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Nutrition Report REPORT ON THE RESEARCH REGARDING NUTRITIONAL STATUS OF RA POPULATION Within the Framework of “Improving Regional Food Security in South Caucasus through National Strategies and Smallholder Production” Project Armenia 2015 Content ACRONYMS .........................................................................................................................4 INTRODUCTION..................................................................................................................5 Executive summary ................................................................................................ 6 1. METHODOLOGY ....................................................................................................... 10 Goal and objectives of the research ..................................................................... 10 Research methods ................................................................................................ 11 Quantitative Survey Sampling .............................................................................. 12 Field work and challenges occurred during interviews .......................................... 16 2. BRIEF SUMMARY ON THE STATE OF HEALTH OF THE POPULATION AND CHALLENGES ................................................................................................................... 17 Risks of development of chronic diseases among the RA population .................. 19 Prevalence of obesity ........................................................................................... 20 Issues of child nutrition ......................................................................................... 21 The state of child nutrition in the Republic of Armenia .......................................... 21 The continuing low level (35% according to 2010 DHS data) of exclusively breast fed children up to 6 months-old is an issue of concern. ........................................ 21 This shows that breast feeding picture has only slightly improved for the 0-4 months age group (45% in 2000, 37% in 2005 and 48% in 2010), as well as 0-6 months age group (30% in 2000, 33% in 2005 and 35% in 2010). ....................... 21 3. NATIONAL POLICY FRAMEWORK ON FOOD SECURITY AND NUTRITION .... 24 Strategic programs and concepts on public nutrition and food safety adopted by the RA Government .............................................................................................. 27 Laws and by-laws on public nutrition and food safety adopted by the Government of RA ..................................................................................................................... 37 4. NUTRITIONAL STATE OF THE POPULATION ...................................................... 45 Research framework ............................................................................................. 45 Food Accessibility and Use ................................................................................... 48 Physical accessibility and infrastructures ........................................................... 48 Food use and tendencies conditioned by accessibility, seasonality and other factors ............................................................................................................... 53 Household diet diversity ..................................................................................... 57 Economic factors affecting households .............................................................. 58 Purchasing Food and Cooking ........................................................................... 60 Water accessibility ............................................................................................. 61 Hygiene and health ............................................................................................ 64 Food consumption among adults ....................................................................... 66 Child nutrition..................................................................................................... 70 Knowledge ......................................................................................................... 73 CONCLUSION ................................................................................................................... 78 Recommendations ............................................................................................................. 81 ANNEXES .......................................................................................................................... 83 Annex 1. List of studied documents ...................................................................... 83 Annex 2: % of mountainous/high mountainous, lowland and border communities in comparison to all provincial/marz communities .................................................... 84 Annex 3. Food Groups .......................................................................................... 85 Annex 3. Food Groups .......................................................................................... 85 Annex 4. Tables of the quantitative survey ........................................................... 86 ACRONYMS WHO World Health Organization DCS Disease of the Circulatory System CHIS Center for Healthcare Information Statistics HBP High Blood Pressure HUI High University Institution ED European Directive MF Milk Formula BM Breast Milk DHS Demographic and Health Survey of Armenia RA Republic of Armenia NA RA National Assembly of the Republic of Armenia MoH RA Ministry of Healthcare of the Republic of Armenia MoA RA Ministry of Agriculture of the Republic of Armenia AIDS Acquired Immune-Deficiency Syndrome UN United Nations HIV Human Immune-Deficiency Virus DM Diabetes Mellitus NCD Non-communicable diseases MN Malignant Neoplasms/tumors RF Risk factor IHD Ischemic Heart Disease INTRODUCTION In April 2015, the Advanced Research Group NGO started research, initiated by OXFAM, on the nutritional state of the RA population. The research was conducted as part of the Food Security Project funded by the European Union. The research was carried out using qualitative and quantitative methods of data collection among 1,600 respondents (citizens) and key informants / experts. The research was tasked with uncovering issues characterizing the state of nutrition of the RA population as well as identifying national policy priorities and a number of other issues in this area through policy analysis and qualitative interviews with experts/key informants. Throughout the research, the APR Group was in active cooperation with OXFAM in Armenia, the Ministry of Healthcare, the Center for Disease Control and Prevention of MoH, the State Service for Food Safety, RA National Statistical Service, and representatives of their agencies who greatly contributed to the research with information or technical guidance. The current report contains sections that describe the research methodology, its goal and objectives, methods of data collection, research sampling, as well as a brief summary on the general state of health of the RA population. The main content of the report is presented in the “Results of the Quantitative Research on the Nutritional State of the Population” section and includes the national nutritional policy framework with a review of the main strategies and existing legislation. Executive summary “Advanced Public Research Group” (APR Group) NGO conducted research on the nutritional state of the Armenian population in cooperation with OXFAM in Armenia. The goal of the research was to identify the current state of the nutrition among the population as well as mechanisms for implementation of current national policies. The main objectives were: 1. To identify the current state of food accessibility for the RA population as well as possible changes, 2. To study the population’s food consumption and purchase patterns, 3. To study the knowledge, attitude and practical approaches of healthy nutrition, 4. Describe national nutrition policies, including strategies and existing legislation as well as their implementation mechanisms. Quantitative interviews were organized in 1,600 households in all 10 regions of Armenia and the capital Yerevan. The questionnaire consisted of 3 main parts: Information on the household - what they pay attention to when buying food, how and where they buy food from (road and transportation, availability of stores), what food products are available during each season of the year, what food the household consumes, household budget, family income, water accessibility, hygiene, state of health, etc. Information on individuals - how often does an individual eat at home and outside, what type of food he/she uses, whether he/she uses additives in food, state of healthcare, knowledge, etc. Information on children 0-59 months old: what do children less than 6 months old eat; what do children eat from between the age of 6 months to 5 years. In addition, qualitative methods such as interviews with key informants and policy analysis were applied The policy analysis and interviews with key informants revealed that unhealthy nutrition has an essential role in the development of non-communicable diseases. The bases of unhealthy nutrition habits are insufficient campaigning on healthy lifestyle and healthy nutrition, (including educational and child entertainment facilities) and enticement conditioned by frequently broadcasted advertisement etc. Currently, the member states of the World Health Organization
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