Infants and young children need diversified diets to grow healthy. However, there is limited evidence on factors associated with consumption of various food groups. This study aimed to identify the ...sociodemographic factors associated with inadequate food group consumption and not meeting the minimum dietary diversity (MDD) among infants and young children aged 6-23 months in Nepal. Using cross-sectional data from the 2016 Nepal Demographic and Health Survey, the factors at the individual-, household-, and community-levels associated with not consuming foods from the seven food groups, which are grains, roots and tubers, legumes and nuts, dairy products, flesh foods, eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD were examined. The least consumed food group was eggs, followed by flesh foods and 46.5% of children received the MDD. Children aged 6-11 months had higher odds of not consuming foods from the seven food groups and not meeting the MDD than older children. Children from the poorest quintile had higher odds of not consuming legumes and nuts, dairy products, flesh foods, and other fruits and vegetables, and not meeting the MDD. Children from Terai/Madhesi Other had higher odds of not consuming foods from the seven food groups compared to those from the other groups. Children from Province 2 had higher odds of not consuming eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD. Dietary diversity among children in Nepal needs improvement. National policies and programs need to promote the consumption of diverse food groups by considering different sociodemographic characteristics.
Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage ...and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.
Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and ...height‐for‐age z‐score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001–2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996–2016 period. Our findings indicate that most age‐appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle‐feeding and introduction of solid, semi‐solid or soft foods are rated fair. Our study also reports that a paucity of age‐appropriate IYCF practices—in particular complementary feeding—are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age‐appropriate IYCF practices—in isolation—made modest statistical contributions to the rapid and sustained reduction in age‐specific child linear growth faltering from 1996–2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies—integrating and advocating optimal IYCF—are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle‐feeding.
South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer ...stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi‐Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts.
Weak market linkages, unavailability of cold-storage, and the significant loss of eggs due to breakage and low shelf-life contribute to the unaffordability and the low consumption of eggs in ...low-income countries like Ethiopia. The effect of spray- and oven-drying of eggs from local (Ethiopian) and exotic (imported) chicken breeds on physical, techno-functional, and nutritional composition of egg-powders were evaluated. Exotic (n = 150) and local (n = 140) eggs were spray/oven dried. The yield, bulk-density, flowability, and the foaming-, emulsification-, and water/oil absorption-capacity of the egg powders were assessed. The concentrations in energy, protein, fat, ash, and minerals were determined. The egg-powders' contribution to nutrient requirements for a child and their potential use as an alternative protein source in ready to use therapeutic foods (RUTF) were estimated. The low moisture (<5%) and water activity (aw~0.4-0.5) of the egg-powders implied unfavorable conditions for microbial growth. Local eggs had higher energy and fat content, whereas protein was higher in the exotic eggs (P <.05). About 12.5 g of egg powder (one egg) can fulfill >75%, 30%, and 40% of fat, energy, and calcium requirements for children 6-23 months of age, respectively. Only 6 g and 4 g of egg-powder are needed to fulfill protein and choline requirements, respectively. Considering the quality/quantity of proteins, egg powders can be alternative protein sources in RUTFs. The drying of local and exotic eggs with oven- and spray-drying yielded egg powders with acceptable techno-functional properties, but future studies should elucidate differences observed by egg type and drying; and investigate the shelf-life. Drying eggs can be a viable food systems' intervention that can improve the safety and quality of diets in low-income countries like Ethiopia.
Frequent consumption of fruits can prevent nutrient deficiencies and promote health. However, the perishability and unaffordability of fruits had led to very low levels of fruit consumption in low‐ ...and middle‐income countries (LMICs). The objective of this study was to evaluate the retention of nutrients and bioactive compounds of papaya fruit (Carica papaya L) with/without ascorbic acid pretreatment and drying under different techniques, to then estimate the vitamin A intakes for vulnerable population. Yellow pulp ripped papaya fruits (i.e., >75% level of skin color/stage level 4) (n = 14), with and without ascorbic acid pretreatment were dried using (a) solar drying: open‐air, tray driers, and glasshouse; (b) refractance window drying; (c) oven drying; and (d) freeze‐drying (control). The fresh fruit had high moisture content (87%) and an acidic pH. The dried papaya had a water activity of 0.5–0.6. The highest TPC, TFC, total carotenoids, and ß‐carotene were found in freeze‐dried papaya samples, followed by refractance window, and solar glass house (p < .05). The highest retention in total carotenoids (81.5%) and ß‐carotene (61.9%) relative to freeze‐drying was for the refractance‐window; 25 g of dried papaya could contribute to 38% of the retinol equivalents’ requirement for young children. Ascorbic acid pretreatment increased the retention of total carotenoids, ß‐carotene, TPC, and TFC (p < .05) by (6–11)%, (8–34)%, (7–58)%, and (6–30)%, respectively, for all the drying methods. Refractance window and solar glass house drying can improve diets and constitute a promising food systems’ intervention that can increase year‐round availability, accessibility, and affordability of vitamin A‐rich fruits like papaya.
This study evaluated the retention of total polyphenols, flavonoids, ß‐carotene contents of papaya fruit with ascorbic acid pretreatment and dried under different techniques of solar, refractance window, and oven drying. Refractance window and solar glass house drying can constitute a promising food systems to increase year‐round availability of vitamin A‐rich fruits like papaya.
Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on ...childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia.
This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations' World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition.
Government effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition.
This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.
Despite some progress in the reduction of the prevalence of child wasting in Ethiopia, the pace of progress has been slow. Despite millions of dollars being spent on the treatment of wasting every ...year, the increased frequency and magnitude of environmental and anthropogenic shocks has halted progress. This study aimed to present the trends of child wasting in Ethiopia and estimate the economic losses related to the slow progress towards meeting the sustainable development goal (SDG) targets. Weather shocks and civil unrest between 2015 and 2018 have halted progress. We used a "consequence model" to apply the coefficient risk-deficit on economic losses established in the global scientific literature to the Ethiopian health, demographic, and economic data to estimate economic losses related to child wasting. The impact of wasting on the national economy of Ethiopia is estimated to be 157.8-230.2 million United States dollars (USD), annually. The greatest contributor to the economic burden (43.5-63.5% of the burden depending on the discount rate) is the cost of supplies and human resources to treat wasting. To reach the 2030 SDGs, Ethiopia should increase its annual average reduction rate (AARR) in the numbers of child (<59 months) wasting from 0.1% to 5.4%. This will avert the wasting in 7.9 million cases and prevent additional economic costs of up to 803.7 million USD over the next decade. Increasing the reach of therapeutic interventions, but also identifying and implementing wasting prevention interventions, will be critical if the SDG targets are to be met and the opportunity of the children to thrive is not to be wasted.
Nepal has one of the highest prevalence of hypertension in South Asia. However, no national studies have examined the gender differences in the determinants of prehypertension and hypertension in the ...country to inform targeted interventions. This study aimed to investigate gender differences in factors associated with prehypertension and hypertension in Nepal using the 2016 Nepal Demographic and Health Survey (NDHS).
Sociodemographic, behavioural, anthropometric and health status data and information on hypertension were obtained from 14,857 (males: 6,245 and females: 8,612) individuals aged 15 years or above from the biomarker sample of the 2016 NDHS. Factors associated with prehypertension and hypertension by gender were investigated using generalized linear latent and mixed models (GLLAM) with the mlogit link and binomial family that adjusted for clustering and sampling weights.
The overall prevalence of prehypertension and hypertension was 26.9% 95% confidence interval (CI): 25.7, 28.1 and 17.2% (95% CI 16.1, 18.3), respectively. Prehypertension was present in 30.4% (95%CI: 28.7, 32.2) of males and 24.3% (95% CI: 23.1, 25.6) of females, while hypertension was present in 20.4%, (95% CI 18.9, 22.0) of males and 14.8% (95% CI: 13.7, 16.0) of females. Key modifiable factors that were strongly associated with prehypertension and hypertension in both genders included overweight and obesity, caffeine intake, tobacco use, no schooling, previously informed of hypertension in a health facility, and alcohol consumption (for males). Other significant factors associated with prehypertension and hypertension included increasing age (> 30 years), ecological zone (Hill), Developmental zone (Western) and being married.
Our results suggest that prehypertension and hypertension were higher in males compared to females. Interventions to improve awareness, screening, treatment and control of prehypertension and hypertension in Nepal are warranted and should target key modifiable factors, as well as people aged 30 years and above.
Developmental impairment remains an important public health problem among children in many developing countries, including Nepal. Iron deficiency in children may affect development and lead to ...anaemia. This study on 1702 children aged 6-59 months aimed to assess the association between nutritional anthropometric indices and iron deficiencies. Data for this study were extracted from the 2016 Nepal National Micronutrient Status Survey. Three nutritional anthropometric indices (stunting, wasting and underweight) and their association with anaemia and iron deficiencies (ferritin and sTfR biomarkers) were assessed by conducting multivariate statistical analyses. The prevalence of stunting, wasting and underweight among children aged 6-59 months was 35.6%, 11.7% and 29.0%, respectively. Most of the children were not stunted (64.4%), not wasted (71.0%) and not underweight (88.3%). Belonging to castes other than the Janajati, Dalit and Brahmin castes increased the odds of anaemia and iron deficiency (ferritin biomarker). Children in the age group 6-23 months were significantly at higher odds of having anaemia and iron deficiency (ferritin and sTfR biomarkers). Stunting significantly increased the odds of anaemia adjusted odds ratio (OR): 1.55; 95% confidence interval (CI): (1.11, 2.17), iron deficiency (ferritin biomarker OR: 1.56; 95% CI: (1.16, 2.08) and sTfR biomarker OR: 1.60; 95% CI: (1.18, 2.15)). Further, underweight significantly increased the odds of anaemia OR: 1.69; 95% CI: (1.12, 2.54) and iron deficiency (sTfR biomarker OR: 1.48; 95% CI: (1.14, 1.93)). Interventions to minimise the occurrence of anaemia and iron deficiencies among children in Nepal should focus on providing appropriate healthcare services that would reduce the burden of stunting and underweight.
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