Zinc can play a much bigger role in the supplementary treatment of diarrhoea in Nepal, experts say.
“In the context of Nepal, it simply makes sense,” Frank Van Assche, director of European Affairs for the International Zinc Association, told IRIN, following a three-day visit to the country.
Essential to a child’s health and growth, it provides a simple and inexpensive means to treat a major cause of death among children, he said.
“We can do more here and we should,” said Macha Raja Maharjan, director of the Micronutrient Initiative (MI) in Kathmandu, which is working to expand zinc supplementation (alongside oral rehydration salts - ORS) for the treatment of childhood diarrhoea.
Since 2010, MI has been working in three districts - Sankhuwasabha, Gorkha and Bajura - in support of a government effort to promote zinc usage.
Here zinc tablets are provided free of charge through a network of health facilities, and some of the country’s 50,000 female community health volunteers. Care givers can also buy the tablets on the open market.
Under the programme, any child suffering from diarrhoea is provided with zinc tablets for 10 days (half this dose for children under six months), in conjunction with ORS.
According to the Ministry of Health, around 54,000 children under five die annually due to preventable diseases. Of these, 15,000 are due to diarrhoea, making it the second leading cause of death after pneumonia.
Various studies suggest that zinc, taken in conjunction with ORS, is the best means of combating diarrhoea-induced dehydration, and can reduce the duration of acute diarrhoea by 25 percent, and treatment failure of persistent diarrhoea by 40 percent.
Preventive benefits include a 25 percent reduction in subsequent episodes of diarrhoea and a 34 percent reduction in subsequent episodes of pneumonia in the 2-3 months after a 10-14 day treatment.
According to a 2009 Food and Nutrition Bulletin, zinc supplementation can reduce child mortality by around 6 percent, making it particularly important in the country’s efforts to reduce child mortality.
Nutrition
Zinc can also be beneficial in terms of nutrition. “There are huge benefits to be had,” said Saba Mebrahtu, chief of the nutrition section for the UN Children’s Fund (UNICEF) Nepal.
In addition to lessening diarrhoea’s severity, it can also improve a child’s overall health, nutrition and development, and mitigate stunting.
According to the Ministry of Health, undernutrition is a significant problem in Nepal, with one in two under-five children stunted, 13 percent wasted (thin for their age), and 39 percent underweight.
UNICEF is currently promoting the use of zinc, as well as other essential minerals and vitamins, in complementary foods as a means of bolstering the child’s immune system and vitamin A deficiency, as well as overall health.
“The best way to deliver zinc is through multiple micronutrient powders,” Mebrahtu said.
Government, USAID support
The government first introduced zinc usage in two districts in 2005 following a 2004 World Health organization/UNICEF joint statement on the clinical management of acute diarrhoea in children under five.
Zinc therapy was later incorporated in the government’s Integrated Management of Childhood Illness programme, which is now operational in an effort to ensure the therapy’s availability in all 75 districts of the country.
Since 2006, the government has also implemented a social marketing project for zinc treatment through private sector providers in 30 districts, with support from theUS Agency for International Development (USAID).
Given its advantages, strengthening and sustaining zinc treatment is now highlighted in Nepal’s upcoming National Health Sector Plan (NHSP-II), which outlines national health and nutrition programming for 2011-2015. The government took over responsibility for the procurement of zinc tablets in 2010.
Challenges
But despite those efforts, zinc usage is far from optimal. A survey conducted in 40 districts in February 2010 (a mid-term survey for Nepal Family Health Programme (NFHP) II) found coverage, through public and private distribution, to be just 7 percent.
According to health workers on the ground, factors hindering zinc coverage include inadequate supply of zinc tablets; weak logistical management; low awareness regarding zinc and its availability within the community; and inadequate understanding of the treatment among health service providers.
To address that, UNICEF is currently working with MI to conduct a strategic review of the zinc programme, as well as with the government to increase public awareness.
ds/cb
“In the context of Nepal, it simply makes sense,” Frank Van Assche, director of European Affairs for the International Zinc Association, told IRIN, following a three-day visit to the country.
Essential to a child’s health and growth, it provides a simple and inexpensive means to treat a major cause of death among children, he said.
“We can do more here and we should,” said Macha Raja Maharjan, director of the Micronutrient Initiative (MI) in Kathmandu, which is working to expand zinc supplementation (alongside oral rehydration salts - ORS) for the treatment of childhood diarrhoea.
Since 2010, MI has been working in three districts - Sankhuwasabha, Gorkha and Bajura - in support of a government effort to promote zinc usage.
Here zinc tablets are provided free of charge through a network of health facilities, and some of the country’s 50,000 female community health volunteers. Care givers can also buy the tablets on the open market.
Under the programme, any child suffering from diarrhoea is provided with zinc tablets for 10 days (half this dose for children under six months), in conjunction with ORS.
| Government Efforts | |
 |
Ministry of Health formally adopts WHO/UNICEF joint recommendation on treating diarrhoea with zinc - August 2004 |
|
Government establishes Zinc Technical Group - January 2005 |
|
Piloted in FY 2005/06 in two districts (Rautahat and Parbat) |
|
Expanded to 25 districts in 2006/2007 |
|
Incorporation of zinc treatment in Nepal’s Community-based Integrated Management of Childhood Illnesses (CBIMCI) programme |
|
Initiates private sector programme |
|
Expanded to all 75 districts by 2010 |
Various studies suggest that zinc, taken in conjunction with ORS, is the best means of combating diarrhoea-induced dehydration, and can reduce the duration of acute diarrhoea by 25 percent, and treatment failure of persistent diarrhoea by 40 percent.
Preventive benefits include a 25 percent reduction in subsequent episodes of diarrhoea and a 34 percent reduction in subsequent episodes of pneumonia in the 2-3 months after a 10-14 day treatment.
According to a 2009 Food and Nutrition Bulletin, zinc supplementation can reduce child mortality by around 6 percent, making it particularly important in the country’s efforts to reduce child mortality.
Nutrition
Zinc can also be beneficial in terms of nutrition. “There are huge benefits to be had,” said Saba Mebrahtu, chief of the nutrition section for the UN Children’s Fund (UNICEF) Nepal.
In addition to lessening diarrhoea’s severity, it can also improve a child’s overall health, nutrition and development, and mitigate stunting.
According to the Ministry of Health, undernutrition is a significant problem in Nepal, with one in two under-five children stunted, 13 percent wasted (thin for their age), and 39 percent underweight.
UNICEF is currently promoting the use of zinc, as well as other essential minerals and vitamins, in complementary foods as a means of bolstering the child’s immune system and vitamin A deficiency, as well as overall health.
“The best way to deliver zinc is through multiple micronutrient powders,” Mebrahtu said.
Government, USAID support
The government first introduced zinc usage in two districts in 2005 following a 2004 World Health organization/UNICEF joint statement on the clinical management of acute diarrhoea in children under five.
Zinc therapy was later incorporated in the government’s Integrated Management of Childhood Illness programme, which is now operational in an effort to ensure the therapy’s availability in all 75 districts of the country.
Since 2006, the government has also implemented a social marketing project for zinc treatment through private sector providers in 30 districts, with support from theUS Agency for International Development (USAID).
Given its advantages, strengthening and sustaining zinc treatment is now highlighted in Nepal’s upcoming National Health Sector Plan (NHSP-II), which outlines national health and nutrition programming for 2011-2015. The government took over responsibility for the procurement of zinc tablets in 2010.
Challenges
But despite those efforts, zinc usage is far from optimal. A survey conducted in 40 districts in February 2010 (a mid-term survey for Nepal Family Health Programme (NFHP) II) found coverage, through public and private distribution, to be just 7 percent.
According to health workers on the ground, factors hindering zinc coverage include inadequate supply of zinc tablets; weak logistical management; low awareness regarding zinc and its availability within the community; and inadequate understanding of the treatment among health service providers.
To address that, UNICEF is currently working with MI to conduct a strategic review of the zinc programme, as well as with the government to increase public awareness.
ds/cb
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
Share this article
