This document discusses several major nutritional problems in Nepal: protein energy malnutrition (PEM), iron deficiency anemia, vitamin A deficiency, iodine deficiency disorder, and low birth weight. It provides data on the prevalence of these issues according to the NDHS 2016 survey. The main causes and consequences of each problem are described. Current government actions to address the nutritional issues include programs to promote breastfeeding and complementary feeding, fortify foods, supplement vulnerable groups, treat deficiencies, and educate the public through health workers and media campaigns. The government aims to reduce malnutrition, anemia, and low birth weight through these multi-pronged preventive and treatment initiatives.

1. NUTRITIONAL
PROBLEMS IN NEPAL
SUBMITTED TO:-Dr.Ang Tshering Sherpa Lama
Department of community Medicine
SUBMITTED BY:- GROUP A
13TH BATCH MBBS

2. Group
members:-
1. Aaradhana Deuba
2. Aashish Paudel
3. Aashma Sharma
4. Aayush Paudel
5. Aayush Sharma
6. Aayush Bhakta
Rajlawat
7. Aayusha Pokharel
8. Aman Basaula
9. Aman Kumar Ray
10. Amar Nath Pandit

3. Objectives
1. List of different nutritional problems in Nepal
2. Status of different nutritional problems
3. Causes and consequences of different nutritional
problems
4. Preventive measures of different nutritionalproblems
5. Current government action to reduce nutritional
problem

4. INTRODUCTION:-
•Nutrition :-Nutrition is the science of food and
its relationship to health.
•It is concerned primarily with the part played by
nutrients in body growth , development and
maintenance.
•Good nutrition means maintaining a nutritional
status that enables us to grow well and enjoy
good health

5. Nutrients are generally classified into 2
groups :-
Macronutrients:-
• Carbohydrates
• Proteins
• Fats
• Water
Micronutrients
• Minerals (iron, iodine, calcium
etc)
• Vitamins

6. ListsofNutrionalproblemsin Nepal
1. Protein energy malnutrition
 Acute malnutrition (Wasting)
 Chronic malnutrition
(Stunting)
 Underweight
 Overweight
2. Iron deficiency anemia
3. Vitamin A deficiency disorder
4. Iodine deficiency disorder
5. Low birth weight

7. Nutritional
statu
s under 5
children
Data in
percentage
1.stunting 36%
2.wasting 10%
3.underwight 27%
4.Overweight 1%
Source:- National Demography and Health Survey,
(NDHS 2016)

9. For U5children
1.
Stunting
(assessed via height-for-
age)
• Height-for-age is a measure of linear growth retardation and
cumulative growth deficits.
• Children whose height-for-age Z-score is below minus two
standard deviations (-2 SD) from the median of the reference
population are considered short for their age (stunted), or
chronically undernourished.
• Children who are below minus three standard deviations (-3
SD) are considered severely stunted.

10. 2.
Wasting
(assessed via weight-for-
height)
• The weight-for-height index measures body mass in
relation to body height or length and describes current
nutritional status.
• Children whose Z-score is below minus two standard deviations (-
2 SD) from the median of the reference population are
considered thin (wasted), or acutely undernourished.
• Children whose weight-for-height Z-score is below minus three
standard deviations (-3 SD) from the median of the reference
population are considered severely wasted.

11. 3.Underweig
ht
(assessed via weight-for-
age)
• It takes into account both acute and chronic undernutrition.
• Children whose weight-for-age Z-score is below minus two
standard deviations (-2 SD) from the median of the reference
population are classified as underweight.
• Children whose weight-for-age Z-score is below minus three
standard deviations (-3 SD) from the median are considered
severely Underweight
4.Overweig
ht
(assessed via weight-for-
height)
• Children whose weight-for-heightZ-score is more than 2
standard deviations (+2 SD) above the median of the reference
population are considered overweight.

12. PEM Causes Consequences
Childre
n
• Inappropriate breastfeeding
• Inadequate complementary feeding
practices
• Insufficient health services (Growth
monitoring and counseling)
• Low birth weight.
• Infectious diseases
• Inadequate energy intake
• Failing to grow (underweight,
stunted, and wasted)
• Reduced learning ability
• Reduced resistance and
immunity against infection
• Reduced productivity in the
future
Women
• Inadequate energy intake
• Inadequate knowledge and practice
of
maternal feeding
• Heavy physical workload
• Lack of extra food intake during
pregnancy and lactation
• Low birth weight
• Increased risk of maternal
mortality and morbidity
• Reduced productivity

13. T
o
reducePEM
in children
andwomen

14. IODINE
DEFICIENCY
DISORDER
(IDD)
• Iodine is a micronutrient essential for
thyroid function.
• In line with food and drug regulations,
household salt should be fortified with iodine
to at least 15 parts per million (ppm) at the
consumption level.
• NDHS 2016 tested for the presence of
iodine in household salt by using a rapid
test kit.
• 95% of the households had iodized salt .
The proportion of households with iodized salt is
lowest in mountain ecological zone (90%), in
Province 6 (85%)lowest And Province 2

15. Iodine DeficiencyDisorder(IDD)
Cause Consequences
• Lack of iodine in food • Cretinism
• Goiter
• Impaired cognitive function
• Increased prenatal morbidity and
mortality
• Reduced productivity

16. T
oeliminate
Iodine
Deficiency
Dorder

17. IRONDEFICIENCY
ANEMIA

18. IRONDEFICIENCYANEMIA(IDA)
Anemia in children andwomen:
• 53% of the children age 6-59 months and
• 41% of the women age 15-49 are anemic.

19. IRONDEFICIENCYANEMIA(IDA)
Cause Consequences
• Inadequate intake of iron from daily
diets
• Inadequate absorption of dietary iron
• Infestations such as hookworms and
malaria
• High requirements of iron particularly
during growth and pregnancy
• Blood loss (menstruation, and injury)
• Vitamin A deficiency
• Impaired human function at all
stages of life
•Impaired work
performances, endurance
and productivity
• Increased risk of maternal
morbidity
and mortality
• Increased risk of sickness and
death

20. Toreduce
prevalenceof
anemia in
children and
women

21. VITAMIN A DEFICIENCY
DISORDER(VAD)

22. VAD STATUS :-
• FCHVs distribute the capsules of vitamin A to the targeted children
twice a year through a campaign-as vitamin A campaign in Kartik
(October) and Baisakh (April) every year
• The overall national achievement is about 85 percent among the
children aged 6-59 months with 82 percent in Kartik and 85
percent in Asadh(2nd Round in Baisakh postponed to Asadh) in
Fiscal year 76/77.
• Coverage by provinces varies with Lumbini province with higher
proportion of children receiving vitamin A supplementation while
Bagmati Province has the lowest coverage of 69 percentage.

23. VITAMIN A DEFICIENCY DISORDER(VAD)
Cause Consequences
•Low intake of Vitamin A from
daily diets
• Restricted Vitamin A (VA)
absorption
• Worm infestation
• Increased VA requirement
resulting from infectious diseases
•Xerophthalmia (Night
blindness, Bitot’s spot,
corneal ulcer,
Keratomalacia, xerosis)
•Increased risk of morbidity
and mortality
• Increased risk of anemia

24. Toeliminate
vitamin A
DeficiencyDisorder

25. LOWBIRTH
WEIGHT
(LBW)
• Normal birth weight:- delivery of baby 2.5
kg-4kg (CB-IMNCI Guideline)
• Low birth weight:- delivery of baby less than
2500 gm
• Very low birth weight:- delivery of baby less
than 1500 gm
• Extremely low birth weight:- delivery of
baby less than 1000gm
• Status :-12% children are low birth
weight(NDHS 2016)

26. LOWBIRTHWEIGHT(LBW)
Cause Consequences
• Small maternal size at conception
(low weight and short stature)
• Low gestational weight gain
• Maternal anemia
• Maternal malnutrition
• Premature delivery
• Early pregnancy
• Increased mortality and morbidity
• Increased risk of stunting
• Poor neurodevelopment
•Reduced strength and
work capacity
• Increased risk of chronic diseases

27. Toreduceprevalenceof
LBW

28. Current Government Action To Reduce Nutritional Problems In Nepal
NUTRITIONAL PROBLEMS GOVERNMENT ACTIONS
PROTEIN ENERGY
MALNUTRITION
• Growth monitoring and nutrition counseling at Primary Health Care
Center(PHCC)
• Promotion of exclusive breastfeeding for first six months
• Implementation of Breast Milk Substitute Act 2049 and Regulation
2051
• Promotion of complementary feeding after 6 months
• Seven hospitals cited as Baby Friendly Hospital Initiatives (BFHI) in
various parts of country.
• Distribute fortified foods to pregnant and lactating women and
children aged 6 to 23 months in food deficient areas
IODINE DEFICIENCY
DISORDER
• Universal iodization of salt
• Strengthen implementation of the Iodized Salt Act,2055 to ensure all
edible salt is edible.
• Systematic monitoring of iodized salt
• Awareness about the importance of using iodized salt to control IDD
through social marketing campaign

29. IRON DEFICIENCY
ANEMIA
• Distribution of iron and folate tablets to pregnant women and lactating
mothers through hospitals, PHCC
• Intensification program of maternal iron supplementation through female
community health volunteers (FCHV)
VITAMIN A
DEFICIENCY DISORDER
• Biannual supplementation of high dose Vitamin A capsules to children aged
6-59 month olds through FCHVs
• Nutrition education activities through Behavior Change Communication
(BCC) and mass media , community level health workers and agricultural
extension workers
• Provide Vitamin A capsules (200,000 IU) to postpartum mothers through
health care facilities and community volunteers
• Treatment of night blind pregnant women with low-dose Vitamin A in
selected districts
• Case treatment for measles, severe malnutrition, chronic diarrhea and eye
problem related to vitamin A deficiency
LOW BIRTH WEIGHT • Advocacy for antenatal checkup and counseling at least 4 times during
prenatal period according to MoH policy
• Nutritional education through health institutions for the general population
with special focus on adolescents and expectant mothers.

30. Summary:-

31. Reference:-
• National Demographic and Health Survey ,(NDHS 2016)
• National Nutrition Policy and Strategy (NNPS 2004)
• Department of health service,(Dohs)Annual report fiscal
year 2076/77

32. THANK YOU!!