Interventions for Maternal and Child Health in Nepal Essay Example for Free

Interventions for Maternal and Child Health in Nepal Essay Macro- and micro-nutrient malnutrition is a major public health problem and a key factor in determining morbidity and mortality. Its underlying determinants include poverty, education, sanitation, climate, food production, cultural norms, and accessibility and quality of health care. Pregnant women and young children are particularly at risk owing to the extra nutritional demands of rapid growth. Malnutrition is the direct cause of approximately 300,000 deaths per year (Muller Krawinkel, 2005), and a contributing factor in over a third— 3.5 million—of all child deaths annually (Horton, 2008). These deaths are largely preventable. For infants, there is a â€Å"golden interval† for intervention from pregnancy to 2 years, during which improvements in nutritional status can have long-lasting benefits (Horton, 2008). Strong associations exist between maternal and child undernutrition and reduced adult economic productivity and other negative outcomes (Victoria et al., 2008). While Nepal has recently demonstrated progress toward improving general maternal and child health (MCH), there are still opportunities to further improve nutritional status of mothers and children. This paper examines and makes recommendations about interventions that have the potential to improve maternal and child nutritional status in Nepal. The interventions discussed in this paper address the underlying causes of nutrition-related maternal and child mortality and morbidity, as outlined by the UNICEF Conceptual framework for maternal and neonatal mortality and morbidity (UNICEF, 2008), and are organized based on the period of intervention, including antenatal care, delivery care, and post-partum and early childhood care. Antenatal care: Within the antenatal period of development, maternal supplementation has been one of the most studied interventions. Evidence is strongest in support of maternal supplementation of multiple micronutrients, calcium, and iron-folic acid. Given the staggering rates of micronutrient deficiencies among pregnant Nepali women and the low cost of supplementation, maternal supplementation of multiple micronutrients, calcium and iron-folic acid is highly recommended. These micronutrients have a range of benefits, including reduction of maternal anemia, maternal mortality, pre-eclampsia, hypertension, puerperal infection, and low birthweight (LBW). This paper also examines the evidence around maternal smoking cessation interventions because of the extraordinary potential for impact of such programs in a population where smoking rates among women are high and knowledge about negative outcomes associated with smoking is low and because maternal smoking cessation appears to have not been a focus of government and other programs in Nepal. However, there is a lack Executive Summary i of solid evidence to suggest that a particular intervention to reduce maternal smoking could be both effective and efficient in developing countries. Delivery care: This paper also examines interventions during delivery that can have an impact on nutritional status. Traditional birth attendants (TBAs) play a crucial role in decreasing nenonatal and maternal mortality during delivery. They also dispense advice regarding antenatal, perinatal, and postnatal care, including nutrition and diet, breastfeeding, and immunizations. One important aspect of training for TBAs, as well as other health professionals, is the promotion of delayed umbilical cord clamping. Due to the high rates of anemia and iron deficiency in children, delayed cord clamping is a critical intervention because it is a cost-effective way to improve hematologic status, increase blood volume, and decrease anemia in infancy. Post-partum and early childhood care: Finally, nutritional interventions in the post-partum and early childhood period can reduce childhood morbidity and mortality and ensure that children are developing in a healthy way. This section of the paper focuses on the promotion of breastfeeding, infant and child vitamin A supplementation and growth monitoring and promotion (GMP). There exists decades of research showing that breastfeeding is a highly effective strategy to reduce all-cause mortality, diarrheal morbidity and mortality, and the risk of gastrointestinal infections and respiratory infections. There is a wealth of empirical data supporting the promotion of breastfeeding in developed and developing countries alike. Vitamin A supplementation for infants and young children has already been successful in Nepal, and it should remain a priority there. Vitamin A supplementation is associated with reductions in night-blindness, Bitot’s spots, xerophthalmia, and severe morbidity and mortality from infectious diseases, and when given before certain immunizations, it can enhance the immune response to the immunizations, making them more effective. Also, the use of GMP, measuring and charting the growth of children and using this information to counsel parents to motivate behaviors that promote growth, provides a cost-effective opportunity to identify growth issues before severe malnutrition manifests. For summary information on recommended interventions, refer to the one-page briefs after this Executive Summary. The interventions examined in this paper collectively have an enormous potential for impact in Nepal. At the same time, it is important to consider some of the challenges and feasibility concerns that these interventions may face. These may Executive Summary include: access to and utilization of antenatal care and other health services; the status of the health system infrastructure; financial resource availability, and cultural considerations. Also, while these recommended interventions can be successful in addressing the underlying causes of malnutrition-related morbidity and mortality, long-term solutions for improving maternal and child nutritional status must address the basic causes, such as political, economic and social conditions. While challenges and other considerations exist, the interventions recommended have the potential to make a real and lasting impact in Nepal by reducing the burden of nutrition-related morbidity and mortality. These interventions are cost-effective tools that should be central to any plan to create a bright and healthy future generation in Nepal.