Nutrition

SPECIFIC STRATEGIES
Government’s initiations to control of vitamin A deficiency in Nepal:-

1. The biannual supplementation of high doses vitamin A capsules to 6-59 months olds through
FCHVs.
2. Postpartum vitamin A supplementation for mothers within 42 days of delivery.
3. Strengthen implementation of vitamin A treatment protocol for severe malnutrition , persistent
diarrhoea, measles, and xeropthalmia
4. Nutrition education to promote dietary diversification and consumption of vitamin A rich foods.
5. Ensuring the availabilities of vitamin A capsules at health facilities.
6. Increase awareness of importance of vitamin A supplementation
7. Advocate for increased home production, consumption and preservation of vitamin A rich
Foods
8. Promote the consumption of vitamin A rich foods and a balanced diet through nutrition
education.
9. Provide vitamin A capsules (200,000 IU) to postpartum mothers through healthcare facilities
and community volunteers
SCHEDULE OF VIT A SUPPLEMENTATION IN NEPAL

Subject Vitamin A supplementation
Infants 6-12 months of age and older children weighing less than 8 kg 100, 000 IU of Vitamin A every six months.
Immunization against measles
Children from 1 to 5 years of age 200, 000 IU of vitamin A every six months
Lactating mothers 200,000 IU of Vitamin A at the time

of delivery or within 2 months
Sources
• The sources of iodine are sea foods (e.g., sea fish, sea salt), cod liver oil, milk, meat, vegetables,
cereals etc.
• Fresh water contents about 1-50 µgms/l iodine.
• About 90% of iodine comes from foods eaten and rest 10% from drinking water.
RISK FACTORS OF IDD

• Low dietary intake
• Selenium deficiency
• Pregnancy
• Exposure to radiation
• Increased intake/ plasma level of goiterogens , such as calcium
• Sex ( higher occurrence in women)
• Smoking tobacco
• Alcohol ( reduced prevalence in users)
• Age (for different types of iodine deficiency at different ages)
• Thiocyanates
• Perchlorates
• Oral contraceptives ( reduced prevalence in users)
INDICATORS
• WHO/UNICEF/ICCIDD* has recommended two indicators to assess status of IDD :
1) Median Urinary Iodine Excretion (MUIE) is bio-chemical indicator.
2) Household coverage *of adequately iodised salt process indicator.
WORLD IODINE DEFICIENCY DAY

 Global Iodine Deficiency Disorders Prevention Day (IDD) or World Iodine
Deficiency Day is observed every year on October 21.
 Under the theme ‘Thyroid and Communication’ in 2022, the idea is to spread
awareness of iodine and its importance
GOVERNMENT’S STRATEGIES TO CONTROL OF IODINE DEFICIENCY DISORDERS
• 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
• 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
Prevention and Control

• As per the policy, Government of Nepal uses the ‘’Two-ChildLogo ‘’packed salt to certify
adequately iodized salt and DoHS has been mobilizing the system for social marketing along
with celebration of the month of February as “Iodine Month” to improve awareness of its use at
the household level.
• The major activities carried out were: Iodine tests in those VDCs, orientation to FCHVs,
conduction of IDD classes, street drama show, and community level orientation.
1. Food fortification:
• Fortification of foods with iodine is an effective means of long-term prevention and control
of many iodine deficiencies, and one that has been shown to be cost effective in many
countries.
• Universal salt iodization
- Iodization of salt for both human and livestock consumption is required
- Use iodized salt in the food industry to the population on a continuous and self sustaining
basis
2. Supplementation
 In areas with lack of transportation and small salt producers are available
 Administration of iodized oil capsule
 Direct administration of iodine solution such as Lugol's iodine at regular intervals
 Iodization of water supplies by addition of iodine solution
3. Health education
• Create awareness about the consequences of iodine deficiency disorder, specially for high risk
groups (infants, pregnant and lactating women)
• Advise the people to use iodized salt for household consumption
• Educate the public to eat iodine rich food items like sea fish, kelp, etc and avoid goiterogenic
foods.
4. Set surveillance technique

• To monitor the distribution of adequately iodized salt in the community
What is Zero reporting?

• The reporting of “zero case” when no cases have been detected by the reporting unit
within a defined time interval.
• Zero reporting avoids misinterpretation of missing numbers, while also allowing the
identification of non-responsive or “silent” health facilities
• All reporting sites should be trained and capacitated to perform zero reporting (the
mandatory reporting of 0 cases if none is seen)
What is sentinel site?
• A sentinel site is a single or small number of health facilities that are responsible for collecting
data on cases enrolled with the case definition under surveillance.
• Sentinel site surveillance provides useful epidemiological information on proportions caused by
different pathogens, age distribution, and risk factors and could also be used for monitoring
trends of hospitalized cases within a health facility if health-care patterns and population have
been stable
• There are 118 sentinel sites out of which CMC is also one.
THE EPIDEMIOLOGICAL TRIAD OF ANAEMIA

Agent (Etiological Factors)
 INFECTIONS
Hemolysis by malaria
Parasitic infections-hookworm, trichuriasis, amoebiasis, schistosomiasis
 INHIBITORS OF IRON ABSORPTION
INFANT/PRESCHOOL/CHILDREN:
• Low iron stores at birth due to anemia in mother.
• Non-exclusive breastfeeding.
• Late introduction of complementary food.
• phytates, present in cereal bran, cereal grains, high-extraction flour
ADOLESCENTS AND WOMEN IN REPRODUCTIVE AGE GROUP/PREGNANCY:
Insufficient intake of qualitative and quantitative iron-rich food.
Iron loss during menstruation.
Iron loss from PPH.
Lactation results in iron loss via breast milk.
Host (Intrinsic Factors)

Age: Iron deficiency commonly occurs after 6 months of age if complementary foods do not provide
sufficient absorbable iron. Peak during preschool years and puberty.
Gender: Following menarche, adolescent females often do not consume sufficient iron to offset
menstrual losses. So, IDA is frequent in adolescent females.
Socioeconomic status: Iron deficiency is more common among groups of low socio-economic status.
Education: Lower the literacy, higher the chance of anemia.
Social: Early marriage
 Percentage married by 18 years= 37%
 Median age at first birth= 19.3 years in far-western terai, 21.5 years in eastern
hills
 Percentage of adolescents who have begun childbearing= 19.8%
Genetic factors: Thalassemia, sickle cell anemia, G6PD Deficiency
Enviroment(Extrinsic Factors)
Poor hygiene
Poor sanitation
Bare foot walking
Unsafe drinking water, Rural > urban
WHO ARE AT RISK OF DEVELOPING ANAEMIA?
 Menstruating women
 Pregnant/post-partum/breastfeeding women
 Vegetarians/vegans/people whose diet lacks iron-rich foods
 Children who drink excess cow’s milk-poor source of iron
 People with peptic ulcer
 People who have undergone major surgery or physical trauma like bariatric surgery
People with gastrointestinal diseases such as celiac disease (sprue), or inflammatory bowel
diseases (IBDs) such as Crohn’s disease or ulcerative colitis.
Interventions for Prevention and Control of Anaemia

Nutrition

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SPECIFIC STRATEGIES

Government’s initiations to control of vitamin A deficiency in Nepal:-

SCHEDULE OF VIT A SUPPLEMENTATION IN NEPAL

Lactating mothers 200,000 IU of Vitamin A at the time

RISK FACTORS OF IDD

2) Household coverage *of adequately iodised salt process indicator.

WORLD IODINE DEFICIENCY DAY

GOVERNMENT’S STRATEGIES TO CONTROL OF IODINE DEFICIENCY DISORDERS

Prevention and Control

4. Set surveillance technique

What is Zero reporting?

THE EPIDEMIOLOGICAL TRIAD OF ANAEMIA

Host (Intrinsic Factors)

Interventions for Prevention and Control of Anaemia

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