30 FEATURES www.unsystem.org/scn A National Plan of Action to Accelerate Stunting Reduction in Vietnam Nguyen Cong Khan, Le Thi Hop, Le Danh Tuyen, Ha Huy Khoi, Truong Hong Son, Phan Hoai Duong, Huynh Nam Phuong National Institute of Nutrition, Vietnam Abstract: Purpose of paper: To outline current maternal and child undernutrition in Vietnam and proposed strategies to overcome the problems. Main findings: During the last decade, Vietnam has achieved remarkable improvement in the nutritional status of its people, especially regarding the nutritional well-being of mothers and children. However, malnutrition is still a serious challenge for health and development. In 2007, 1.6 million children under 5 were underweight (21.2%), and 2.6 million were stunted (33.9%) country-wide (WHO standards). Micronutrient deficiencies, especially sub-clinical deficiencies in vitamin A, iron and iodine, are still significant public health problems. To accelerate the reduction of maternal and child undernutrition, the Vietnamese government is committed to prioritized investment for nutrition in order to achieve the MDGs. Special attention will be given to pre-pregnant and pregnant women to reduce intrauterine malnutrition. A key point of the intervention strategy is that more focus will be placed upon women and children in the first two years of life. The current national malnutrition control program should be maintained and expanded, focusing more on care at the household level. Resources should be prioritized for areas that are disadvantaged in social economic development, geographical features, and access to health and social services. Principal conclusion: Nutrition is fundamental for development of the Vietnamese society. Multi-sectoral cooperation, public-private partnerships and further assistance and support from international organizations, NGOs and UN agencies, should be sought out for malnutrition control activities in Vietnam along with improved monitoring and evaluation activities. Introduction Child malnutrition impairs the physical and mental development of the child and, potentially, of future generations, which will have long term effects on socio-economic development. It is estimated that there are about 32% under five children in developing countries (178 million) being stunted and 20% being underweight (Black et al 2008). Reducing malnutrition among children under five is critical in achieving Millennium Development Goals (MDGs) 1, 4 and 5, which concern the reduction of hunger and undernutrition, child mortality and maternal mortality, respectively. Over the last decade, Vietnam has been regarded by UNICEF/EAPRO as one of the countries in the region with the most striking reduction of malnutrition (UNICEF/EAPRO 2003). However, malnutrition is still a major public health problem in the country. Reduction of child malnutrition is high on the government’s agenda (Government of Vietnam 2001) but the prevalence of stunting in the country was still around 30% in 2005 (NIN/GSO 2005) and therefore a continued major concern and threat to the success of national development plans. In Vietnam, malnutrition limits the stature and productivity of future adults, increases the child mortality rate by 2.5 to 8.4 times and contributes to 7,000 young child deaths a year (NIN unpublished). In this paper, we describe observed changes in the prevalence of undernutrition in children under five years old based on annual surveys from 1999 to 2005 conducted by the National Institute of Nutrition, Vietnam, and present main directions and plans for accelerating the reduction of child stunting in the period 2008 to 2010 and beyond. Trends in child undernutrition in Vietnam (1985 - 2006) and risk factors of malnutrition Trends in child undernutrition in the period 1985 - 2006 There has been remarkable progress made in reducing child undernutrition in Vietnam over the past two decades. The prevalence of underweight has fallen from 51.5% in 1985 to 24.6% in 2006, which represents an average 1.3% per year (NCHS reference). The prevalence of stunting also exhibits a substantial decrease of 1.5% per year in the same period, from 59.7% in 1985 to 27.9% in 2006 (NCHS reference) (Figure 1). These trends, together with declining fertility rates, have led to annual decreases in the numbers of underweight and stunted children. About 0.6 million and 0.5 million fewer children were underweight and stunted, respectively, in 2005 than in 2000 (Table 1). However, the current prevalence of child malnutrition, in terms of both underweight and stunting in Vietnam remains high based on the classification of the World Health Organization (WHO 1995). <strong>SCN</strong> NEWS # <strong>36</strong> back to contents
www.unsystem.org/scn FEATURES 31 Regional differences exist for child malnutrition prevalence and trends in Vietnam. Between 1999 and 2005, the Central Highlands, where malnutrition rates are the highest, has seen the largest reduction, of almost 15% in underweight and 12% in stunting, equivalent to 2.4% and 1.9% per year on average in underweight and stunting, respectively. The Mekong River Delta had the smallest average yearly reduction in underweight, 1.5% per year, while the Southeast had the smallest average yearly reduction in stunting, 1.0% per year. However, these two regions had some of the lowest rates of malnutrition in Vietnam (Table 2). Low birth weight (LBW) (
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