to supplement during the postpartum for 6 months or increase the dose to 120 mg iron in pregnancy

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40. Cont … Where iron-fortified complementary foods are not widely and regularly consumed by young children, infants should routinely receive iron supplements in the first year of life. Where the prevalence of anemia in young children (6-24 months) is 40% or more, supplementation should continue through the second year of life  

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42. Women living in the terai ecological zone are more likely to be anemic (45%) than those living in hills (20%) and mountain (23%) regions. More than half of the women (52%) are anemic in Madhesh Province, which is in the terai ecological zone .

43. The prevalence of anemia among women age 15–49 increased from 36% in 2006 to 41% in 2016 and declined to 34% in 2022.

44. Promotion of breastfeeding Breast milk contains all of the nutrients needed by infants in the first 6 months of life and is a non contaminated nutritional source. It is recommended that children be exclusively breastfed in the first 6 months; that is, that they be given nothing but breast milk. Breast milk substitutes during this time are unnecessary and discouraged because the likelihood of contamination and resulting risk of diarrheal disease are high

45. Cont… Exclusive  breastfeeding  (% of children under 6 months) in  Nepal  was reported at 65.16 % in 2017, according to the World Bank collection of development indicators, compiled from officially recognized sources

46. Breast feeding policies in Nepal Nepal  passed the Substitute of  Breast Milk  Act in 1992 to control the sale and distribution of  breast milk  substitutes.

47. Breastfeeding practices by age

48. Cont… Exclusive breastfeeding among children under age 6 months increased from 53% in 2006 to 70% in 2011. However, in 2016, there was a slight decline in the percentage of exclusively breastfed children,to 66% NDHS2016

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50. Deworrming Most children in developing countries are infected with common intestinal worms.

51. Cont… Biannual deworming of children aged 1-5 years during vitamin A capsule supplementation in all 75 districts. • Deworming of all pregnant women after completing the first trimester of pregnancy.

52. NUTRITION OF CHILDREN AND ADULTS

53. Introduction. Nutritional status of children: Thirty-six percent of children under age 5 are stunted (short for their age), 10% are wasted (thin for their height), 27% are underweight (thin for their age), and 1% are overweight (heavy for their height).

54. Cont.. Breastfeeding: Fifty-five percent of children under age 2 are breastfed within 1 hour of birth, and 66% of children under age 6 months are exclusively breastfed.

55. Cont… Complementary feeding: Forty-seven percent of children age 6-23 months receive meals with the minimum recommended diversity (at least four food groups), 71% receive meals at the minimum frequency, and 36% meet the criteria of a minimum acceptable diet.

56. Cont… Coverage of vitamin A and deworming in children: During the 6 months before the survey, 86% of children age 6-59 months received a vitamin A capsule, and 76% of children age 12-59 months received deworming medication

57. Cont… Anemia in children and women: More than half (53%) of the children age 6-59 months and 41% of the women age 15-49 are anemic. ▪ Nutritional status of adults: Eleven percent of women age 15-49 are short (less than 145 cm), and 17% are thin (BMI less than 18.5). Another 22% of women are overweight or obese (BMI greater than or equal to 25.0). Among men, 17% percent are thin, and 17% are overweight or obese.

58. Cont… Intake of iron supplements and deworming in women: Forty-two percent of women age 15-49 with a child born in the past 5 years took iron tablets for at least 180 days, and 69% took deworming medication during the pregnancy of their last child. ▪ Salt iodization: Ninety-five percent of households use iodized salt for cooking.