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30 years of Nutrition program in Vietnam: Implementation,
progress and challenges
Ha Huy Khoi, MD, DSc
Vietnam Nutrition Association- National Institute of Nutrition
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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)
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Period 1980 - 1995
In 1980: The National Institute of Nutrition VN was established
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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
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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).
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Nutrition Policy
and
Strategy in Vietnam
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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.
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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…
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Period 2001-2010
In 2001: The NNS 2001- 2010 was approved by the Government.
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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.
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How to implement the
nutrition activities/programs
in Vietnam?
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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
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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…
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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…
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Intervention Strategies
• Preventive Orientation: Nutrition throughout the lifecycle
• Prioritizing: High risk groups; Provinces with high malnutrition rate
• Community-based and Multi-sectoral Approach
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Nutrition Capacity Building from Central
to local level
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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
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Implementation Mechanism/System
MOH
NIN
Preventive Medicine /Maternal and Child Care Centers
Commune Health Center
104,000 Nutrition Collaborators
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National Conference for Nutrition Collaborators
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Food preparation demonstration/practices
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Mother’s club
Nutrition contest
Growth monitoring
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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…)
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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
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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
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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
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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”
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- Nutrition Training and Education- Credit programs- Providing new seeds and breeds
World Mission projects
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Progress and sustainability
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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
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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.
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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
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Underweight (W/A)
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Ninh ThuËnNinh ThuËnNinh ThuËnNinh ThuËnNinh ThuËnNinh ThuËnNinh ThuËnNinh ThuËnNinh ThuËn
Phó ThäPhó ThäPhó ThäPhó ThäPhó ThäPhó ThäPhó ThäPhó ThäPhó Thä
Phó YªnPhó YªnPhó YªnPhó YªnPhó YªnPhó YªnPhó YªnPhó YªnPhó Yªn
Qu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nhQu¶ng B×nh
Qu¶ng NamQu¶ng NamQu¶ng NamQu¶ng NamQu¶ng NamQu¶ng NamQu¶ng NamQu¶ng NamQu¶ng Nam
Qu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· iQu¶ng Ng· i
Sãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ngSãc Tr ng
Th i NguyªnTh i NguyªnTh i NguyªnTh i NguyªnTh i NguyªnTh i NguyªnTh i NguyªnTh i NguyªnTh i Nguyªn
T©y NinhT©y NinhT©y NinhT©y NinhT©y NinhT©y NinhT©y NinhT©y NinhT©y Ninh
TiÒn GiangTiÒn GiangTiÒn GiangTiÒn GiangTiÒn GiangTiÒn GiangTiÒn GiangTiÒn GiangTiÒn Giang
Th i B×nhTh i B×nhTh i B×nhTh i B×nhTh i B×nhTh i B×nhTh i B×nhTh i B×nhTh i B×nh
TP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ MinhTP. Hå ChÝ Minh
Tuyªn QuangTuyªn QuangTuyªn QuangTuyªn QuangTuyªn QuangTuyªn QuangTuyªn QuangTuyªn QuangTuyªn Quang
Trµ VinhTrµ VinhTrµ VinhTrµ VinhTrµ VinhTrµ VinhTrµ VinhTrµ VinhTrµ Vinh
VÜnh LongVÜnh LongVÜnh LongVÜnh LongVÜnh LongVÜnh LongVÜnh LongVÜnh LongVÜnh Long
VÜnh PhócVÜnh PhócVÜnh PhócVÜnh PhócVÜnh PhócVÜnh PhócVÜnh PhócVÜnh PhócVÜnh Phóc
Yªn B iYªn B iYªn B iYªn B iYªn B iYªn B iYªn B iYªn B iYªn B i
Ninh B×nhNinh B×nhNinh B×nhNinh B×nhNinh B×nhNinh B×nhNinh B×nhNinh B×nhNinh B×nhNam §ÞnhNam §ÞnhNam §ÞnhNam §ÞnhNam §ÞnhNam §ÞnhNam §ÞnhNam §ÞnhNam §Þnh
Thõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕThõa Thiªn- HuÕ
Kon TumKon TumKon TumKon TumKon TumKon TumKon TumKon TumKon Tum
Hµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnhHµ TÜnh
Thanh HoThanh HoThanh HoThanh HoThanh HoThanh HoThanh HoThanh HoThanh Ho
S¬n LaS¬n LaS¬n LaS¬n LaS¬n LaS¬n LaS¬n LaS¬n LaS¬n La
Lµo CaiLµo CaiLµo CaiLµo CaiLµo CaiLµo CaiLµo CaiLµo CaiLµo Cai
Qu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng NinhQu¶ng Ninh
Qu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞQu¶ng TrÞ
HËu GiangHËu GiangHËu GiangHËu GiangHËu GiangHËu GiangHËu GiangHËu GiangHËu Giang
CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬CÇn Th¬
§¨k L k§¨k L k§¨k L k§¨k L k§¨k L k§¨k L k§¨k L k§¨k L k§¨k L k
§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng§¾k N«ng
Lai Ch©uLai Ch©uLai Ch©uLai Ch©uLai Ch©uLai Ch©uLai Ch©uLai Ch©uLai Ch©u
§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn§iÖn Biªn
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%
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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
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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
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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
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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)
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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 ÷
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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
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Challenges• High rate of stunting among <5
• Problems of Micronutrient deficiencies
• Increasing overweight/obesity and NCD…
• Problems of nutrition in transition
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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…
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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
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