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The aim of the Nutrition Program is to plan, implement and develop nutrition services to achieve and maintain the nutritional well-being of the population and promote healthy eating practices.
 
The National Nutrition Policy (Ministry of Health, 2005) and the National Plan of Action for Nutrition of Malaysia (NPANM II) (Ministry of Health, 2006-2015) provide the policy framework for this program.
 
The specific objectives of the Nutrition Program are:
 
1. To monitor and evaluate nutritional status of the people of Sarawak and assist in nutritional surveillance.
   
2. To plan, implement and evaluate:
 
  • nutrition rehabilitation programmes and activities
 
  • nutrition promotion activities
   
3. Provide technical advice and consultancy services on nutrition
   
4. Identify research needs and conduct studies on nutrition
   
Nutrition services are delivered through all health clinics. Nutrition activities can be broadly categorized into nutrition planning and development, nutrition surveillance, nutrition rehabilitation and nutrition promotion.
 
Nutrition Surveillance
 
Monitoring nutritional status of children aged below five years is one of the activities under nutrition surveillance. Growth monitoring of infants and children below five years is conducted in health clinics through the Health Management Information System (HMIS). The system uses weight-for-age as an indicator of children’s nutritional status. Based on nutritional status assessment, nutritional problems of children below five years are identified and malnourished children are managed using specific protocols.
 
In 2011, a total of 31,852 children below five years were followed-up under nutritional status surveillance. Of these, 28,343 (89.0%) were normal weight, 3,053 (9.6%) were underweight and 456 (1.4%) were overweight.
 
Nutrition Rehabilitation
 
Nutrition rehabilitation activities include planning, coordinating and evaluating intervention activities in the prevention and control of malnutrition. Malnutrition problems targeted include protein-energy malnutrition in children, anaemia in pregnancy, iodine deficiency disorders (IDD) and obesity.
 
Nutrition intervention activities are mainly targeted to pregnant women and children. Activities include provision of food baskets to undernourished children from hard-core poor families. Growth monitoring and health education is also conducted in health clinics with referrals to relevant agencies to help improve socio-economic factors which impact health and nutrition. Meanwhile, nutritional rehabilitation for pregnant women with anaemia includes health education, provision of haematinics and referral to nutritionists for further counselling and management.
 
To prevent and control diet-related non communicable diseases, nutrition counselling is conducted by Nutritionists in health clinics. The program is mainly targeted to individuals with diet-related chronic diseases such as diabetes as well as overweight and obese individuals.
 
Prevention and control of iodine deficiency disorders (IDD) include activities such as distribution of iodized salt, universal salt iodization and nutrition education. Mandatory sale of iodized salt throughout the state has been enforced through the Food Act 1983 & Food Regulations 1985; sub-Regulation 285(3) effective 1st July 2009. Monitoring and enforcement of iodized salt is carried out at entry points namely Kuching Port and Sibu Port. In addition, monitoring of iodized salt sold in the market meaning retail outlets such as grocery stores and supermarkets is routinely conducted.
 
Community-based nutrition projects are carried out in targeted districts to improve nutritional status and health of children. These projects focus on growth monitoring and nutrition education, especially optimal infant and young child feeding practices.
 

Figure 1: Nutrition Education session for mothers at Rumah Saba, Sarikei

 
Nutrition Promotion
 
Promotion of optimal infant and young child feeding practices has been carried out in health clinics since the 1970s through various strategies to ensure nutritional well-being and health. Strategies to promote breastfeeding and optimal young child feeding practices are part of the Global Strategy for Infant & Young Child Feeding (WHO, 2003). Global efforts to promote, protect and support breastfeeding include celebrating World Breastfeeding Week annually on the 1st to 7th of August.
 
The Baby-Friendly Hospital Initiative is implemented to support breastfeeding mothers in hospitals. Sarawak has 19 hospitals designated as Baby-Friendly Hospitals by WHO & UNICEF. In addition, the Baby-Friendly Clinic project was initiated in 2006 to strengthen breastfeeding promotion in selected health clinics.
 
The Code of Ethics for the Marketing of Infant Foods and Related Products (MOH, 2008) aims to curb unethical marketing of infant foods. Activities under the Code include monitoring of Code violations by manufacturers and distributors of designated products (infant formula, follow-up formula, special formula, feeding bottles, teats and pacifiers) and complementary foods. The Code also monitors practices of health professionals in the health care system to discourage unethical marketing practices of designated products and complementary foods by food manufacturers.
 
Nutrition Month Malaysia is celebrated in April every year to promote healthy eating and behavioural changes amongst selected target groups. The theme for 2012 is “Let’s Create Healthier Families” with activities mainly targeted to parents and children aged between 4 to 12 years.
 
Nutrition promotion in schools include giving technical input for school canteen guidelines & menu planning in fully residential schools and monitoring of nutritional status of school children. School children with malnutrition are also referred to Nutritionists for management through school health teams.
 
Activities to promote healthy eating and physical activity are conducted in collaboration with other government agencies, NGOs and associations to enhance health status and prevent chronic diseases.
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