After 10 years implementing the National Strategy on Nutrition (2011-2020), although Vietnam has reduced the rate of malnutrition, it is still facing a lot of problems such as a rapid increase in childhood obesity, a big gap in malnutrition between regions and a high percentage of children with micronutrient deficiencies. Vietnam is facing dual problems of child nutrition: deficient and redundant in nutrients.
FAILING TO MEET NATIONAL STRATEGY GOAL
According to the results of the 2017-2020 National Nutrition Census conducted by the Ministry of Health, after 10 years, Vietnam has achieved the goals of reducing the rate of malnutrition and increasing the height set out in the strategy and the National Action Plan on Nutrition for the 2017-2020 period.
However, there is still a huge disparity in the malnutrition rates among regions, with the rates in many regions remaining high compared to the recommendation of the World Health Organisation (WHO). The height of Vietnamese people is also modest compared to that of other countries.
Specifically, the stunting rate among children under 5 years old nationwide decreased from 29.3 percent in 2010 to 19.6 percent in 2020, moving from the high to medium level in accordance with the WHO’s classification of public health. The rate in school children (from 5 to 19 years old) decreased from 23.4 percent in 2010 to 14.8 percent in 2020.
However, there is a big gap among the rates of stunted children of different regions. The proportions were 12.4 percent in urban areas and 14.9 percent in rural areas, but that in mountainous areas was 38 percent – the very high level in the WHO’s classification.
The average height of Vietnamese people increased by more than 2cm after 10 years (168.1cm for men and 156.2cm for women), exceeding the set targets of 167cm for men and 156 cm for women, but was still much lower than that of other countries in the region (Thailand: 170.3cm for men and 159cm for women; and Singapore: 170cm and 160cm, respectively).
Although Vietnam has achieved positive results in reducing the malnutrition and improving the average height, the reduction of deficiency in micronutrients such as Vitamin A, iron and zinc fails to meet the set target.
According to the Ministry of Health, this shows that the rate of severe micronutrient deficiency can be reduced in parallel with the improvement of socio-economic conditions. However, without specific interventions, it is difficult to reduce to the moderate level.
The National Strategy on Nutrition for the 2011-2020 period with a vision to 2030 aims to control the obesity rate in children under 5 years old to less than 5 percent in rural areas and less than 10 percent in big cities in 2015 and maintain the figures until 2020. However, in reality, the obesity rate in children not only is uncontrolled, but also rapidly increases at all ages, both in urban and rural areas.
According to health experts, the above figures point to the fact that Vietnam is facing dual problems of both overnutrition and malnutrition. While over-nutrition can lead to chronic diseases, under-nutrition seriously affects the mental and physical development of children, and both have long-term consequences.
MODEL WITH COMPREHENSIVE INFLUENCES
According to the Ministry of Health, one of the reasons leading to these above-mentioned shortcomings is that important nutrition interventions which are decisive to develop children’s stature and physical strength such as nutritious meals in households and schools have only been implemented on a narrow scale. The promotion of physical activities and movement for children has not been given due attention.
Besides, public awareness about nutrition for children is still limited. Survey results show that up to 53 percent of parents do not know their children are overweight. In urban schools, there is an increase tendency in the sale of soft drinks and fast food.
Therefore, in a draft National Strategy on Nutrition for the 2021-2030 period with a vision to 2040 submitted to the Prime Minister for signing and promulgation, stepping up communications to raise public awareness about nutrition, especially in schools and among parents, is defined as one of the important solutions by the Ministry of Health.
These are also issues that have been raised by the Government since 2019 when it decided to implement a project on ensuring proper nutrition and increasing physical activites for children, pupils and students to improve their health, prevent cancer, cardiovascular disease, diabetes, chronic obstructive pulmonary disease and asthma in the 2018 – 2025 period (Project 41). The project’s goal is to improve the understanding of proper nutrition and appropriate physical activities for children, pupils, and students of educational administrators, teachers, school staff, children, pupils, students and their parents.
The specific target is that by 2025, 100 percent of staff involved in school health work; at least 85 percent of pupils, students and teachers; and at least 50 percent of students’ parents are informed about the benefits of proper nutrition and physical activities for the prevention and control of non-communicable diseases. At least 90 percent of educational institutions provide nutritious school meals, and 100 percent fully implement regulations on physical activities through curricular and extra-curricular activities.
According to Nguyen Thanh De, Director of the Department of Physical Education under the Ministry of Education and Training, after more than one year of implementing the project, the awareness and responsibilities of all levels of education management in developing and directing the implementation of relevant policies have increased, and the knowledge and practice of teachers, pupils, students, and their parents about proper nutrition and physical activities have been improved as well.
The project has received the engagement of many units, of which the TH Group is a pioneer, accompanying the Ministry of Education and Training in implementing the “School meals ensure proper nutrition, in combination with strengthening physical activities for Vietnamese children, pupils and students” model.
From the fact that urban children have different development from those in rural and ethnic-inhabited areas, 10 schools in 10 provinces and cities with different geographical features, namely Hanoi, Ho Chi Minh City, Hai Phong, Thai Binh, Son La, Nghe An, Thua Thien Hue, Quang Nam, Lam Dong and An Giang, were selected to implement the model in the 2020-2021 academic year. In each locality, 10 other schools are also chosen to serve as a basis for comparison.
Knowing that the lack of practice and awareness about nutrition and physical activities of parents and schools is a reason leading to the high rates of stunting or overweight in children, the model has followed Project 41’s spirit in physical development for children: combination between nutrition and exercise, schools and parents, and theory and practice.
Accordingly, pilot schools will provide properly nutritious meals using fresh milk and in combination with intensifying physical activities.
Thai Huong, Chairwoman of TH Group’s Strategy Council, said that TH signed contracts with leading Japanese nutritionists and Vietnamese experts to pilot a diet that is suitable for the physical conditions of Vietnamese people. The model has built hundreds of menus suitable for each age group and seasons in different geographical regions, and ensuring balanced nutrition, in combination with increased physical activities, helping children form a healthy diet and have active exercise. In particular, a proper portion of fresh milk is added to the daily diet of all students at schools participating in the model.
Schools receive training by nutritionists and physical therapists, are equipped with kitchens and utensils suitable for school meals as well as tools and toys helpful to physical activities.
Under the model, over 80 percent of students should engage in at least 60 minutes of physical activities per day, in line with World Health Organisation recommendations.
According to Dr. Tu Ngu, Vice President and General Secretary of the Vietnam Nutrition Association, the comprehensiveness and the periodic supervision of experts are the new positive points of this model compared to other previous studies and activities that promote school meals. The rich nutrients from clean fresh milk added to children’s daily meal is also a remarkable highlight. Whole milk containing proteins in a “complete” form directly benefits children’s growth and development process. When drinking fresh milk regularly, children will grow and develop, both physically and intellectually.
The model has been carried out methodically, from field survey to training, financial support, with the supervision of experts, and with cultural, natural and social factors of each locality taken into account. This is an important and comprehensive experiment, and provides necessary and feasible solutions to nutrition problems and physical and mental development for children./.