CURRENT NUTRITIONAL SITUATION IN CAMBODIA

Although death rates in children in Cambodia are decreasing, they remain the 2nd highest in the South Eastern Asian region only second to Myanma.

Myanma	Cambodia	Lao PDR	Indonesia	Philippines
106	83	83	38	34
China	Viet Nam	Thailand	Malaysia	Singapore
31	23	21	12	3

While there has been significant progress in the child survival rate in Cambodia, 1 in 12 children (83/1000 live births) still die before reaching their fifth birthday and 1 in 5 infants (66/1000 live births) still die before reaching their first birthday (CDHS 2005). 

Over a third of child deaths under 5 years in Cambodia are directly related to under-nutrition, and poor infant and youn child feeding (IYCF) practices also contribute to deaths from diarrhea, pneumonia, and neonatal causes.

In addition to preventing deaths, good nutrition is essential for growth, health and development. Chronic malnutrition during the first 2 years of life causes stunting - which means that a malnourished child may be small for life. Adults who were not breastfed or were malnourished as a young child have lower intelligence and reduced work capacity, which means that it will be more difficult for them to provide for themselves and their families as adults. Their communities and the nation also suffers economically.

According to recent surveys (WHO Global Database 2007, CAS 2008), the percentage of Cambodian children who are chronically malnourished (stunting) remains unacceptably high at 40% and the percentage of wasting and underweight have not decreased and may even be increasing.  This means that we still have a lot of work to do in Cambodia to improve nutrition and infant and young child feeding (IYCF).

We need to do more to improve the survival and well being of infants and young children in Cambodia by improving their nutritional status, growth, and development through optimal feeding. Studies show that breastfeeding can prevent 13% of child deaths, and with appropriate complementary feeding, another 6% of child deaths can be avoided. 

Optimal infant and young child feeding (IYCF) strategies that we need to

 Encourage and support in Cambodia are:  

 1- Early initiation of breastfeeding within 1 hour of delivery

 2- Exclusive breastfeeding of infants < 6 month old: This mean the child receives no water or other food or    

     fluids other than breast-milk during the first six months of life.

 3- Appropriate complementary feeding starting at 6 month of age with continued breastfeeding for at least 

     two year of age or beyond.  

 4- Appropriate care for sick and malnourished children 

Recently, Cambodia has shown some good progress in improving the first 2 of these key IYCF practices. The good news is that since 2000, there has been a large increase in exclusive breastfeeding of infants under 6 months of age from only 1 in 10 infants under 6 months in 2000 to almost 7 in 10 infants in 2008 (CDHS, 2000, 2005, CAS 2008). This means that the majority of Cambodian parents now understand the importance of and exclusively breastfeed their infants in the first 6 months of life.

There has been a 3 fold increase in early initiation of breastfeeding (within 1 hour) from only 1 in 10 newborns in 2000 to more than 3 in 10 newborns in 2005. and, although it used to be a common practice, fewer Cambodian mothers now withhold breastfeeding for the first day of life (down from almost 9 in 10 newborns to less than 4 in 10 in 2005).

Although these are positive steps forward- there are still areas for improvement. In particular, health center and hospital staff who assist at deliveries should make sure to improve their own practices to: 

• get 10 out of 10 mothers to breastfeed their infants in the first hour after delivery 
• avoid pre-lacteal feeds, giving water, sugar water, honey or tea to any baby in the first day after delivery
• ensure that breastfeeding is well established before the mother and her newborn are discharged from the health facility, and 
• support exclusive breastfeeding for 6 months.

The bad news is that while exclusive breastfeeding of infants under 6 months has increased in rural Cambodia, exclusive breastfeeding rates have declined in urban areas since 2005. More efforts need to be made to support and encourage exclusive breastfeeding in urban areas. There needs to be a push to increase the uptake of exclusive breastfeeding in urban areas which would involve: 

• better training of health professionals
• more positive media campaigns
• more peer support programs
• stronger midwife and physician support for breastfeeding when they assist at deliveries in a health center, hospital or private clinic
• better access to antenatal and postnatal counseling 
• more work place support for breastfeeding

All health professionals have a responsibility to get the message to all women that breastfeeding provides significant health benefits for the mother and baby.

A second problem is that half of all Cambodian children stop breastfeeding before the recommended age of 2 years, depriving them of valuable nutrients. The CDHS (2005) notes that infants and young children under 2-3 years of age who are no longer breastfeeding are much more likely to be malnourished than those who are still breastfed. Hence continue to breastfeed your child for as long as she or he wants after the age of 2 years. 

Third, complementary feeding practices: giving 6-24 month olds other foods in addition to breast-milk-are still very poor in Cambodia.

Complementary foods are often introduced too early or too late and are often nutritionally inadequate and unsafe. The quality, quantity, and nutrient density of complementary foods are sometimes poor, as are frequency of feeding and feeding practices such as active feeding.

Only slightly more that half (63%) of Cambodian children age 6-23 months have a minimally diverse diet, meaning they do not eat foods from the 3 food groups each day. 

Other reasons for the poor feeding practices are poor awareness of the value of local produce and mis-conceptions or taboos about feeding certain foods to infants or young children. 

Studies in Svay Rieng province (Formative Research 2005) show that although most mother and caretakers there knew when to start complementary food, how to cook and how to actively feed the children, some said they were not able to follow feeding recommendations due to lack of money, lack of time, or lack opf support from their family which includes lack of understanding and good practices by siblings and others caring for children.

There is an urgent need to reduce infant and child morbidity and mortality by improving how families feed infants and young children in Cambodia.

The National Nutritional Strategy is aimed at increasing the coverage of proven interventions such as:

1. Education and counseling to improve knowledge about breast feeding and appropriate about breast feeding and appropriate complementary feeding and effect behavior change
2. Growth promotion, assessment and monitoring
3. Food fortification

As health worker, you have a major role in helping to achieve these objectives.