kazal 4d issues in nutrition and policies revise

FOOD SECURITYConcepts, Basic

Facts,and Measurement

Issues

June 26 to July 7, 2011Dhaka, Bangladesh

Kazal 4d:Issues in Nutrition and

Policies for Its Promotion in Bangladesh

Learning: The goal is to identify and understand links between food and nutrition, and available and potential policy instruments and institutional arrangements. Focus on policy documents related to nutrition aimed at expanding and strengthening nutritional support.

Brief Contents

• food and nutrition plans and policies• conceptual framework in designing

food & nutrition security interventions

• linkages between food security and nutrition

• National Nutrition Services• important issues of nutrition and

malnutrition situation in Bangladesh• institutional arrangements and

nutrition interventions of MH&FW

Food and nutrition plans and policies

What is food and nutrition policy?

“The Food and Nutrition Policy encompasses the collective efforts of the government and other stakeholders to influence the decision-making environment of food producers, food consumers and food marketing agents in order to improve the nutritional status of the population.”


Key elements for developing the food and nutrition policySustainable food production,

processing, distribution and consumption

Ensure optimal food quality and safety

Collective/multi-sectoral efforts for sustainable food and nutrition security

Achieve and maintain nutrition well-being and healthy lifestyle of the population


Key stakeholders for developing food and nutrition policy Government UN agencies International organizations Nongovernmental

organizations (national and international)

Industry Professional bodies Academia/researchers Consumers Mass Media

Steps involved in developing the food and nutrition policyUnderstanding the need for a

policy;Review the current food and

nutrition status of the population;Review the existing the policies (if

any) and identify the lacunae;Develop appropriate food and

nutrition policy using: − Direct policy instruments; and − Indirect policy instruments; Develop plans of action for

implementation; Evolve an effective and strong

monitoring and evaluation mechanism;

and Establish a nutrition surveillance

system to facilitate programme appraisal and follow-up action.

The evolution of Food and Nutrition Security

concerns

Conceptual framework in designing food & nutrition

security interventions

(Source: adapted from Metz, 2000)

A Conceptual Framework – Food and Nutrition security

Figure: Conceptual framework of the nutritional status at household level

The Food and Nutrition Security Conceptual Framework

The household food security conceptual framework adopted by EFSAs considers food availability, food access and food utilization as core determinants of food security, and links these to households’ asset endowments, livelihood strategies, and political, social, institutional and economic environment.Figure : The Food and Nutrition Security

Conceptual Framework

Linkage between nutrition, poverty alleviation, employment generation and gender

Linkages between food security and nutrition

Gender of the head of the household and nutritional status of children and women

Relationship between household food consumption pattern and nutritional status of children and women and young child-feeding practices

Relationship between food consumption score and nutritional status of children and women

Relationship between food consumption score and young child-feeding practices

Relationship between household food consumption groups and nutritional status of children and women

Relationship between Coping Strategy Index and nutritional status of children and women

Relationship between Coping Strategy Index and nutritional status of children and women by area and by division

Relationship between most affected livelihoods and nutritional status of children and women


Relationship between percentage of food expenditures and nutritional status of children and women

Relationship between wealth status and nutritional status of children and women

Relationship between households without enough food in the past 12 months and nutritional status of children and women

Relationship between decrease in health expenditures in the past 12 months and nutritional status of children and women

Relationship between monthly income per household and nutritional status of children

Relationship between “informal borrowing” and nutritional status of children


Figure : Food consumption score and nutritional status of children and women


Figure: Average CSI at household level amongst acutely malnourished children by division, by area, and nationality in Bangladesh

National Nutrition Services

Important Nutrition Projects in Bangladesh

• Bangladesh Integrated Nutrition Project (BINP)

• National Nutrition Project (NNP)

• Expanded Program on Immunization (EPI)

• Nutritional Surveillance Project (NSP)

• The National Immunization Days (NIDs)

• National Vitamin A Plus Campaign (NVAC)

• The Integrated Horticulture and Nutrition Development Project

National Nutrition Services

Policy and Programmatic Responses to MalnutritionThe Government of Bangladesh (GoB) finalized and endorsed the National Plan of Action for Nutrition (NPAN) in 1995.

NPAN was a cross Ministerial Action Plan, but could be adequately implemented and monitored Nutrition needs to be firmly highlighted on the national development agenda, articulating the roles of the various Ministries.NFP and the NFP PoA and NNS are recent policy and programmatic actions towards strategic nutrition improvement

Important issues of nutrition and malnutrition situation in Bangladesh

Key statistics of child and maternal nutrition in Bangladesh

Source: UNICEF, April 2009

Nutrition % of the population

Malnutrition, in children (birth to 59 months)

Wasting (weight-for-height) 17.4

Stunting (height-for-age) 43.2

Underweight (weight-for-age) 41

Low birth-weight 36

Exclusive breastfeeding (birth to 6 months)

43

Anemia, in children (6-23 months) 64

Chronic energy deficiency, in mothers 32

Night blindness (Vitamin A deficiency), in children (18-59 months)

0.04

Iodine deficiency, in children (6-12 years)

33.8

Nutrition and malnutrition situation in Bangladesh

Nutrition situation in Bangladesh Dietary pattern

Childhood Under-nutrition

Maternal malnutrition

Micronutrient Deficiencies

Nutrition and malnutrition situation in Bangladesh

The underlying causes include (i) household food insecurity resulting from

inability to grow or purchase a nutritionally adequate amount and variety of food;

(ii) lack of dietary diversity;(iii) inadequate maternal and child care due to

inappropriate hygiene, health and nutrition;(iv) low rates of exclusive breast feeding; (v) inadequate access to quality health services;(vi) poor environmental hygiene and sanitation

along with low levels of income and maternal formal education.

Malnutrition early in life has long-lasting and negative effects on overall growth, morbidity, cognitive development, educational attainment and adult productivity.

Institutional arrangements and nutrition interventions of MH&FW

INSTITUTE OF PUBLIC HEALTH NUTRITION (IPHN)

IPHN is implementing quite a good number of important work intended for the improvement of the nutritional status of the people particularly for the under 5 children and mothers.

IPHN Activities:A. Vitamin A Plus Campaign :• Children under 1 year - High potency vitamin A capsule (1

lack I.U) Supplementation during measles vaccination at EPI site.

• Children 1 to 5 years-High potency vitamin A capsule (2 lack I.U) supplementation through national events 2 times (4-6 month Intervals) a year.

• Children 2 to 5 years- Supplementation of Albendazole through national events 2 times (4-6 month Intervals) a year.

• Mother - High potency vitamin A capsule (2 lakh i.u.) supplementation during postpartum period. (With in 6 wks of delivery).

IPHN Activities

B. Reduction in the incidence of iodine deficiency diseases (IDD)• Iodized salt monitoring • Awareness creation activities • Training of field workers of health and family planning

on control of iodine deficiency disorder (CIDD) • Training for testing Iodized salt • Surveillance of salt for iodization

C. Reduction of incidence of Anemia: • Awareness creation activities to control anemia • Parasitic disease control • Strategy implementation address the major causes of

the malnutrition and anemia including iron-foliate supplementation, longtime food fortification & implementation.

IPHN Activities

D. Reduction of Protein Energy Malnutrition (PEM) by training program

• Awareness program for PEM control. • Growth monitoring of 1-3 years old children • Communication on weaning

E. Infant and Young Child Feeding (IYCF) • Strategy implementation. • Promotion and protection of Breast feeding through

proper implementation of BMS code and proper child weaning Practice

F. To strengthen laboratory activities:• To develop the effective laboratory facilities of food and

biochemical aspects of nutrition. • Serological tests for Nutrition related diseases

G. Guideline for the “Management of Severe Malnutrition of Children in Bangladesh”

IPHN ActivitiesH.Nutritional survey.

• To evaluate nutrition related situation at present in selected districts

• To assess rapidly the impact of price hike on household food security, food quality and nutritional status among poor women and children in Bangladesh

• Recently a survey prepared from 164 family in Bangalypoor union, Sayidpur Upazila, Nilphamary district

I. Strengthening Nutrition & Food Safety Education WHO supported Program• Training for nutrition Sector. • Training for nutrition vulnerable population. • Development of Radio & Television spot on Nutrition

awareness creation. • Research on nutrition.

J. Strengthening of Child Nutrition Unit:• Identification of malnourished children under 1-3 years of

age through growth monitoring • Orientation and education program for mother

Institutional arrangements and nutrition interventions of

MH&FWCurrently few nutrition services are delivered as part of core health service delivery. These are Iron Folic Acid (IFA) supplementation is a part of antenatal

care for pregnancy, but only about 50% of women make one visit to a health facility

Zinc Supplementation: Zinc supplementation during treatment of childhood diarrhea has recently gained importance under the leadership of ICDDR,B and MOHFW.

De-worming and distribution of Vitamin A capsules. IPHN also manages the program to combat iodine deficiency

disorder The National Nutrition Program has prime responsibility for

implementing the area based community nutrition (ABCN) program.

The core components of ABCN include: Behavior change and communication (BCC) activities; Growth Monitoring and Promotion (GMP); Food supplementation to children under 2 years of age and pregnant women from ultra poor households; Micronutrient supplementation (vitamin A and iron-foliate); deworming. Additionally it is responsible for promoting infant and young child feeding, particularly breast feeding.

A Multi-sectoral Approach of National Food and Nutrition Policy in

BangladeshA draft national food and nutrition policy (FNP) was prepared and approved by the Bangladesh National Nutrition Council (BNNC) and the Council of Ministers (Cabinet).The strategy for effective implementation of the FNP is divided into four major sectors: (a) Food, agriculture, fisheries, livestock, and forestry

for increased production, proper distribution, and food security;

(b) Health, family welfare, and environment for primary health care, caring practices, disease control, sanitation, and hygiene;

(c) Nutrition education and communication for the creation of awareness at different levels with formal and non-formal education; and

(d) Community development and social welfare for poverty alleviation, income generation, and economic growth.

To implement the various provisions of the FNP, a national plan of action for nutrition has been approved.

kazal 4d issues in nutrition and policies revise

Health & Medicine