NUTRITION PROGRAMMES AND INTERVENTIONS

PHD annual review meeting

Held at: Erata Hotel8th -9th March 2007.

PREVALENCE OF MALNUTRITION

The major nutritional problems are under nutrition mostly PEM, Micro nutrient deficiencies (Emerging) diet related non communicable

diseases such as obesity, overweight, diabetes, hypertension, etc. with their attendant consequences

Women and children are mostly affected

Prevalence of Protein Energy Malnutrition-PEM

PEM levels in children generally high

About 30% of children under five are stunted i.e. too short for their age

7% are wasted i.e. too thin

22% are underweight i.e. have low weight for their age

PEM

0

5

10

15

20

25

30

35

Underwt Wasting Stunted

PEM IN CHILDREN BY URBAN/RURAL AREA (DHS 2003)

URBAN RURAL

Malnutrition is generally higher in rural than urban areas.

PEM -Nutritional Status of Children by Region (DHS 2003)

Except for GAR, stunting is generally high but highest in NR, UWR, UER & CR

VR, UER,UWR recorded wasting levels above the national average of 7%

NR, UER, UWR, VR & CR had underweight levels above the national average of 22%

PEM HIGHLY PREVALENT IN 3 NORTHERN REGIONS + VR + CR

REG Underwt Wasting Stunting

ASH 20.8 6.7 29.1

BA 20.4 5.7 29.4

CEN 22.0 3.0 31.6

EAS 17.3 6.2 27.4

GAR 11.5 7.2 13.9

NOR 35.5 6.6 48.8

UER 32.4 12.9 31.7

UWR 25.9 11.0 34.1

VOL 25.7 13.9 23.3

WES 16.5 5.3 28.4

Malnutrition in Women PEM in Women

Maternal malnutrition measured by BMI<18.5declined slightly from 11% (’93 & ‘98) to 9% (2003)

Over nutrition among women 25% of women in Ghana are overweight,

one-third of these are obese. Greater Accra has the highest prevalence -

46% of women overweight with more than half obese.

Micronutrient Malnutrition

Iron Deficiency/Anaemia Preschool children – 76% pregnant women – 65% women 15-49 years - 45% (DHS 2003)

Vitamin A Deficiency (VAD) U5s had severe VAD - 72% Children aged 12 – 24 mon. & those in rural areas most

at risk Breastmilk retinol showed low prevalence- 6.7% (VAD –

breast milk retinol < 30 ug / dl)

Iodine Deficiency 9 districts out of 27 (33%) surveyed had serious IDD

problems

Goal and Areas of focus

Goal: To ensure that all persons living in Ghana are well nourished.

Areas of Focus: improving awareness, knowledge in

nutritional issues including infant and young child feeding practices and maternal nutrition

promoting improved management of malnourished children / persons and

preventing /controlling micronutrient deficiencies due to iodine, iron and vitamin A

INTERVENTIONS

Promoting Healthy Eating and Healthy Lifestyle

Infant and Young Child feeding Community Based Growth Promotion Supplementary Feeding Micronutrient Deficiency Control

Vitamin A deficiency Control Iodine Deficiency Disorders Iron Deficiency Anaemia

Interventions Control of Micronutrient Deficiencies.

Micronutrient deficiencies of importance are:

iodine deficiency, vitamin A deficiency and iron deficiency/anaemia.

Strategies adopted for control of these deficiencies are: Education on diversifying the diet through promoting the

production and consumption of micronutrient rich foods.

Micronutrient Supplementation. Fortification of selected foods.

Other public health interventions done in collaboration with other stakeholders e.g. promoting good hygiene and sanitation and deworming, malaria control and immunization.

Achievements

Imagine Ghana Free of Malnutrition Strategy A Director-General initiative which enjoins the

various stakeholders to prevent and control malnutrition in an integrated manner covering all intervention areas. A roll out plan was developed for advocacy and

dissemination to policy makers at all levels and development partners.

Six episodes on child feeding, growth promotion and food hygiene were prepared for TV under the theme ‘Healthy child, every child counts’.

Achievements

Healthy Eating and Lifestyle New Health Paradigm-Regenerative Nutrition

The new health paradigm is promoting healthy lifestyles among people living in Ghana.

In 2006, a draft training manual was revised and training piloted. There are plans to scale up training of health workers community based change agents and other extension agents nationwide.

Achievements

Infant and Young Child feeding Strategy

The strategy seeks to promote appropriate feeding

for different stages of infancy and early childhood. In 2006 Wall Charts on Essential Nutrition Actions

(ENAs) were printed, distributed and training organized for health workers to operationalise use of ENAs.

The ENAs are actions taken at any health contact with the child or the mother covering breastfeeding, complementary feeding, feeding the sick child, women’s nutrition, control of iron, vitamin A and iodine deficiencies.

IYCF - Achievements

Twenty-six agents from FDB. Environmental Health and GHS trained on monitoring of BF Regulation 2000.

12 Health Workers from Central, Western and Volta regions trained on infant feeding counseling.

Achievements

Community Based Growth PromotionCommunity Participation in child growth monitoring and promotion implemented through the District Assemblies.

After running the project for 2 years, some positive impact was realized e.g. project contributed to increases in exclusive breastfeeding rate in project communities.

In 2006 programme was planned for expansion into 500 communities in 50 districts.

Achievements

Supplementary Feeding Programme A programme that provides health and nutrition education,

growth monitoring, deworming, vitamin A supplementation, immunisation and food to children under five, pregnant and lactating women in 26 districts in the 3 Northern regions.

After running programme for a number of years, mean birth weight has increased from 2.2 to 2.8kg

Proportion of lactating women with low Body mass index(BMI) ie underweight, has reduced.

In 2006, programme scaled up to 170 communities covering 14,000 children 6-24 months, 60,000 children 2-5years 10,000 pregnant and lactating women.

Achievements

Nutrition and HIV/AIDSAdequate nutrition is a co-therapy for HIV-AIDS. Good nutrition is required to boost the compromised immune system in HIV/AIDS patients

Dietary guidelines have been developed for people living with HIV/AIDS.

Achievements

Iodine DeficiencyThe main control strategy is Universal Salt Iodisation and the target set was to increase household coverage from 74.4% (in 2005) to at least 90% or more by end of 2006. (50%-2002; 44.4%-2003)

In 2006, IEC activities included development of a TV documentary with Miss Ghana 2006 as main star.

Achievements

Iron deficiency/Anaemia controlAims at reducing anemia among women and children by

25% over a 5-year period

Radio spots on anaemia control in pregnancy translated in local languages and aired on 16 radio/Fm stations nationwide

Guidelines for school aged children were developed and piloted in collaboration with stakeholders and partners

National School age Deworming was undertaken by Nutrition Unit, RCH, Disease Control Unit in February in collaboration with GES.

Achievements

Vitamin A deficiency controlThe programme aims to eliminate vitamin A deficiency.

Promoting the consumption of vitamin A rich foods is on-going.

2 rounds of vitamin A capsules were distributed to children 6-59 months. National coverage of 81% was achieved in Nov 2006.

Distribution of capsules to lactating women within 8 weeks after delivery is on-going. National coverage from the Demographic and Health Survey, 2003 was 43%.

AchievementsFood fortificationProgramme aimed at fortifying vegetable oil with vitamin A and

wheat flour with vitamin A iron, B-vitamins and zinc.

Last year a proposal submitted by a multisectoral committee, the National food fortification Alliance won approval for award of a grant to kick start the programme

A legislative instrument developed for the amendment of the food law was submitted for approval of cabinet.

Fortification of commercially processed vegetable oil and wheat flour is expected to start in April 2007.

CHALLENGES

Key Challenges faced: (Large) Funding Gaps for implementation of

Programmes / planned activities Need for a comprehensive and integrated

nutrition communication strategy Inadequate staff at district level in particular

and also at national level Securing District Assembly support for program

activities at community level Inadequate commitment by collaborators

STRATEGIC PLAN 2007-2011

Build capacity for growth promotion at regional, district/sub-district and community levels.

Implement the new W.H.O. growth standards.

Intensify nutrition BCC/IEC in all program areas especially complementary feeding.

Increase awareness and knowledge on ENAs.

STRATEGIC PLAN 2007-2011

Implement a roll out plan on guidelines for nutrition care and support for PLWHIV.

Initiate development of Nutrition guidelines in the management of TB.

Mobilize support to provide Vitamin A capsules to children aged 6 to 59 months and lactating women and strengthen data capture.

Support Micronutrient Food Fortification in collaboration with Global Alliance for Improved Nutrition (GAIN) & FDB.

STRATEGIC PLAN 2007-2011

Conduct survey to appraise the Vit. A supplementation program and impact of consumption of iodated salt.

Ensure effective enforcement of LIs on salt iodation, fortified wheat flour/vegetable oil and the breastfeeding regulations.

Disseminate, sensitize and roll out IGFM.

Intensify Monitoring/Supportive visits to regions and districts

THANK YOU