Breaking the cycle of malnutrition: Designing an adolescent programme in Nepal

Approximately 25% of adult height and up to 50% of adult ideal weight is attained during this period, and inadequate diet during adolescence can compromise growth. Adolescence includes current parents and younger adolescents who may be future mothers and fathers; hence their health and nutritional wellbeing influences not only their own lives but also the health and nutritional status of their children, who are the future human capital of the country. Reducing adolescent malnutrition can help to break the intergenerational cycle of malnutrition and, in the short term, improve the physical, mental, social, and emotional wellbeing of adolescents. In Nepal, adolescents make up almost a quarter of the total population. Malnutrition is a major public health problem. Among adolescent girls aged 15-19 years, the prevalence of anaemia is 44%, being short (height below 145 cm) is 10%, and being thin (based on adolescent girls' body mass index (BMI)) is 30%. Dietary diversity is an important determinant of nutritional wellbeing; meeting minimum adequate diversity requires that an individual eats food from at least five of 10 food groups. Dietary diversity is low in Nepal; the recent Demographic Health Survey (DHS) shows that older married adolescent girls (aged 15-19 years) eat foods from an average of four out of 10 of the recommended groups. Over 1,000 health facilities throughout the country have been designated adolescent-friendly service (AFS) centres by the Ministry of Health and Population (MoHP). Services adapted for the needs of adolescents include health facilities open at convenient hours and offering privacy and confidentiality for counselling by health-service providers with appropriate training for this age group. The Suaahara II programme, a multi-sector nutrition programme implemented in 42 of Nepal's 77 districts, primarily targets households in the 1,000-day period between the beginning of pregnancy and a child's second birthday. In 2018, Suaahara II initiated an integrated, school-based, adolescent intervention package in coordination with government actors in 84 secondary schools in disadvantaged areas in four programme intervention districts. The intervention focuses on younger adolescents (aged 10-15 years) and thus targets students in grades 6 to 8, in part because their beliefs are less ingrained, more of them can be reached in school, and the initiative aligns with the government's school nurse programme and the newly endorsed adolescent health and development strategy. The integrated nutrition curriculum for teachers and students includes topics such as dietary practices, taking deworming and iron and folic acid tablets, consulting health institutions for any health and nutrition problems/issues, drinking water treatment, handwashing with soap and water at critical times, maintaining menstrual hygiene, and delaying marriage and continuing education. The overall approach is to engage extensively with adolescents to increase their awareness of the importance to their lives of key health and nutrition-related practices and equip them with knowledge, skills, and agency to take responsibility and leadership for these issues in their communities. The programme has also created episodes based on this peer curriculum to be integrated into a pre-existing radio programme for teens called 'Chatting with my best friend'.