Engagement in agriculture protects against food insecurity and malnutrition in peri-urban Nepal

BACKGROUND: Urbanization is occurring rapidly in many low- and middle-income countries, which may affect households’ livelihoods, diet, and food security and nutritional outcomes. OBJECTIVE: The main objective of our study was to explore whether agricultural activity amongst a peri-urban population in Nepal was associated with better or worse food household security, household and maternal dietary diversity, and nutritional outcomes for children and women. METHODS: A cross-sectional survey administered to 344 mother-child pairs in Bhaktapur district, Nepal, including data on household agricultural practices, livestock ownership, food security, dietary diversity and expenditures, anthropometric measurements of children (aged 5–6 years old), maternal body mass index (BMI), and maternal anemia. Multivariable adjusted and unadjusted odds ratios (AOR and OR respectively) were calculated using logistic regression. RESULTS: Our findings suggest that in this sample, cultivation of land was associated with a lower odds of child stunting (AOR 0.55, 95% CI 0.33,0.93) and household food insecurity (AOR 0.33, 95% CI 0.18, 0.63), but not low (or high) maternal BMI or anemia. Livestock ownership (mostly chickens) was associated with lower of food insecurity (AOR 0.34, 95% CI 0.16, 0.73) but not with nutrition outcomes. Women in farming households were significantly more likely to eat green leafy vegetables than women in non-farming households, and children living in households that grew vegetables had a lower odds of stunting than children in households that cultivated land but did not grow vegetables (AOR 0.49, 95% CI 0.25, 0.98). CONCLUSIONS: Our study suggests that households involved in cultivation of land in peri-urban Bhaktapur had lower odds of children's stunting and of food insecurity than non-cultivating households – and that vegetable consumption is higher among those households. Given Nepal's rapid urbanization rate, more attention is needed to the potential role of peri-urban agriculture in shaping diets and nutrition.Funding was provided by the USAID Feed the Future Security Innovation Lab for Nutrition - Asia [award number AIDOAA-l-10-00005] through a sub-contract to the Harvard T.H. Chan School of Public Health and the Johns Hopkins Bloomberg School of Public Health from the Friedman School of Nutrition Science and Policy, Tufts University; and by the GC Rieber Foundation.https://academic.oup.com/cdn/advance-article/doi/10.1093/cdn/nzy078/5154906Accepted manuscrip

Many Rivers to Cross: Evaluating the Benefits and Limitations of Strategic Environmental Assessment for the Koshi River Basin

This paper assesses the value of using Strategic Environmental Assessment (SEA) to account for the spatially and temporally diverse and diffuse impacts of hydropower development in South Asia’s Koshi basin. A policy and practice review and key stakeholder interviews identified opportunities for SEA to improve existing planning procedures, but also barriers to effective adoption. Whilst stakeholders are interested in employing SEA to evaluate cumulative impacts, institutional blockages and an economic development imperative for power generation leave little space for consideration of alternative scenarios as part of SEA. The analysis is conducted through the formulation and application of a conceptual framework for SEA best practice which is then used to identify priority next-steps for SEA in the region

Maternal and Child Nutrition in Nepal: Examining drivers of progress from the mid-1990s to 2010s

This paper explores the drivers of Nepal's maternal and child nutrition success using document review, interviews with mothers, and quantitative analysis of DHS datasets. Our qualitative and quantitative analyses both highlight similar policy and community level changes but limited improvements in child feeding and care practices. Improvements in four key drivers of nutritional change emerged: health services, sanitation, education, and wealth. However, the relative contributions of each factor varied by indicator, with health services more important for linear growth among children, and sanitation more important for weight gain among both children and mothers. We conclude with a discussion bringing the qualitative and quantitative findings together into key lessons from Nepal's success

Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011

Background: Postnatal care is essential to save the life of the mother and newborn. Knowledge on the determinants of postnatal care assists the policy makers to design, justify and implement appropriate interventions. The current study aimed to analyse the factors associated with utilisation of postnatal care services by mothers in Nepal based on the data from Nepal Demographic and Health Survey (NDHS) 2011. Methods: This study utilised the data from NDHS 2011. The association between utilisation of at least one postnatal care visit (within 6 weeks of delivery) and immediate postnatal care (within 24 hours of delivery) with selected factors was examined by using Chi-square test (?2), followed by multiple logistic regression.Result: Of the 4079 mothers, 43.2% reported attending postnatal care within the first six weeks of birth, while 40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families, who were educated, whose partners were educated, who delivered in a health facility, who had attended a four or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report attending at least one postnatal care visit. On the other hand, mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the urban areas, from rich families, who were educated, whose partners were educated, who had attended four or more antenatal visits, who delivered in a health facility and had delivered in the presence of a skilled birth attendant were more likely to report attending immediate postnatal care. Mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to attend immediate postnatal care. Conclusion: The majority of postnatal mothers in Nepal did not seek postnatal care. Increasing utilisation of the recommended four or more antenatal visits, delivery at health facility and increasing awareness and access to services through community-based programs especially for the rural, poor, and less educated mothers may increase postnatal care attendance in Nepal

Maternal nutritional status, food intake and pregnancy weight gain in Nepal

This is the author's accepted version (version 2) of an article published by SAGE in Journal of Health Management, March 2016. The published version is available at http://pss.sagepub.com/lookup/doi/10.1177/0972063415625537Poor maternal nutrition during pregnancy may predispose to intrauterine growth restriction (IUGR), immunological and metabolic adaptations which manifest as low birth weight and increase the risk of adult non-communicable disease. This study examined the relationships between maternal nutritional status, food intake and pregnancy weight gain (PWG) which may account for risk of low birth weight (LBW) in Nepal

Ambivalence towards discourse of disaster resilience

This paper investigates empirically how the international aid community (IAC)—donors and practitioners—considers and implements disaster resilience in a specific country setting, Nepal, and throughout the rest of the world. A key finding is that there is ambivalence about a concept that has become a discourse. On a global level, the IAC utilises the discourse of resilience in a cautiously positive manner as a bridging concept. On a national level, it is being used to influence the Government of Nepal, as well as serving as an operational tool of donors. The mythical resilient urban community is fashioned in the IAC's imaginary; understanding how people create communities and what type of linkages with government urban residents desire to develop their resilience strategies is missing, though, from the discussion. Disaster resilience can be viewed as another grand plan to enhance the lives of people. Yet, regrettably, an explicit focus on individuals and their communities is lost in the process

Understanding the burden of injuries in Nepal: A systematic review of published studies

BackgroundThe population of Nepal are vulnerable to injuries from natural disasters as well as those occurring in the home, at work and on the roads.AimTo collate and synthesise the published literature reporting injuries to people of any age resident in Nepal.MethodWe searched five electronic databases using an inclusive search strategy. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Data were extracted by two researchers. Synthesis was reported narratively by injury type and study design.ResultsWe identified 186 publications reporting 176 unique studies. Most studies used designs likely to underestimate the true burden of disease, including 144 case series and 36 cross-sectional studies. No trials were identified. The largest number of publications were related to poisoning and self-harm with only 22 focussing on road traffic injuries. There was minimal exploration of inequalities in injury occurrence other than descriptive reporting by age and gender. ConclusionsThere is limited research using study designs at low risk of bias on injuries occurring to residents of Nepal, even on areas of concern such as road traffic injuries. The findings indicate a lack of robust epidemiological evidence to inform strategic approaches to injury prevention and suggest a need for capacity strengthening for injury prevention research

Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components

BACKGROUND: Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. METHODS: The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. RESULTS: Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. CONCLUSIONS: Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened