NUTRITION
Presented by: Ms. Shemsa N. Mselem
Introduction
• Good nutrition is a prerequisite for national development and
for wellbeing of individuals
• Adequate nutrition is essential for health, growth and
development
• Poor nutrition is an underlying cause of death in children and
also plays a significant role in morbidity and mortality from
diet related non-communicable diseases in later life
TREND IN Malnutrition AMONG <5 yr
Zanzibar
60
Prevalence (%)
50
40
30
20
10
0
1992
1996
Stunting
1999
Underweight
2004
2010
2014
Wasting (acute)
3
Trend in stunting among <5 yr in
Zanzibar
Trend in wasting among <5yr in
Zanzibar
Status of infant and young child feeding
(PROPAN Study 2012)
• 20% of children are given other food
within three days of birth
• Many of the children(6-23 month) do not
meet the recommended amounts of
their dietary intake


Protein and Vitamin C – Most of the children met recommended nutrient
intake
Energy – slightly more than half of children met the recommended intake
Iron, Zinc, Calcium and Vitamin A – Many of the children did not meet the
recommended amounts
96
100
90
80
67
70
Percentage

Amount of nutrients consumed
60
58
61
55
51
50
40
30
20
11
8.5 7 9
10
0
22
18
0.5 1.4 0
Energy
Iron
0.5 0 0.8
Zinc
Vitamin A
Vitamin C
Calcium
7
Achievements
• Reduction in 2014 National Nutrition
Survey(preliminary results) vs. 2010 TDHS
– Stunting 24.4% vs 30%
– Underweight 13.9% vs 19.9%
– Wasting 7.2% vs 12%
• Integrated management of Acute
malnutrition(IMAM)
– Treatment of Severe Acute Malnutrition(SAM)
– Supportive supervision and training of 40 health
workers on inpatient care of children with SAM
Achievements cont…
Micronutrient interventions ;
• Vitamin A supplementation coverage (Feb 2014) 77.5%
to 98% (2014) during Integrated Measles Rubella
campaign (targeted 80%)
• Deworming 78.1% to 107% IMR, targeted 80%
• HHs utilization of Iodated salt from 49.3% (DHS, 2010)
to78.5% NNS, 2014) slightly above 70% targeted,
According to WHO when 90% of the HHs are using
iodated salt it poised to attain the goal of eliminating
iodine deficiency
– Training of 200 salt traders on importance of
iodating salt
– Provision of 200 kg of Potassium Iodate to salt
farmers
Challenges
• Poor coverage of treatment of acute malnutrition (only
1000 children enrolled against targeted 5,000)
• Inadequate infant and young children feeding practices
(median duration of exclusive breast feeding 2 weeks)
• Shortage of nutrition staff in line with scaling up nutrition
– Current status of personnel 4 nutritionist in the MOH
nutrition unit, 4 on training,
– Current requirements at least 20 to cover districts, zone
and hospitals
Proposed Solutions
Implementation of Comprehensive and integrated
community health worker program in Zanzibar
– To bridge the gap between community and health
facilities and increase the uptake of health
services
– CHWs will be identified and trained on Community
infant and young child feeding and management
of acute malnutrition (to start with) and will have
major task on counseling on IYCF, following up
women in the Shehia and screening and referral of
acute malnutrition
Proposed Solutions: Implementation of Comprehensive and
integrated community health worker program in Zanzibar
– There will be a team leader among CHWs, and
health facility staff will supervise CHWs in the
catchment area of the facility.
– 1CHW per 500 people (approximately 50
pregnant/lactating women)
– Two district to start (North A and Mkoani)
– Incentives and regular follow up and feedback
Proposed Solutions
Scaling up IMAM services
– Quarterly active case finding and referral by CHWs
• More children identified, more children enrolled and
managed
Rollout cIYCF program
•Community level interventions to address inadequate infant
and young child feeding practices
Recruitment of nutritionist
Each district should have at least one professional
nutritionist
Finances
• 2013-2014
Source of funds
RGoZ
Unicef
Planned
finances
Funds
received
15,117,500
324,787,000
expenditure
430,000
430,000
36,419,500
36,419,500
• 2014-2015
Source of
funds
Planned
finances
RGoZ
Funds received Expenditure
-
-
18,821,800
Unicef
445,023,860
151,772,000
56,772,000
2014-2015 plans
• Strengthen management of acute malnutrition
(trainings, supplies, supervision, active case
finding, data quality improvement, quarterly
meetings between CHWs and PHCU HS)
• Rollout cIYCF (TOT, training of health workers,
training of CHWs, counselling mothers/guardians
on IYCF both at health facility and community
2014-2015 plans cont ..
• IDD (procure KIO3, training of school teachers
on monitoring iodated salt, quarterly
monitoring of Iodated salt utilization at HH
level)
Thank You