Context
Over the past two decades, Nepal has made tremendous progress in many of the maternal and child health indicators. According to Nepal Demographic and Health Survey 2022, under-5 child mortality has declined from 118 deaths per 1,000 live births in 1996 to 33 in 20221. Stunting has also steadily declined since 2001 when 57% of children under age 5 were too short for their age to 25% in 2022. Similarly, the prevalence of underweight among children under age 5 decreased from 42% in 1996 to 19% in 2022. At the same time, wasting declined from 15% to 8%. Nepal achieved a reduction in anemia prevalence among children from 53% in 2016 to 43% in 2022. Also, there have been progresses in many maternal health indicators which contribute directly to improvements in the child health and nutrition.
Nevertheless, challenges remain. The under-5 mortality rate of 33 deaths per 1,000 live births is still alarmingly high. Nepal has to progress at a faster rate to achieve the 2030 SDG target of 15% stunted, 5% wasted and 9% underweight children. Despite some progress, the overall prevalence of anemia among children, adolescents and women of reproductive age remains alarmingly high. While 94% of women received antenatal care (ANC) from a skilled provider for their most recent live birth or stillbirth and 80% of women had at least four antenatal care visits, only half of them received counseling on breastfeeding during the ANC visit. Breastfeeding is a low-investment, high-return intervention, and direct contributor to improved nutritional outcome for children.
Poor maternal diets, infant and young child feeding practices, including insufficient dietary diversity, and food insecurity are key contributors to undernutrition. Failure to timely identify and treat severe acute malnutrition has a lifelong impact on a child’s life. Similarly, failure to identify and manage malnutrition increases severity which can have life-threatening consequences. To holistically address this problem, household practices should be complemented and reinforced by quality health and sanitation services including a robust, community-owned system for identifying and treating malnourished children.
Objectives
The high-level objectives of the program are as follows:
- Strengthen the capacity of health workers to identify, refer, and treat severely and moderately malnourished children.
- Strengthen community-based screening, referral, treatment and follow-up of malnourished children.
- Scale-up moderate acute malnutrition management through Super Cereal Plus.
- Strengthen and scale up GoN’s MBFHI to promote breastfeeding and complimentary feeding practices.
- Build capacity of food inspectors and industrial workers to monitor complementary food products that meet CBCF standard.
Project Goal
The goal of Transforming Lives through Nutrition Phase II (July 2023 - June 2024) is to avert deaths of children attributable to malnutrition by scaling up life-saving breastfeeding, Infant and Young Child Feeding (IYCF), and management of acute malnutrition interventions. The project will use the government-endorsed Integrated Management of Acute Malnutrition (IMAM) protocol for the treatment of acute malnutrition, the Mother Baby Friendly Hospital Initiative (MBFHI) for breastfeeding promotion and Cereal Based Complementary Food (CBCF) Standard for improving the quality of complementary foods. This project will build the capacity of health workers and female community health volunteers (FCHV) to strenthen counseling for breastfeeding and child feeding practices; and to screen children for malnutrition, refer the malnourished children for treatment and follow-up the progress. This initiative will also support the Department of Food Technology and Quality Control to improve the quality and strengthen monitoring of commercially produced complementary foods.
Coverage and target groups:
The project works in 16 municipalities of Nawalparasi (West), Rupandehi and Kapilbastu districts of Lumbini Province. By the end of the 1-year project, it will benefit the following people:
- 65,000 children of 6-59 months will be screened
- 4,680 moderately malnourished children will be treated
- 570 health workers will be trained on IMAM
- 1,401 FCHVs will be trained on screening for malnutrition using mid-upper-arm circumference
- 210 Health Workers will be trained on MBFHI
Strategic Approaches
- Promote exclusive breastfeeding counseling through health service providers:
-
- Scale up the MBFHI at hospital and Primary Healthcare Centers by providing training to doctors, nurses, paramedics and health facility management committee on the implementation of MBFHI guideline.
- Provide technical support to conduct monthly meetings at birthing centers to review the progress on breastfeeding and IYCF practices.
- Improve the quality of complementary foods:
-
- Development of training manual on CBCF standard.
- Training of Food Inspectors on CBCF standard to monitor the quality of commercially produced complementary foods.
- Provide technical support to conduct regular monitoring visits to industries where CBCF produced.
- Increase the coverage of effective treatment for acute malnutrition:
-
- Training for health facility staffs in the protocols for identification and treatment of acute malnutrition
- Training of FCHVs in MUAC measurement, counseling, and referral procedures
- Providing supportive supervision and mentoring of community mobilizers, FCHVs and health facility staff in screening children aged 6-59 months for SAM and MAM.
- Procuring, distributing, and tracking of SC+ for the management of MAM children.
- Strengthen identification, admission, and treatment of SAM children with RUTF supplied by government.