Difficulties in preventing malnutrition for children under 5 years old in mountainous areas

Many positive results

Nam Thanh is a commune in the semi-mountainous area located in the north of Nam Dan district. The commune will meet the advanced new rural standards in 2022 and the model new rural standards in education in 2023. One of the bright spots in Nam Thanh commune is the good implementation of the program to prevent malnutrition for children under 5 years old.

Mr. Tran Dang Khoa - Chairman of Nam Thanh Commune People's Committee said: The commune has included the target of preventing malnutrition in children under 5 years old in the system of local economic and social development indicators. From this target, the commune has annually developed a specific action plan, with many activities such as weighing children to monitor growth and identifying priority groups in need of intervention; giving Vitamin A to children under 5 years old; giving deworming medicine to children from 24 months to 60 months old; supporting pregnant women, breastfeeding mothers and children under 24 months old in difficulty; promoting breastfeeding; guiding the development of nutritional menus suitable for each subject...

With many active activities implemented, the rate of malnourished children under 5 years old in Nam Thanh commune has decreased year by year. Specifically, in 2021, the rate of underweight malnutrition was 9.6% and the rate of stunting malnutrition was 19.2%. By September 30, 2024, the rate of underweight malnutrition was 8.9% and the rate of stunting malnutrition was 18%... With these positive results, Nam Thanh commune was highly appreciated by the Central Inter-sectoral Working Group led by the Deputy Minister of Health when it came to inspect in October 2024.

It is known that not only in Nam Thanh commune, in recent years, the work of preventing malnutrition for children under 5 years old in Nghe An has been increasingly concerned and focused on by all levels and sectors. The goals and targets on preventing malnutrition have been included in the documents of Party Congresses at all levels and have become the goals to strive for in the socio-economic development programs of all levels of government as well as the action programs of social organizations.

According to Nghe An Department of Health, many nutrition activities under the National Nutrition Strategy for the 2021-2025 period, the National Target Program for Sustainable Poverty Reduction for the 2021-2025 period, the National Target Program for Socio-Economic Development in Ethnic Minority and Mountainous Areas... have been actively implemented by all levels and sectors, such as: nutrition communication and education; monitoring growth and assessing the nutritional status of children under 5 years old; intervening to prevent malnutrition and providing multi-micronutrient products and nutritional products; training and capacity building for care staff...

Problems and difficulties in mountainous areas

Besides the positive aspects, it must be said that although the rate of child malnutrition has decreased over the years, the decrease is still slow and in remote communes and particularly difficult areas, the rate of malnutrition and stunting is still very high. The rate of malnutrition and stunting is still higher than the average rate of the North Central and Central Coast regions and the whole country.

The reasons for this situation are: Nghe An is a province with a large area, complex mountainous areas, scattered population, inconvenient transportation; people in some localities, especially those with particularly difficult economic conditions, have not yet recognized the role of health care. Many localities have not really paid attention to investing in nutrition work, and have not considered it a priority political task in the socio-economic development of the locality. Specialized staff at the grassroots level who are in charge of many programs are often changed. Many nutrition interventions have only been implemented on a small scale, not reaching a large number of malnourished groups and the general population.

Since 2022, the work of preventing child malnutrition in mountainous districts has been improving as Nghe An has actively implemented nutrition projects under the National Target Program for Sustainable Poverty Reduction for the 2021-2025 period, the National Target Program for Socio-Economic Development in Ethnic Minorities and Mountainous Areas... However, the implementation process still has many difficulties and shortcomings.

Doctor Vi Thi Thanh - Head of the Medical Station of Mon Son Commune, Con Cuong District said: Mon Son Commune currently has over 500 children under 5 years old, the rate of children in this age group suffering from malnutrition is 17% (higher than the average of the district and province). One of the difficulties in preventing and combating malnutrition in the locality is that people's awareness of nutritional care is still limited, especially in the two villages of Bung and Co Phat of the Dan Lai people. The roads are difficult, so access to propaganda for the people of the two villages is still limited. To get to these two villages and implement the program, it is necessary to overcome 20 km of steep, slippery mountain roads or spend 1 million VND for each boat trip in and out. Meanwhile, human resources and funding to implement the program are very limited. Of the two villages, only one has a village health center.

Next, although the funding for the activities of the National Target Program was fully provided, the allocation was slow and disbursement encountered many difficulties due to the lack of detailed instructions. Doctor Lo Anh Tuan - Deputy Director of the Con Cuong District Medical Center said: "The allocation of funding is very slow, it is not until mid-August every year that the Center receives the decision to allocate funding for implementation. Therefore, the implementation of activities cannot be continuous between years; the accumulation at the end of the year is ineffective and cannot be fully disbursed. The list of malnourished subjects for intervention is made at the beginning of the year, but by the time the funding is available, the subjects are past the age of eligibility."

Doctor Tran Van Cong - Deputy Director of Tuong Duong District Medical Center pointed out another difficulty: Tuong Duong, like many other localities, is facing difficulties in bidding to purchase multi-micronutrient products for malnourished children, as well as weighing and measuring tools for children. Enterprises are not interested in participating in bidding because the purchase quantity is small and many procedures must be carried out. All levels and sectors need to study the implementation of bidding and centralized purchasing at the provincial level to remove difficulties for units.

In the mountainous districts recently, there is also a social phenomenon that has a great impact on the work of preventing and combating malnutrition that needs attention. Ms. Xen Thi Thanh - an officer of the Health Station of Luu Kien Commune, Tuong Duong District shared: "In Luu Kien Commune in particular and mountainous communes in general, after giving birth to children for 4-5 months, parents leave their children to their grandparents to take care of, then go to work. The whole commune currently has 281 children aged 0-5. 70% of them have parents working far away, living with their grandparents; 17% of the children are malnourished... Although grandparents love their grandchildren, due to their old age, difficult economic conditions, and limited awareness of nutritional care, children in this situation are always stunted and pale".

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The rate of malnutrition in children under 5 years old in Nghe An has improved, reaching the target set by the Provincial People's Council Resolution, but is still higher than the general average. This comes from the fact that we have a low starting point when implementing the programs. Currently, we still face many difficulties in intervening and improving nutrition for children in mountainous areas.
Currently, the health sector is actively implementing solutions to prevent and combat malnutrition; focusing on removing difficulties. However, it must also be said that malnutrition prevention and combat activities require the active participation of all levels, sectors, organizations, communities and people. The solutions that have been and are being implemented and the participation of the political and social system are the necessary impetus to change awareness and behavior on malnutrition prevention and combat in each person and family.

Dr. Le Thi Hoai Chung - Director of Nghe An Department of Health

Thanh Chung