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

Initiation of Breastfeeding and Factors Associated with Prelacteal Feeds in Central Nepal

Background: Prelacteal feeds and delayed initiation of breastfeeding may lead to undernutrition of the infant but are still prevalent in many countries.Objective: A prospective cohort community-based study was conducted in central Nepal to ascertain the rate of early breastfeeding initiation and factors associated with the introduction of prelacteal feeds.Methods: Breastfeeding information was collected from 639 women who recently gave birth in the Kaski district of central Nepal. Backward stepwise logistic regression analysis was performed to determine factors associated with the use of prelacteal feeds.Results: The incidence of prelacteal feeds was 9.1%, with infant formula being the most common prelacteal food. Approximately 67% and 90% of mothers breastfed within 1 hour and 4 hours of delivery, respectively. Women who reside in urban areas (odds ratio [OR] = 2.68; 95% confidence interval [CI], 1.35-5.39), first-time mothers (OR = 2.15; 95% CI,1.15-4.02), and those who underwent cesarean section (OR = 10.10; 95% CI, 5.47-18.67) were more likely to give prelacteal feeds to their infants.Conclusion: The early initiation of breastfeeding with colostrum as the first feed was common in the study area. The introduction of prelacteal feeds was associated with urban residency, first-time motherhood, and cesarean delivery

Role of antenatal care and iron supplementation during pregnancy in preventing low birth weight in Nepal: Comparison of national surveys 2006 and 2011

Background: Low birth weight (LBW) is a major cause of neonatal deaths in developing countries including Nepal. Its social determinants in Nepal have rarely been identified. This study aimed to identify the factors associated with low birth weight among under-five children comparing data from the Nepal Demographic and Health Surveys (NDHS) of 2006 and 2011. Methods: Pooled data from the Nepal Demographic and Health Surveys (NDHS) of 2006 and 2011 were analysed initially and the two survey data were then compared separately. The association between LBW and socio-demographic and health related factors were analysed using multiple logistic regression analysis with a stepwise backward elimination procedure. Complex Sample Analysis method was used to account for study design and sampling.Results: A total of 2845 children, 923 children in 2006 and 1922 children in 2011, had their birth weight recorded. The mean birth weight was 3024 (SD = 654.5) grams. A total of 12.1% (95% Confidence interval (CI); 10.6%-13.7%) children had low birth weight (<2500 grams) at the time of birth. Attending antenatal care was found to be consistently associated with low birth weight for the pooled survey data, and both 2006 and 2011 survey data, respectively. Not attending antenatal care increased the odds of having a LBW infant by more than two times [OR 2.301; 95% CI (1.526-3.471)]. Iron supplementation, which is an integral part of antenatal care in Nepal, was also significantly associated with birth weight for combined and individual surveys. Mothers not consuming iron supplementation during their pregnancy were more likely to have LBW infants [OR 1.839; 95% CI (1.282-2.363)]. Residing in the Far-western and Eastern region were also significant risk factors for LBW in the pooled dataset and in 2011 survey. Conclusions: The current study indicated there was no significant decrease in the LBW prevalence and there is a need of targeted interventions aimed at decreasing the high rate of LBW through increasing antenatal care and consumption of iron supplementation during pregnancy

Low Compliance with Iron-Folate Supplementation Among Postpartum Mothers of Nepal: An Analysis of Nepal Demographic and Health Survey 2011

One in five maternal deaths are directly attributable to anaemia in the world. The World Health Organization recommends iron supplementation from the second trimester of pregnancy to 45 days after delivery. The aim of this study was to determine the compliance rate of iron-folate consumption and the factors associated with iron-folate consumption among post-natal mothers in Nepal. This study utilised the data of Nepal Demographic and Health Survey (NDHS) 2011. The NDHS 2011 is a cross sectional and nationally representative survey. Of the 4,148 respondents, only 20.7 % consumed iron throughout the post-natal period for 45 days. Mothers who had higher and secondary education [adjusted Odd ratio (aOR) 3.101; 95 % CI (2.268–4.240)]; had attended four or more antenatal care visits [aOR 9.406; 95 % CI (5.552–15.938)]; lived in Far-western development region [aOR 1.822; 95 % CI (1.387–2.395)]; delivered in health facility [aOR 1.335; 95 % CI (1.057–1.687)]; and attended postnatal care [aOR 2.348; 95 % CI (1.859–2.965)] were more likely to take iron for 45 days of postpartum. Intervention to increase the compliance with the postpartum iron-folate supplementation are required to avoid adverse pregnancy outcomes associated with poor iron status with especial focus on the mothers who delivered at homes and did not attend postnatal check up

Determinants of facility delivery after implementation of safer mother programme in Nepal: A prospective cohort study

Background: There are several barriers for pregnant women to deliver in a health care facility. This prospective cohort study investigated factors affecting facility delivery and reasons for unplanned place of delivery after implementation of the safer mother programme in Nepal. Methods: Baseline interviews using a validated questionnaire were conducted on a sample of 700 pregnant women representative of the Kaski district in central Nepal. Follow-up interviews of the cohort were then conducted within 45 days postpartum. Stepwise logistic regression analysis was performed to determine factors associated with the facility delivery outcome. Results: Of the 644 pregnant women whose delivery location had been identified, 547 (85%) gave birth in a health care facility. Women were more likely to deliver in a health facility if they were educated especially with higher secondary or above qualification (adjusted odds ratio (OR) 12.39, 95% confidence interval (CI) 5.09 to 30.17), attended 4 or more antenatal care visits (OR 2.15, 95% CI 1.25 to 3.69), and lived within 30 minutes to the facility (OR 11.61, 95% CI 5.77 to 24.04). For the 97 women who delivered at home, 72 (74.2%) were unplanned, mainly due to quick precipitation of labour making it impossible to reach a health facility. Conclusions: It appeared that facility delivery occurs more frequent among educated women and those who live nearby, even though maternity services are now freely available in Nepal. Because of the difficult terrain and transportation problem in rural areas, interventions that make maternity service physically accessible during antenatal period are needed to increase the utilisation of health facility for child birth

Women’s Empowerment Mitigates the Negative Effects of Low Production Diversity on Maternal and Child Nutrition in Nepal

We use household survey data from Nepal to investigate relationships between women’s empowerment in agriculture and production diversity on maternal and child dietary diversity and anthropometric outcomes. Production diversity is positively associated with maternal and child dietary diversity, and weight-for-height z-scores. Women’s group membership, control over income, reduced workload, and overall empowerment are positively associated with better maternal nutrition. Control over income is positively associated with height-for-age z-scores (HAZ), and a lower gender parity gap improves children’s diets and HAZ. Women’s empowerment mitigates the negative effect of low production diversity on maternal and child dietary diversity and HAZ

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