National Nutrition Strategy Research Articles

Determination of nutrient adequacy of the food catered in the child care homes (CCHs) of Sunsari district

Summary Malnutrition continues to be a primary cause of ill health and mortality among school age orphan and vulnerable children in developing countries. Objective: Determination of nutrient adequacy of the food catered in the child care homes of Sunsari district. Methods: Weighing method was used for determining the amount of food eaten. T-test and bivariate spearman correlation coefficients were used to compare the nutrient intake with respective RDA and to determine the association between nutrient intake and malnutrition respectively. Results: The study revealed, 33.82% and 17.39% of study population were stunted and underweight respectively. Equal percentages (7.81%) of study population were overweight and thin. Probability of calorie and protein adequacy was found in 52.94% and 89.71% of study population in CCHs. Calcium intake of all children and adolescent were found to be below their RDA. Cereals contributed the highest amount by weight (355.3 g) and proportion (39%) to the total diet for the study population in CCHs. Fruits 1% (12.9 g) and additional oil 2% (20.9 g) made a small contribution to the study population dietary intake. Fish and eggs were completely lacking in their diet. Probability of iron inadequacy was found in 80.9% of study population in CCHs.

Australia's Progress in Improving Diets and Preventing Obesity: Clear Opportunities for Action.

Australia, like other developed countries, has a high prevalence of overweight and obesity, in both adults and children. This review examines progress in food policy in Australia, particularly at a national level, around key policy domains as well as in relation to public education. Australia lacks a national nutrition strategy or an obesity prevention strategy, incorporating best practice recommendations to improve diets. Examination of current progress shows patchy implementation of key food policy initiatives and significant gaps, particularly at the federal level. In the absence of a long-term strategic approach, the response of the federal government has been ad hoc around the adoption of key policies and funding for programs to improve what Australians eat. Consensus around a platform for obesity prevention for national action, including food policy, is building from public health, academic and consumer groups.

Enhancing nutrition and health survey and implementing effective interventions to reduce the incidence of nutritional diseases

Public nutrition is related to the improvement of population health and the development of social economy. Nutrition and health survey can provide indispensable information for public health and disease prevention and control to improve people's nutritional and health status and support the policy making of food production and chronic diseases prevention and control. In recent years, China's nutritional supply capacity has increased significantly. Our people's nutritional and health status has improved significantly. The articles published in "Nutrition and Health Survey" column come from nutrition surveys both at the national and provincial level. They are making full use of data to give information on not only nutritional and health status of residents throughout the country, but also regional features. These results will provide a detailed and reliable reference for both national and regional nutrition and health policy and strategy making. At present, China's nutrition work faces many challenges. China's Party Central Committee and the State Council always places great emphasis on people's nutritional and health status. In order to promote the health of the whole population in our country, our government has implemented a number of nutrition promotion policies or strategies. Chinese nutrition and health survey will further evaluate the effect of these movements.

Food fortification for impact: a data-driven approach.

Food fortification for impact: a data-driven approach.

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program.

Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time? Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis. The total funds allocated in Tanzania's districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%. District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania's National Nutrition Strategy Implementation Plan. VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level.

A nutrition strategy to reduce the burden of diet related disease: access to dietician services must complement population health approaches.

Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden. Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into: (i) population level socio-educational approaches to enhance diet knowledge; (ii) pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods); (iii) regulations to modify the food environment, and (iv) the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of “junk foods” is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians) per 10,000 persons or 75 nurses per 10,000 persons. It is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs.

Cooperation between Japanese and Cambodian Dietitians in Setting up a Hospital Diet Management System

Cambodia faces a considerably high percentage of the stunted under 5 (Unicef, 2014). Despite the National Nutrition Strategy Launched by the Ministry of Health in cooperation with development partners, nutrition improvement projects have not always been effective. It is generally said these issues are addressed in many other developing nations, and the literature largely documented that successful nutrition programmes are community-based programmes because of their sustainability and the intensive communications between health workers and beneficiaries. Learning from the past experiences, the Foundation for International Development/Relief organized a project team with a Cambodian dietitian and an experienced Japanese dietitian to implement a hospital diet programme for children from April 2006 to March 2014 in the National Pediatric Hospital (NPH) in Cambodia. The project has two objectives: establishing a hospital diet management system, and developing the capacity of NPH staff. Hospital food menus were created paying particular attention to Cambodian culture, eating habits and accessibility to the ingredients for the purpose of continuous supply. We have also put emphasis on the communication between dietitians and family members of the children to let them understand the importance of a nutritious diet. After 8 y of project implementation, the hospital diet management system was established providing 7 types of menu with nutritious diets. The final evaluation of the project showed that NPH staff have the intention to continue hospital food supply with their acquired knowledge and capacity. In practice, a Cambodian dietitian currently takes the initiative for a continuous nutritional diet in NPH. The key to this success is the collaboration between Japanese dietitians with experience and Cambodian dietitians with knowledge of Cambodian eating habits. Taking our experience into account, it is highly recommended to educate Cambodian dietitians, as they are extremely scarce, and to increase the awareness of health care staff towards the importance of nutrition management.

The Contribution of Forests and Trees to Sustainable Diets

With the growing demands from a population expected to reach 9 billion people by 2050, it is unclear how our current global food system will meet future food needs. Ensuring that all people have access to adequate and nutritious food produced in an environmentally and socio-culturally sustainable manner is one of the greatest challenges of our time. “Sustainable diets” have been proposed as a multidimensional framework to address the need for nutritious and adequate food in the context of the many challenges facing the world today: reducing poverty and hunger, improving environmental health, enhancing human well-being and health, and strengthening local food networks, sustainable livelihoods and cultural heritage. This paper examines the contribution of forests and trees to sustainable diets, covering among others, nutritional, cultural, environmental and provisioning aspects. The literature reviewed highlight major opportunities to strengthen the contribution of forest and tree foods to sustainable diets. However, several constraints need to be removed. They relate to: cultural aspects, sustainable use of non-wood forest products, organization of forest food provisioning, limited knowledge of forest food composition, challenges in adapting management of forests and trees to account for forest foods, and in integrating forest biodiversity into complex landscapes managed for multiple benefits. Finally, the paper identifies research gaps and makes recommendations to enhance the contribution of forest foods to sustainable diets through increased awareness and better integration of information and knowledge on nutritious forest foods into national nutrition strategies and programs.

Biofortification, Agricultural Technology Adoption, and Nutrition Policy: Some Lessons and Emerging Challenges*

Biofortification is a rapidly emerging strategy to address micronutrient malnutrition, but as an agricultural strategy with health objectives, it faces unique challenges. This article identifies three challenges to agricultural technology adoption that biofortification must meet to become a successful component of national nutrition strategies: (i) biofortification will need to achieve high rates of adoption and consumption in geographically distinct areas; (ii) strategies for delivery of biofortified crops must be tailored to the local context for each crop–nutrient pair; and (iii) biofortification needs to identify more cost-effective delivery strategies in order to offer an alternative to supplementation and commercial fortification. Evidence to support these arguments is provided from recent biofortification experiments in Uganda and Mozambique. (JEL codes: I12, O33, Q16)

How are maternal‐child nutrition activities integrated at the community level? Lessons from Haiti

A variety of nutrition interventions are needed to meet national and global goals for women and children, and scarce resources necessitate integration of those activities. Haiti's national nutrition strategy includes 3 priority intervention areas: 1) promotion of age‐appropriate infant and young child feeding (IYCF) practices 2) prevention of micronutrient deficiencies (PMD) in young children, adolescent girls and pregnant women and 3) management of severe acute malnutrition (SAM) in children under 5. Policy makers need to identify program delivery models that effectively integrate these areas at the community level. To address the question of integration, we mapped the program impact pathways for 3 large‐scale nutrition programs serving rural Haitian communities. Two programs were managed by NGOs and one by the public sector. For each program, we assessed how activities related to IYCF, PMD, and SAM were integrated at the service delivery level. Data was collected through document review and semi‐structured interviews with program staff and beneficiaries. Analyses and findings reveal ways that various community‐based nutrition activities can be most efficient and synergistic. Research support: UNICEF Haiti

School meal program in Ho Chi Minh city, Vietnam: reality and future plan.

The socio-economic status in Vietnam has developed during the past decades. People become busier for work, and thus they do not have enough time to prepare meal for their children. The school meal program, organized by Department of Education, was first implemented at a kindergarten in 1977, which has been extended to elementary school since 1980. Up to date, 100% of kindergarten and approximately 90% of elementary schools have school meal programs. The purposes of this program are to provide appropriate meals for students, and to serve as education and communication tool for students. About 90% of school meals are prepared in the school's kitchen and the rest are provided by food companies. The weekly menu provides approximately 30% of recommended dietary allowances (RDA) for students. To date, there has been is no official dietitian training school in Vietnam. The head of school kitchen, who is not dietitian, is required to participate in a short-term training course, where s/he learns basic nutrition, nutrition requirements and food hygiene and safety. The food companies, which provide meals to school, must be approved for the hygiene and safety condition by the Human Health Services Department of Ho Chi Minh City. In the next plan of national nutrition strategy, establishing dietitian training schools will be prioritized. In addition, the regular nutritional surveillance for school-aged students will be introduced in school system thus we can develop and evaluate the school meal program in terms of nutrients, food safety and nutrition education.

REACH: An Effective Catalyst for Scaling up Priority Nutrition Interventions at the Country Level

Renewed Efforts Against Child Hunger (REACH) is the joint United Nations initiative to address Millennium Development Goal (MDG) 10, Target 3, i.e., to halve the proportion of underweight children under 5 years old by 2015. The United Nations Food and Agriculture Organization (FAO), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Food Programme (WFP), and the International Fund for Agricultural Development (IFAD) developed and tested a facilitation mechanism to act as a catalyst for scaling up multisectoral nutrition activities. The UN-REACH partners developed pilot projects in Mauritania and Lao PDR from 2008 to 2010 and deployed facilitators to improve nutrition governance and coordination. Review missions were conducted in February 2011 to assess the REACH approach and what it achieved. The UN review mission members reviewed documents, assessed policy and management indicators, conducted qualitative interviews, and discussed findings with key stakeholders, including the most senior UN nutrition directors from all agencies. Among other UN-REACH achievements, the Prime Minister of Mauritania agreed to preside over a new National Nutrition Development Council responsible for high-level decision-making and setting national policy objectives. REACH facilitated the completion of Lao's first national Nutrition Strategy and Plan of Action and formation of the multistakeholder Nutrition Task Force. During the REACH engagement, coordination, joint advocacy, situation analysis, policy development, and joint UN programming for nutrition were strengthened in Lao PDR and Mauritania. Improvements in the nutrition governance and management mechanisms in Mauritania and Lao PDR were observed during the period of REACH support through increased awareness of nutrition as a key development objective, establishment of governmental multisectoral coordinating mechanisms, improved government capacity, and new joint UN-government nutrition programming.

Analysing Success in the Fight against Malnutrition in Peru

SummaryThe prevalence of underweight children worldwide fell from 31per cent in 1990 to 26 per cent in 2008 (UNICEF 2009). However, progress is still slow and very uneven. Half of the countries have made progress on hunger, but levels of malnutrition did not improve in 28 countries and got worse in 24. The case of Peru appears to be an encouraging exception to the rule. With the support of CARE and others organisations from civil society and the donor community, the Peruvian Government has generated the political momentum to overcome obstacles and create national coordination structures and mechanisms, increase public (and private) spending on programs to tackle malnutrition and align social programs with the national nutrition strategy (known as CRECER). This included adding conditionalities on taking children to regular growth monitoring in the Conditional Cash Transfer programme, JUNTOS. The international aid system has also aligned itself around CRECER. After ten years of almost no change in child chronic malnutrition (stunting) rates (25.8 per cent in 1996, and 22.9 per cent in 2005 – with rural rates moving from 40.4 per cent to 40.1 per cent), this change in strategy has started to lead to results: malnutrition rates fell to 17.9 per cent between 2005 and 2010, with reductions mainly occurring in rural areas where malnutrition rates are highest (from 40.1per cent in 2005 to 31.3 per cent in 2010) according to the Peruvian National Statistical Office (INEI). Over 130,000 children under five are now not chronically malnourished who would have been had rates not fallen. Indeed, there is a strong case to be made that these changes would not have occurred without the formation in early 2006 of the Child Nutrition Initiative, and its advocacy success in getting ten Presidential candidates to sign a commitment to reduce chronic malnutrition in children under five by 5 per cent in five years (‘5 by 5 by 5’), followed by the support provided subsequently to the new government to meet that commitment.This paper documents and systematises Peru's recent experience in tackling malnutrition. Through an intensive review of quantitative and qualitative evidence, it argues that success is not explained by the presence of favourable socioeconomic changes in Peru, and it explores the political determinants of success in three dimensions. Horizontally, it looks at government efforts to form policy coalitions across representatives of different government and non‐government agencies; it looks at the vertical integration of agencies and programmes between national, regional and municipal governments, and it analyses the allocation of government resources used to fund the government's nutrition effort.In closing, the paper identifies some salient challenges to ensure long term sustainability of the initiative and draws policy recommendations and knowledge sharing lessons that could be of use for Southern Governments, donor agencies and civil society organisations.

Thin gruel in the face of the national child obesity epidemic

Canada’s child obesity epidemic will never be stemmed without a national school food program and a national child nutrition strategy, complete with restrictions on junk food advertising and clear nutrition standards and guidelines, according to health advocates at an international food conference

Research on Iodine Deficiency and Goiter in the 19th and Early 20th Centuries

In 1811, Courtois noted a violet vapor arising from burning seaweed ash and Gay-Lussac subsequently identified the vapor as iodine, a new element. The Swiss physician Coindet, in 1813, hypothesized the traditional treatment of goiter with seaweed was effective because of its iodine content and successfully treated goitrous patients with iodine. Two decades later, the French chemist Boussingault, working in the Andes Mountains, was the first to advocate prophylaxis with iodine-rich salt to prevent goiter. The French chemist Chatin was the first to publish, in 1851, the hypothesis that iodine deficiency was the cause of goiter. In 1883, Semon suggested myxedema was due to thyroid insufficiency and the link between goiter, myxedema, and iodine was established when, in 1896, Baumann and Roos discovered iodine in the thyroid. In the first 2 decades of the 20th century, pioneering studies by Swiss and American physicians demonstrated the efficacy of iodine prophylaxis in the prevention of goiter and cretinism. Switzerland’s iodized salt program has been operating uninterrupted since 1922. Today, control of the iodine deficiency disorders is an integral part of most national nutrition strategies.

Food and nutrition policies: what's being done in Turkey

The aim of the present paper is to describe the development of the National Plan of Action for Food and Nutrition (NPAFN) for Turkey. Access to a safe and healthy variety of food, a fundamental human right, was stressed by the International Conference on Nutrition and by the World Food Summit. In the International Conference on Nutrition in December 1992, one major commitment was the preparation of NPAFN. The NPAFN for Turkey was designed according to this commitment. Turkey. To this end, under the coordination of the State Planning Organization, a Working Committee Report for National Food and Nutrition Strategy of Turkey was prepared and published, with the participation of different sectors. The goal of the prepared National Food and Nutrition Strategy for Turkey is to protect and promote health through and healthy nutrition and reduce the burden of diseases, while contributing to socio-economic development and a sustainable food security. In Turkey the NPAFN was developed and implementation has initiated. Nearly for all the actions, related projects are being developed.

Food Strategy Formulation and Development Planning in Ethiopia

Summary The paper describes the preparation and major features of the National Food and Nutrition Strategy for Ethiopia; and discusses current policy issues, including the impact of the liberalisation announced in March 1990. The country produces only 70 per cent of food requirements and has at least 9m food insecure people. The NFNS addresses these problems with a conservation-based strategy to increase production and marketed surplus in high potential as well as food deficit areas. Population growth, environmental pressure and the risks of input-intensive growth packages are the main issues of concern. The abolition of producer grain quotas may also be inflationary if urban price subsidies are to be maintained.