Diets and food security in vulnerable groups and the potential for agriculture-related approaches to improve diet Findings from the PoSHAN Study – Nepal (Feed the Future Innovation Lab for Nutrition) Swetha Manohar Johns Hopkins Bloomberg School of Public Health
NEPAL – COUNTRY CONTEXT 2 out of every people experience food insecurity during some season • of the year (WFP) Childhood stunting: 36% Childhood wasting:10% (NDHS 2016) • Maternal BMI<18.5: 17%, BMI>25: 22% (NDHS 2016) • Impressive gains in improving undernutrition over the past 10 years, • particularly in under-five stunting, 1996: 57% - 2016: 36% Notwithstanding these gains, • nutritional deficiencies and undernutrition persist ; disparities are apparent Agro ecological diversity • Nutrition programmatic inputs have tripled • in the past 10 years
POSHAN STUDY Purpose Assess and monitor household food security, dietary intake and nutritional status of preschool aged children and their mothers with measures of agricultural diversity, market food prices and exposure to agricultural, nutrition and health programs in Nepal. Design • Longitudinal, observational study with annual surveys (2013- 2016) • Seasonal surveys in subsample (2013-2015) • Sampled to elucidate agro ecological variations Sampling Method 21 systematically randomly • sampled VDCs; 7 per agro zone 3 wards/ VDC (63 wards) • ~ 4286 – 5097 HHs/ year •
DATA DOMAINS Food Prices Community Community Infrastructure: water, health, education, roads Agricultural extension infrastructure and reach Access to credit and support services Household Assets Agricultural production, inputs &practice Water and sanitation Program participation (frequency & type) Household Food Security Annual data • collection, same Dietary intake season (May-July) Nutritional status Access to health & nutrition services Morbidity Seasonal data • Healthcare utilization collection Knowledge of health & nutrition message (Sept-Oct & Jan-Feb) IYCF Individual Family planning
% HOUSEHOLD FOOD INSECURITY (HFIAS) BY AGRO ECOLOGICAL ZONE 40 35 30 25 20 % 15 10 5 0 Mountain Hills Tarai Household Food Insecurity Severely Food Insecure Mild- moderate Food insecure
INEQUITY AND HOUSEHOLD FOOD INSECURITY 70 60 50 Household food 40 % 30 insecurity by 20 wealth quintile 10 0 Lowest Lower Middle Higher Highest Wealth quintile Household food insecurity: Mild % Moderate % Severe % 60 50 40 30 % Household food 20 insecurity by caste 10 0 Brahmin/chhetri Newar Janjati Dalit Other
COPING STRATEGIES AMONG FOOD INSECURE HOUSEHOLDS SEVERELY FOOD INSECURE 2013 2014 2016 (n=262) (n=142) (n=176) % % % Took a cash loan in the past 30 days 70.2 62.7 60.8 Took in-kind loan (groceries) in the past 30 days 55.3 54.2 43.2 Collected wild food in the past 30 days 5.3 3.5 1.7 Consumed seed in the past 30 days 17.6 14.8 6.8 Sold assets in the past 30 days 6.9 4.2 4.0 Sold livestock in the past 30 days 3.8 2.1 3.4 2013 2014 2016 MOD. FOOD INSECURE (n=664) (n=443) (n=385) % % % Took a cash loan in the past 30 days 45.3 37.2 45.2 Took in-kind loan (groceries) in the past 30 days 45.8 31.8 48.6 Collected wild food in the past 30 days 0.6 0.5 0.3 Consumed seed in the past 30 days 3.9 2.7 4.7 Sold assets in the past 30 days 1.4 0.0 9.6 Sold livestock in the past 30 days 2.6 1.1 2.3
WOMEN’S DIET QUALITY OVER TIME, BY AGROECOLOGY 10 9 8 7 * * Mean WDDS 6 * * * 5 4 3 2 1 0 2013 2014 2016 2013 2014 2016 2013 2014 2016 Mountains Hills Tarai * P < 0.05 between years within zones.
DIETARY PATTERNS AND ASSOCIATED CHARACTERISTICS Research Question • Describe dietary patterns among Nepali women and factors associated with these patterns Methods • Latent class analysis • Nationally- representative sample of 962 women • Data collected on # of times each food was eaten in past week, consolidated 52 commonly consumed food items into 12 food groups • Categorized into low (<20%), medium (middle 60%), high (upper 20%) consumption categories • Used “radar” or “spider” plots to visualize differences in the high and low consumption %.
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DIET QUALITY AMONG CHILDREN In Nepal, diets consist primarily of rice and other • staple grains which are inadequate sources of many essential nutrients • Increasing household access to, and children’s consumption of non-staple nutritious foods is essential for improving diet quality Seasonal patterns in availability and consumption of • staple grains are well documented not non-staple nutritious foods periods (differs by region)
NON-STAPLE FOODS: VITAMIN NON-STAPLE FOODS: A-RICH FRUITS & VEGETABLES ANIMAL SOURCE FOODS Mango Pumpkin Eggs Dairy Meat Leafy Greens Papaya
RESEARCH QUESTION 1. Examine seasonal variation in children’s consumption of non-staple nutritious foods (vitamin A-rich fruits and vegetables, eggs, meat, and dairy) across the mountains, hills, and Tarai 2. Assess whether seasonal consumption patterns vary by wealth and by caste/ethnicity DATA SOURCE & METHODS PoSHAN Seasonal Site Data • • Three seasonal surveillance sites (one per region) – Mountains: Jumla (N = 226) – Hills: Arghakhanchi (N = 168) – T erai: Banke (N = 225) • Children 6-72 months (one child per household; up to 6 data points per child) Surveys included 7-day food frequency questionnaire • • Negative binomial regression Elena T Broaddus-Shea, Andrew L Thorne-Lyman, Swetha Manohar, Bareng A S Nonyane, Peter J Winch, Keith P West; Seasonality of Consumption of Nonstaple Nutritious Foods among Young Children from Nepal's 3 Agroecological Zones, Current Developments in Nutrition, Volume 2, Issue 9, 1 September 2018
RESULTS: SEASONAL VARIATION Fruits & Vegetables Eggs Average Weekly Consumption Frequency Mountains Hills Terai Mountains Hills Terai S. F. W. S. F. W. S. F. W. S. F. W. S. F. W. S. F. W. Dairy Meat & Fish Mountains Hills Terai Mountains Hills Terai S. F. W. S. F. W. S. F. W. S. F. W. S. F. W. S. F. W. • Average consumption of all foods less than once/day (except for dairy in the hills)
RESULTS: DIFFERENCES IN SEASONAL VARIATION BY WEALTH AND CASTE Fruits & Vegetables, Mountains Region Average Weekly Consumption Frequency
RESULTS: DIFFERENCES IN SEASONAL VARIATION BY WEALTH AND CASTE Dairy, Mountains Region Average Weekly Consumption Frequency
HH PRODUCTION ASSOC. W/ DIETARY DIVERSITY IN CHILDREN? MDDC >= 4 MDDC >= 4 6-23 mos 24-59 mos Log- Odds Ratio (SE) Log- Odds Ratio (SE) Food groups grown (0-7) 0.139 (0.17) 0.253*** (0.09) Wealth quintile (1-5) 0.232 (0.18) 0.497***(0.19) Wealth quintile – food grown interaction -0.030 (0.02) -0.039 (0.03) Land rented/used -0.075** (0.03) -0.014 (0.02) Child (female) 0.021 (0.18) 0.128 (0.1) Whether breastfed -1.354*** (0.18) -0.033 (0.06) Mother’s schooling -0.168** (0.08) -0.005 (0.07) Mother’s BMI -0.001 (0.03) 0.049**(0.02) Female head of household -0.204 (0.18) -0.0389*** (0.08) Socially excluded caste -0.515***(0.19) -0.737*** (0.20) Mulmi P, Masters WA, Ghosh S, Namirembe G, Rajbhandary R, et al. (2017) Household food production is positively associated with dietary diversity and intake of nutrient-dense foods for older preschool children in poorer families: Results from a nationally-representative survey in Nepal. PLOS ONE 12(11): e0186765. https://doi.org/10.1371/journal.pone.0186765
RELATIONSHIP BETWEEN ANIMAL PRODUCTION AND CHILDREN’S CONSUMPTION OF ANIMAL SOURCE FOODS RESEARCH QUESTION: Assess the relationship between animal production and children's animal source food consumption, as well as between expenditure on animal source foods and children's animal source food consumption METHODS • Longitudinal data: PoSHAN Seasonal Site Data • N=485 farming households with children children 6-59 months of age • Negative binomial regressions to determine whether number of cattle, poultry, and meat animals owned was associated with children’s weekly consumption frequencies of dairy, eggs, and meat, respectively, while adjusting for expenditure on each food type, mother’s nutrition knowledge and decision-making power, and caste/ethnicity • Surveys included 7-day food frequency questionnaire Unpublished: Elena T Broaddus-Shea, Swetha Manohar, Andrew L Thorne-Lyman, Bareng A S Nonyane, Peter J Winch, Keith P West; The relationship between animal production and children’s consumption of animal source foods in Nepal
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