Question 1 Nutritional status in SAARC member states and include the specific interventions related to nutrition, implemented by each member states of SAARC. (prefer latest data) Answer According to the latest data from the World Health Organization (WHO), the South Asian Association for Regional Cooperation (SAARC) member states have some of the highest rates of malnutrition in the world. Malnutrition is defined as a condition where a person's diet does not provide enough nutrients for proper growth and development, leading to health problems. In SAARC member states, malnutrition is a complex issue, resulting from a combination of factors such as poverty, food insecurity, inadequate healthcare infrastructure, and inadequate access to clean water and sanitation. The following is a breakdown of the nutritional status and specific interventions related to nutrition that have been implemented by each SAARC member state. 1. Afghanistan According to the latest data from the World Bank, 27.9% of the population in Afghanistan is undernourished, and 50.9% of children under the age of five are stunted (low height-for-age). To combat malnutrition, the Afghanistan National Nutrition Strategy was launched in 2018. This strategy includes interventions such as promoting exclusive breastfeeding for the first six months of a baby's life, providing vitamin and mineral supplements to children under five and pregnant and lactating women, and improving access to clean water and sanitation. 2. Bangladesh In Bangladesh, 45.4% of children under the age of five are stunted, and 18.5% are underweight, according to the latest data from UNICEF. To address these issues, the Bangladesh National Nutrition Services Program has been implemented, which includes interventions such as promoting exclusive breastfeeding, providing vitamin and mineral supplements to children and pregnant women, and increasing the availability of nutritious food through social safety nets. 3. Bhutan The latest data from UNICEF shows that 33% of children under the age of five in Bhutan are stunted, and 9% are underweight. To address these issues, Bhutan has implemented several interventions, including the National Micronutrient Program, which provides iron and folic acid supplements to pregnant women and children under two years old, and promoting community-based growth monitoring programs. 4. India India has the highest burden of malnutrition among SAARC member states, with 38.4% of children under the age of five being stunted and 20.8% being wasted (low weight-forheight), according to the latest data from UNICEF. The National Nutrition Mission was launched in 2017 to address malnutrition and has interventions such as the distribution of iron and folic acid supplements, promoting breastfeeding, and providing nutritious meals in schools. 5. Maldives According to the latest data from the World Food Programme (WFP), 8.6% of the population in Maldives is undernourished. The government has implemented the Maldives National Nutrition Strategy, which focuses on improving access to nutritious food, promoting breastfeeding, and improving hygiene and sanitation practices. 6. Nepal In Nepal, 36.6% of children under the age of five are stunted, and 10.3% are wasted, according to the latest data from UNICEF. The government has implemented several interventions, including the National Nutrition Program, which includes interventions such as promoting exclusive breastfeeding, providing vitamin and mineral supplements, and promoting improved hygiene and sanitation practices. 7. Pakistan According to the latest data from UNICEF, 37.5% of children under the age of five in Pakistan are stunted, and 17.7% are wasted. To address these issues, the government has implemented the National Nutrition Program, which includes interventions such as promoting breastfeeding, providing micronutrient supplements, and improving access to clean water and sanitation. 8. Sri Lanka The latest data from UNICEF shows that 13.8% of children under the age of five in Sri Lanka are stunted and 15.1% are wasted. The National Nutrition Policy of Sri Lanka was launched in 2010 and includes interventions such as promoting exclusive breastfeeding, providing vitamin and mineral supplements, and increasing the availability of nutritious food for pregnant women and children. Question 2 1. A couple in their late 20s were infertile in spite of regular sexual intercourse over a two- and-a-half-year period. Each partner had a child by a previous marriage. The woman’s periods had recently become irregular. A semen sample contained a normal count of motile sperm. Physical examination revealed no abnormality. The woman was on steroid replacement treatment for adrenal failure, which had been diagnosed in her late teens. Investigations (woman) Serum: Prolactin 309 mU/L LH. 10U/L FSH 23U/L (a) Comment on the above results (b) Suggest a possible diagnosis with explanation Answer 1. (a) Upon reviewing the results of the couple's fertility investigations, there are a few key findings that should be noted. Firstly, the woman's prolactin levels are significantly elevated at 309 mU/L, which is well above the normal range of 2-29 mU/L. Prolactin is a hormone that is primarily responsible for stimulating milk production in the breasts during pregnancy and after birth. High levels of prolactin can interfere with ovulation and fertility. Additionally, the woman's LH (luteinizing hormone) levels are within the normal range, but her FSH (follicle-stimulating hormone) levels are elevated at 23U/L. FSH is responsible for regulating the menstrual cycle and the development of eggs in the ovaries. High FSH levels can indicate that the ovaries are not responding properly to the hormone, which can also affect fertility. Overall, these results suggest that the woman may be experiencing some hormonal imbalances that could be contributing to her infertility. (b) One possible diagnosis for this couple's fertility issues could be polycystic ovary syndrome (PCOS). PCOS is a common hormonal disorder affecting women of reproductive age, and it is one of the most common causes of female infertility. Women with PCOS often have high levels of androgens (male hormones) such as testosterone, which can disrupt ovulation and lead to irregular periods. Additionally, PCOS can cause high levels of prolactin and LH, and elevated FSH levels can also be seen in some cases. The woman in this case has a history of irregular periods and is on steroid replacement treatment, which could be masking the symptoms of PCOS. Furthermore, PCOS is often seen in women who have had previous children, as it can worsen with age and weight gain. Further investigations, such as an ultrasound to look for cysts on the ovaries and a more detailed medical history, would be necessary to confirm a diagnosis of PCOS. Question 3 State the types of abortion. Overview of safe abortion law and strategies in Nepal. Answer Abortion is a highly debated and sensitive topic, with the ethical, legal, and health implications being extensively studied and discussed in academic circles. As a university student with high marks, it is important to provide an accurate and comprehensive overview of the types of abortion and the safe abortion law and strategies in Nepal. Types of Abortion: There are two main types of abortion - medical and surgical. Medical abortion, also known as the abortion pill, involves taking medication to terminate a pregnancy. It is typically only available up to 10 weeks of pregnancy and consists of two drugs, usually mifepristone and misoprostol, which work together to end the pregnancy. Surgical abortion, on the other hand, involves a medical procedure to remove the contents of the uterus. It can be done through aspiration, dilation and curettage (D&C), dilation and evacuation (D&E), or induction abortion. Safe Abortion Law and Strategies in Nepal: Nepal legalized abortion in 2002, making it one of the few countries in Asia with liberal abortion laws. The law allows abortion on request up to 12 weeks of pregnancy, with exceptions for cases of rape, incest, fetal abnormalities, and risk to the woman's physical or mental health. After 12 weeks, abortion is allowed only with a health justification. In addition to this, Nepal has implemented various strategies to ensure safe and accessible abortion services, such as sex education, training and certification of health providers, and increasing access to contraceptives. One notable strategy is the introduction of Comprehensive Abortion Care (CAC) services, which combines safe abortion services with post-abortion care and family planning. This approach has been successful in reducing the number of unsafe abortions and associated complications in Nepal. In conclusion, Nepal has made significant progress in ensuring safe and legal abortion services, with the legalization of abortion and implementation of strategies such as CAC. As a responsible and knowledgeable university student, it is important to understand the types of abortion and the safe abortion law and strategies in Nepal, and to continue to advocate for women's reproductive rights.