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Linking Agriculture, Food Security, Diet and Nutrition in Nepal: Insights from the USAID Nutrition Innovation Lab, Kathmandu, Nepal.
Sudeep Shrestha, Swetha Manohar, Jamie Dorsey, Abhigyna Bhattarai, Binod Shrestha, Sumanta Neupane, Rolf Klemm, Shibani Ghosh, Patrick Webb, Keith P. West, Jr.
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Aims• Design and implement a nationally representative
surveillance system
• Explore causal pathways between agriculture and nutrition in the community
• Assess in two national panel survey data (collected annually, every May-July (2013/14), in a nationally representative sample of VDCs in the Mountains, Hills and Terai):
• Household food access and security• Diet quality• Nutritional status
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Food Security, Diet, Nutrition
?????
Agriculture to Nutrition Pathways
Agriculture
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Crops, Gardens and Markets
…to Household Food Security & Wealth
...to Dietary Intake, Quality of Life & Services
… to Nutritional Status of Women & Children
...to
Info
rm P
olic
ies
and
Prog
ram
s Agriculture to Nutrition Pathways
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The Nutrition Innovation Lab-Nepal: Agriculture-to-nutrition national surveillance
Policy and Science for Health, Agriculture and Nutrition (PoSHAN)
New ERA
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Nepal:
• Poor agricultural country(25% population < $1.25/day)
• Over 80% engaged in agricultural sector, mostly on subsistence family farms.
• Two third of Nepal’s poor are farming households
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Nepal: Undernutrition and food insecurity are endemic
Food Insecurity
Undernutrition
Food Deficit Food Insecure43 23
Food Insecure Districts
Stunting Wasting Underweight41 11 29
Child Undernutrition (%)Underweight Overweight/Obese Short stature
18.2 13.5 11.6
Maternal Undernutrition (%)
Overall Moderate Severe~50 23 16
Food Insecure Households (%)
(UNICEF 2009)
(NDHS 2011)
hh cha
Table 1: Sample characteristics of households in the PoSHAN Community Studies, 2nd Annual Panel Survey
Total%
Household headship
Male353370.9
Female144729.1
Mean size of household42755.56 (2.5)
Education (HHH)
No education226245.4
Some primary62912.6
Completed primary3507.0
Some secondary82816.6
Completed secondary3777.6
More than secondary53410.7
Source of drinking water
Improved source
Piped into dwelling/yard/plot179536.28
Tube well or borehole279456.48
Protected well60.12
Stone Tap951.92
Bottled water931.88
Non-improved source1643.32
Household effects
Electric Fan201340.7
Radio113623.0
TV234447.4
Bicycle210942.6
Motorcycle70314.2
Mobile452091.4
Hand Pump/Tube Well/Tap/Rower Pump/Shallow Tube Well275355.7
Ring Well (Protected)140.3
Ethnicity
Hill Brahmin3096.3
Hill Chhetri86717.5
Terai Brahmin/Chhetri501.0
Other Terai caste148129.9
Hill Dalit50110.1
Terai Dalit3166.4
Newar1182.4
Hill Janajati79216.0
Terai Janajati2635.3
Muslim2274.6
Other230.5
Main Occupation of Women
Not working60.1
Retired00.0
Student901.7
Non earning occupation(eg. housewife/FCHV)345266.4
Wage employment2464.7
Business/trader/self employment3616.9
Salaried worker1743.3
Agriculture/Livestock/Poultry/Aquaculture87116.7
Other 20.0
Main Occupation of Head of HH
Not working1082.2
Retired370.7
Student280.6
Non earning occupation(eg. housewife/FCHV)67413.6
Wage employment82516.6
Business/trader/self employment106021.3
Salaried worker4939.9
Agriculture/Livestock/Poultry/Aquaculture172534.7
Other 260.5
Table 2: Sample Characteristics of PoSHAN 1st Annual Panel Survey, by agro ecoglogical zone
MountainsHillsTeraiPoSHAN Total
No. Households (N)834135227614947
No. of Women (N)826142429525202
Household size, Mean (SD)4.8 (1.8)4.8 (1.9)6.2 (2.7)5.6 (2.5)
No. of Children
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Mountains543 VDCs
Hills2,034 VDCs
Terai1,394 VDCs
7 VDCs 7 VDCs 7 VDCs
21 Wards 21 Wards 21 Wards
Annual assessment of all consenting households & eligible individuals with children
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DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
DANG
BANKE
ACHHAM KALIKOT
JHAPA
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI BAJURA
MAH
OTT
ARI
CHITWAN
KASKI
TANAHU
PALPA
GULMI
ILAM
BHOJPUR
DHANKUTA
TAPLEJUNG
OKHALDHUNGA
KHOTANG
LALIT
BKT
NUWAKOT
KAVRE
RASUWALAMJUNG
GORKHAROLPA
SALYANMYAGDI
DAILEKHJAJARKOT
RUKUM
MUSTANG
MANANG
PoSHAN Nationally Sampled Districts
Terai (n=7)
Mountains (n=7)
Hills (n=7)
21 Districts, 21 VDCs, 63 wardsN = ~5000 households with preschool children
Annual assessments: May-July 2013, 2014
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Panel 2 (2014) Mts Hills Terai TotalNo. Households (N) 834 1352 2761 4947No. of Women (N) 826 1424 2952 5202No. of Children
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37.136.2
34.835.5
39.1
36.9 37.237.4
41
Mountain Hill Terai PoSHAN Total
Stunting prevalence (among children
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8.3
10.8
23.3
17.7
7.38.8
21.6
16.3
11
Mountain Hill Terai PoSHAN Total
Wasting prevalence (among children
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26 29.1
39.134.4
25.7 27.1
39.834.6
29
Mountain Hill Terai PoSHAN Total
Underweight prevalence (among children
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Underweight Overweight/Obese Short stature
Panel 1 (2013)
Panel 2 (2014)
NDHS (2011)
Panel 1 (2013)
Panel 2 (2014)
NDHS (2011)
Panel 1 (2013)
Panel 2 (2014)
NDHS (2011)
Mountains 19.2 16.8 8.7 10.9 6.9 7.63
Hills 16.3 13.7 13.3 17.3 8.7 9.9
Terai 37.2 33.7 7 8 14.3 14.6
PoSHANTotal 28.4 25.3 18 9 11.1 13.5 11.6 12.2 11.6
Risk of Maternal Wasting (by BMI)Highest in the Terai
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61
52
25 24
34
26
1.9 2.2
50
38
2623 25
15
0.0 0.0
70
59
31 32
38
26
0.2 0.4
63
52
46
29 28 27
34
23
18
0.4 0.6 0.5
0
10
20
30
40
50
60
70
80
Pane
l 1 (2
013)
Pane
l 2 (2
014)
NDH
S(20
11)
Pane
l 1 (2
013)
Pane
l 2 (2
014)
NDH
S(20
11)
Pane
l 1 (2
013)
Pane
l 2 (2
014)
NDH
S(20
11)
Pane
l 1 (2
013)
Pane
l 2 (2
014)
NDH
S(20
11)
Any Mild Moderate Severe
Anemia prevalence (among children 6-59 M) between Panel 1 (2013) and Panel 2 (2014) surveys
Mountain Hill Terai PoSHAN Total
Anemia in children improved but still high
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42
31
2316 18 15
1.2 0.6
3630
17 18 18
11
0.8 1.0
66 66
3135 35
30
1.0 1.0
5350
26 27 2722
1.0 1.00
10
20
30
40
50
60
70
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
Any (
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Anemia (non-pregnant) Any Mild Moderate Severe
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Mountains 42 31 23 16 18 15 1.2 0.6Hills 36 30 17 18 18 11 0.8 1.0Terai 66 66 31 35 35 30 1.0 1.0
PoSHAN Total 53 50 26 27 27 22 1.0 1.0
Anemia (pregnant) Any Mild Moderate Severe
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Panel 1 (2013)
Panel 2 (2014)
Mountains 53 22 32 17 21 6 0 0Hills 48 29 28 21 20 8 0 0Terai 64 63 33 27 32 36 0 0
PoSHAN Total 59 50 32 24 28 25 0 0
Terai is Anemic..
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51
64
18 1821
1410
5
58
71
2017 18
104 2
64
77
1813 12
7 63
60
73
1915 16
96
3
49
12
23
16
0
10
20
30
40
50
60
70
80
90
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
Panel 1(2013)
Panel 2(2014)
None Mild Moderate Severe
Mountain Hill Terai Total NDHS(2011)
Household Food Insecurity Access Scale (%)
HHs food insecurity improving, Terai is better..
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Agricultural Practices by Agro Ecological Zone:Better Agricultural Practices in Terai
Agricultural practices Mtns Hills Terai
Use of agro chemicals (pesticide) 11.3 8.2 49.6
Market prices checking 18.3 1.8 15.1
Composting 47.1 64.3 42.5
Improved seed 28.3 34.0 48.4
Improved drying methods/tools 48.9 59.3 52.9
Inter-cropping 48.7 62.5 28.9
Intergrated pest management 14.3 13.0 10.3
Mechanized tools 1.9 3.0 52.5
Food processing 48.3 53.2 71.8
Storage equipment 6.3 3.6 8.3
Livestock vaccination 3.8 14.5 23.2
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Maternal nutritional status paralleled improved food security from 2013-14, but child growth did not improve. Nutritional status was poorest in the terai despite better food security and agricultural practices.
Conclusion
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Acknowledgements• Funding: USAID through Feed the Future Innovation Lab for
Collaborative Research on Nutrition• Management Entity: Tufts University • PoSHAN Community Studies
– PI: Dr. Keith P. West, Jr., Dr. Rolf D.W. Klemm – Co-I: Dr. Devendra Gauchan, Dr. Ramesh Adikhara, Swetha
Manohar, Dr. Shibhani Ghosh, Dr. Patrick Webb, Dr. Sudeep Shrestha
• Data Collectors: New Era Pvt Ltd; NTAG• PoSHAN-JHU Technical Team: Ruchita Rajbhandary, Abhigyana
Bhattarai, Dr. Raman Shrestha, Hari Krishna Shah, Binod Shrestha, Sumanta Neupane, Jamie Dorsey
• PoSHAN-Tufts Technical Team: Diplov Sapkota
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