SCN News No 36 - UNSCN

www.unsystem.org/scn FEATURES 33
Main directions and plans for the control of child malnutrition in Vietnam in the period 2006-2010
Main strategy directions
Accelerating the reduction of child malnutrition is one of the priorities within the comprehensive human development
strategy of the Government of Vietnam. Reducing child malnutrition is a goal in the 10th Party Conference's
document and has become an action objective of authorities and sectors at all levels. The main strategy directions,
described in Khan and Khoi (2007), of the Child Malnutrition Control Program in the period 2006 to 2010 are:
• The Early care strategy requires nutrition care activities for every child and mother. According to this strategy,
nutrition care should be started before and during pregnancy in order to prevent foetal malnutrition.
Every child should receive good care and feeding right after delivery. Special attention to nutrition care
should be given during the first two years of life.
• The Specific priority strategy includes specific interventions based on an analysis of the actual situation at
each locality. According to this strategy, Priority should be given to interventions involving stunting reduction
in difficult regions, and urgent nutrition interventions should be conducted in case of emergency. However
in some regions focus will be upon prevention of overweight/obesity. Therefore, activities on malnutrition
prevention for each region in the next period will not be the same.
• The Nutrition improvement strategy based on the life cycle is founded on scientific evidence of a close and
continuous relationship between nutritional status and its health consequences in all periods of the life cycle.
It is clear that nutrition interventions should be implemented for various subjects, including pupils and
adolescents. This strategy requires an application of nutrition activities for all members in a household.
Implementation plans
Specific implementation plans of the Child Malnutrition Control Program 2006-2010 are listed in Box 1.
Evaluations, Assessments and Evolving Insights
Although there have been no formal or extensive evaluations of the national PEM control strategy, limited
studies of integrated nutrition programs for preschool children in Vietnam have shown that they successfully
improve complementary food intake (Pachon et al 2002). In addition, they reduce both morbidity (Sripaipam
et al 2002), and weight growth faltering during infancy among the most malnourished (Schoroeder et al
2002). However such programs seem to do little to prevent or cure moderate undernutrition, which is more a
reflection of stunting than underweight per se.
It is now well recognized that the process of stunting is largely complete by two years of age in almost all populations
and is caused by inadequate diet and frequent infections (Shrimpton et al 2001). Furthermore half of the
stunting at two years of age is due to growth faltering in the uterus and another half to inadequate growth in the
first two years of life (Victoria et al 2008). The Lancet Nutrition Series has listed a package of interventions that
it considers suitable for reducing maternal and child undernutrition, which are for implementation in all 36 countries
that are home to 90% of the worlds stunted children (Bhutta et al 2008). This includes Vietnam.
Most of these interventions are included in the implementation plans listed in Box 1, but they make up less than
a half of the planned activities. This suggests that it is necessary to focus and prioritize the national plan, and
concentrate on those activities aimed at the window of opportunity from conception to two years of age when
most growth faltering takes place. In other words, as recommended in the Lancet paper 4, "doing the right
things, and doing far less of the wrong things that don't impact on maternal and child undernutrition" (Bryce et al
2008). Of the list of interventions in Table 3, those aimed at reducing intra-uterine growth faltering have received
the least attention in Vietnam. Moreover, it is necessary to focus on implementing the proven interventions
at scale and as a continuum of care, beginning from conception though to two years of age.
Preliminary review information coming from the work of the Mainstreaming Nutrition Initiative points to inadequate
provincial planning capacity as a constraint for achieving high coverage of the various nutrition activities
(MNI 2008). Not only is it difficult to link nutrition activities across programs within the health sector,
(antenatal care, integrated management of childhood illness, primary health care) but also across sectors to
the agricultural and education sectors.
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