Introduction
Good nutrition is crucial at every stage of life, from prenatal development through adulthood, for survival, physical growth, mental development, performance, productivity, health, and overall well-being. Malnutrition during the first 1,000 days of life can cause irreversible damage. The World Health Assembly aims to reduce the percentage of stunted children under five by 40% by 2025, emphasizing that every child has the right to a healthy diet as outlined in the Convention on the Rights of the Child.
Micronutrient powders (MNP) are single-dose packets containing a variety of essential vitamins and minerals in powder form, designed to be sprinkled over any semi-solid meal. They are a key method to enhance the micronutrient intake of children under two years old is the use of MNP for point-of-use or at-home fortification of their meals. Undernutrition causes approximately 3.5 million deaths of women and children under five annually in developing nations, with many of these deaths linked to micronutrient deficiency. Over the last 16 years, the prevalence of anemia in children aged 6 to 59 months has fluctuated significantly. It peaked at 53% in 2006, dropped to 48% in 2011, further decreased to 43% in 2016, and then increased again to 46% in 2022. Anemia rates are highest in the Terai zone (49%) compared to the Hill (34%) and Mountain (43%) zones. Among provinces, Madhesh Province has the highest rate of child anemia at 51%, while Gandaki Province has the lowest rate at 31%.
In Nepal, 43% of children under five suffer from anemia, with a striking 65.7% among those aged 6-23 months. Only 40.9% of children in this age group have received at least one cycle of Baal Vita, a supplement tackling nutritional deficiencies. Madhesh province leads with 53.1% coverage, while Bagmati province lags at 27.7%. Just 5.1% of children receive three cycles of Baal Vita, with Sudurpaschim Province at 8.8% and Koshi at 2.5%. These numbers underscore the urgent need for improved anemia management and broader nutritional support across Nepal.
The Government of Nepal, Ministry of Health and Population (MoHP), in collaboration with UNICEF and US CDC Atlanta, implemented an integrated approach to address anemia among children aged 6-23 months. This initiative combines community promotion of Infant and Young Child Feeding (IYCF) practices with the distribution of Multiple Micro-Nutrient Powder (MNP). The training for Community Based (CB) IYCF and MNP was integrated into the Comprehensive Nutrition Specific Initiative (CNSI) package in 2019, allowing for streamlined nutrition-related training alongside the rollout of the Multi-Sector Nutrition Plan (MSNP, 2018-2022) across all 753 local levels.
Since 2019, Health Coordinators, Health Workers, and Female Community Health Volunteers (FCHVs) have undergone capacity-building training on CB-IYCF/MNP under the CNSI package, leading to a nationwide scale-up of the program. Despite these efforts, the prevalence of anemia among children aged 6-23 months remains high at 66%. According to the Annual Department of Health Services (DoHS) Report for 2021-2022, only an average of 21% of children aged 6 to 23 months have received their first cycle (60 sachets) of MNP (Baal Vita), and a mere average of 3% have received all three cycles (180 sachets). Given the reported coverage and compliance rates, there are concerns about the likelihood of improving the quality of children’s food and reducing the prevalence of anemia in this age group.
This study aims to investigate the primary barriers hindering the distribution and consumption of Multiple Micro-Nutrient Powder (MNP) among children aged 6-23 months across 14 municipalities in 7 districts. It also seeks to offer recommendations to overcome these identified barriers, collaborating with relevant sectors at various levels of government.
The proposed bottleneck analysis aims to examine the health system in three tiers of government around 6 domains namely (i) governance, (ii) information, (iii) financing, (iv) service delivery, (v) human resources and (vi) commodity & technologies using Tanahashi approach on nutrition service coverage and its evaluation. It will follow MoRES Ten Determinants (Social norms, legislation/policy, budget/expenditure, management/coordination, availability of the commodities/inputs, access to adequately staffed services, facilities and information, financial access, social and cultural practices and beliefs, timing and continuity of use and quality) framework to examine the bottleneck in improving infant and young child feeding practices and MNP coverage and compliance.
Objective of the Study
General Objectives:
To carry out the bottleneck analysis on improving community promotion of infant and young child feeding practices and multiple micronutrient powder (MNP) coverage and compliance and develop key recommendations to improve coverage, acceptance and utilization of MNP and optimal IYCF and hygiene practice for children aged 6-59 months.
Specific objectives:
- Map out both period and point coverage of MNP programme in the targeted areas.
- Identify factors (boosters/enablers and barriers) affecting uptake of the MNP services.
- Identify factors (boosters/enablers and barriers) affecting the utilization of MNP for home fortification.
- Identify factors (boosters/enablers and barriers) optimal IYCF and hygiene practice.
- Examine the health system’s effectiveness in promoting infant and young child feeding practices and to improve the children’s diet quality through home fortification at family level.
- Develop in collaboration with the MoHP and provincial health directorates specific recommendations/action plans to improve acceptance and coverage of MNP among children aged 6-23 months.
Team
Dr. Janak Thapa, Ms. Pragya Pokharel, Ms. Salina Thapa, Ms. Pabitra Balampaki and Mr. Sushanat Luitel
Partner: UNICEF Nepal
Duration: Aug 2024- December 2024