Tackling malnutrition and stunting in Viet Nam

Song A Chia was born in Viet Nam's northwest mountainous province of Dien Bien. Like nearly a third of the children in this very poor province, Chia was severely malnourished, weighing less than 5kg by the time he was eight months old.

"When Chia was born, his cleft palate meant he had trouble latching on to the breast. His mother didn't have enough breast milk, explained his father, Son A Phinh." A community health care worker came to check on him and told us he was not gaining enough weight."

Son A Phinh is holding his son Song A Chia, eight months old baby, born cleft palate, malnourished and weighing less than 5kg. They are queuing for their turn during a regular health check in the Commun Health Centre of Viet Nam's northwest mountainous province of Dien Bien. Photo: UNICEF Viet Nam\2014\Truong Viet Hung

Dien Bien is the second poorest province in Viet Nam and the majority of its half a million residents are ethnic minority people, mostly from the Thai, Mong and Kho Mu tribes. Chia and his family are Mong and they live in hard-to-reach Muong Cha where, among the district's 593 children under age five, nearly 30 per cent are too short for their age or stunted. 

Malnutrition and stunting in Viet Nam

Stunting is caused by long-term malnutrition and frequent infections which are often the result of poor hygiene and sanitation. It generally occurs in the first 1,000 days of a child's life and the effects are largely irreversible. Photo: UNICEF Viet Nam\2014\Truong Viet Hung

Almost one in three—or 1.9 million-- under age five children in Viet Nam are considered too short for their age, or stunted. The level of stunting is approximately three times higher amongst Vietnamese children from the poorest households and in ethnic minority groups.

Children under two years of age are most vulnerable to stunting, and this is the period of life when poor breastfeeding and inappropriate complementary feeding practices put children at hig h risk. Each year more than 700,000 children develop acute malnutrition manifested by low height for weight.

Viet Nam is among the 34 countries in the world with the highest burden of stunting, particularly in areas with large populations of ethnic minority people such as the Central Highlands and Northern Midlands and Mountainous regions.

Stunting is caused by long-term malnutrition and frequent infections which are often the result of poor hygiene and sanitation. It generally occurs in the first 1,000 days of a child's life and the effects are largely irreversible. These include delayed motor development, impaired cognitive function and poor school performance, which in turn have consequences on future social and economic outcomes.

A package of child friendly services

Nearly two thirds of Dien Bien's children live in poverty, making the province one of eight UNICEF priority areas for a package of critical, child friendly services that aim to improve the welfare of the most vulnerable families.

With support from the Luxembourg Embassy in Viet Nam, UNICEF has been able to deliver high impact interventions in ethnic minority bilingual education, maternal and child health care, improved hygiene and sanitation, social services and child protection to address critical children's issues, including child stunting and management of severe acute malnutrition. The critical success factor in all these services is their availability at the community level.

Community based management of malnutrition

Identifying severely malnourished children at community level is crucial to reducing child deaths, especially in hard-to-reach areas such as Muong Cha, where access to health care facilities requires a whole day of travel or more. Photo: UNICEF Viet Nam\2014\Truong Viet Hung

As part of UNICEF's package of child friendly services, community health care workers or volunteers are trained to identify malnourished children in remote communes using a simple plastic strip that measures their upper arm. An upper arm circumference less than 11 cm suggests severe acute malnutrition.

Once children under age five, like Chia are identified as suffering from severe acute malnutrition, they are seen by a health worker who has the skills to fully assess them following UNICEF's Integrated Management of Acute Malnutrition (IMAM) model. This includes determining whether the child can be treated in the community with regular visits to the health centre, or whether referral to in-patient care is required.

"When Chia was first brought in at 8 months old, his upper arm measured only 9,5 centimeters," said Ms Nguyen Thi Bien, a village health care worker in Muong Cha district. "In this particular area, people have to work very hard to survive. They are very poor and have limited knowledge on how to care for their children," she explained.

Early detection, coupled with village-based treatment, makes it possible to start management of severe acute malnutrition before the onset of life threatening complications. Evidence shows that about 80 per cent of children with severe acute malnutrition who have been identified through community health workers, or through sensitizing and mobilizing communities to access decentralized services themselves, can be treated at home.

Early detection, coupled with village-based treatment, makes it possible to start management of severe acute malnutrition before the onset of life threatening complications. Photo: UNICEF Viet Nam\2014\Truong Viet Hung

Chia was provided with an intensive nutritional rehabilitation at home with ready-to-use therapeutic food until he gained adequate weight. In Viet Nam, this ready-to-use therapeutic food—referred to as HEBI--is produced locally with nutrient dense foods and added micronutrient supplements.

In addition to nutritional therapy, severely malnourished children also receive a short course of oral medication to treat infections, vitamin A and deworming medication. They are then followed-up by health care worker home visits to for monitoring.

At 18 months, Chia is still small for his age but can feed himself, and is no longer considered severely malnourished. He and 13 other children in the district have been successfully treated for severe acute malnourishment and are thriving through the IMAM model.

Expanding IMAM to other provinces

In addition, UNICEF is strengthening networks of community support groups and communication activities in disadvantaged provinces to increase the rates breastfeeding and optimal complementary feeding practices. Photo: UNICEF Viet Nam\2014\Truong Viet Hung

To date, the IMAM approach has only been introduced in a few communes in Viet Nam's poorest provinces, focusing primarily on children with severe acute malnutrition. In the future it is hoped that it will be possible to include children, as well as pregnant and lactating women, suffering from moderate acute malnutrition. Earlier treatment could prevent long term consequences of acute malnutrition developing, and increase their chance of recovery.

"Malnutrition is at critical levels in remote parts of Dien Bien Province," said Youssouf Abdel-Jelil, UNICEF's representative in Viet Nam.Photo: UNICEF Viet Nam\2014\Truong Viet Hung

We can no longer turn a blind eye to this issue. Greater investments are sorely needed in early integrated services that ensure long-term, continuous care, especially in these remote communities," he noted.

UNICEF and its partners, such as the Luxembourg Embassy in Viet Nam, work to make nutrition a national priority. Together they are accelerating efforts to improve maternal, infant and young child nutrition practices through easier and equitable services at the community level, especially in the most vulnerable areas like Dien Bien Province.


The IMAM model has been included in Viet Nam's National Nutrition Programme and is being used in selected areas with a view to replicate it on a national scale.

In addition, UNICEF is strengthening networks of community support groups and communication activities in disadvantaged provinces to increase the rates breastfeeding and optimal complementary feeding practices.

These efforts aim to reduce stunting prevalence from 30 to 23 per cent by 2020.

Nutrition is the best investment a county can make. Well-nourished children perform better in school, grow into healthy adults and in turn give their children a better start in life. At the same time, well-nourished women face fewer risks during pregnancy and childbirth, and their children set off on firmer developmental paths, both physically and mentally.