Myanmar Iodine

Nepal

Vitamin A

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EPIDEMIOLOGICAL DATA
     
Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey:  Nepal Micronutrient Status Survey
Date: Dec 1997- May 1998
Groups Surveyed: Women, children 6-59 months, and children 6-11 years of age
Sample Size: Children 6-59 mos:         17,550
Children 6-11 yrs:           15,600
Women:                        15,600
Sampling Method: Two- stage cluster survey
Sampling Strategy: The survey was conducted nationally, but was designed to provide sub-national and regional estimates by selecting representative samples from each of the thirteen Eco- development zones (based on 3 Eco- zones and 5 development regions).  The two- stage cluster design was used to select 30 clusters from each of the Eco-development zones, and 40 households from each of the selected clusters.  Household eligibility was determined to be the presence of a woman with a pre-school aged child.  The sample sizes were then weighted based on analysis of differences among Eco- development zones.
Estimated Prevalence of VAD:  

Group

Sample Size
Indicator

Prevalence in Sample

Population Affected*

Women

15,536

Night-blindness

4.7                (19.3 in last pregnancy)

271, 426

Children 6-11 yrs

15,507

Night-blindness

1.2

39,859

Children 6-11 yrs

15,548

Bitots spots

1.9

63,110

Children 6-59 mos

15,307

Night-blindness

0.27

9,954

Children 6-59 mos

17,455

Bitots spots

0.33

12,166

*The estimates for the population affected were based on the US Census Bureau population estimates for Nepal 2000.  The number of women affected is based on the estimated population of women ages 15-49.  Children 6-59 months were based on the population of children 0-5 years.   The population of children 6-11 years was based on estimates of the number of children 5-10 years
 
Sub-clinical Vitamin A Deficiency
Most Recent Sub-Clinical VAD Survey

    

The most recent sub-clinical VAD survey was described above.

    

The only exception was that blood samples were taken from 25% of children 6-59 months and their mothers, and urine samples were collected from 25 % of children 6-11 years and from their mothers (however, the later was not reported)
   
Estimated Prevalence of VAD: 
 

Group

Sample Size
Indicator

Prevalence in Sample

Population Affected

Women

842

%<0.35umol/l

1.4

80,850

Women

842

%<0.70umol/l

16.6

958,654

Children 6-59 mos

843

%<.35umol/l

2.6

95,858

Children 6-59 mos

843

%<0.70umol/l

32.3

1,190,858

 
 
     
 

POLICY AND LEGISLATION
 

Legislation on VAD
     There is no VAD legislation in Nepal, however documents concerning the national policy have been published by the MOH.
     In 1992 the MOH outlined the National Vitamin A Programme of which the stated goal was the reduction of child mortality due to VAD through biannual supplementation of VA for pre-school children (6-59 mos).
 

Government Agency to Address VAD

      Nutrition Section of the Child Health Division of the Department of Health Services, Ministry of Health.  It is to fund and coordinate activities, but does not currently monitor them.

    

Contact Information:  Mrs. Sharanda Pandey, Chief, Nutrition Section, Teku, Kathmandu, +977-1-261660
     

PROGRAM DATA
Supplementation
Program Description
     Biannual supplementation of children 6-59 mos with high doses of VA capsules 
     Case treatment to patients with xerophthalmia, measles, malnutrition, prolonged diarrhea, and supplementation for post partum women within 8 wks. of delivery.
     IEC campaigns to increase the awareness of VAD and the importance of supplementation, treatment, and VA rich foods.
     Program coverage is considered high for children.  Estimates of coverage come from several surveys, which were consistent and include the NMSS 98, BCHIMES 2000, and NDHS 2001 to be published.
     In 1993 the program began supplementation of children, and in 1995 is started to supplement post partum women within 8 wks of delivery.
     Children over 1 year receive a doxe of 200,000 IU, children less than 1 year receive a dose of 100,000 IU and women receive a dose of 200,000 IU.
Targeting

    

The program targets 3.15 million children aged 6-59 months.  Coverage exists in 73 out of 75 districts, but political unrest has delayed expansion into the remaining two districts
Capsule Information

    

Children over 1 year receive a dose of 200,000 IU, and children less than 1year receive a dose of 100,000 IU.
Implementation

    

Supplementation is through national immunization days in the two districts with low coverage.  In the remaining 73 districts supplementation is through other mass campaigns, national vitamin A day.  There is no supplementation through schools or market days, but exists in clinics mostly for case treatment and for post partum women

   

Coverage:

Group

Estimated # Supplemented

# times/year

Coverage rate*

Children 6-59 months

3.1 million

2

85%

Post partum women

.2 million

Within 8 weeks delivery

20%

                                      *VA Supply for 2002 Information not yet provided
Fortification
 
            Fortified Foods:

Fortified Foods

 

Status of Program

 

Approx. % commodity fortified

 

Level of Food Fortification

 

Monitoring of Food Fortification

Yes

No

Oil

Through WFP

Entire quantity dist. By WFP, but not for commercial dist. 

30 IU/ gram

Partially

 

Vegetable ghee

Legislated

Less than 25%

25 IU/ gram

 

X

One brand of Biscuit

Piloted

Negligible

 

 

X

Complementary and blended foods

Through WFP food program

Entire quantity dist. By WFP, but not for commercial dist. 

16.64 IU/ gram

Partially

 

* Sugar, Maize, Milk, Wheat flour, Margarine, and Rice were all reported as not being fortified.

Production and Consumption

Product

Annual Production of Fortified Commodity

Estimated Number of People Consuming

Vegetable ghee

20,000 MT (rough estimate)

90% of production is exported to India.  Consumption in Nepal is not significant.  ( about 1% of households)

Cooking oil

1,200 MT

106,000

Complementary foods

5,000 MT

214,000
 
Micronutrient Premixes
     The premixes used are all imported and the annual tonnage and Value estimates are not available.  The premixes used are Ultramix, Vanitin, Trymix, Vitamix, and Paul Wellmix.
 
Other Programs
Community Based Programs
     Community programs are run by HKI.
     It focuses on dietary promotion through home gardening.
     
     
 
MONITORING
 

Clinical and Sub-clinical VAD
     There is no regular monitoring of clinical or sub-clinical vitamin A deficiency.  The surveys in the Epidemiology section are not planned to be repeated, but are likely to be undertaken again when it is suspected that VA status has changed
 
Supplementation
     There is monitoring of supplementation through the MOH’s Logistic Management Information System.  It is designed to track the number of capsules imported and distributed.  Secondly, The Nepal Technical Assistance Group (NTAG) conducts “mini surveys” biannually after each round of supplementation of children 6-59 months.  These surveys assess the coverage rate in 15 selected districts in each round (30-districts/ year). The surveys also collect other information, including mothers’ knowledge of VAD and VA rich foods, as well as supply and logistic issues perceived by community health workers.  The results of the mini surveys have been verified by national surveys, including the BCHIMES 2000 and the Nepal Demographic Health Survey (NDHS) 2001
Fortification
     A monitoring mechanism at the main government regulatory agency is being established.  In the case of fortified products distributed by WFP, samples of each batch of fortified foods are sent to India for analysis of VA and other micronutrient contents and the results are submitted to WFP.
     
     
PROGRAM RESOURCES
   
Donor Agencies

Implementing Agency

Description of Activities

Expenditure for Current Year

Suppl.

Fort.

Other

National/ state governments (MOH)

-          Supervision of capsule distribution.

-          Materials for distributors that are female community health volunteers.

9,000

 

 

UNICEF

-          Capsule procurement.

-          IEC/ promotional activities.

-          Training and orientation.

-          Monitoring.

589,000

 

 

USAID

-          IEC/ promotional activities.

-          Monitoring.

258,000

 

 

AusAID

-          Training

94,000

 

 

Micronutrient Initiative

-          Mainly strengthening monitoring system at government level. 

 

25,000

 

TOTAL

 

950,000

25,000

 

 

VAD Program Funding History and Forecast

Year

VAD Activity

Total

Supplementation

Fortification

Other

2001

950

National VA Programme (Nepali fiscal year July-June 2002).

25

System for monitoring (MI).

 

975,000

2002

221

National VA Programme (UNICEF’s planned contribution only).

110

-For cooking oil fortification.

- System for monitoring (MI).

 

331,000 (with just UNICEF and MI)

2003

220

Only UNICEF contribution.

170

Sugar fortification (MI).

 

390,000 (as above year).

2004

220

Only UNICEF contribution.

 

 

 

2005

220

Only UNICEF contribution.

 

 

 

Note:  The projected figures (2002-2005) do not include the cost of VA capsules that are estimated to cost $US150,000 per year.  VA capsules are also provided through CIDA and MI.