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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.

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

Food Security, Diet, Nutrition

?????

Agriculture to Nutrition Pathways

Agriculture

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

The Nutrition Innovation Lab-Nepal: Agriculture-to-nutrition national surveillance

Policy and Science for Health, Agriculture and Nutrition (PoSHAN)

New ERA

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

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

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

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

Panel 2 (2014) Mts Hills Terai TotalNo. Households (N) 834 1352 2761 4947No. of Women (N) 826 1424 2952 5202No. of Children

37.136.2

34.835.5

39.1

36.9 37.237.4

41

Mountain Hill Terai PoSHAN Total

Stunting prevalence (among children

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

26 29.1

39.134.4

25.7 27.1

39.834.6

29

Mountain Hill Terai PoSHAN Total

Underweight prevalence (among children

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

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

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 (

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..

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..

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

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

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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