Research Article: Prevention of malnutrition among children under 5 years old in Iran: A policy analysis

Date Published: March 7, 2019

Publisher: Public Library of Science

Author(s): Mohammad Mohseni, Aidin Aryankhesal, Naser Kalantari, Sukumar Vellakkal.


Malnutrition is one of the main causes of death in children under 5 years of age and one of the most common factors threatening children’s life and health. Nutrition policy analysis and solving existing problems in children can reduce the effects of malnutrition. This study aimed to analyze the current policies of malnutrition prevention in children under five years of age in Iran.

This study was conducted in 2017 to analyze policies using the “policy triangle framework”. In order to examine the policy-making process, the Kingdon’s multiple streams model was used. A combination of two sampling methods, including purposeful and snowball sampling, was applied to select the interviewees. In relation to the implemented documents and policies, the country’s most important policies were selected based on the suggestions of policy makers as well as searching scientific databases and electronic portals. A data collection form was used to identify the current policies and documents and a semi-structured interview guide form was used for the interviews. The framework analysis and MaxQDA software were applied to analyze the data obtained from the interviews.

The key factors affecting policies in Iran included the status of indicators as well as economic, social, structural-legal, policy and international factors. Among the most important policies and implemented programs, the following can be mentioned: growth monitoring, oral rehydration, breastfeeding, immunization, female education, family spacing, food supplementation, nutrition for children under five years of age, and control of nutritional deficiencies. Currently there is a need for a nationwide program and comprehensive document in the field of the nutrition in children under 5 years of age, which requires strengthening of the political process. Participants and stakeholders in nutrition-related policies for children under the age of five were divided into four categories of governmental, semi-governmental, non-governmental, and international organizations.

More attention should be paid to the shortage of some micronutrients, accurate implementation of breastfeeding programs, supplementary nutrition, fortification and supplementation programs for children and mothers, utilization of the advantages of each region and its resources, and better coordination between organizations and their policies, and finally strong incentives are needed to promote macro nutritional goals for children under five years of age.

Partial Text

Malnutrition is a common and widespread condition that usually occurs as a deficiency in the intake of energy, protein, or micronutrients [1]. Malnutrition is one of the main causes of the death of children under the age of 5 years and is one of the most common causes of the decline in the health and life of children, which results in decreased learnability, inefficiency, and inability to acquire skills [2]. Malnutrition contributes to the death of nearly half of the children under five years of age in Asia and Africa. Inadequate nutrition increases the risk of death due to common infections, increases the number and severity of the infections, and may lead to delayed recovery [3–7].

This study was conducted in 2017 to analyze policies implemented for malnutrition prevention among children under 5 years old in Iran using the “policy triangle framework”. This model covers four general areas: context, content, policy-making process, and actors [19]. In the present study, Kingdon’s multiple streams model was used for the policymaking process phase. This model provides a basis to understand the policymaking process as a fluid cycle of stages with the key stages being agenda setting, policy formation, implementation, and evaluation. Moreover, the Kingdon’s multiple streams model was used to examine the agenda setting phase. This model is presented with an emphasis on the agenda, and contains three independent streams as the problem stream, policy stream, and politics stream, which reach each other in a place called “windows of opportunity” and lead to adopting an appropriate policy for problem solving. In other words, the streams come together and open a window of opportunity and then governments decide to address it [20]. Textual review and document analysis were used to identify policies. The main focus at this stage was selection of the main policies of the Ministry of Health and policies that were interlinked by the Ministry of Health. Subsequently, semi-structured interviews were conducted with senior policy makers and nutrition senior managers as key informants. The findings were reported in accordance with COREQ (consolidated criteria for reporting qualitative research) guidelines [21].

In this section, the results of the interviews, document reviews, and policy analyses are presented based on the policy triangle framework in four areas of context, content, policy-making process, and actors. The characteristics of the key informants who were interviewed are listed in Table 1.

An examination of the policies adopted in Iran indicates that there are adequate nutrition policies for food and nutrition security, but there is no specific document and policy related to nutrition and prevention of malnutrition in children under 5 years although nutrition is very important in this age group.

The field of child nutrition is very important, but some related issues are not on the policymakers’ agenda as required. Issues such as lack of some micronutrients, which is highly prevalent in children, require policies that need to be pursued more seriously. Precise formulation and implementation of breastfeeding programs, complementary nutrition, and therapeutic supplementation for children, and fortification and sumpplementation for mothers should receive priority in this regard. The advantages and capabilities of each region are among the most important elements to be considered in policies. The use of ethnic and local foods in each region, correction of malnutrition, and promotion of nutritional literacy should be considered in different areas. Furthermore, given the fact that the policies of different organizations affect each other and lack of coordination between these policies may affect the success of the overall policies adopted, there is a strong need for more cooperation to materialize macro objectives.




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