Transcript 4th National Seminar on and Nutrition – ( Theme Child and

4th National Seminar on Food Security and Nutrition
Under the theme “Child and Maternal Nutrition”
Needs and challenges for scaling
up evidence-based nutrition
interventions in Cambodia
National Maternal and Child Health Centre, MoH
Dr. Prak Sophonneary
1. Success at scale
• Breastfeeding
• Vitamin A supplementation,
immunization and deworming
• Iron/Folic Acid supplementation for
pregnant & postpartum women
• Antenatal care, delivery & Postnatal
care
• Household use of iodized salt
2. Specific Problems/Challenges
• Many women are entering
pregnancy thin and anemic
• Iron supplementation for
women of reproductive age
expensive
• Promoting dietary intake and
weight gain during pregnancy
not previously emphasized
• Despite improvement in Iron/
Folic Acid, pregnant/
postpartum women still anemic
2. Problems/Challenges (cont)
• Many young children receive
inappropriate diet
• Formula use is increasing and
mothers are stopping breastfeeding
earlier
• No intervention for child multiple
micronutrient deficiency until
recently
• Resources allocated to identifying
and treating child malnutrition
insufficient
2. Overall Problems/Challenges
• Nutrition improvement relies on behavior change, which
is expensive and takes time
• Financial allocation for nutrition low
• No structure to support community based nutrition
program
• Limited number of Cambodian nutrition experts with
formal training
• Limited multi-sectoral program
based approach
3. Solutions
For anemia and low weight gain
during pregnancy:
• Emphasize nutrition counseling
and promotion and monitoring of
weight gain during Antenatal care
(ANC)
• Improve early ANC and
compliance to Iron/Folic Acid
supplementation
• Identification and treatment of
anemia
3. Solutions (con’t)
For anemia & thin women of
reproductive age:
• Iron fortification of food
• Targeted iron supplementation to
high risk women
• Social marketing of iron
supplementation
• Scale up nutrition promotion
with homestead food
production
3. Solutions (con’t)
For inappropriate feeding of
children:
• Implement behavior change
communication campaign for
complementary feeding
• Strengthen enforcement of
Sub-Decree 133 to stop
marketing of breastmilk
substitutes
• Scale up multiple micronutrient
powder supplementation
3. Solutions (con’t)
For identifying and treating child
malnutrition:
• Connect identification and treatment of
malnutrition to the Health Equity Fund
and other social protection mechanisms
• MoH and local government financing for
Village Health Support Group (VHSG)
screening and referral of malnutrition
• Create structure to support community
based nutrition program to prevent
malnutrition
4. Way forward - Immediate
• Improve quality of nutrition counselling during ANC/PNC
• Health Information System includes indicator for weight
gain during pregnancy
• Gain better understanding of lack of
response to Iron/Folic Acid
supplementation during pregnancy
• Develop plan for iron supplementation
of women of reproductive age
• Review homestead food production
programs and connect to nutrition
activities
4. Way forward - Immediate
• Evaluate complementary feeding campaign and secure
financing for scaling up
• Scale up treatment of diarrhea using ORS + zinc
• Identify advocate/champion for enforcement of sub
decree 133
• Cost-sharing arrangement between partners and MoH
for procurement of Multiple Micronutrient Powders
• Identify appropriate structure for community based
program
• Start using Health Equity Fund for treatment of
malnutrition in hospitals
4. Way forward (medium & long term)
• Moving from visual to biochemical
test for anaemia during pregnancy
• Private sector engagement for
social marketing of iron
supplementation for women of
reproductive age and fortification
• Test new structure for community
based program
• Human resource development for
nutrition professional