Status of Child health programs in Nepal

The Child Health Division of the Ministry of Health and Population (MOHP), Nepal has launched several child survival interventions, including various operational initiatives, to improve the health of children in Nepal. These include the Expanded Program on Immunization (EPI), the Community-Based Integrated Management of Childhood Illnesses (CB-IMCI) program, the Community-Based Newborn Care Program (CB-NCP), the Infant and Young Child Feeding program, a micronutrients supplementation program, vitamin A and deworming campaign, and the Community-Based Management of Acute Malnutrition program. [1]

 

Immunization

Background

The National Immunization Program (NIP) is a high priority program (P1) of Government of Nepal. Immunization is considered as one of the most cost?effective health interventions. NIP has helped in reducing the burden of vaccine preventable diseases (VPDs) and child mortality and has contributed in achieving the Millennium Development Goal on child mortality reduction (MDG4). (2)

Currently NIP provides vaccination against TB (BCG), diphtheria?pertussis?tetanus?hepatitis B and haemophilus influenza (DPT?HepB?HiB), poliomyelitis (OPV) and measles throughout the country andJE vaccine in high risk post campaign districts through routine immunization. TT vaccination is provided to all pregnant women. The routine immunization services are provided through health facilities (fixed clinic), private, NGO or INGO clinics, urban clinics, outreach session and mobile team in geographical inaccessible areas. All vaccines under NIP are provided free of cost.  In addition to routine immunization services NIP carries out several supplementary immunization activities either to eradicate, eliminate or control vaccine preventable diseases (VPDs).

Trends in Vaccination Coverage among Children 12-23 Months, Nepal 1996-2011

 

Community-Based Integrated Management of Childhood Illnesses (CB-IMCI)

 The Community-Based Integrated Management of Childhood Illness (CB-IMCI) program is an integrated package that addresses the management of diseases such as pneumonia, diarrhea, malaria, and measles, as well as malnutrition, among children age 2 months to 5 years. It also includes management of infection, Jaundice, Hyperthermia and counseling on breastfeeding for young infants less than 2 months of age. CB?IMCI program has been implemented up to community level at all districts in Nepal and it has shown positive results in management of childhood illnesses. Over the past decade, Nepal has had success in reducing under-five mortality, largely due to the implementation of the CB-IMCI program. Initially, the Control of Diarrheal Diseases (CDD) Program began in 1982; and the Control of Acute Respiratory Infections (ARI) Program was initiated in 1987. The CDD and ARI programs were merged into the CB-IMCI program in 1998. (2)

Objectives of CB- IMCI: (2)
• Reduce frequency and severity of illness and death related to ARI, Diarrhoea, Malnutrition, Measles and Malaria.
• Contribute to improved growth and development.

Current status of ARI and Dirrhoea in Nepal (2)


Community-Based Newborn Care Program (CB-NCP)

Nepal Family Health Survey 1996, Nepal Demographic and Health Surveys and World Health Organization estimations over the time have shown that neonatal mortality in Nepal has been decreasing at a slower rate than infant and child mortality. Nepal Demographic and Health Survey 2011 has shown 33 neonatal deaths per 1,000 live births, which accounts for 61 percent of under 5 deaths. The major causes of neonatal death in Nepal are infection, birth asphyxia, preterm birth, and hypothermia. Given Nepal’s existing health service indicators, it becomes clear that strategies to address neonatal mortality in Nepal must consider the fact that 72 percent of births take place at home (NDHS 2011). (3)

Therefore, as an urgent step to reduce neonatal mortality, Ministry of Health and Population (MoHP) initiated a new program called ‘Community Based New born Care Package (CB?NCP) based on the National Neonatal Health Strategy 2004.

Objectives:
•    To prevent and manage Newborn infection;
•    To prevent and manage hypothermia and low birth weight newborns;
•    To manage post?delivery asphyxia; and
•    To develop an effective system of referral of the sick newborns.

Trends in Childhood Mortality, Nepal 1991 to 2010

National Nutritional Program

The National Nutrition Program under Department of Health Services has laid the vision as “all Nepali people living with adequate nutrition, food safety and food security for adequate physical, mental and social growth and equitable human capital development and survival” with the mission to improve the overall nutritional status of children, women of child bearing age, pregnant women, and all ages through the control of general malnutrition and the prevention and control of micronutrient deficiency disorders having a broader inter and intra?sectoral collaboration and coordination, partnership among different stakeholders and high level of awareness and cooperation of population in general.

Malnutrition remains a serious obstacle to child survival, growth and development in Nepal. The most common form of malnutrition is protein?energy malnutrition (PEM). The other forms of malnutrition are iodine, iron and vitamin A deficiency. Each type of malnutrition wrecks its own particular havoc on the human body, and to make matters worse, they often appear in combination. Even moderately acute and severely acute malnourished children are more likely to die from common childhood illness than those adequately nourished. In addition, malnutrition constitutes a serious threat especially to young child survival and is associated with about one third of child mortality. Major causes of PEM in Nepal is low birth weight of below 2.5 kg, due to poor maternal nutrition, inadequate dietary intake, frequent infections, household food insecurity, feeding behaviour and poor care and practices leading to an intergenerational cycle of malnutrition.

An analysis of the causes of stunting in Nepal reveals that around half is rooted in poor maternal nutrition and half in poor infant and young child nutrition. Around a quarter of babies are born low birth weight. As per the findings of Nepal Demographic and Health Survey (NDHS, 2011), 41 percent of children below 5 years of age are stunted. The survey also showed that 29 percent of the children are underweight and 11 percent of the children below 5 years are wasted.

In order to address the under nutrition problem in young children, Government of Nepal (GoN) has implemented
a)     Infant and Young Child Feeding (IYCF),
b)    Control of Protein Energy Malnutrition (PEM)
c)    Control of Iodine Deficiency Disorder (IDD)
d)    Control of Vitamin A Deficiency (VAD)
e)    Control of Iron Deficiency Anaemia (IDA)
f)    De?worming of children aged 1?5 years and vitamin A capsule distribution.
g)    Community Management of Acute Malnutrition (CMAM)
h)    Hospital based nutrition management and rehabilitation.

The hospital based nutrition management and rehabilitation program treats severe malnourished children at Out?patient Therapeutic Program (OTP) centres in Health Facilities. As per requirement, the package is linked with the other nutrition programs like Child Nutrition Grant, Micronutrient powder (MNP) distribution to young children (6?23 months) and food distribution in the food insecure areas.

 

Trends in Nutritional status of children under five years

 


Infant and Young Child Feeding program

UNICEF and WHO recommend that children be exclusively breastfed (no other liquid, solid food, or plain water) during the first six months of life (WHO/UNICEF, 2002). The nutrition program under the 2004 National Nutrition Policy and Strategy promotes exclusive breastfeeding through the age of 6 months and, thereafter, the introduction of semisolid or solid foods along with continued breast milk until the child is at least age 2. Introducing breast milk substitutes to infants before age 6 months can contribute to breastfeeding failure. Substitutes, such as formula, other kinds of milk, and porridge, are often watered down and provide too few calories. Furthermore, possible contamination of these substitutes exposes the infant to the risk of illness. Nepal’s Breast Milk Substitute Act (2049) of 1992 promotes and protects breastfeeding and regulates the unauthorized or unsolicited sale and distribution of breast milk substitutes.

After six months, a child requires adequate complementary foods for normal growth. Lack of appropriate complementary feeding may lead to malnutrition and frequent illnesses, which in turn may lead to death. However, even with complementary feeding, the child should continue to be breastfed for two years or more.

IYCF indicators on Breast feeding status ( NDHS 2011)

 

 

To sum up, Nepalese children under age five face multiple obstacles for survival and development. Exposure to infectious diseases, malnutrition, and poor hygiene and sanitation and lack of a healthy environment compromise early childhood development. Nepal government, though inadequately, is implementing several initiatives to improve the health of children.

 

Reference

1.    Department of Health Services, Anual Report 2009/10. 2011, Ministry of Health and Population, Government of Nepal.
2.    Department of Health Services, Anual Report 2010/11. 2012, Ministry of Health and Population, Government of Nepal.
3.    Ministry of Health and Population, N.E., and ICF International, Nepal Demographic and Health Survey Report 2011. 2012, Ministry of Health and Population, Government of Nepal.


My education includes training in medicine, public health, clinical research, biostatistics and health response in complex emergency. I have more than seven years of experiences in health research (Survey, Case control studies, Randomised Controlled Trials (RCT), Health Policy and Systems Research). My areas of expertise also include the project management particularly in health sector. I have also experience and interest to work in health emergency in large population in disaster setting.

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