Diets and food security in vulnerable groups and the potential for - - PowerPoint PPT Presentation

Swetha Manohar Johns Hopkins Bloomberg School of Public Health

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)

• 2 out of every people experience food insecurity during some season
• f 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

NEPAL – COUNTRY CONTEXT

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

Food Prices Community Infrastructure: water, health, education, roads Agricultural extension infrastructure and reach Access to credit and support services Assets Agricultural production, inputs &practice Water and sanitation Program participation (frequency & type) Household Food Security Dietary intake Nutritional status Access to health & nutrition services Morbidity Healthcare utilization Knowledge of health & nutrition message IYCF Family planning

• Annual data

collection, same season (May-July)

• Seasonal data

collection (Sept-Oct & Jan-Feb)

DATA DOMAINS

Community Household Individual

% HOUSEHOLD FOOD INSECURITY (HFIAS) BY AGRO ECOLOGICAL ZONE

5 10 15 20 25 30 35 40 Mountain Hills Tarai

%

Household Food Insecurity

Severely Food Insecure Mild- moderate Food insecure

INEQUITY AND HOUSEHOLD FOOD INSECURITY

10 20 30 40 50 60 70 Lowest Lower Middle Higher Highest

% Wealth quintile

Mild % Moderate % Severe %

10 20 30 40 50 60

Brahmin/chhetri Newar Janjati Dalit Other

%

Household food insecurity by caste Household food insecurity by wealth quintile

Household food insecurity:

COPING STRATEGIES AMONG FOOD INSECURE HOUSEHOLDS

2013 (n=262) 2014 (n=142) 2016 (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 (n=664) 2014 (n=443) 2016 (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

SEVERELY FOOD INSECURE

• MOD. FOOD INSECURE

WOMEN’S DIET QUALITY OVER TIME, BY AGROECOLOGY

* P < 0.05 between years within zones.

1 2 3 4 5 6 7 8 9 10

2013 2014 2016 2013 2014 2016 2013 2014 2016 Mountains Hills Tarai

Mean WDDS * * * * *

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 A-RICH FRUITS & VEGETABLES

Leafy Greens Papaya Pumpkin Mango

NON-STAPLE FOODS: ANIMAL SOURCE FOODS

Dairy Eggs Meat

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

• 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

DATA SOURCE & METHODS

RESULTS: SEASONAL VARIATION

Average Weekly Consumption Frequency

Fruits & Vegetables Eggs Dairy Meat & Fish

Mountains Hills Terai Mountains Hills Terai Mountains Hills Terai Mountains Hills Terai

• Average consumption of all foods less than once/day (except for dairy in

the hills)

• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.
• S. F. W.

RESULTS: DIFFERENCES IN SEASONAL VARIATION BY WEALTH AND CASTE

Average Weekly Consumption Frequency Fruits & Vegetables, Mountains Region

RESULTS: DIFFERENCES IN SEASONAL VARIATION BY WEALTH AND CASTE

Average Weekly Consumption Frequency Dairy, Mountains Region

HH PRODUCTION ASSOC. W/ DIETARY DIVERSITY IN CHILDREN?

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

MDDC >= 4 6-23 mos MDDC >= 4 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)

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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TAKE AWAY & IMPLICATIONS

1. Women’s and children’s diet diversity and consumption of non- staple nutritious foods is very low overall in Nepal vNeeds to be increased year-round

• 2. Children’s consumption frequency of vitamin A-rich fruits and

vegetables and of dairy differed significantly by season, and seasonal differences varied by region v Identify and address season-specific barriers in order to improve diet quality year- round v Use region-specific strategies

• 3. Some differences in seasonal variation by caste/ethnicity and

wealth vMay be more difficult to improve year-round consumption among certain groups vNeed a better understanding of the livelihood and resource-access factors that determine household access to non-staple nutritious foods

TAKE AWAY & IMPLICATIONS

• 4. Both production and expenditure are important pathways

for children’s consumption of ASF vAlthough for meat consumption, expenditure seems to be a more “effective/direct” Pathway vIndicates that income generation activities may be more effective than programs promoting animal production as a strategy for increasing children’s consumption of meat

• 5. Both small-scale animal production and income generation

activities are likely to increase children’s consumption of dairy/eggs vSupports the idea that programs providing just a small number of poultry or cattle can be beneficial to improving children’s dietary intake

ACKNOWLEDGEMENTS

• Respondents of PoSHAN sites
• Funding: USAID through Feed the Future Innovation Lab for Collaborative

Research on Nutrition

• Management Entity: Tufts University, Friedman School of Food Policy &

Nutrition

• Investigative

T eam: Drs. Keith West, Rolf Klemm, Devendra Gauchan, Ramesh Adhikari, Andrew Thorne- Lyman, Shibani Ghosh, Patrick Webb, Elena Broaddus, Prajula Mulmi, William Masters, Angela KC

• Data Collection & Human Resource Management: New Era Pvt. Ltd; NTAG,

NNIPS

• PoSHAN-JHU

T echnical T eam: Binod Shrestha, Shiva Bhandari, Ruchita Rajbhandary, Abhigyna Bhattarai, Raman Shrestha, Hari Krishna Shah, Dev Raj Gautam, Dev Mandal, Sudeep Shrestha, Sumanta Neupane, Chandni Karmacharya

• PoSHAN-Tufts

T echnical T eam: Diplav Sapkota, Robin Shrestha

THANK YOU!