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.
In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. ...In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community‐based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12‐fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
Nepal is located in what was once known as the Himalayan Goitre Belt and once had one of the highest prevalence's of iodine deficiency disorders in the world. However, through a well‐executed ...universal salt iodization program implemented over the past 25 years, it has achieved optimal iodine intake for its population, effectively eliminating the adverse consequences of iodine deficiency disorders. A comprehensive review of policy and legislation, surveys, and program reports was undertaken to examine the key elements contributing to the success of this program. The paper reviews the origins and maturation of salt iodization in Nepal, as well as trends in the coverage of iodized salt, the iodine content in salt, and population iodine status over the past two decades. The paper describes critical components of the program including advocacy efforts, trade issues with India, the role of the Salt Trading Corporation, monitoring, and periodic program reviews. The paper discusses the recent findings from the 2016 national micronutrient survey demonstrating the success of the salt iodization program and describes emerging challenges facing the program in the future.
Iron, vitamin A and zinc deficiencies are the top three micronutrients contributing to disability‐adjusted life years globally. The study assessed the factors associated with iron, vitamin A, and ...Zinc deficiencies among Nepalese children (n = 1709) aged 6–59 months using data from the 2016 Nepal National Micronutrient Status Survey. The following cut‐off points were applied: iron deficiency ferritin < 12 μg/L or soluble transferrin receptor (sTfR) > 8.3 mg/L, vitamin A deficiency (retinol‐binding protein < 0.69 μmol/L) and zinc deficiency (serum zinc < 65 μg/dl for morning sample and <57 μg/dl for afternoon sample). We used multiple logistic regression adjusted for sampling weights and clustering to examine the predictors of micronutrient deficiencies. The prevalence of iron depletion (ferritin), tissue iron (sTfR), vitamin A and zinc deficiencies were 36.7%, 27.6%, 8.5% and 20.4%, respectively. Children were more likely to be iron deficient (ferritin) if aged 6–23 months, stunted, and in a middle‐wealth quintile household. Vitamin A deficiency was associated with development region and was higher among children living in severe food‐insecure households and those who did not consume fruits. Zinc deficiency was higher among children in rural areas and the poorest wealth quintile. The Government of Nepal should focus on addressing micronutrient deficiencies in the early years, with emphasis on improving food systems, promote healthy diets, among younger and stunted children and provide social cash transfer targeting high‐risk development regions, poorest and food insecure households.
Individual, household and national risk factor for hidden hunger among under 5 s in Nepal.
Key messages
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This study examined risk factors and concurrent micronutrient deficiencies in children aged 6–59 months in Nepal.
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The likelihood of vitamin A deficiency was significantly higher in children from households who reported severe food insecurity compared with those in food‐secure households.
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The odds of being zinc deficiency were significantly higher among rural children compared with their urban counterparts.
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Existing and potential interventions to alleviate iron deficiency among Nepalese children should target geographical and ethnic differentials.
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Encouraging the government to improve food systems, promote healthy diets among younger and stunted children, and provide social cash transfer targeting high‐risk development regions and poorest and food‐insecure households.
We used data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia (World Health Organization cut‐points using altitude‐ and smoking‐adjusted ...haemoglobin Hb) among nationally representative samples of adolescents 10–19 years. Hb, biomarkers of micronutrients, infection and inflammation were assessed from venous blood. Sociodemographic and household characteristics, dietary diversity, pica and recent morbidity were ascertained by interview. We explored bivariate relationships between candidate predictors and anaemia among boys (N = 967) and girls (N = 1,680). Candidate predictors with P < 0.05 in bivariate analyses were included in sex‐specific multivariable logistic regression models. Anaemia prevalence was 20.6% (95% confidence interval CI 17.1, 24.1) among girls and 10.9% (95% CI 8.2, 13.6) among boys. Among girls, living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio AOR 0.28, 95% CI 0.15, 0.52 and AOR 0.42, 95% CI 0.25, 0.73, respectively), ln ferritin (μg/L) (AOR 0.53, 95% CI 0.42, 0.68) and ln retinol binding protein (RBP) (μmol/L) (AOR 0.08, 95% CI 0.04, 0.16) were associated with reduced anaemia odds. Older age (age in years AOR 1.19, 95% CI 1.12, 1.27) and Janajati ethnicity relative to the Muslim ethnicity (AOR 3.04, 95% CI 1.10, 8.36) were associated with higher anaemia odds. Among boys, ln RBP μmol/L (AOR 0.25, 95% CI 0.10, 0.65) and having consumed flesh foods (AOR 0.57, 95% CI 0.33, 0.99) were associated with lower anaemia odds. Open defecation (AOR 2.36, 95% CI 1.15, 4.84) and ln transferrin receptor mg/L (AOR 3.21, 95% CI 1.25, 8.23) were associated with increased anaemia odds. Anaemia among adolescents might be addressed through effective public health policy and programs targeting micronutrient status, diet and sanitation.
Interventions distributing micronutrient powders (MNPs) and small‐quantity lipid‐based nutrient supplements (SQ‐LNS), or home fortification products (HFPs), have the potential to improve infant and ...young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ‐LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF‐MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ‐LNS studies came from randomised trials without an IYCF component (SQ‐LNS only) and one from a programme with both IYCF BCC and SfQ‐LNS (IYCF‐SQ‐LNS). Five IYCF‐MNP programmes reported positive associations with some IYCF practices—four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ‐LNS (one from a related set of randomised controlled trials and the sole IYCF‐SQ‐LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ‐LNS and one found no association with IYCF practices. SQ‐LNS and MNP can address nutrient gaps for young children in low‐resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.
We systematically searched for studies on the effect of interventions distributing home fortification products (HFPs) on infant and young child feeding (IYCF) practices and identified 12 (8 micronutrient powders, 4 small‐quantity lipid‐based nutrient supplements) studies. Some interventions found an association with improved IYCF practices, and most of the interventions with significant associations were integrated programmes that included the distribution of HFP with a new, intensive IYCF behaviour change strategy that included frequent interpersonal counselling.
Key messages
We identified 12 studies distributing home fortification products (HFP) that assessed infant & young child feeding (IYCF) outcomes; few used experimental or quasi‐experimental study designs.
Interventions associated with improved IYCF practices were predominantly programs that integrated HFP with a new, intensive IYCF behavior change strategy.
HFP can fill nutrient gaps for infants and children in low‐resource settings; programs that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.
We used cross‐sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women 15– 49 ...years (n = 1, 918). Haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood. Soil‐transmitted helminth and Helicobacter pylori infections were assessed from stool. Sociodemographic, household, and health characteristics and diet were ascertained by interview. We conducted bivariate analyses between candidate predictors and anaemia (haemoglobin <12.0 g/ dL, altitude‐ and smoking‐adjusted). Candidate predictors that were significant in bivariate models (P < 0.05) were included in the multivariable logistic regression model, accounting for complex sampling design. Anaemia prevalence was 20.2% (95% confidence interval CI 17.6, 22.8). Associated with reduced anaemia odds were living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio AOR 0.35, 95% CI 0.21, 0.60 and AOR 0.41, 95% CI 0.29, 0.59, respectively), recent cough (AOR 0.56, 95% CI 0.38, 0.82), hormonal contraceptive use (AOR 0.58; 95% CI 0.38, 0.88), ln ferritin (micrograms per litre; AOR 0.43, 95% CI 0.35, 0.54), and ln retinol binding protein (micrograms per litre; AOR 0.20, 95% CI 0.11, 0.37). Residing in a house with an earth floor (AOR 1.74, 95% CI 1.18, 2.56), glucose‐6‐ phosphate dehydrogenase deficiency (AOR 2.44, 95% CI 1.66, 3.60), and haemoglobinopathies (AOR 6.15, 95% CI 3.09, 12.26) were associated with increased anaemia odds. Interventions that improve micronutrient status, ensure access to hormonal birth control, and replace dirt floors to reduce infection risk might help reduce anaemia in this population.
Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, ...including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.
Micronutrient deficiencies remain a public health burden among non-pregnant women in developing countries, including Nepal. Hence, this study examined micronutrient deficiencies among non-pregnant ...Nepalese women aged 15–49 using the 2016 Nepal National Micronutrient Status Survey (NNMSS). Data for 2143 non-pregnant women was extracted from the 2016 NNMSS. The study analysed the levels of ferritin, soluble transferrin receptor (sTfR), red blood cell (RBC) folate, and zinc of the participants. Multivariable logistic analysis was carried out to assess factors associated with micronutrient deficiencies. The prevalence of ferritin, sTfR, folate, and zinc was observed to be 19%, 13%, 16%, and 21%, respectively. Non-pregnant women from the Janajati region were significantly less prone to high levels of ferritin adjusted odds ratio (AOR): 0.45; 95% confidence interval (CI): 0.25, 0.80, and those who had body mass index (BMI) of 25 kg/m2 or higher had significantly elevated ferritin levels AOR: 2.69; 95% CI: 1.01, 7.17. Non-pregnant women aged 35–49 years were significantly less predisposed to folate deficiency AOR: 0.58; 95% CI: 0.40, 0.83, and the odds of zinc deficiency were significantly lower among non-pregnant women from wealthier households AOR: 0.48; 95% CI: 0.31, 0.76. This study provides further insight into screening high-risk subgroups and instituting public health interventions to address the prevailing micronutrient deficiencies among non-pregnant Nepalese women.
CHITEKWE et al Chitekwe, Stanley; Parajuli, Kedar Raj; Paudyal, Naveen ...
Maternal and child nutrition,
01/2022, Volume:
18
Journal Article
Peer reviewed
Open access
Iron, vitamin A and zinc deficiencies are the top three micronutrients contributing to disability-adjusted life years globally. The study assessed the factors associated with iron, vitamin A, and ...Zinc deficiencies among Nepalese children (n = 1709) aged 6–59 months using data from the 2016 Nepal National Micronutrient Status Survey. The following cut-off points were applied: iron deficiency ferritin < 12 μg/L or soluble transferrin receptor (sTfR) > 8.3 mg/L, vitamin A deficiency (retinol-binding protein < 0.69 μmol/L) and zinc deficiency (serum zinc < 65 μg/dl for morning sample and <57 μg/dl for afternoon sample). We used multiple logistic regression adjusted for sampling weights and clustering to examine the predictors of micronutrient deficiencies. The prevalence of iron depletion (ferritin), tissue iron (sTfR), vitamin A and zinc deficiencies were 36.7%, 27.6%, 8.5% and 20.4%, respectively. Children were more likely to be iron deficient (ferritin) if aged 6–23 months, stunted, and in a middle-wealth quintile household. Vitamin A deficiency was associated with development region and was higher among children living in severe food-insecure households and those who did not consume fruits. Zinc deficiency was higher among children in rural areas and the poorest wealth quintile. The Government of Nepal should focus on addressing micronutrient deficiencies in the early years, with emphasis on improving food systems, promote healthy diets, among younger and stunted children and provide social cash transfer targeting high-risk development regions, poorest and food insecure households.
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