1
Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs
Pradiumna DahalNutrition Specialist, UNICEF
Vitamin A Coverage
NDHS2006 NDHS 20110
20
40
60
80
100
8890
Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-59 months
Surveys
6-59
mon
ths
child
ren%
NDHS2006 NDHS 20110
20
40
60
80
100
44
70
Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-8 months
Surveys
6-8
mon
ths
child
ren
%
NDHS2006 NDHS 20110
20
40
60
80
100
8186
Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-59 months living in urban areas
Surveys
6-59
mon
ths
urba
n ch
ildre
n %
UNICEF will focus on under-reached and unreached children (children 6-11 months and children in given in urban areas)
VAS modeling for 6-11 months children is proposed in Jumla, Kavre and Chitwan districts for 2012- 2013 aiming to scale up this approach to rest of country by 2017.
Protocol for Vit A Modeling • The Routine Vit A Biannual Supplementation continued
with BCC focus on urban/Children 6-11 months.
• After 6 months the child receive 100,000 IU vitamin A supplement (In HF or through FCHV- Only the first dose)
• Integrated with routine measles vaccination - If the child is fails to receive routine Vit A biannual supplementation
• The time gap should be more than 30 days
Anemia Prevalence High in Children: The Problem is serious among 6-23 months children
6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total0
102030405060708090
78 74 72
57
4438
25
46
Age in months
Perc
ent o
f chi
ldre
n ag
e 6-
59 m
onth
s w
ith
anem
ia
Source: NDHS 2011
Source (Year) Breastfeeding (BF) Complementary feeding (CF)
Early initiation (within 1 hour)
EBF among 0-6 months
CF (6-9 months)
NDHS (2011) 45% 70% 70%
NDHS (2006) 35% 53% 75%
NDHS (2001) 31% 68% 66%
Trends on IYCF practices in Nepal: DHS 2001, 2006, 2011
IYCF Practices among Under 5 Children
Exclusively breastfed
70%
Breast milk plus water
10%
Breast milk plus other
milk9%
Breast milk plus other non-milk
liquids<1%
Breast milk plus
complementary foods
10%
Not breastfed
1%
Breastfeeding Status Under 6 Months
Percent of children 6-23 months
Recommended IYCF Practices among 6-23 months children
National Programme
Feasibility study on MNP distribution in two districts, Makawanpur and Parsa
Piloting of the MNP program(6 districts: 2010 Onwards) and roll out
in 9 districts by 2012
Scale up of the MNP Programme by 2015
Phase I
Phase II
Phase III
To Improve Anemia, Other micronutrient deficiencies and timely introduction of Complementary food
IYCF Community Promotion linked with MNP
IYCF/MNP Program Goal
• To improve the nutritional status of children aged 6 to 24 months
by reducing prevalence of anemia and by improving
complementary feeding and care practices.
Pilot Objectives
To identify an effective delivery mechanism to distribute
MNPs integrated with IYCF counselling to children 6-24
months of age.
To use the findings of this pilot program to develop
national strategy for nationwide scale up
Program Districts for Piloting- 6 districts
Phase 1: Makwanpur (May, 2010);Palpa (June, 2010)
Phase 2: Rasuwa (Sept, 2010); Gorkha (Jan, 2011)
Phase 3: Rupandehi (May, 2011); Parsa (June, 2011)
DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
NAWALPARASIKAPILBASTURUPANDEHI
DANG
BANKE
ACHHAM KALIKOT
JHAPAMORANG
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI
DADEL-DHURA
KANCHAN-PUR
BAJURA
PARSA
BARA RAUTA-
DHANUSAMAHO-TARI
SUNSARI
SARLAHI
DHADING
MAKAWANPURCHITWAN
KASKI
TANAHU
PALPA
SYANGJA
PARBAT
ARGHAKHACHI
GULMI
UDAYAPUR
SINDHULI
ILAM
BHOJ-PUR
DHANKUTA
TAPLEJUNG
OKHAL-DHUNGA
TERHA-THUM
KHOTANG
Patan
BKTM
SOLUK-HUMBU
DOLAKHA
SANKHUWA-SABA
NUWAKOTSINDHU-PALCHOK
KAVRE
RASUWALAMJUNG
GORKHA
PYUTHAN
ROLPASALYAN
MYAGDI
DAILEKHJAJARKOT
RUKUM
MUSTANG
MANANG
•Simikot•Darchula
•Baitadi
•Dadeldhura
•Mahendranagar
•Dhangadi
•Dipayal
•Chainpur •Martadi
•Magalsen
•Gularia
•Birendranagar
•Dailekh
•Manma
•Jumla
•Gamgadi
•Jajarkot
•Dunai
•Jumlikhalanda
•Salyan
•Nepalgunj
•Ghorahi
•Liwang
•Jomosom
•Beni
•Baglung
BAGLUNG
•Kusma
•Pyuthan
•Taulihawa
•Sandhikharka
•Tamghas
•Sidharthanagar
•Tansen
•Syangja
•Pokhara
•Chame
•Besisahar
•Damauli
•Parasi•Bharatpur
•Gorkha
•Dhadingbesi
•Dhunche
•Bidur
•Hetauda
•Birgunj•Kalaiya
•Gaur
HAT
•Dhulikhel
•Chautara
•Charikot
•Ramechhap
•Sindhulimadi
•Malangwa
Jaleshwor•Janakpur•Siraha
•Rajbiraj
•Ineruwa
•Gaighat
•Diktel
•Salleri
•Okhaldhunga•Bhojpur
•Khandbari •Taplejung
•Phidim•Ilam
•Biratnagar•Chandragadi
•Dhankuta
•Terhathum
EASTERNREGION
CENTRALREGION
WESTERNREGION
MID-WESTERNREGION
FAR-WESTERNREGION
CHINA
INDIA
Distribution Models
UNICEF/DOHS/LMD
DHO/DPHO
6 to 24 months Children
PHC/HP/SHP
FCHV
Procurement Department/UNICEF
DHO/DPHO
HP/SHP/PHC
6 to 24 months Children
HEALTH FACILITY (RURAL MODEL)
FEMALE COMMUNITY HEALTH VOLUNTEERS (RURAL MODEL)
Procurement Department/UNICEF
DHO/DPHO
Municipality Office
6 to 24 months Children
Ward Office
FCHV
MUNICIPALITY WARDS (URBAN MODEL)
5257
83
65
39
55
73
0
20
40
60
80
100
Makw anpur Parsa Palpa Rupandehi Urbanclusters
HealthFacility
FCHV
Pe
rce
nt
Districts Distribution ModalityFigure 3: Compliance of Baal-vita
40
56
39
53
4351 48
0
20
40
60
80
100
Makw anpur Parsa Palpa Rupandehi Urbanclusters
HealthFacility
FCHV
Pe
rce
nt
Districts Distribution Modality
Coverage
Compliance
Updates from External Survey: Preliminary Report New Era
Ever breastfed the child
Initiation of breastfeeding to the child within an hour of birth
Currently breastfeeding the child
Timely introduction of com-plementary food
Minimum dietary diversity
0 20 40 60 80 100 120
99.6
52.4
91.4
83.8
31.8
99.6
54.6
94.6
83.3
45.1
98.3
50.3
88.9
76.2
45.8
Urban
FCHV Modality
HF Modality
Updates from External Survey: Preliminary Report New EraInfant and Young Child Feeding Practices
External Survey: Preliminary Report New Era
Sub-EcologyAnemia (6-59)
Rank
Anemia (6-23) Ran
k Districts
No. of Districts Scale up Plan*
Far West Terai 60.4 1 68.4 5 Kailali, Kanchanpur 2
15 districts to be covered by 2012 (UNICEF). In case of additional funding from NAFSP – 8 Districts (Jumla, Kalikot, Dolpa, Mugu, Humla, Bajhang, Bajura and Jajarkot and WB Health Swap- 7 districts (Ramechhap, Jhapa, Chitwan, Tanahun, Pyuthan, Surkhet and Kavre, UNICEF 3 possible districts Dhanusha, Nawalparashi and Baitadi]
33 by 201375 by 2017
Mid-West Terai 56.9 2 83.8 1 Bardiya, Banke, Dang 3 (1)
West Mountain 52.7 380.3 2 Darchula, Bajhang, Bajura, Kalikot, Jumla,
Dolpa, Mugu, Humla, Mustang, Manang 10East Mountain 51.3 4 65.9 8 Solukhumbu, Sankhuwashaba, Taplejung 3 (2)Eastern Terai 49.5 5 74.8 3 Siraha, Saptari, Sunsari, Morang, Jhapa 5Western Terai 48.8 6 65 9 Kapilvastu, Rupandehi, Nawalparashi 3 (2)
Central Terai 46.7 767.7 6 Chitwan, Bara, Parsa, Rautahat, Sarlahi,
Mahottari, Dhanusa 7 (6)
Western Hill 43.6 8
63 11 Palpa, Tanahun, Arghakhachi, Syanja, Parbat, Gulmi, Baglung, Myagdi, Kaski, Lamjung, Gorkha 11 (9)
Eastern Hill 42.3 959.7 12 Okhaldhunga, Khotang, Udaypur, Bhojpur,
Dhankuta, Terathum, Panchthar, Illam 8Far-West Hill 40.9 10 70.4 4 Baitadi, Dadeldhura, Doti, Achham 4 (2)
Central Hill 40.2 11
66.6 7 Dhading, Nuwakot, Makwanpur, Kathmandu, Lalitpur, Bhaktapur, Kavre, Sindhuli, Ramechhap 9 (8)
Mid-West Hill 36 1258.5 13 Dailekh, Surkhet, Salyan, Rolpa, Pyuthan,
Rukum, Jajarkot 7 (6)Central Mountain 33.1 13
63.7 10Rasuwa, Sindhupalchok, Dolakha 3 (1)
Total Number of Districts 756 Districts in Orange IYCF/MNP Piloted, 9 districts in Blue IYCF MNP being expanded in 2012
Draft IYCF/MNP Scale up Plan by 2016/17
Background• Since 2009/10, - GoN- Child Cash Grant (CG) (NRs
200/child for maximum 2 children) is provided for each child in Karnali. Dalit families in rest of the country
• Disbursed through VDCs quarterly• Meant to be utilized for the improvement of nutritional
status of the targeted children.• UNICEF- complemented Infant & Young Child Feeding
(IYCF) training/Social mobilization in 4 districts
IYCF PROMOTION LINKED WITH CHILD GRANT (IYCF/CG)
Objectives
• Improve Child Grant beneficiaries’ knowledge on IYCF, Hygiene and Sanitation and other key nutritional behaviours
• Assist mothers and caretakers to identify the best possible locally available food - to improve the nutritional status of the children
• Build capacity of health workers and volunteers on IYCF
Strategies
• Advocacy: Capacity building • Orientation:• Process monitoring:• BCC• Evaluation
Training Achievement
SN District FCHV HF StaffsVDC
Influential People
Traditional Healers MGM
1Jumla
514 146 347 270 4711
2Kalikot
264 131 353 267 4590
3Humla
240 1o8 310 236 4655
4Dolpa
151 51 188 144 2440
Total 1169 436 1198 917 16396.
Challenges/Future directionChallenges• Optimum utilization of the Cash Grant in improvement of nutritional
status of targeted children.• Easy access to nutritious food for buying.
Focus for 2012• Monitoring of the IYCF/CG programme.• Midline Evaluation of IYCF/CG• Promotion of locally available foods.• Sustainability - functioning/revitalization of the mother’s group
meetings (MGM) and use of the VDC block grant.• Airing of IYCF messages, performance of street drama and advocacy
meetings at the ward level.
Updates in Growth Monitoring
Old Growth Monitoring Card New Growth Monitoring Card
•Unnecessarily covers under five children-not evidence based and also extra burden to health workers
•Uses -3SD for lower line-thus only identifies severe malnutrition, which defeats the purpose of GMP promotion and its too late for action
Revised HMIS Formats for Feasibility
• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 7-Revised.xls
• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 17-Revised.xls
• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 31-Revised.xls
• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 32-Revised.xls
Dietary Pyramid for Nepal
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PLEASE DON’T FEEL INFERIOR EATING INDIGENOUS FOOD…..FEEL PROUD AND HEALTHY and PROMOTE THEM
THANK YOU FOR YOUR ATTENTION!
Let us work together to make them smiling
