Policy & Science for Health, Agriculture and

Nutrition (PoSHAN Community Studies), Nepal

1

Manohar S, 2Shrestha R, 3Gauchan D, 4Adhikari R 1Klemm R, 1West Jr, K

Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, 2 PoSHAN Study Team, Johns Hopkins University, Kathmandu,
Nepal, 3 Nepal Agricultural Research Council, Kathmandu, Nepal, 4 Kathmandu Medical College, Kathmandu, Nepal

Introduction

Results

An emerging approach to accelerating gains made in food security and

nutrition outcomes of rural, agrarian populations is improved agriculture in
combination with efficacious microcredit, health and nutrition interventions.
Yet limited empirical evidence exists on the kinds of actions in agriculture
that support or impede nutrition and health and the optimal ways to
integrate actions beyond pilot activities to achieve value-added outcomes.
The PoSHAN Community Studies seeks to generate evidence on whether,
how, to what extent and in what contexts, agricultural interventions can
improve nutrition and health outcomes among women and young children
across the major agro-ecological zones of Nepal.

Table 1: Mean BMI of women of reproductive age by pregnancy status across

agro ecological zones

Objective
To assess and monitor household food security, dietary intake and nutritional
status of preschool-aged children and their mothers, with measures of
agricultural diversity, local market food prices and exposure to agricultural
and microeconomic extension, nutrition and health programs in Nepal.

MOUNTAINS

HILLS

TERAI

ALL

MEAN (SD)

MEAN (SD)

MEAN (SD)

MEAN (SD)

All

20.9 (2.8)

21.5 (3.2)

20.0 (2.9)

20.6 (3.1)

Pregnant

20.9 (2.8)

21.5 (3.3)

20.0 (3.1)

20.5 (3.1)

Non-pregnant

21.5 (2.7)

22.2 (2.7)

20.4 (2.5)

20.9 (2.6)

Lactating

20.6 (2.7)

21.2 (3.2)

19.7 (2.9)

20.3 (3.0)

Table 2: Nutrition status of children <5 years across agro ecological zones
INDICATOR
Height-for-Age z-scores*
% <-2 SD (Stunting)
%<-2 to -3 SD
(moderate)
%< -3SD (severe)
Weight-for-height z-score*
% <-2 SD (Wasting)
%<-2 to -3 SD
(moderate)
%< -3SD (severe)
Weight-for-age z-scores*
% <-2 SD (Underweight)
%<-2 to -3 SD
(moderate)
%< -3SD (severe)
3
* Mean SD

MOUNTAINS
HILLS
(N=947)
(N=1276)
-1.50 1.39 -1.45 1.36
37.1
36.2
24.3
25.2

TERAI
(N=3178)
-1.45 1.41
34.8
22.7

TOTAL
(N=5401)
-1.46 1.39
35.5
23.8

12.9
-0.60 1.06
8.3
6.1

11
-0.74 1.05
10.8
9.1

12.0
-1.28 1.01
23.3
18.5

11.7
-1.03 1.07
17.0
13.7

2.2
-1.28 1.12
26.0
20.9

1.7
-1.34 1.17
29.1
22.5

4.8
-1.71 1.13
39.1
27.0

3.3
-1.55 1.15
34.0
24.7

5.1

6.6

12.1

9.4

Future Analyses
Methods
Design: Three nationally representative, annual (April-June, 2013-15)
panel surveys of ~5,000 preschool-aged children and mothers each will be
conducted in 21 randomly-selected Village Development Committees
(VDCs, 3 wards in each) balanced across mountain, hill and terai zones of
Nepal. One sentinel VDC in each zone has been established for yearround assessments.
Methods: Households in each site are screened for children <5 years and
mothers. Women and children in eligible households will be measured for
weight, height/length, mid-upper arm circumference, and hemoglobin, 7day diet frequency, morbidity, and participation in health, nutrition and
microcredit services. Household data will allow us to assess socioeconomic
and food security status, land and asset ownership and use, income and
expenditures, program participation, and agricultural production.
Community-level data using GIS will enable us to map and characterize
markets and food prices, health and agricultural services infrastructure, and
other factors.

Data will undergo initial exploratory and

descriptive analyses to quantify distributions
of discreet and continuous variables.
Longitudinal panel component: estimations of
year-to-year differences in indicators of
nutritional status, dietary diversity, food
security and production among other indices
of interest to discern the direction and
quantify rates of change.

Upcoming Embedded Sentinel Site Studies

Testing the context-specific validity of various measures of diet quality
and nutrition outcomes
Exploring biological mechanisms linking food systems, health and
nutrition: water quality, aflatoxin exposure in stored foods & amongst
women and children < 5 years
Children <5 yrs: N= 5401
Women of reproductive
age : N=4509