NATIONAL 5 (Spotlight Weekly)]

Healthy Progress

Significant gains in fight against iodine and vitamin A deficiencies

By AKSHAY SHARMA

Nepal has made significant strides in the fight against two major global nutrition problems -- deficiencies of iodine and vitamin A -- according to the first nation-wide micronutrient status survey released this month. But anemia, another global nutrition problem, continues to trap Nepalese in a vicious cycle of poor growth and ill health.

The survey, a random sampling of 15,000 households, notes that iodine deficiency disorders, which retards children's cognitive development, is nearing elimination in Nepal. Vitamin A deficiency, which decreases the ability to fight illness, has almost disappeared in preschool children.

Children : Iodized

"We attribute our remarkable progress to two successful public health interventions," said Minister of Health Ram Baran Yadav, at a press conference organized to release the survey findings. "The rigorous promotion of iodized salt among consumers, and the distribution of vitamin A capsules through mass campaigns, are measures taken by His Majesty's Government and will continue to be supported."

Over four million Nepali children in 69 districts receive vitamin A capsules twice a year, in a campaign made possible by the mobilization of community leader, volunteers, and health workers. The campaign is conducted through the joint efforts of the Ministry of Health, USAID, Austrian SID, NTAG, JSI and UNICEF. Nearly all the sodium in the market is fortified with iodine, and a social marketing campaign is under way to promote packaged iodized salt.

The survey findings show that visible goiter, a common sign of iodine deficiency, is no longer found in school-aged children and affects only 1.3 percentage of women. Night-blindness is detected in 0.27 and Bitots spots, a more advanced sign of deficiency, in 0.33 percent of preschool children -- a great reduction from past surveys. The data point to an overall substantial drop in indicators related to insufficient intake of nutrients vital to human growth and well-being.

Reducing anemia, the deficiency of iron, is the new challenge. The survey shows that 68 percent of women and 78 percent of preschool children suffer from anemia. Anemia also affects 75 percent of Nepali pregnant women. This is alarming because during pregnancy, the fetus requires its own supply of iron that can only be obtained from the mother.

Anemia greatly increases the risk of a mother suffering complications in labor and delivering a low birth weight baby, and helps put both the mother and child in a vicious cycle of malnutrition.

The highest anemia prevalence of 88 percent, according to the survey, is found in children between 6 and 23 months -- a very critical period of growth and development. The staggering figure signifies that Nepali children are being born with low iron stores and are not receiving enough iron in their food.

"Anemia is damaging to both mother and children, yet it is so widespread,'' said Stewart McNab, UNICEF country representative in Nepal. "Nepal has shown it can triumph over two of the most pervasive micronutrient problems,'' he added. "It now needs action to achieve another breakthrough in controlling iron deficiency."

The survey also points to little improvement in the general nutrition status of children over the last 23 years. Using height as an indicator, Nepali children are shorter than expected for their age. The prevalence of stunting among children aged from 6-5.9 months has dropped only 15.3 percentage points since 1975, from 69. And to 54 percent in 1998.

"His Majesty's Government is convinced of the need for new approaches to solving the problem of malnutrition. Malnutrition hinders a child's health and development, so we cannot passively accept it,'' said Minister Yadav.

McNab agreed that the poor progress in reducing general malnutrition called for new approaches. "We are seeing exciting results from HMG's decentralized, community-based approach, which we would like to see replicated."

The survey was conducted by New Era in 1997-98 with the support of the Ministry of Health, the Micronutrient Initiative, UNICEF and the World Health Organization.