Nutrition Action Plan Research Articles

Changing paradigm of malnutrition among Bangladeshi women of reproductive age and gaps in national Nutrition Policies and Action Plans to tackle the emerging challenge.

The main objective of this paper is to document the changing paradigm of malnutrition in Bangladesh and estimating how this is creating an intergenerational risk. This paper also examines national policy responses to tackle the silent epidemic of double burden of malnutrition. Publicly available datasets of five Bangladesh Demographic and Health Surveys were used to see the changing paradigm of malnutrition among Bangladesh women. In addition to that, four national policies concerning, maternal and child health; and nutrition were reviewed using CDC's 2013 Policy Analytical Framework. In Bangladesh, the share of ever-married women aged 15-49 who were underweight declined sharply between 2007 and 2017-2018, from 30 to 12%. In the same period, the proportion of women who were overweight or obese increased from 12 to 32%. Despite remarkable progress in reducing undernourishment among women, the share of well-nourished remained unchanged: 58% in 2007 and 56% in 2017-2018, mainly due to the shift in the dominant burden from undernutrition to overnutrition. This shift occurred around 2012-2013. Currently, in Bangladesh 0.8 million of births occur to overweight women and 0.5 million births occur to underweight women. If the current trend in malnutrition continues, pregnancies/births among overweight women will increase. Bangladesh's existing relevant policies concerning maternal health and nutrition are inadequate and mostly address the underweight spectrum of malnutrition. Both forms of malnutrition pose a risk for maternal and child health. Underweight mothers are at risk of having anemia, antepartum/postpartum hemorrhage, and premature rupture of membranes. Maternal obesity increases the risk of perinatal complications, such as gestational diabetes, gestational hypertension, and cesarean deliveries. Currently, around 24% of the children are born to overweight/obese mothers and 15% to underweight mothers. Bangladesh should revise its national policies to address the double burden of malnutrition among women of reproductive age across pre-conception, pregnancy, and post-natal stages to ensure optimum maternal and child health.

Combating obesity in Southeast Asia countries: current status and the way forward

Obesity is gaining prominence as a serious public health challenge in the Southeast Asia (SEA) region, with an alarming rate of increase in its prevalence. Countries in the region have shown commitment to curbing the rise of obesity by establishing policies, strategies, and action plans. This paper summarises the current situation and strategies undertaken to combat obesity and related chronic diseases. Although a range of policies and strategies have been developed, including national nutrition action plans, community intervention programmes, fiscal measures, nutrition labelling to promote healthier choices, countries in the region are struggling to make significant progress toward halting the scourge of obesity. It is imperative to strengthen existing health systems with a paradigm shift from a focus on “sick care” to and enhancing nutrition initiatives to support obesity prevention. A comprehensive and coordinated approach is essential, one that emphasises high-level coordination across all levels of government and multiple sectors, and a unified plan rather than fragmented initiatives. For strategies to be effective and sustainable, they must address the fundamental environmental determinants of poor dietary choices and nutritional inequalities. A more holistic approach is clearly needed to improve the entire food environment, which in SEA countries must include the multitude of eating places where large segments of the population “eat out” everyday to meet their energy and nutrient needs. There is a recognised need for more comprehensive measures to promote healthy eating among school children and ensure a supportive environment for lifelong healthy habits. This paper calls for a whole-of-government, whole-of-society approach that combines changes to the fundamental food environment and accompanied by systematic monitoring and surveillance systems to achieve long-lasting health outcomes.

Online training needs assessment (TNA) among Municipal Nutrition Action Officers (MNAOs) in the Philippines

Introduction: A training needs assessment (TNA) was conducted by the Department of Science and Technology, Food and Nutrition Research Institute (DOST-FNRI) to design appropriate and relevant trainings for Municipal Nutrition Action Officers (MNAOs). In the Philippines, MNAO is a nutrition officer who serves at the municipal level and is tasked to ensure the localisation of the Philippine Plan of Action for Nutrition (PPAN) in Local Government Units (LGU) to ensure proper implementation of activities on Public Health Nutrition (PHN). Methods: A total of 162 MNAOs in the country answered the online TNA survey conducted from April to May 2023. Results: Based on the results of the TNA survey, there was a need for DOST-FNRI to design and conduct trainings related to the top three core competencies identified by MNAOs: Creating policies and standards related to food and nutrition; advocating legislation, regulation, and nutrition policies; and designing appropriate nutrition information education and communication (IEC) materials. Conclusion: Based on the study results, it is recommended that LGUs allocate funds for capacity building of the public health workforce to create a skilled workforce in the community that will coordinate the formulation, implementation, monitoring, and evaluation of nutrition plans at the municipal level. For future consideration, curriculum design for professional development in public health nutrition should include core competencies on food and nutrition policy programme, nutrition programme management, and IEC development.

Bridging the evidence-to-action gap: enhancing alignment of national nutrition strategies in Cambodia, Laos, and Vietnam with global and regional recommendations.

Nutrition policies are critical frameworks for tackling the triple burden of malnutrition, including undernutrition (i.e., stunting and wasting), overweight, and hidden hunger (i.e., micronutrient deficiencies). We examined (1) the alignment of recent National Nutrition Strategies and Action Plans (NNS) in Cambodia, Laos, and Vietnam with recent global and regional recommendations and standards with a focus on maternal, infant, and young child nutrition and (2) changes compared to the previous NNS. We extracted information regarding the context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNSs in Cambodia (2019-2023), Laos (2021-2025), and Vietnam (2021-2030). Recent NNSs aimed to reduce malnutrition among priority populations and described program development, monitoring, and evaluation plans for the following interventions: breastfeeding promotion, improved complementary feeding, dietary diversity, safe water, food security, nutritional/health campaigns, strategies for vulnerable groups, and strengthening of policies related to food and nutrition. Direct interventions to improve women's general nutrition (outside of pregnancy) and adolescent nutrition were not the focus of any NNSs. Although some indicators (e.g., wasting and exclusive breastfeeding) were covered in all recent NNSs, other indicators (e.g., low birth weight and childhood overweight and obesity) were inconsistently incorporated. In comparison to the previous NNS, the following interventions were discontinued in three countries: dietary counseling, maintaining physical activity, monitoring weight gain during pregnancy, maternal micronutrient supplementation, and nutrition and HIV. Despite similarities in structure and content, the recent NNSs of Cambodia, Laos, and Vietnam do not consistently align with global and regional recommendations. Variations in the types of interventions and indicators included may reflect a shift in priorities, attention, or resources. In conclusion, the NNSs of Cambodia, Laos, and Vietnam exhibit both structural and content similarities; however, certain interventions and indicators vary across countries and differ from global and regional recommendations. Enhancing alignment while prioritizing country-specific needs, optimizing coordination, ensuring policy efficacy, and updating nutrition strategy data for cross-country comparisons and knowledge exchange is critical to ensure progress on reducing malnutrition in the region.

Improving complementary feeding practices, programs and policies for optimal early childhood nutrition in Kenya: What would work?

Complementary feeding practices are greatly influenced by local contexts. Therefore, national home-grown evidence, policiesand guidelines are critical to improving infant and young children's diets. This Special Issue has provided a comprehensive, evidence-based analysis of the situation, gapsand context-specific opportunities for improving young children's diets in Kenya. The primary research findings of the Special Issue supported the identification of a set of recommendations articulated across the four systems (food, health, water, sanitation and hygiene[WASH]and social protection) to improve food availability and accessibility in Kenya at the national and subnational levels. It is anticipated that the decentralised government functions seen in Kenya provide a strong opportunity to develop and mainstream context-specific recommendations into action. This Special Issue recommends adopting a multi-sectoral systems approach, including a shared vision, joint planning, implementationand monitoring, towards improving young children's diets with a focus on service delivery as well as scaled-up community social behaviour change interventions. In particular, the approach should entail advocacy for policy revisions for service delivery that support complementary feeding and development of costed implementation strategies in support of the same, across four critical systems-food, health, WASHand social protection, along with, the strengthening of national coordination, monitoringand accountability structures as per the Kenya Nutrition Action Plan. Finally, the development of a legal framework for enhanced accountability from all relevant sectors towards sustainable, nutritious, safeand affordable children's diets. These recommendations provide a clear direction in addressing the complementary feeding challenges, which the primary research of this Special Issue has presented.

Sustainable food security in modern framework for optimal nutri-tional well-being of Malaysians

Food security is Malaysia’s second Sustainable Development Goal (SDG), which ensures access to nutritious food available for everyone in the country. In 2006, the Ministry of Health (MOH) launched NPANM II, the National Plan of Action for Nutrition of Malaysia, to handle food and nutrition issues. National surveys revealed that most Malaysians still cannot completely com-prehend and implement the Food Pyramid into practice. The Ministry intends to continue the programme through NPANM III to advance the population’s health and strengthen food and nutrition security. Therefore, this empirical study aims to develop inclusive, sustainable food security in a modern framework to identify possible reasons affecting nutritional well-being. In the data collection phase, a questionnaire survey is administered among 318 respondents from five states, i.e. Selangor, Pinang, Johor, Kuantan, and Melaka. The data collection process was taken over three months, from January to March 2023, and it ensured the rectification of miss-ing data. The results derived from the study would provide valuable insights to the policymakers towards identifying the most influential factors toward ensuring food security for enhancing the quality of health and well-being of the Malaysian population and have significant implications for achieving the objectives set under the NPANM III, 2016-2025.

Assessing the Progress of the Philippine Plan of Action for Nutrition From 1974 to 2022: A Narrative Review.

Malnutrition remains a public health burden in the Philippines, with the country struggling to meet global nutrition targets. This study aims to review the Philippine Plan of Action for Nutrition (PPAN) and its progress in addressing malnutrition in the Philippines. A narrative literature review of the PPAN and its implementation from 1974 to 2022 was conducted, including an analysis of relevant data on the nutrition status and programs for Filipinos. The study found that the PPAN has been largely supportive in addressing malnutrition in the Philippines over the years. However, obstacles hindering the achievement of its nutrition-related goals have been identified. Challenges include inadequate coordination of programs at the local level, concerns regarding data quality, and insufficient training of personnel involved in implementing the PPAN. The results also indicate that the country has made limited progress toward achieving the global nutrition targets set by the Sustainable Development Goals 2030. This study highlights the need to revisit and refine the PPAN to respond to the changing nature of malnutrition in the country. Recommendations to address the remaining gaps in the planning, implementing, and monitoring of the PPAN are discussed. Finally, the paper offers some valuable insights from the experiences of the PPAN that can be applied to other countries facing comparable nutrition contexts.

Inclusive diets within planetary boundaries

Inclusive diets within planetary boundaries

Malaria reduction drives childhood stunting decline in Uganda: a mixed-methods country case study

ABSTRACTBackgroundUganda has achieved a considerable reduction in childhood stunting over the past 2 decades, although accelerated action will be needed to achieve 2030 targets.ObjectivesThis study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda.MethodsThis mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a scoping literature review; 2) quantitative data analyses, including Oaxaca–Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national- and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives.ResultsStunting prevalence declined by 14% points from 2000 to 2016, although geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z-scores (HAZs) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women's empowerment, cultural norms, water and sanitation, dietary intake/diversity, and reduced childhood illness as important. The 2011 Uganda Nutrition Action Plan was an essential multisectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors.ConclusionsUganda's success in stunting reduction was multifactorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated, and rural populations along with high-burden districts.

The European Food Regulatory Environment Index: a tool to monitor progress in implementing food environment policies.

BackgroundEvidence based health policy, such as that put forward in the European Food and Nutrition Action Plan 2015–2020 and the WHO Global Action Plan on the Prevention and Control of Noncommunicable Diseases, has a role in curbing the consumption of unhealthful foods and drink. We ask how countries are performing in the adoption of these policies and how the comprehensiveness of their food environment policies explains variations in consumption of unhealthful products across Europe.MethodsIn order to assess the state of policy adoption, we developed a composite indicator—the Food Regulatory Environment Index (FREI) for which we calculated unweighted and weighted formulations according to the strength of the evidence base. We used linear regression models to explain variations in the consumption of unhealthful products as well as variations in a composite indicator of obesogenic diets.ResultsOverall, wealthier countries in the Region perform better. The weighting of the constituent policies does not affect the rankings. We find negative associations between unweighted and weighted formulations of the Index and household consumption of sugary and carbonate drinks as well as with the composite indicator for obesogenic diets.ConclusionsThe main strength of this study is the comprehensiveness and comparability of the policy data across the relatively large number of countries covered. There is a negative association that is statistically significant, between all formulations of the FREI and the household consumption of sugary and carbonated drinks. There is also a negative association between some FREI formulations and obesogenic diets.

Malaria Reduction Drove Childhood Stunting Decline in Uganda: A Mixed-Methods Country Case Study

Background: Uganda has achieved a considerable reduction in childhood stunting over the past two decades, though accelerated action will be needed to achieve 2030 targets. This study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda. Methods: This mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a systematic literature review; 2) quantitative data analyses, including Oaxaca-Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives. Findings: Stunting prevalence declined by 14% points from 2000 to 2016, though geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z-scores (HAZ) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women’s empowerment, cultural norms, water and sanitation, dietary intake, and childhood illness as important. The 2011 Uganda Nutrition Action Plan was an essential multi-sectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors. Interpretation: Uganda’s success in stunting reduction was multi-factorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated and rural populations along with high-burden northern and western districts. Funding: This study was funded by the Bill & Melinda Gates Foundation and Gates Ventures. Declaration of Interest: None to declare. Ethical Approval: Ethics approval was obtained from the Makerere University School of Public Health Higher Degrees Research Ethical Committee (Uganda), the Uganda National Council of Science and Technology, and the Research Ethics Board at the Hospital for Sick Children (Canada).

A review of national plans of action for nutrition in Southeast Asian countries

This review describes national plans of action for nutrition (NPANs) in six Southeast Asia countries (Indonesia, Malaysia, Myanmar, Philippines, Thailand and Vietnam) in order to provide an understanding of the approach and framework undertaken by these countries in the formulation and implementation of NPANs, as well as the similarities and differences in various NPAN components. The six countries recognised the persistent undernutrition and escalating rates of obesity and other diet-related chronic diseases as the key drivers for nutrition action plan implementation. The prioritisation of nutrition interventions outlined in these NPANs are based on respective country context and needs. Although differing in strategies and targets set, these countries show similarities in several components including objectives, stakeholder involvement, nutritional issues to be addressed, implementation, monitoring and evaluation mechanism, programme/ activities identified and challenges in implementing NPANs. Countries have recognised that effective implementation, monitoring and evaluation are essential to successfully address both extremes of the challenging nutrition situation. Several important similarities in the NPANs studied suggest that closer collaboration among countries and stakeholders on NPANs would be beneficial. Opportunities should be created for periodic exchanges to enable sharing of experiences in the development and implementation of NPANs among the countries. Recommendations and conclusions drawn from this review could serve as useful reference for nutrition policy and planning in the future.

Development of Regional Strategic Framework for Nutrition Action Plan as a tool for Health and Nutrition Diplomacy of the Prevention of Non-Communicable Disease (NCD) in ASEAN Countries

The trend of prevalence of Non-Communicable Diseases (NCD) such as hypertension, cardiovascular diseases, diabetes mellitus, and cancer has increased for the last few decades among low and midle income-countries including Indonesia. Based on the results of Basic Health Resarch performed in Indonesia in 2013, the prevalence of hypertension was 25.8 %, diabetes mellitus was 6.9 %, central obesity was 26.6 %, and stroke was 1.2 %. The cause of NCD is multi-factorial and the main risk factors are high consumption of sugar, salt, and fat, low consumption of vegetables and fruit, overweight, lack of physical activity, and smoking habit.
 Lower income countries such as Indonesia are beginning to experience disease patterns like high-income countries, as more processed foods are incorporated into diets in a nutrition transition, with less of the necessary healthcare resources to cope with increased disease burden. Globally, obesity or Body Mass Index (BMI) greater than 30 kg/m2 was estimated to have been the cause of 3.4 million deaths in 2010. Excess sugar consumption, particularly consumption of sugar-sweetened beverages (SSBs) is a well- documented, significant causal factor for weight gain. Several studies have found increases in BMI per additional daily serve of SSB and decreases in BMI when SSB consumption is reduced. Excess body mass is a significant risk factor for many NCDs such as ischemic heart disease (IHD), stroke, type 2 diabetes mellitus (T2DM) and various cancers, with the associated morbidity and mortality contributing to rising healthcare costs and reduced productivity. Excess sugar consumption directly increases
 
 the risk of T2DM, mediated through both the risk due to higher weight and directly through inflammatory mechanisms triggered by elevated blood sugars.

National nutrition strategies that focus on maternal, infant, and young child nutrition in Southeast Asia do not consistently align with regional and international recommendations.

We examined the consistency of national nutrition strategies and action plans (NNS) focusing on maternal, infant, and young child nutrition in Southeast Asia with regional and international recommendations. Between July and December 2017, we identified and extracted information on context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNS in nine Southeast Asian countries. All NNS described context, objectives, and the following interventions: antenatal care, micronutrient supplementation during pregnancy, breastfeeding promotion, improved complementary feeding, nutrition in emergencies, and food fortification or dietary diversity. Micronutrient supplementation for young children was included in eight NNS; breastfeeding promotion during pregnancy and support at birth in seven; and school feeding, deworming, and treatment of severe acute malnutrition in six. All NNS contained programme monitoring and evaluation plans with measurable indicators and targets. Not all NNS covered wasting, exclusive breastfeeding, low birthweight, and childhood overweight. Strategies for achieving NNS goals and objectives were health system strengthening (nine), social and behaviour change communication (nine), targeting vulnerable groups (eight), and social or community mobilization (four). All addressed involvement, roles and responsibilities, and collaboration mechanisms among sectors and stakeholders. There was a delay in releasing NNS in Indonesia, Myanmar, and the Philippines. In conclusion, although Southeast Asian NNS have similarities in structure and contents, some interventions and indicators vary by country and do not consistently align with regional and international recommendations. A database with regularly updated information on NNS components would facilitate cross‐checking completeness within a country, comparison across countries, and knowledge sharing and learning.

Towards better nutrition in Europe: Evaluating progress and defining future directions

This paper provides a snapshot of the implementation of the WHO European Food and Nutrition Action Plan 2015–2020 among Member States in the WHO European Region. The focus is on the level and degree of implementation of selected policies recommended in this regional framework to promote healthy nutrition and prevent diet related noncommunicable diseases including obesity. Data was gathered through online and off-line versions of the Global Nutrition Policy Review questionnaire in 2017, through appointed focal points from the ministries of health. Almost all (94%) countries in the European region responded to the questionnaire, although not all responses were equally detailed. Significant progress has been made in some areas of public health nutrition, such as within school food policies, product reformulation, and implementation of trans fat regulations. However, if countries are to achieve global NCD targets, more ambitious policies with appropriate breadth and depth are needed. This is mainly the case for consumer-friendly front-of-package labelling, restrictions on marketing of foods to children as well as policies to protect, promote and support exclusive breastfeeding and appropriate complementary feeding practices. Lastly, it is crucial to prioritize robust monitoring, surveillance and evaluation systems in order to understand the effect of these actions and to guide timely and appropriate adjustment of policies.

Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Background50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016.MethodsThe data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15–49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were > 1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level.ResultsOf 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days.Greater paternal engagement (OR 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. Adolescent motherhood (OR. 4.09 (1.40, 11.87)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR (95%CI = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). Stunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors.ConclusionsIn this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay.

Challenges Associated with Formulation of Urban-Based Food and Nutrition Policy in Surabaya City, Indonesia.

Following the enactment of Law No. 18/2012 on Food, the Govenment of Indonesia mandated all districts/cities to translate a 5-yearly National Food and Nutrition Action Plan to address food security and nutrition problems suited with the local context. However, until 2019 only 18 of 514 districs/cities that has manifested this mandate. That the National Regulation is is more suitable for rural contect, challenges to translate the mandate into urban context are obvious. This study assessed how the Surabaya city develops an implementable food and nutrition action plan complying with the national mandate and the adjustments to fit the action plan with urban characteristics. A structured observational study of individual behaviour in developing a policy document was conducted in Surabaya city from May to December 2018. The Food and Nutrition Action Plan in Surabaya city was developed by the multi-stakeholders forum to allow participation from related stakeholders. Because city has insufficient capacity to self-produce the food, therefore the Surabaya City Food and Nutrition Action Plan focused on maintaining food distribution and affordability, which are not among the outcomes indicators of the national guideline. To prioritizing nutrition issues on the action plan, it must be ensured that the issues are also included in the city Medium-Term Development Plan. Otherwise, it will not be funded despite the national government mandates it. Unfortunately, food and nutrition issues are less prioritized in the Surabaya development plan. It is challenging to translate the national mandate to the city-level food and nutrition policy when there is no clear, differentiated reference policy for urban area. The completed Surabaya City Food and Nutrition Action Plan needs to be legalized by the City Mayor to ensure the implementation and monitoring. The support for the action plan implementation and monitoring is needed so that the outcomes of the food and nutrition action can be experienced by all the citizens in Surabaya.

Local Regulation as a Nutritional Improvement Solution: Case Study of Moringa Program in West Sumbawa.

The monitoring of the nutritional status in 2017 showed that the percentage of underweight in West Sumbawa was 20.8%-higher than national (17.8%). In 2016, Pencerah Nusantara, a program that strengthen primary health care through youth empowerment and interprofessional collaboration, encouraged the use of moringa as local food ingredient to improve the nutritional status of children at Poto Tano Health Center, West Sumbawa District. Moringa Program is an innovation program to educate community about nutrition and provide moringa-based foods to improve community nutrition. This program was then implemented not only at one health center but in all sub-districts. Furthermore, BAPPEDA (Local Development Planning Agency) included moringa program to Local Nutrition Action Plans as stipulated in the District Regulation No. 80/2017 about preservation of moringa. This study aims to describe the impact of local regulation on the development of moringa program as one of the solutions to overcome the nutritional problems of children under five. The study uses a case study design on community readiness assessment and is complemented by secondary data collection. The study shows clearly that the regulation is the key factor in strengthening cross-sector partnership and in maximizing efforts to improve community nutrition through the Moringa Program. During the implementation of providing moringa-based foods as a provision of supplementary feeding and complementary feeding at integrates health posts (Posyandu), there was a decrease in cases of underweight in children under five at the Poto Tano Health Center from 21.9% in 2017 to 19.9% in 2018.

Diet related NCDs: Time for action

Noncommunicable diseases (NCDs) are the leading cause of mortality and morbidity, and posing significant challenges both in developed and developing countries including Bangladesh. In 2016, of the total 56.9 million global deaths, 71.0%, were due to NCDs. Some 85.0% of premature deaths from NCDs, are in low and middle income countries, where greater burden of undernutrition and infectious diseases exist.1-3 Evidence suggests a higher age specific mortality for NCDs among Bangladeshi population compared to Western populations, which putting burden on healthcare systems. 4 Bangladesh NCD Risk Factors Survey, 2018 showed that among the adult population, the mean salt intake was 16.5 gram per day and the prevalence of dislipidaemia was 28.4 %.5 Sugar consumption also continues to rise, driven by increased intake of beverages, biscuits, sweets and confectionary items. Industrially produced transfat in some food items is also an important issue in the country.
 Malnutrition is a key risk factor for NCDs. Globally, nearly one in three people has at least one form of malnutrition, and this will reach one in two by 2025, based on current trends.6-8 All forms of malnutrition are caused by unhealthy, poor quality diets. Unhealthy diets that include high sugar, salt and fat intake, malnutrition, and NCDs are closely linked. Not only on the health, malnutrition and diet related NCDs pose a substantial burden on the economy and development.
 Food systems worldwide face major challenges, such as population growth, globalisation, urbanisation, and climate change. Today’s food systems are broken and do not deliver nutritious, safe, affordable, and sustainable diets; they undermine nutrition in several ways, particularly for vulnerable and marginalised populations. Billions of dollars are spent annually marketing foods high in calories, fats, sugars, and salt, and intake has increased globally, including in low income countries.8
 United Nations (UN) is well committed to prevent and control noncommunicable diseases through adopting series of resolutions in its General Assembly. In 2013, Member States of the World Health Organization (WHO) resolved to develop and implement national action plans, in line with the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020).9 NCDs are also embedded in sustainable development goal (SDG) target 3.4, that is, to reduce by one-third the premature mortality from noncommunicable diseases by 2030. NCDs are also linked to other SDGs, notably SDG 1 to end poverty. In 2017, the WHO Global Conference on Noncommunicable Diseases reaffirmed noncommunicable diseases as a sustainable development priority in the Montevideo roadmap 2018–2030.10
 Bangladesh has also developed the Multisectoral Action Plan for Prevention and Control of Noncommunicable Diseases 2018-2025, with a three-year operational plan.11 Earlier the country has developed National Nutrition Policy, 2015, Second National Plan of Action for Nutrition, 2016-2025, Dietary Guidelines and other policies, strategies and action plan. The country is putting efforts for the prevention and control of malnutrition and NCDs.
 Furthermore, to prevent and control the diet related noncommunicable diseases across the life cycle nutrition labelling, re-formulation of food standards with limiting high sugar, salt and fat, and banning industrial transfats; restriction of food advertising particularly marketing of unhealthy foods to children, imposing tax on sugar sweetened drinks, junk food etc. Aimed at behavior change communication, mass-media campaigns, nutritional advice and nutrition education on NCDs in general and diet related NCDs in particular are thus recommended.

Philippines Case Study: Government Policies on Nutrition Education.

Government policies at the national and local levels are central to the promotion, protection, and implementation of sound food and nutrition concepts in the Philippines. According to the 2015 national nutrition survey, persistent malnutrition problems, such as protein-energy malnutrition and micronutrient deficiencies (anemia, vitamin A deficiency, and iodine-deficiency disorders), continue to afflict a major proportion of Filipinos. In the Philippines, nutrition education and promotion date back as early as 1900 with the conduct of educational campaigns directed towards the prevention and control of epidemic diseases and to the care and feeding of young infants. This presentation begins with an overview of the Philippine Government, nutritional status of children, the Philippine Plan of Action for Nutrition, then devotes substantial attention to nutrition program for school children, and examines other potential legislative actions that may have an impact on the community and industry. While various nutrition education initiatives, addressing malnutrition problems among Filipinos, resulted in an improvement in some of the conditions, much is still to be done to achieve zero malnutrition for the Philippines. Eliminating hunger and malnutrition is technically feasible. The challenge lies in generating the requisite political will, developing realistic policies, and taking concerted actions nationally and internationally.