National Plan of Action for Nutrition of Malaysia II (2006-2015)

The National Plan of Action for Nutrition of Malaysia II 2006 - 2015 Contents Page FOREWORD BY MINISTER OF HEALTH FOREWORD BY DEPUTY DIRECTOR GEI\JERAL OF HEALTH 2 1.0 INTRODUCTION 3 2.0 THE FOOD AND NUTRITION SITUATION 3 3.0 CURRENT FOOD AND NUTRITION INTERVENTIONS 7 4.0 OBJECTIVE OF THE NPANM II 16 4.1 General Objectives 16 4.2 Specific Objectives 16 5.0 INDICATORS AND TARGETS 16 5.1 Improving Breastfeeding and Complementary Feedings Practices 16 5.2 Improving Food Intake and Dietary Practices 17 5.3 Reducing Protein - Energy Malnutrition 17 5.4 Reducing Micronutrient Deficiency 18 5.5 Reducing OVE~rweight and Obesity 18 5.6 Preventing and Controlling Diet-Related Non-Communicable 19 Diseases 6.0 STRATEGIES 20 6.1 Foundation Strategies 20 6.2 Enabling Strategies 20 6.3 Facilitating Strategies 20 7.0 NPANM II FRAMEWORK 22 8.0 ACTIVITIES 8.1 Activities for Foundation Strategy 23 8.2 Activities for Enabling Strategy 24 8.3 Activities for Facilitating Strategy 37 9.0 IMPLEMENTATIONS 45 10.0 REFERENCES 46 11.0 APPENDIX 11 .1 List of Abbreviations 48 11.2 NCCFN Committee 50 11.3 NPANM II Drafting Committee 51 11.4 NPANM II Editorial Committee 54 11 FOREWORD BY THE MINISTER OF HEALTH MALAYSIA The World Declaration on Nutrition and Plan of Action adopted by the International Conference on Nutrition (ICN) in Rome in December 1992 called a concerted multisectoral effort and commitment of all nations, non-government organisations and the international community to eliminate or reduce substantially, within the decade, starvation, widespread undernutrition and micronutrient deficiencies which hinder progress in human and societal development around the world. Malaysia rallied to this call with the first National Plan of Action for Nutrition of Malaysia (NPANM) covering the period of 1996 to 2000. The development and formulation of the second NPANM reflect the natural follow through of the first plan. It is also based on the goals and objectives of the National Nutrition Policy approved by the government in 2003. It is imperative for the country to continually address nutrition issues and to face the current and future challenges and the prospects of nutrition development both globally and locally in order to ensure the nutritional well-being of the population. In addition, the impact of globalization and Malaysia's own development on the health and nutritional status of Malaysians must be monitored and issues must be addressed appropriately. The National Plan of Action for Malaysia" (NPANM II) is a document detailing the recommendations for strategies, targets, programmes and activities of the implementing agencies for the period of 2006 to 2015. We in the Ministry of Health believe and aspire that NPANM II will continues as the guiding principles and framework for the integration of all nutrition and nutrition-related activities in the country through the multisectoral and collaborative approach of all stakeholders. (THE HONOURABLE DATO' SERI DR. CHUA 501 LEK) MINISTER OF HEALTH MALAYSIA FOREWORD BY THE DEPUTY DIRECTOR GENERAL OF HEALTH MALAYSIA The national Plan of Action of Malaysia II (NPANM II) is the follow-up of the first NPANM formulated in 1994. As with NPANM I (1996 - 2000), NPANM II is a culmination of consultation and collaboration among various agencies, institutions, and non-government organisations (NGOs) coordinated by the multisectoral National Coordinating Committee on Food and Nutrition (NCCFN). The second National Plan of Action for Nutrition (NPANM II) provides framework and window of opportunity particularly for more creative and effective nutrition promotion and research efforts towards further improving the nutritional well-being of the people, in line with the objectives of the National Nutrition Policy of Malaysia. I would like to record my thanks to all the workshop participants from different qgencies and organizations for their valuable input in developing the first draft of the plan. I therefore wish to express my appreciation and sincere thanks to every member of the NCCFN and the NPANM II Editing Committee for their deliberation and input to finalise the preparation of NPANM II. In addition, I would like to express my utmost gratitude to the Nutrition Section, Division of Family Health Development. for providing the necessary secretarial and technical support. I believe the National Plan of Action for Nutrition of Malaysia II is an important document as well as a guide to the implementation of nutrition programmes and activities in the country in the Ninth and Tenth Malaysia Plans. (DATO' DR. SHAFIE OOYLlB) Deputy Director General of Health Malaysia Chairman of the National Coordinating Committee on Food and Nutrition 2 THE NATIONAL PLAN OF ACTION FOR NUTRITION OF MALAYSIA II 2006-2015 1.0 Introduction The National Plan of Action for Nutrition of Malaysia (NPANM) II is a 10-year plan for the period of 2006 to 2015. The objectives, strategies, activities and targets of NPANM II are based on the National Nutrition Policy review of NPANM I (1996-2000) and its implementation beyond 2000. Current and emerging issues in nutrition were also taken into consideration in the development of NPANM II. The policy was approved by the Cabinet on 17 December 2003. A national workshop to develop NPANM II was held from 26 to 29 April 2004 with the participation of representatives from government agencies, the academia, non-government organizations (NGOs), professional bodies and the private sector. The NPANM II draft was approved by the National Coordinating Committee on Food and Nutrition (NCCFN) on 2 November 2004 and subsequently presented to the Food Safety and Nutrition Council on 22 February 2005. The final draft was approved by the Cabinet on 20 April 2005. 2.0 The Food and Nutrition Situation Increasingly more developing countries are undergoing nutritional changes which are characterised by manifestations of the dual burden of malnutrition. While macronutrient and micronutrient deficiencies persist resulting in poor nutritional status and morbidity, the prevalence of overweight and obesity has been on the rise in urban and rural areas in many countries. Malaysia typifies a rapidly developing which has undergone major demographic and socioeconomic changes since attaining independence in 1957. Notably, fertility rates decline substantially from 6.94 in 1995 to 2.94 in 2005, while life expectancy at birth markedly increased from 48.5 years to 73.1 years during the same period. Urbanisation growth rate 3% in recent years has resulted in 62% of the present population, which is estimated as 25.35 million in 2005, living in urban areas. The country has also experienced an epidemiological transition from a situation with the 3 predominance of infectious diseases to one distinguished by the growing prevalence of chronic and degenerative diseases. In recent years, coronary heart disease, cancer and stroke constitute the leading causes of mortality, accounting for more than 40% of medically certified deaths. Set against this backdrop, fundamental changes in the food supply patterns have emerged in the recent decades. These changes have led to not only increasing amounts of food available but also to changes in the composition of the diet. Availability of food commodities has increased considerably on a per capita basis, principally for meat, sugar, vegetables oils, vegetables milk, eggs and fish. The amount of total calories available was on an upward trend from 2,407 calories per capita in 1965 to 2,881 in 2002. Over the same period, the proportion of calories from cereals declines from 59% to 45%, while that from animal products rose to 18% of total calories. While food availability data is useful in portraying trends and patterns on food supply at the macro level, such information has intrinsic limitations and does not depict actual consumption in various population groups. Intakes of the poorer groups are usually found to be lower than the availability levels. Based on several dietary studies, albeit mostly on a relatively small sample size, poor households are frequently reported to suffer from deficient intakes of calories, iron, calcium, folate, retinol and the B complex vitamins. Detrimental nutritional outcomes are the consequences particularly among the vulnerable, namely young children, pregnant and lactating mothers, and the elderly. In relation to nutrition of infants and young children, the sUbject of breastfeeding practices in Malaysia has been the focus of numerous studies over the decades. The overall prevalence of ever breastfed remains high at 88.6% according to the Second National Health and Morbidity Survey (NHMS II) in 1996, compared to the Malaysian Family Life Survey (MFLS) prevalence of 85% in 1998. However, the median duration of breastfeeding appears to have declined from 6 months (MFLS) to 4.5 months (NHMS II). NHMS \I also noted that the prevalence of exclusive breastfeeding through the first four to six months was low at 29% and bottle-feeding was high at 86% among children aged below 2 years. The principal outcomes of undernutrition affecting young growing children are underweight and stunting. According to the MiniStry of Health/UNICEF Survey that was 4 undertaken nationwide in 1998-2000 among children less than six years, 19.2% were underweight « -2SD weight-for-age) and 16.7% stunted « -2SD height-for-age). Based on the surveillance data of the Ministry of Health (MOH), the overall prevalence of underweight among children aged below five years was 17.3% in 2004 compared to 25% in 1990. In contrast, research studies often report prevalence of underweight and stunting in children of similar ages from poor households exceeding 25% and 30% respectively. Meanwhile in adults, the problem of underweight has also been reported in urban and rural areas. NHMS II determined the overall prevalence of underweight in adults as 25.2%, while other studies on smaller numbers of subjects reported underweight rates for men and women at 7% and 11% in urban, and 11% and 14% in rural areas, respectively. Undernutrition not only brings about energy deficits affecting growth and physical performance, but also results in the "hidden hunger" problem of micronutrient deficiency. An important micronutrient deficiency in Malaysia over the decades is anaemia, affecting chiefly young children, women of childbearing age and the elderly. Based on the MOH/UNICEF survey in 1998-2000, the prevalence of anaemia in children below six years of age was 17.7% for boys and 20.5% for girls. Research studies have also recorded anaemia prevalence levels of 20 to 25% in children, adults and the elderly from poor communities. The prevalence is appreciably higher among pregnant women, often exceeding 25%. Another micronutrient deficiency that has been monitored for many years is Iodine Deficiency Disorders (100) especially in Sarawak and Sabah. Through legislation on universal salt iodisation, which was fully implemented in 2000, the gravity of 100 has abated to a large extent in Sabah. Since 2002, the median urinary iodine levels of children aged 8 to 10 years in Sabah has been within the normal range. Continued monitoring efforts, however, are needed in Sarawak and some endemic districts in the peninsula to further reduce the prevalence of 100 in the areas. Prior to the 1960s, vitamin A deficiency accompanied by clinical symptoms used to be encountered among young undernourished children from poor communities. However, the situation has improved significantly over the years. The finding of the MOH/UNICEF survey in 1998 - 2000, in which 2.5% of boys and 4.5% of girls less than five years of age 5 had blood retinol level::;; 0.7 ~moI/L, indicated that vitamin A deficiency prevalence in Malaysia is at a mild sub-clinical level. As for other nutrient deficiency, there is a dearth of data. Recent research interests have emerged but tend to be limited to a few nutrients such as calcium, vitamin D, zinc and folate. More studies should supported to establish intake levels and deficiency prevalence of nutrients for which data is lacking among Malaysians, including the nutrients mentioned above as well as selenium, vitamins K and B12 . As a country bearing the dual burden of malnutrition, Malaysia is also confronted with the mounting problem of overweight and obesity. NHMS II found 4.4% obesity (body mass index or BMI ~ 30.0 kg/m 2 ) and 16.6% overweight (BMI =25.0 - 29.99 kg/m 2 ) in adults aged 18 years and above in 1996. Since then, several studies have reported rising prevalence of overweight and obesity in men and women from both urban and rural areas. The preliminary result of the first Malaysia Adult Nutrition Survey conducted in 2002 and 2003 (MOH, 2006) showed that 26.7% of Malaysian adults aged 18 to 59 years are overweight and 12.2% were obese. An emerging paradox is the overweight burden on the poor, especially among women, as revealed by studies that identified one-third to half of women from poor households as being overweight and obese. The prevalence of overweight in Malaysia children is marked lower than that in adults. The MOH surveillance data showed that in 2004, 4.1 % of children aged below five years were overweight (weight-for-age ~ 2SD). By the same criteria, the MOH/UNICEF survey (1998-2000) recorded 2.9% male and 2.2% female children below six years as overweight, with higher prevalence in metropolitan (3%) and large urban areas (2.8%) than in rural areas (1.8%). The proportion of overweight children in poor rural communities remains relatively low, below 1% generally. The escalating problem of overweight and obesity in Malaysia reflects the global trend in modern industrialised countries, which face similar underlying factors of an upsurge in consumption of energy-dense food accompanied by increasing sedentary work and leisure lifestyles. A consequent major challenge is the rising medical and healthcare costs and other problems linked to nutrition-related chrome diseases. Death from chronic diseases worldwide accounted for more than hat of projected total deaths in 2005, with cardiovascular disease contributing 30%, followed by cancer (13%), chronic respiratory diseases (7%) and diabetes (2%). 3.0 Current Food Nutrition Interventions Nutrition interventions to improve the nutritional well-being of the Malaysian population have been implemented by the Ministry of Health in collaboration with other ministries. They include the Ministry of Social Welfare and Rural Development, Ministry of Education, Ministry of Agriculture, Ministry of Information, Ministry of Rural Development, Ministry of Youth and Sports, Ministry of Domestic Affairs, Ministry of Internal Trade and Consumer Affairs, Ministry of Women, Family and Community Development, Ministry of Housing and Local Government, non-government organisation (NGOs) and the food industries. The programmes and activities that have been carried out include alleviation of macronutrient and micronutrient deficiencies, nutrition promotion and improving household food security. The NGOs that has been involved in nutrition intervention programmes include the Malaysian Society for the Study on Obesity (MASO), Nutrition Society of Malaysia (NSM). Malaysian Dietitians Association (MDA), Malaysian Paediatric Association (MPA), Obstetric and Gynaecology Association, Malaysian Breastfeeding Advisory Association (PPPIM), Malaysian Federation of Malaysian Manufactures (FMM), Private Hospital Association (PHA), Assiciation of Registered Childcare Providers Malaysia (ARCPM) and the Malaysian Lactation Advisors and Consultants Associations. 3.1 Alleviation of Macronutrient and Micronutrient Deficiencies Rehabilitation Programme for Malnourished Children The main macronutrient deficiency problem among Malaysian children is protein and energy malnutrition. This is manifested in children being underweight for their age. The Ministry of Health started a programme for the rehabilitation of malnourished children in June 1989. It was an immediate strategy to rehabilitate 12,690 children who were detected to be undernourished through the Nutrition Surveillance System in 1988. This programme, better known as the "Food Basket Programme", is still being carried out in government health clinics. 7 The objectives of the programme are: i) To improve health and nutritional status through food and micronutrient su pplementation. ii) To improve health through provision of sanitary facilities and clean water supply. iii) To improve health through providing education on health and nutrition. The criteria for eligibility for this programme are children aged less than six years who are underweight (weight-for-age is less than -2SD of the median) and from hardcore poor families. They are given foods and multivitamin supplement every month until they are recovered, with the minimum period of six months of supplements. The basic food items include rice, wheat flour, ikan bilis, green gram, cooking oil, biscuits, full cream milk and multivitamins. Some of the food items can be exchanged with other foods depending on the local preference and their availability. These food supply approximately 150% of the child's Recommended Daily Allowance (RDA) for calorie and 250% RDA for protein, taking into consideration that the foods are likely to be shared among other siblings. Close monitoring of the children is done through monthly nutrition assessment in the health clinics and home visits by the health staff. Nutrition education and counseling are also given to the parents or care givers to ensure that the children obtain maximum benefits from the programme. Instructions and demonstrations on the preparation of nutritious meals using items from the food basket are also given. Families that have no water supply or sanitation facilities are provided assistance such as piped water supply and toilet facilities. The families may be referred to other agencies which can provide appropriate assistance to improve their economic status. The number of recipients for this programme has decreased since it began, from 12,690 children in 1989 to 4986 in 2004. From 1994 until 2004, the average number of new cases was 2407 per year. A study was conducted in 2002 to evaluate this programme. It found that 76 percent of the children showed improvement in weight-for-age after being enrolled in the programme for about two and a half years. Several weaknesses of the programme were reported. These included the delay in the delivery of foods once a child was identified to 8 be eligible in the programme, unsuitability and unacceptability of some of the food especially among infants and younger children. The food items were found to be low in key nutrient such as calcium and iron. The study also found that there were poor linkages and coordination with the relevant agencies. The programme has been revised and a new approach has been identified for future implementation. Other malnourished children who are not eligible for the "basket food" are given one kilogram of full cream milk per month as a food supplement. The Ministry Of Rural and Regional Development under its Division of Proverty Eradication has carried out a similar food assistance programme since 2002. It is called the "Balances Food Supplementary Programme". It is one of ten programmes conducted under the "Health Community Development Scheme". It provides balanced and nutritious food supplementation packages to school children aged 12 years and below from hardcore poor households. The programme aims to promote physical growth and learning capacity of the target school-going children. Prevention and Control of Iodine Deficiency Disorder (100) Activities to control 100 in Malaysia are focused in endemic areas, namely the state of Sabah and certain districts in the states of Sarawak, Perlis, Kedah, Perak, Terengganu and Kelantan. The objectives of the 100 Prevention and Control Programme are: i) To reduce the prevalence of goiter among children eight to ten years to less than five percent. ii) To increase the median urinary iodine excretion of school-age children to more than 100IJg/dl. iii) To increase the proportion of population in iodine deficient areas consuming adequately iodised salt to more than 95 percent. Several interventions have been carried out in these states. 9 The interventions are: i) Mandatory universal salt iodisation in the state of Sabah through the gazettement of Sabah as a goitre endemic area in 1999. ii) Mandatory salt iodisation in endemic districts in Sarawak through the gazattement of 16 districts and three sub-districts in Sarawak as goitre endemic area since August 1990. iii) Distribution of iodised salt to pregnant women living in endemic areas through government health clinics. iv) Iodination of water supply in villages, health clinics, schools, long houses and community water supply located in remote villages of the endemic areas. However, water iodination has been phased out owing to problems in the supply of iodine source and the high cost of maintenance. v) Nutrition and health education on food choices and preparation with the objectives to promote the intake of iodine-rich food, the proper use and storage of iodised salts and ways to reduce goitrogens in food. Monitoring of iodised salt is in line with the Malaysian Food Act 1985 (revised in 2004) which states that iodine content in iodised salt should be 20 to 30 ppm or 20 to 30 mg iodine per kilogram of salt. 3.2 Nutrition Promotion Nutrition promotion in the country involves giving nutrition education and dissemination to the target groups and providing the infrastructure for the community to have access to the nutrition information. The programmes and activities that are carried out include Nutrition Education through Health Clinics, Healthy Eating, Promotion of Breastfeeding. Complementary Feeding, Healthy Community Kitchens (Oapur Sihat), Institutional Feeding, Healthy Eating through Healthy Shopping, Healthy Catering, Healthy Cafeterias and Healthy School Canteens. Healthy Eating Healthy Eating was a yearly component of the thematic Healthy Lifestyle Campaign when it was first lunched in 1991, with "Cardiovascular Disease" as the theme. "Healthy Eating" was the theme of the Healthy Lifesty1e Campaign in 1997 that focused on behavioural change. It emphasised on dietary and lifestyle practices that promoted heath and prevented the development of chronic diseases. Healthy eating promotion provides the community with the nutrition massages developed based on current scientific evidence. They were also based on the recommendations of the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) for diet and nutrition and the prevention of chronic diseases. Prime and supportive nutrition messages are developed annually for specific target groups. These educational massages are disseminated to the community through various electronic and print media for various setting such as health clinics, schools, work places and food outlets. The spin-offs from the Healthy Eating promotion were development of the Malaysian Food Pyramid and the Malaysian Dietary Guidelines in 1999. The eight principles incorporated in the Malaysian Dietary Guidelines are: 1. Enjoy a variety of foods. 2. Maintain a healthy body weight by balancing food intake with regular physical activity. 3. Eat more rice and other cereal products, legumes, fruits and vegetables. 4. Minimise fat in food preparation and choose foods that are low in fat and cholesterol. 5. Use small amount of salts and choose foods low in salt. 6. Reduce sugar intake and choose foods low in sugar. 7. Drink plenty of water daily. 8. Practise and promote breastfeeding. The dietary guidelines were designed to prevent nutritional deficiency and chronic diseases and targeted at the population aged two years and above. The Ministry of Health was worked in partnership with various government agencies, non-government organisations and professional bodies in promoting healthy eating. Two recipe books have been published as a result of collaborative efforts between the Ministry of Health and the Nutrition Society of Malaysia. "Health Recipe, Wise Choice" Volume 1 is a collection of local recipes and Volume 2 is a collection of ethnic and 11 traditional recipes. In both books, the original recipes have been modified to reduce use of fat, oil, coconut milk, sugar and salt. Their fibre content have been increased by use of vegetables. The Promotion of Breastfeeding Another important aspect of health eating is the promotion of breastfeeding which has been an integral component of maternal and child health services in the country since the 1950s. A multi-pronged strategy has been adopted in the promotion of breastfeeding since the 1970s. This include mass media education, lactation management training (18 hours) and breastfeeding counseling course for health professionals (40 hours), and school curriculum development (Physical and Health Education ) for primary and secondary school children. This effort started in 1979 with the publication of the Malaysian Code of Ethics for Infant Formula Products. It is an indication of the government's commitment to protect, support and promote breastfeeding. The code covers the basic principles of marketing and product information for all infant formula products (including feeding bottles and teats) in Malaysia. It also provides guidelines on ethical practices for the infant formula industry and the medical and health professionals in the healthcare system. The code was developed based on the International Code of Marketing of Breast Milk Substitutes. There are three committees set up under this code: i) The National Committee on the Code of Ethics for Infant Formula Products - to formulate policies on the promotion, protection and support of breastfeeding. ii) The Vetting Committee on the Code of Ethics for Infant Formula Products - to vet all materials including product labeling related to infant formula products. iii) The Disciplinary Committee on the Code of Ethics for Infant Formula Products ­ to coordinate investigations on specific complaints in alleged violations of the code. The code has been revised several times since 1979 and IS now in its fourth revision. The promotion of breastfeeding was reinforced wher the Mmistry of Health launched the Baby Friendly Hospital Initiative (BFHI) in Augus: '993. an initiative adopted from the WHO. Its objective is to mobilized and involvec "1'1atemity hospitals, wards and hospital staff to technically support breastfeeding. !: a.sc a.rns to create a demand for hospitals that support mothers who wish to breasjee: This initiative ensures that the maternity facilities in the baby friendly hospitals fully practise all the ten steps to successful breastfeeding. In March 1998 Malaysia was recognised by the WHO for making all 110 government hospitals baby friendly, after Sweden and Oman. In 2005 all 114 government hospitals were recognised as baby friendly. Four private hospitals have also been recognized as baby friendly. To support this effort, BFHI training and advocacy activities have been carried out. These include: i) Lactation management courses for state trainers ii) Breastfeeding counsellors' course iii) Mother-to-mother support training for local women with breastfeeding experience. iv) Short courses for administrators and policy makers on the promotion of breastfeeding v) Seminars on breastfeeding vi) Exhibition and counseling on breastfeeding vii) Launching of baby friendly shopping centres The World Breastfeeding Week in the first week of August is also observed by the Ministry of Health. During this week all state health departments have their own activities such as exhibitions and public forums on breastfeeding. 3.3 Improving Household Food Security The World Summit-Plan of Action defined food security as ".... when all people, at all times, have physical and economics access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life." This implies that besides having enough food for the individual and family, other conditions must prevail to ensure true food security. The food available to the household must be shared according to individual need; it must be of sufficient variety, quality and safety; and each member must have good health status in order to utilise the food consumed. 13 The Food and Agriculture Organisation's (FAO) goals for achieving food security are to : ensure a safe and nutritionally adequate food supply at the national and household levels ensure stability in food supply during the year and from year to year ensure each household has physical, social and economic access to enough food to meet its needs Improving household food security is one of the nine thrust areas in the first National Plan of Action for Nutrition Malaysia (NPANM) 1996-2000. Nine strategies and activities have been identified for implementation to ensure availability of quality and safe food at affordable prices to all household at all times. These strategies and activities may have contributed directly or indirectly towards improving household food security in this country. A strategy that could have contributed indirectly towards improving household food security is the incorporation of nutritional objectives, considerations and components into the national policies and programmes. For example, one of the specific objectives of the third National Agricultural Policy (NAP 3) is enhancing food security both at the national and household levels. Other strategies include the strengthening of technical capabilities in the Ministry of Agriculture and Agro-Based Industry to integrate nutrition in agricultural and development projects; research to improve food production. utilisation and distribution; and research on cost-effective indicators to measure household food security. The following strategies and activities of the Ministry of Agriculture and Agro-Based Industry could have direct positive impact on household food security, they are: ­ i) enhancing rice production; zoning of areas for growing vegetables ii) encouraging aquaculture to increase fish production iii) improving post-harvest handling iv) establishing an integrated food cold-chain to lower post-harvest loses and increase supply v) encouraging home and community gardens vi) encouraging farmers to sell direct to consumers 14 vii) improving employment opportunities in rural areas by encouraging private sector involvement in agriculture viii) effective dissemination of nutrition information Activities mentioned in other thrust areas of NPANM I that may have an impact on food security are the Poverty Eradication Programme, Programme for the Hardcore Poor, and the Social Welfare Programme. These programmes are mainly targeted at poor families in the rural areas. Special programme for poor families in the urban areas, for example the NADI programme in Kuala Lumpur, have been handled by the local authorities. Many of these activities have been successfully implemented and monitored by their respective agencies because they are part of the existing programme in those agencies. The Ministry of Agriculture and Agro-Based Industry closely monitors the self-sufficiency level of major food items such as rice, fish, meat, poultry, fruits and vegetables. It also monitors the local demands and exports to ensure that national food security is maintained. Several other activities in NPANM I may have contributed to the improvement of household food security. These include the Ministry of Health's efforts in the prevention and control of infectious diseases, promotion of breastfeeding, care of infants, young children, pregnant women and lactating mothers, prevention and control of micronutrient deficiencies, promotion of healthy lifestyle, and the Rehabilitation Programme for Malnourished Children. The Ministry of Education School Feeding Programme is also an effort to improve household food security in Malaysia. 15 4. Objectives of NPAN M II 4.1 General Objective To achieve and maintain optimal nutritional well-being of Malaysian 4.2 Specific Objectives 1. To enhance the nutritional status of the population 2. To prevent and control diet-related non-communicable diseases 5. Indicators and Targets To meet the objective of NPANM II, the following indicators and targets have been set 5.1 Improving Breastfeeding and Complementary Feeding Practices Target for improvement by the year 201Indicators for action Prevalence of exclusive breastfeeding at 4 months I Increase from 29% (1996) to 40% Establish 15% exclusive breastfeeding up to six months amongst infant Establish 50% timely introduction to Prevalence of exclusive breastfeeding at six months Timely introduction to . complementary foods complementary food amongst six to under ten months 16 5.2 Improving Food Intake and Dietary Practices Target for improvement by the~;~ Increase proportion of the people meeting ~h~1 I to the First Malaysian Food I Indicators for action Energy and nutrients adequacy Dietary practices Malaysian Recommended Nutrient Intake (RNI) compared Consumption Survey Increase recommendations Pyramid compared to the First Malaysian Food Consumption Survey Increase i proportion of people meeting the in the Malaysian Food proportion of people aware of the Malaysian Dietary GUidelines compared to the I -----L N a ti o n al H e a lt h a n d Morbidity Survey III, 2006 ~ 5.3 Reducing Protein-Energy Malnutrition ,--­ Indicators for action Low birth weight Children below 5 year: · Underweight · Stunting · Wasting Underweight: · Children 6 to 12 years · Children 13 t018 years Target for improvement by the year 2015 Reduce from 8.9% in 2000 to 6% Reduce from 10.6% in 2003 to 5% Reduce from 19% in 2000 to 10% Reduce from 13% in 2000 to 6.5% I I I I Reduce by 25% Reduce by 25% 17 Indicators for action Target for improvement by the year 20151II C-h-ro-n-ic-e-n-e-r-g-y-d-e-fic-i'e-n-C-Y-:---r --II I I Above 18 to 59 years I Reduce from 25% in 1996 to 15% ! Above 60 years Reduce from 29.4% in 1996 to 20% 5.4 Reducing Micronutrient Deficiency f-- ---1~Target for improvement by the year 2° 1 5I n d ic a t o rs fo r a c t i.o n 1 Anaemia: I Children below 5 years Reduce from 18% in 2001 to 9% Pregnant women Reduce from 43.8% in 2003 to 30% Iodine deficiency: I School children 8 to 10 years Median urinary iodine excretion level between 100 ~g/L and 200 ~g/L Vitamin A deficiency: ~"dren below 5 years Reduce the prevalence of low serum vitamin A (less than 30 ~g/dl) from 19.8% in 2000 to 10% 5.5 Reducing Overweight and Obesity Target for improvement by the year 2015 Prevalence not more than 10% Prevalence not more than 15% Prevalence not more than 30% Prevalence not more than 15% Indicators for action i School children: iTo 12 years 13 to 18 years I Adult: t I I Overweight I I Obese I I 18 5.6 Preventing and Controlling Diet-Related Non-Communicable Diseases Indicators for action Cardiovascular disease Cancer Osteoporosis Target for improvement by the year 2015 Prevalence of hypercholesterolemia (>5.2 mmol/L) not more than 20% compared to the National Health and Morbidity Survey III, 2006 Decrease proportion of people with dietary fat intake more than 30% of total calories compared to the First Malaysian Food Consumption Survey Prevalence of overweight and obesity in adult not more than 30% and 15% respectively in adult compared to the First Malaysian Food Consumption Survey Increase proportion of people doing adequate exercise (at least 30 minutes a day, 3 times a week) compared to the First Malaysian Food Consumption Survey Increase proportion of people consuming fruits and vegetables, whole grains and legumes as recommended in the Malaysian Food Pyramid Increase proportion of people consuming foods rich in calcium as indicated in the Recommended Nutrient Intake (RNI) for Malaysia and practicing adequate physical activity I I 19 6. Strategies The National Nutrition Policy strategies constitute the basis in formulating the objectives of NPANM II. To ensure effective implementation, monitoring and evaluation of the plan of action, these strategies are oriented into the foundation, enabling and facilitating strategies. 6.1 Foundation Strategy The national Nutrition Policy strategy on "incorporating nutrition objectives. considerations and components into national developmental policies and programmes" forms the overarching strategy and is vital for the effective operation of the plan. 6.2 Enabling Strategies Five strategies of the policy, identified as having direct impact on achieving the specific objectives of the plan, serve as the enabling strategies. These are: Improving household food security especially among the low income group Promoting optimal infant and young children feeding practice Preventing and controlling nutritional deficiencies Promoting healthy eating and active living Supporting efforts to protect consumers in food quality and safety 6.3 Facilitating Strategies Five other policy strategies, identified as providing the mechanism and support for the realisation of the enabling strategies, form the facilitating strategies of the plan. These are: Ensuring all have access to nutrition information Continuous assessment and monitoring of the nutrition situation 20 Promoting continuous research and development Ensuring nutrition and dietetics are practised by trained professionals Strengthening institutional capacity in nutrition activities 21 7.0 NPANM II Framework General TO ACHIEVE AND MAINTAIN OPTIMAL NUTRITIONAL WELL-BEING Objective OF MALAYSIANS Enabling Strategies P~ventlngandcoiltrolllng~nUttitJona'-defic'encles -,- ., - . . . . . - .... -pmmotj,!g;~!I!tW.,,~~g~~~~,L,,¥{~~·}(:;/, .. Specific Objectives Facilitating Strategies Foundation Incorporating nutrition objectives, considerations and components into Strategy national development policies and programmes Figure 1: A Pictorial Representation of Components in NPANM " and Their Linkages 22 8. Activities 8.1 Foundation Strategy 8.1.1 Incorporating nutritional objectives, considerations and components into national development policies and programmes INo. Activities 1Time Frame 1. Incorporate nutrition 9th MP policy statement(s) and 2006-2010 programmes in the development plans of all relevant ministries and agencies for the 9th and 10th Malaysia Plans 10th MP 2010-2015 2. Ensure commitment and 2006-2015 support of all relevant agencies for nutrition through the National I Food Safety and Nutrition Council (NFSNC) 3. Establishment of the 2008 'I INational Institute of Nutrition (NIN) as a focal i point for multisectoral collaboration in nutrition planning, advocacy, training, research and development Ensure effective 2006-2015 coordination and 4. I monitoring of National I Performance indicator Number of ministries and agencies having nutrition policy statements and programmes in their development plans. Number of nutrition related projects Number of council meetings NIN established Number of advocacy activities 23 Target IBy 9th MP all major ministries and agencies By 10th MP all relevant ministries and agencies At least one project per year Twice a year I I Set up in 2008 All states I I Implementing , agency MOH (NPANM secretariat) PMD (EPU) MOE, MOA&ABI MY&S MRRD MWF&CD MH&LG MDT&CA , MEWT ~ All members of the council MOH I NCCFN I I I I No. Activities Time Frame Performance indicator Target Implementing agency Plan of Action for Nutrition (NPANM) II through the National Coordinating Committee for Food and Nutrition (NCCFN) Number of states having State Exco and District Office meetings with NPANM II as an agenda 5. Provision of adequate resources for nutrition and nutrition-related activities: i. Funds ii. Manpower, nutritionist and other required personnel 2006-2015 Specific funds for nutrition under various agencies Number of posts To increase by 10% As recommended in Facilitating Strategy section 8.11 (item no. 3) MOH (NCCFN) i '-----­ 8.2 Enabling Strategies 8.2.1 Improving household food security especially among the low income group No. Activities Time Frame Performance indicator Target Implementing agency 1. Continue existing food and programmes for the identified vulnerable groups: i. Programme for the Rehabilitation of Malnourished Children ii. Supplementary feeding programmes for children, pregnant and lactating mothers By 2015 , Number of recipients II All eligible groups MOH MWF&CD 24 Performance Implementing Activities Time Frame TargetNo I indicator agency I I iii. Food assistance to I Iother groups Provide nutritious and safe supplementary foods to eligible pre-school and primary school children: 2. i. Continue the School Supplementary Feeding Programme ii. Review the criteria for eligibility to increase coverage iii. Continue School Milk Programme through: Free milk distribution to eligible children 3. Ensure access to affordable, safe and nutritious food in schools through: i. Enforcement of the 2004 School Canteen Guidelines ii. Ban on sale of non nutritious and unhygienic foods outside school premises Develop food service and 4. management guidelines for boarding schools 1 (hostels), special homes and institutions 2006-2015 2006-2015 2006-2015 2006 2006-2015 2006-2007 I I i , i Number of recipients I Criteria reviewed i Number of recipients I Number of schools complying with the guidelines Number of schools with "No Hawking" signs outside their premises : Guidelines prepared I i 1 i ! I II I ! ! I MOH MOE I MWF&CD I100% of eligible recipients MRRD (KEMAS) Coverage increase to 50% MOE I 1 I MOE I 100% of eligible recipients Industry MOH MOE Association Canteen Operator MH&LG, i Local Authorities MOH MOE special homes, institutions using No. of schools, MWF&CD guidelines Universities Professional bodies 25 8.2.2 No. 1. 2. Promoting optimal infant and young child feeding practices Performance Activities Time Frame indicator Review the existing End of 2006 Policy developed Breastfeeding Policy and develop a comprehensive policy, guidelines and curriculum for breastfeeding and complementary feeding of young children I i Implement policy, I i guidelines and curriculum I , through: , i. Advocacy to related 2006-2015 Advocacy session to agencies all ielevant agencies: MOH, KEMAS, i RCPA, Information Dept, Women Devt, LPPKN, Community Devt, Welfare Dept, MH&LG,MHR,FMM ii. Intra and inter 2006 Training Module agency training · Development of 2006 Number of training training modules for courses training the trainers Number of participants trained · Training of trainers 2006 Number of echo training sessions Number of participants trained · Echo training (to be integrated into existing training programmes of related agencies) I 26 i Target National policy and guidelines developed Curriculum developed ! I I I All related agencies advocated One training module Two national training sessions per year 80 participants per year At least one training session per agency At least 30 participants per training session i I : Implementing , agency i,, ! MOH i MRRD I MWF&CD I I Universities ! I I i NGOs (PPPIM, i PPPLM, RCPA) I MOH I I MOH MOH MOH MRRD (KEMAS) Relevant NGOs MWF&CD I No. I Activities Time Frame ~~r::itor and evaluate 2006-2007 2007 2006 2008 2006-2015 2006-2015 2006-2007 2007 2006-2015 Performance indicator i ~ I Target Monitoring tools Piloted in 2006 and implemented in ~ Number of centres 100% ABCs and health centres with deliveries Number of private hospitals l\Jumber of other health facilities Number of baby friendly public areas i + 100% private hospitals 100% other health facilities 30% by 2010 60% by 2015 Number of sessions Working mothers Number of educational materials Working mothers Number of dialogue sessions Number of breastfeeding and child care facilities at work place i Mass media 50% by 2010 100% by 2015 27 Implementing agency MOH MOH MOH I MOH I I i MOH I I MH&LG I I j MOH I I I MOl I i I NGOs MOH MHR MWF&CD 4. activities Develop monitoring tools Strengthen and expand the implementation of Baby Friendly Hospital Initiative (BFHI) to: i. Alternative Birthing Centres (ABCs) and health centres that conduct deliveries ii. Private hospitals iii. Other health facilities I Public areas iv. I ' ~ ~-';;end and strengthen ~ ~.. ~ i, 6. ~i,••, I I t ~, ~ education on exclusive breastfeeding and child feeding to working mothers i. Development of educational materials (including AVAs and TV trailers) ii. Dialogue with and use of mass media to create an environment supportive of exclusive I breastfeeding , Promote breastfeeding and adequate child care facilities at work place (for I, public and private sectors) i I No. Activities Time Frame ~opment of guidelines I I ~~~~~ establishment of . ! breastfeeding and child , care facilities at work , place i ~ 7. Strengthen the 2006-2015 establishment of support I groups in the community for breastfeeding and infant feeding 8. Strengthen the 2006-2015 implementation of the Code of Ethics for Infant Formula products through continuous advocacy 2006-2015 marketing and distribution of complementary foods 9. Regulate inappropriate 10. Adopt the policy of mater­ 2006 nity entitlement consistent I with the International Labour Organisation (ILO) Maternity Convention and Recommendations: to extend maternity leave to 4 months Develop nutritious foods I 2006-2015 for infants based on local foods and culture 11. Performance Targetindicator I I I ! Number of support ! I groups established i ! I I I I Number of I , seminars/training on the Code of Ethics I I I ! Draft regulation develop , Duration of maternity leave I I I I I I Publication of food items developed I I I I I I I I I One per district by 2015 One per year Completed by 2010 Four months' maternity leave Implementing agency i I MH&LG FMM MOH MOH I I i MOH MWF&CD MOH Universities MARDI Note: Infant is defined as from birth up to 12 months; young child is defined as 12 to 36 months 28 8.2.3 Preventing and controlling nutritional deficiencies i) r I No. I I 1. ii) 3. Preventing and controlling protein energy malnutrition (PEM) Activities Setting up a National Technical Committee for PEM (as well as those at risk) to: i. Monitor the prevalence of protein energy malnutrition problem amongst various groups ii. Implement coordinated intervention I programmes to address PEM Preventing and controlling iron deficiency anaemia (IDA), vitamin deficiency (VAD) and folic acid deficiency No. Activities 1. Set up National Micronutrient Technical Committee for iron, vitamin A and folic acid , 2. I Conduct a national survey for iron and folic acid in relevant groups Review the need for a national food fortification programme Time Frame Performance indicator 2006-2015 Committee established I Collection of data I I and information on prevalence by I I location, affected I i groups, severity and I causes I Number of I programmes I I implemented ~ Performance Time Frame 2006 2006-2008 I 2009-2010 indicator Multisectoral and multi-disciplinary committee established I I Survey conducted i Review conducted and decision made 29 Implementing Target agency t MOH I Updated data and recommendations made At least one coordinated programme Target 2006 Nationwide J Implementing agency I MOH I I I MOH I I 2010 MOH MDT&CA Industries Performance Implementing Activities Time Frame Target indicator agency , i , I 4. Conduct systematic 2006-2008 II Completed evaluation I 2008 MOH evaluation of the iron I with I ! I supplementation recommendations , UniversitiesI 5. 6. programme being undertaken by maternity ! I,hospitals and antenatal I I clinics II I I I I of iron supplement to I receiving 1 Continue the distribution !m-2015 Number of children All beneficiaries I MOH I Ichildren under the I , supplementation rehabilitation programme I ! ! for the malnourished I I I Implement iron i 2008-2015 I Number of children , All targeted MOH supplementary receiving children and programme for pre-school j su pplementation adolescent girl MOE and primary school I I MR&RD girls I children, and adolescent I +-­ I I IPromote intake of folic 12006-2015 Number of education All attendees in MOH7. ! iacid amongst vulnerable I programmes/ antenatal clinics ~--J ~-1 I MOHPromote dietary I Number and type of Various setting and 8. 12006-2015 target groups the consumption of I programmes by diversification to increase promotion activities/ MOA&A81 ,micronutrient-rich foods I setting target group I I I I MRRD I vegetables I including fruits and I t I I Recommendations MOH committee to examine 9. Set up a technical 2010 2015 madeI deficiencies in other I minerals and trace I groups e.g. pregnant Iwomen and adolescent girls, including s I I upplementation when I necessary activities I and pre-marital JAKIM courses: I adolescent girls MOE I , I elements e.g. calcium, zinc and selenium, and recommend appropriate actions I I I I I I ! I 30 l' ~ ! I I I I l ! p I ~ E i ~ I l I •! I iii) No. 1. 2. 3. 4. 5. Preventing and controlling iodine deficiency disorders (100) Performance Activities Time Frame indicator Strengthen the 100 2006-2015 Regular 100 Technical Committee at Technical Committee national and state levels meetings involving the industries and consumer groups Update guidelines on 100 2006-2015 Updated guidelines in line with the current strategies Train health personnel on 2006-2015 I Number of personnel i 100 control, including in the following ! urinary iodine categories trained: determination and use of ultrasonography in the -Assistant detection of goitre Environmental Health Off'lcers in charge of food safety and quality Public Health Nurses Medical and Health Officers / Medical Assistants Continue with monitoring 2006-2015 i Median urinary iodine and evaluation activities levels ! Proportion of samples of iodised salt at specific levels of the distribution chain not complying with the Food Act 1983 and Food : Regulations 1985 I Conduct a national survey 2008-2010 Survey conducted on 100 Target All states with 100 problem Every year All staff in the categories in the 100 affected areas are trained Gazzetted areas Nationwide Implementing agency MOH MOH MOH MOH i i I I I 1 I J I I I I I 1 I I MOH i i I I -----.J 31 i 1 Performance Impk8" Time Frame TargetActivitiesNo. indicator a~ ... 6. Prepare a proposal to gazette the whole of Sarawak as a goitrous region under existing provisions of the Food Act 1983 and Food Regula­ tions 1985 2006-2008 Gazettement '[ Implemented by 2008 MOH Sarawak SIIII Govel"l'lmEllllllJ' 7. Strengthen the i 2006-2015 I enforcement of regulations I on iodised salt 'I Number of samples taken for inspection 100% compliance MOH 8. Review the need to gazette Peninsular Malay­ sia as a goitrous region under existing provisions I of the Food Act 1983 and i Food Regulations 1985 2008 i Decision made 2010 MOH 9. Strengthen the capacity 2006-2015 Adequate trained At least two trained MOH and capability of regional personnel specifically staff members for public health/dedicated for IDD each laboratory laboratories in IDD (Public health laboratories in Sungai Buloh and Ipoh, IDD laborato­ ries in Kota Kinabalu and Designate Institute for Baling) Medical Research (IMR) as an IDD referral An officer to be laboratory assigned to take charge of the referral laboratory 10. Involve the salt industry 2006-2015 Number of meetings At least annually MOH (salt importers, involving the salt distributors, wholesalers, industry retailers) in the programme Number of participating salt The salt industry importers, distributors. wholesalers and retailers 32 No. Activities ! I Time Frame 'I I Performance indicator I Target Implementing agency 11. Strengthen consumer I 2006-2015 Number of education MOHCommunities in education on 100 programmes 100 affected areas I prevention and control conducted MOE 1 1--------,---1~ ------'-------- ---'---- 1 8.2.4 Strategies in promoting healthy eating and active liVing for all No. 1. 2. Activities Intensify healthy eating programmes Establish a programme focusing on the prevention and control of obesity i. Set up an inter­ sectoral technical committee on obesity ii. Strengthen the obesity component in the "Wellness Clinics" at Health Centres iii. Develop a childhood obesity prevention programme Time Frame I 2006-2015 2006 2007-2015 2007-2008 Performance indicator Number of targeted healthy eating-related : activities I I I I Inter-sectoral technical committee on obesity set up Standard operation procedures for the programme devel­ oped and , implemented Standard operation procedures for the programme developed and implemented Number of campaigns on obesity Target Six per year At least one inter­ sectoral technical committee meeting a year To develop and establish Standard operating procedures for the programme To develop and establish standard operating procedures for the programme ' KEM ASJ JHEOA I Implementing agency I , I I I MOH NSM MASO NGOs MOH MDA MH&LG MY&S Other relevant mins. & assoc. NSM MASO NGOs MY&S I 33 I No. Activities I ~+ I . vi. Increase awareness campaign on obesity ! amOllg all sectors of the I community Establish a weight manqgement programme for the overweight and obese individuals in all Educate health care providers, pre-school teachers and care givers on appropriate nutritional are for the identified vulnerable groups Produce educational materials for target groups Disseminate information to target groups and care givers/child minders Develop training Conduct training Develop and review institutional menus Carry out consultations with the food industry to develop a wider variety of healthy food choices v. age groups 3. i. ii. iii. modules iv. v. 4. I I i Time Frame 2006-2015 2006-2015 2006-2015 ! 2006-2015 2006-2015 i 2006-2015 2006-2015 2006-2015 Initiated in 2005 Performance indicator All clinics with nutrionists will implement the I programme Number of nutrition educational materials produced Number of target groups and care givers given informa­ tion Training modules developed Number of training courses and number of participants Number of institutional menus developed Consultation carried out Appropriate changes in line with healthy eating principles Target At least one campaign a year Programme to be piloted in 2007 and implemented from 2008 onwards At least one educational material per group All target groups At least one training session per year Annually Fast food industries Food manufactures Supermarkets Implementing agency MOH MWF&CD MRRD MOE Relevant NGO~ (e.g. AIDS council) MOH MDT&CA NGOs FMM SMIDEC 34 Performance Implementing No. Activities Time Frame Target indicator agency Universities Consumer associations 5. Promote availability of healthy food choices: . . in eating outlets by food caterers 6. Promote availability of healthy food choices in school canteens in line with the Malaysian Dietary : Guidelines and the new School Canteen Guidelines I Promote physical fitness activities for the general population at work place I 7. : Support and participate in the training of physical fitness instructors using the revised Basic Fitness i 8. i Instructor Course which includes nutrition component 9. Incorporate nutrition considerations in the review of National Sports Policy (NSP), 1988 to meet the objectives of the National Nutrition Policy 2006-2015 Initiated in 2005 2006-2015 2006-2015 2006-2015 2006-2015 I Consultation carried ! out Appropriate changes made to existing : menu, in line with I healthy eating I ! principles Number of promotional activities Availability of healthy food choices in school canteens i I i I I I i Promotion carried out ! Number of trained personnel I ! I I I Nutritionist involved I in review of NSP I ! Annually Fast food i ndustries All schools by 2010 Nationwide All districts should have accredited physical fitness instructors Nutrition considerations adopted in NSP MOH NGOs MDT&CA I Consumer I associations MOE I MOH I I MOH I I MY&S I MY&S MOH , I Department of National Unity and Integration MH&LG MY&S MOH NSM I I ! I I 35 I Performance Implementin~I:T ... A Time Frame TargetNo. ctlvltlesI I indicator agency Produce educational materials to improve 1. I I consumer awareness on i food labelling, food safety and consumer rights to safe and quality foods I I I Educate consumers on food labelling 2. 3. IIntegrate aspects of food labelling (including nutrition labelling and claims) into the school curriculum 4. Support the implementation of the National Food Safety Policy and the National Plan of Action for Food Safety i 2006-2015 ! 2006-2015 i 2006 2006-2015 I I Type and number of educational materials produced Number of consumer , education activities Relevant aspects integrated Number of I programmes with nutrition input At least one educational material produced annually on food labelling, food safety and consumer rights I I 4At least six times a year I By 2006 All relevant programmes requiring nutrition input \ MOl I I I MOH ! ! DT&CA Food industry Professional bodies NGOs Consumer associations MOl MOH MDT & CA Food Industry Professional bodies NGOs (Consumer associations) Mass media MOH MOE MOH Universities Professional bodies Industry 36 Performance Implementing Activities Time Frame TargetNo. indicator agency 5. I Review the Nutrition From 2008 Review completed Annually MOH I Labelling Regulation I gazetted in 2003 for: II a) List of mandatory foods , b) Mandatory nutrients 8.3 Facilitating Strategies 8.3.1 Ensuring all have access to nutrition information I No. I Activities II Time Frame Performance indicator T Target Implementing agency r----------t-----,----------t 1. Intensify the publicity of 2006-2015 Number and Increase in MOH Healthy Eating frequency of media electronic media Programmes publicity and print coverage MAl , by 50% MWF & CD I! MY&S f---+-------~~-- j~----+-------­ 2. Review the Malaysian . 2006-2007 Relevant Dietary 2008 MOH I Dietary Guidelines and I Guidelines published I publish the updated • I ' version fo' specific gmups I I~~ ~3. Produce educational I 2006-2010 Number and type of At least one ! MOH material based on the . educational materials educational Malaysian Dietary Guide- produced material prepared lines (e.g. posters, book­ annually for each lets and pamphlets) dietary guideline , Percentage of the At least 20'/'0 of population that have adult population access to educational have access to the materials material 37 38 i i IActivitiesNo. ! i 9. Educate consumers on i appropriate use of dietary supplements 10. Review periodically dietary I 2006-2015 protocols for the management of obesity and diet-related non-communicable i diseases such as i cardiovascular diseases, diabetes and cancer 11. Support efforts in the regulation and enforcement of mass media advertisement on foods I Time Frame 2006-2015 2007 Performance indicator I Number and type of promotional activities by setting and target group Protocols review and updated Gazettement of relevant advertise I ment I I I I I I I I I I ! I I I I i I Target Consumers Twice between 2006 and 2015 Food industry and mass media 8.3.2 Continuous assessment and monitoring of the nutrition situation No. 1. Activities Conduct periodic and comprehensive national nutrition surveys i I I PerformanceI Time Frame i I indicator 2006-2015 Surveys conducted 39 Target Once every five years nationwide All age groups i Implementing I I agencyI I I i MOH MOl MDT & CA NGOs Consumer bodies Professional bodies Professional bodies MOH MOH I I Implementing agency MOH Universities Research institutes No. 2. 3. 4. Activities i. Continue nutrition surveillance for children below five years i i I ii Establish surveillance for pre-school children i. Establish surveillance for school children iv. Establish surveillance for the elderly Growth monitoring for all pre-school and school children i. Advocacy I I I I I ii. Training including use of child health cards iii. Provide technical support including data collection and analysis Strengthen the acquisition and dissemination of information on assessment and monitoring of the nutrition situation Time Frame 2006-2015 2006-2015 2007-2015 2008-2015 2006-2015 Performance indicator Data and information on nutritional status by target group and location System established System established I Advocacy activities carried out Training carried out I i I i i , I Technical support provided Number of nutrition materials acquired and disseminated by the Nutrition Information Centre, MOH I Target Improve coverage by 25% (MOH clinics) System established by 2008 System established by 2010 All relevant agencies (government and private conducting pre-school programmes All relevant agencies I Implementing agency I i , i MOH I I i : MOE i MWF&CD MRRD (KEMAS) PMD Dept of National Unity & Integration MOE MOH MWF&CD MRRD (KEMAS) Private kindergartens Professional bodies MOH Universities Research institutions 40 I 8.3.3 Promoting continuous research and development in food and nutrition I 3. 4. 5. I I Incorporate nutrition I components into studies of other disciplines, e.g. I poverty, economics, I education, consumerism I !and environment i Establish smart I I partnership with industries ; and research and ! development foundations ! Develop the research capabilities of the National Institute of Nutrition (NIN) to be a centre for I collaborative research at I ! , I national and international I i levels I 2006-2015 2006-2015 2010-2015 Number 0 training courses Number of research incorporating nutrition Number of research projects Amount of funding received Number of research staff and type of equipment meeting recognized norms I 10 research projects by 2010 At least one collaborative project per year i ! I i 2015 I Other relevant I I agencies MOSTI Other relevant agencies i I : I UniversitiesI i i ! MOH (NCCFN) ! Industry R&D foundations Professionals i Bodies I I MOH (NIN) 1 41 8.3.4 Ensuring that nutrition and dietetics are practiced by trained professionals No. Activities 1. Periodic review of nutrition and dietetic curriculum in universities 2. Enact the proposed Allied Health Professional Act (AHPA) for: i. Credentialing and registration ii. Use of code of professional conduct of nutritionists and dietitians 3. Provide more I opportunities for post graduate su b-specia Iity I I training and I cross-disciplinary training for dietitians and I nutritionists Time Frame 2006. to evaluate every five years 2006 2006-2015 I Performance indicator Number of meetings between universities and potential employers AHPA enacted Code to be made known to all nutritionists and dietitians Number of trained personnel Target Two meetings per year Tabled in Parliament by 2006 Use of code by nutritionists and dietitians All nutritionists and dietitians Implementing agency Universities MOH Food industry Relevant agencies MOH NSM MDA Universities Agencies with nutritionists and dietitians 42 8.3.5 Strengthening institutional capacity in nutrition activities 43 Performance Implementing Activities Time Frame Targetindicator agency 4. 5. 6. MY&S-1 per major Industry dealing sport With food MWF&CD- 1per ! Nutrition and i , I state I fitness I MR&RD-1 per i ! , : i ! i Strengthen nutrition I 2006-2015 , Nutrition curriculum componenet in the training I developed for each of: target group Ii. Health professionals i I i ii. Teachers J Include nutrition , 2006 Inclusion of nutrition component in the current i component into the i I Food Handlers' Training ! training curriculum I Course mandatory for canteen operators, food , I Icaterers, cooks, hawkers ! and other food services personnel Carry out training on the 2008-2015 I Number of training effective use of dietary I sessions I protocols for the I management of chronic I i I Number of trained personnel diseases I state I ! Industry- at least I one per company i ! One curriculum per MOH group !. ~ ! All canteen MOH operators, food caterers, cooks, Local I hawkers and other government food services personnel I I i I I All relevant health I Professional care professionals bodies I I MOH i I 44 9. Implementation The National Coordinating Committee for Food and Nutrition ( NCCFN ) being the high­ est body in the country has the overall purview to monitor and evaluate the implementa­ tion of the plan Appropriate technical working groups and committees are established to focus on relevant nutritional issues and to implement activities accordingly. These include TWG for Nutrition Policy, Nutrition Guidelines, Nutrition Training, Nutrition Research and Nutri­ tion Promotion. Terms of reference for the technical working groups (TWG) are as follows: To review and strengthen the National Nutrition Policy To advocate the National Nutrition Policy and NPANM II To identify the nutrition training needs of related agencies To develop nutrition modules and conduct nutrition training based on the modules To identify nutrition research priorities in the country based on NPANM " To plan, coordinate and evaluate nutrition research related to NPANM II To revise the current Malaysia Dietary Guidelines and develop new guidelines To implement, monitor and evaluate the nutrition promotion activities identified in t\lPANM II To act as focal points in the development of nutrition educational materials The plan has included several agencies and organisations which could implement the activities at the national and local levels. However, the participation and active involvement of other agencies does not preclude them from contributing in other ways. It is important that the plan be implemented with the guiding principle of close collaboration within the multisectoral framework. 45 10. References 1. Department of Statistics Malaysia (2002). Vital Statistics Malaysia. Department of Statistics. PutraJaya. 2. Family Health Development Division, Ministry of Health Malaysia (1993). Guidelines for the Supplementation of the Programme for the Rehabilitation of Undernourished Children from Hardcore Poor Households. 3. Family Health Development Division, Ministry of Health Malaysia. Annual Reports for 1993 - 2005 . 4. Food and Agriculture Organisation (various years). Food Balance Sheets. FAO, Rome. 5. John Hoddinott (Editor) ( 2001 ). Food Security in Practice. Methods for Rural Development Projects. International Food Policy Research Institute. Washington, DC, 2001. 6. Khor Geok Lin (2003). Food and Nutrition Security in Malaysia. In "Accessibility to Basic Needs: A Report of SUHAKAM'S Seminars on Economic, Social and Cultural Rights". 31 July 2003, Kuala Lumpur. 7. MA MENDEZ, CA Monterio & BM Popkins (2006). Overweight Now Exceeds Underweight among Women in Most Development Countries. Am J Clin Nutr 81: 714-21. 8. Ministry of Health Malaysia (1997). Report of the Second National Health and Morbidity Survey Conference. Public Health Institute, MOH, Kuala Lumpur. 9. Ministry of Health Malaysia (1997). Report of the Second National Health and Morbidity Survey Conference. Public Health Institute, MOH, Kuala Lumpur. 10. Ministry of Health Malaysia (2002). Malaysia's Health 2001. Technical Report of the Director-General of Health Malaysia 2001. MOH, Kuala Lumpur. 46 11. Ministry Of Health Malaysia (2003). Report of an Evaluation of the Programme for the Rehabilitation of Undernourished Children from Hardcore Poor Households. 12. Ministry of Health Malaysia (2006). Report on Nutritional Status of Children below 5 Years. Information and Documentation System Unit, MOH, Putrajaya. 13. Ministry of Health/UNICEF (2000). Nutritional Status of Children below 6 Years in Malaysia. MOH, Kuala Lumpur. 14. National Coordinating Committee for Food and l\Jutrition (1995) The National Plan of Action for Nutrition of Malaysia (1996 - 2000). 15. Proverty Eradication Division, Ministry of Rural Development (2002). Guidelines for the Balanced Food Supplementation Programme. 16. United Nations System Standing Committee on Nutrition (2004/2006). Overweight and Obesity a New Emergency? SCN, Geneva. 17. Zalilah MS & GL Khor (2006). Obesity and Household Food Insecurity: Evidence from a Sample of Rural Household in Malaysia. European J Clin Nutr 59: 1049. 47 11.0 Appendix List of Abbreviations Abbreviation 1. FMM 2. JAKIM 3. JHEOA 4. KEMAS 5. MARDI 6. MASO 7. MDA 8. MDT & CA 9. MEWT 10. MHE 11. MHR 12. MH & LG 13. MOA&ABI 14. MOE 15. MOH Name of agency Federation of Malaysian Manufactures Department of Islamic Development Malaysia Department of Orang Asli Affairs (Jabatan Hal Ehwal Orang Asli) Community Development Division (Jabatan Kemajuan Masyarakat) Malaysian Agricultural Research and Development Institute Malaysian Associate for the Study of Obesity Malaysian Dietitians Association Ministry of Domestic Trade and Consumer Affairs Ministry of Energy, Water and Telecommunications Ministry of Higher Education Ministry of Human Resources Ministry of Housing and Local Government Ministry of Agricultural and Agro-Based Industry Ministry of Education Malaysia Ministry of Health Malaysia 48 Abbreviation Name of agency 16. MOl 17. MOSTI 18. MPA 19. MRRD 20. MWF & CD 21. MY&S 22. NCCFN 23. NGO 24. NSM 25. PHA 26. PMD 27. PPPLM 28. PPPIM 29. RCPA 30. SMIDEC Ministry of Information Malaysia Ministry of Science, Technology and Innovation Malaysian Paediatic Association Ministry of Regional and Rural Development Ministry of Women, Family and Community Development Ministry of Youth and Sports National Coordinating Committee for Food and Nutrition Malaysia Non-Government Organisation Nutrition Society of Malaysia Private Hospital Association Prime Minister's Department Breastfeeding Advisory and Lactation Consultant Association of Malaysia (Persatuan Penasihat dan Pakar Laktasi Malaysia) Malaysian Breastfeeding Advisory Association Registered Childcare Providers Association Small and Medium Industries Corporation 49 11.1 The National Coordinating Committee for Food and Nutrition (NCCFN) Chairman Deputy Director General Of Health (Public Health), Ministry of Health Members: Ministry of Health Director, Family Health Development Division Deputy Director (Nutrition), Family Health Development Division Principal Assistant Director (Family Health), Family Health Development Division Principal Assistant Director (Nutrition), Family Health Development Division Principal Assistant Director, Food Safety and Quality Division Principal Assistant Director, Diseases Control Division Institute of Medical Research (IMR) Institute of Public Health (IKU) Representatives from other agencies: Economic Planning Unit, Prime Minister's Department Implementing and Coordinating Unit, Prime Minister's Department Ministry of Agriculture and Agro-Based Industry Ministry of Education Malaysia Department of National Unity and Integration Ministry of Regional and Rural Development National Family Development and Population Board (LPKKN) Institute of Medical Research (IMR) Institute of Public Health (IKU) 50 Malaysian Agriculture Research and Development Institute (MARDI) Universiti Kebangsaan Malaysia (UKM) Universiti Putra Malaysia (UPM) Universiti Islam Antarabangsa (UIAM) Nutrition Society of Malaysia (NSM) Malaysian Dietitians Association (MDA) Malaysian Association for the Study of Obesity (MASO) Malaysian Breastfeeding Advisory Association (PPPIM) Drafting Committee for the National Plan of Action for Nutrition of Malaysia II Advisors Dato' Dr Shafiee Ooyub, Deputy Director General of Health (Public Health) Dato' Dr Narimah Awin, Director of Family Health Development Division Members Ministry of Health Puan Angela Bong Encik Azmi Md. Yusof Puan Fatimah Salim Encik Jamal Khair Hashim Puan Jamilah Ahmad Dr. Mohd Ismail Abdul Samad Dr. Nik Rubiah binti Nik Abdul Rashid Puan Rokiah Don Datin Dr. Safiah Mohd. Yusof Puan Somsiah Parman 51 Puan Taziah Fatimah Ibrahim Dr. Tony Ng Kock Wai Dr. Haji Yahya bin Haji Baba Cik Hjh. Zainab Tambi Ministry ofAgriculture and Agro-Based Industry Puan Azizah Mat Jan Cik Hanisah Husin Puan Khazlita Abdol Adzim Encik Mazlan Kasran Dr. M. Sivamoorthy Encik Samsuri Mokhtar Prime Minister's Department Miss Daisy Rajoo Encik Rohani Salleh Department of National Unity and Integration Encik Inau Edin Nom Ministry of Housing and Local Government Cik Norliza binti Taib Encik Zazali bin Salehudin Ministry of Youth and Sports Encik Suroya bin Selamat 52 Ministry of Education Encik Mohd Anuar Abd.Hamid Cik Nyam Kiau Ministry of Domestic Trade and Consumer Affairs Encik R. Narasingam a/I Ratnasingam Malaysian Food Manufacturing Group (MAFMAG) Encik Ng Kim Keat Nutrition Society Malaysia (NSM) Dr. Tee E Siong Malaysian Dietitians Association (MDA) Dr. Winnie Chee Malaysia Association for the Study of Obesity (MASO) Dr. Nik Mazlan Nik Mamat Universiti Kebangsaan Malaysia Prof. Aminah Abdullah Prof. Dr. Mohd Ismail Noar Universiti Sains Malaysia Prof. Dr, Wan Abd. Manan Wan Muda Universiti Putra Malaysia Prof. Dr Khor Geok Lin Secretariat Puan Nor Azah Ahmad Puan Nor Azliana Mohamat Nor 53 Puan Siti Shuhailah Shaik Abd. Rahim Miss Logeswary Arumugan Puan Surainee Wahab Encik Jaafar Mohamed Idris Editorial Committee Advisors Dato' Dr. Narimah Awin, Director of Family Health Development Division Chairman Cik Hajjah Zainab bt. Tambi, Deputy Director of Health (Nutrition) Members Ministry of Health Puan Angela Bong Puan Fatimah Salim Puan Rokiah Don Datin Dr. Safiah Mohd. Yusof Puan Zalma Abdul Razak Universiti Putra Malaysia Prof. Dr. Khor Geok Lin Dr. Mohd Nasir Moh Taib Universiti Kebangsaan Malaysia Prof. Dr. Mohd Ismail Noar Ministry Of Education Puan Rohani Abd. Samad 54 Ministry of Agriculture and Agro-Based Industry Puan Azizah Mat Jan Nutrition Society Malaysia (NSM) Dr. Tee E Siong Secretariat Puan Zuraini Abdullah Puan Nor Azliana Mohamat Nor Puan Siti Shuhailah Shaik Abd. Rahim Puan Khairul Zarina Mohd Yusop 55