presentation icn vn

30 years of Nutrition program in Vietnam: Implementation,

progress and challenges

Ha Huy Khoi, MD, DSc

Vietnam Nutrition Association- National Institute of Nutrition

Nutrition in Vietnam before 1980

• Food shortage. No sector responsible for nutrition.

• Nutrition and Food safety Dep. (NIHE): Nutrition Research

• Nutrition Section at Hanoi Medical University: Nutrition Module and Medical doctors nutrition oriented (42 persons)

Period 1980 - 1995

In 1980: The National Institute of Nutrition VN was established

Nutrition Program/activities 1980-1995

• Conducting nutrition epidemiological researches Nutrition problems and causes

• Introduction of VAC Eco-System to alleviate the Household Food Insecurity (V-garden, A-fish pond, C-animal husbandry)

• Nutrition Education and Training to Set –up the Network of Nutrition in the whole country

Nutrition Program/activities 1980-1995

• WFP project 2651 (1983-1988): supplementary feeding for vulnerable groups (pregnant and lactating mothers, under five children)

• Since 1989: Nationwide Vit. A capsule distribution to children 6-60 mo in 1994 Vietnam was Xerophthalmia free

• Iron-folic acid tablets supplementation to pregnant women (pilot UNICEF project).

Nutrition Policy

and

Strategy in Vietnam

Period 1995-2000

In 1995: The NPAN 1995-2000 was ratified by the Prime Minister; the Government asked authorities at all levels to integrate nutrition goals, reduction of malnutrition into their SE development plan.

NPAN 1995-2000• Development of PEMC program (Government

allocated budget to 63 provinces)

• Since 1996: 1-2 of June – “National Vit.A distribution Day” “Micronutrient Day”.

• Iron supplementation project for pregnant women (Supported by UNICEF)

• Providing In-service training for nutrition staff at provincial and district level…

Period 2001-2010

In 2001: The NNS 2001- 2010 was approved by the Government.

General objective

By the year 2010, this strategy aims to ensure the significant improvement of nutritional status of the country’s population; primarily children and mothers. In addition, it will attempt to minimize emerging nutrition-related health problems.

How to implement the

nutrition activities/programs

in Vietnam?

NNS 2001-2010Development of Nutrition project/programs:• National PEMC Program (Increased the Gov.

Budget and mobilized resources from local)• National Vitamin A distribution program:

– <2005: Supported by UNICEF– > 2005: partly by Gov. and ADB, other sources

• Iron supplementation:– < 2005 supported by UNICEF in selected

districts– > 2005: Pregnant women paid for Fe tablets

• Pilot project on Multi-Micronutrient supplementation

NNS 2001-2010How to implement Nutrition program/activities?

• Advocacy for stakeholders in nutrition

• Multi-sectoral approach in implementation of NNS activities: Health, Agricultural, Training & Education…

• Involvement of social organizations: Women Union, Farmer Union, Youth Union…

NNS 2001-2010How to implement Nutrition program/activities?

Strengthening International cooperation:– Program/projects of UN organizations (UNICEF,

WHO, FAO)– Capacity Building Project (the Netherlands

government)– GAIN (Fe Fortified Fish Sauce)– ADB project (Vit, A + De-worming)– Community- based projects of the WM, SCUS,

IRD, ILSI, JICA, GRET…

Intervention Strategies

• Preventive Orientation: Nutrition throughout the lifecycle

• Prioritizing: High risk groups; Provinces with high malnutrition rate

• Community-based and Multi-sectoral Approach

Nutrition Capacity Building from Central

to local level

Nutrition Training in Vietnam• In 1990: Nutrition, Food hygiene and Safety

Dep-t at Hanoi Medical University was established.

• In 2005: Nutrition Dep-t was established in other Medical Universities, Agricultural Universities…

• Since 1994: Carrying out the M.Sc in Community Nutrition Training

• Since 2005: PhD in Nutrition Training at NIN

Implementation Mechanism/System

MOH

NIN

Preventive Medicine /Maternal and Child Care Centers

Commune Health Center

104,000 Nutrition Collaborators

National Conference for Nutrition Collaborators

Food preparation demonstration/practices

Mother’s club

Nutrition contest

Growth monitoring

A comprehensive Package of Interventions in 3 provinces

(UNICEF/NIN Vietnam)

1. Adding new items in the existing PEMC program to make it more comprehensive and target more on pre-pregnancy

2. Strengthening partnership among health and with social sectors (Women Union, Youth Union…)

Additional Interventions

Before pregnant– De-worming every 6 months – Weekly dose of MMN– IEC activities

During pregnant– Multiple micronutrients daily dose– IEC activities

Infancy– Ensured vitamin A supplementation high

coverage– Quality of the growth monitoring activity– Communication for nutrition behavior change at

the household level

IEC activities

• IEC center has been set up at NIN in 1995

• IEC campaign: –1-2 Jun Micronutrient Days

–16-23 Oct Nutrition Week

• Education materials: Booklets :To be mother. Nutrition: questions and answers..

• RDA: approved in 1996, revised in 2007

• FBDG: ten recommendation for healthy nutrition, revised in 2006

Provision of healthy foods

• A food workshop has been set up at NIN

in 1985

• Products: balanced food mixtures,

micronutrient fortified cakes, multiple

micronutrient sprinkles, functional foods

The Netherlands Project

“Local capacity building for effective and sustainable implementation of community-based nutrition activities for improving nutritional status of women and children in 10 disadvantaged provinces in Vietnam”

GAIN project

“Iron fortified fish sauce for control iron deficiency anemia in Vietnam 2006-2008”

- Nutrition Training and Education- Credit programs- Providing new seeds and breeds

World Mission projects

Progress and sustainability

1. Malnutrition Reduction is 1 of the National criteria of the SE development.

2. Increasing Gov. Budget year by year + Mobilizing the local resources Socialization of nutrition activities

Progress and Sustainability

Progress and Sustainability

3. Building up a strong nutrition network from central to grassroots levels

4. High level political awareness and support of the stakeholders/local leaders.

Trend of underweight among under 5 children in Vietnam 1985-2008 (%)

S D D đ ộ I S D D đ ộ I I + I I I

1 9 8 5 3 6 .5 1 61 9 9 4 3 3 .9 1 11 9 9 9 2 9 7 .72 0 0 0 2 7 .7 6 .12 0 0 1 2 6 .5 5 .42 0 0 2 2 5 .5 4 .82 0 0 3 2 3 .8 4 .62 0 0 4 2 2 .8 3 .82 0 0 5 2 1 .9 3 .32 0 0 6 2 1 .6 1 .82 0 0 7 1 9 .7 1 .52 0 0 8 1 9 . 9 2 . 4 2 2 . 3

5 1 . 5

4 4 . 9

3 6 . 73 3 . 8 3 1 . 9 3 0 . 3

2 8 . 4 2 6 . 6 2 5 . 2 2 3 . 4 2 1 . 2 1 9 . 9

0

1 0

2 0

3 0

4 0

5 0

6 0

1 9 8 5 1 9 9 4 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8

S D D đ ộ I S D D đ ộ I I +I I I

Underweight (W/A)

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Suy dinh d ì ng c©n nÆng theo tuæin¨m 1999

40 - 100 (20)35 - 40 (15)30 - 35 (22)25 - 30 (2)20 - 25 (1)15 - 20 (1)

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40 - 100 (20)35 - 40 (15)30 - 35 (22)25 - 30 (2)20 - 25 (1)15 - 20 (1)

% SDD

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Suy dinh d ì ng c©n n¨ng theo tuæiN¨m 2004

35 - 40 (7)30 - 35 (12)25 - 30 (30)20 - 25 (11)15 - 20 (2)00 - 15 (2)

Suy dinh d ìng trÎ em n¨m 2008: 19,9%

Suy dinh d ìng trÎ em n¨m 1999: 36,7%

04/12/23 33

Trend of Stunting among children under 5 years of age in Vietnam from 1985 -2008 (%)

59.7

56.5

46.9

36.5

33.9

32.6

1985

1989

1995

2000

2007

2008

Secular trend in growth of Vietnamese children during 1875-2003 periods

Female

50

65

80

95

110

125

140

155

170

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Age

cm

Mondière (1875) National reference (1975)National Institute of Nutrition (1985) National reference (2003)NCHS reference population (1981)

Male

50

65

80

95

110

125

140

155

170

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Age

cm

Prevalence of vitamin A deficiency (serum retinol <0.7umol/L) among <5

43

33.6

27.1 25.922.7

29.8

0

10

20

30

40

50

.6-12 .12-24 .24-36 .36-48 .48-59 .6-59

Nhóm tuổi (tháng)

%

(VDD/UNICEF, 2006)

Vietnam: xerophthalmia free since 1994

45,3%

34,1%

40,2%

24,3%

52,7%

32,3%

0

10

20

30

40

50

60

Children <5 Non-pregnantwomen

Pregnantwomen

1995

2000

Anaemia prevalence (in 1995 and 2000)

Overweight and obesity (BMI≥25) in 2005

1 1 . 81 0 . 9

1 5 . 7

1 8 . 7

1 6 . 1

2 4 . 1

1 6 . 1

2 4 . 6

1 4 . 6

1 8 . 1

0

5

1 0

1 5

2 0

2 5

2 5 - 3 4 3 5 - 4 4 4 5 - 5 4 5 5 - 6 4 C h u n g

N a m N ÷

Overweight and Obesity of adults (2005)

13.8

32.5

0

5

10

15

20

25

30

35

N«ng th«n Thµnh thÞNguån: Tổng điều tra BÐo ph× toµn quèc 2005

Challenges• High rate of stunting among <5

• Problems of Micronutrient deficiencies

• Increasing overweight/obesity and NCD…

• Problems of nutrition in transition

Nutrition Plan

• Conducting the National Nutrition Survey 2009 Development of NNS 2011-2020.

• Development of Stunting Reduction Plan

• Strengthening the Inter. Cooperation in nutrition research and training…

Vietnam nutrition association (VINUTAS)

• Set up in 2001, represent the nutrition community of the whole country, member of IUNS

• Work closely with NIN in implementing nutrition program

• Scientific seminars, biannual national Nutrition scientific meeting

• Quarterly journal “Nutrition and food science” since 2005

presentation icn vn

Documents

nutrition collaborators

healthy nutrition

nutrition module

nutrition behavior

nutrition staff

network of nutrition

nutrition goals

nutrition policy