Journal of Food Security
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Journal of Food Security. 2018, 6(2), 79-89
DOI: 10.12691/jfs-6-2-5
Open AccessArticle

Pathways from Agriculture-to-Nutrition: Design and Conduct of the National PoSHAN Surveys of Nepal

Klemm RDW1, 2, , Manohar S1, Rajbhandary R3, Shrestha K4, Gauchan D5, Adhikari R6, Thorne-Lyman AL1, KC A1, Nonyane BAS1, Ghosh S7, Webb P7 and West KP Jr1

1Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

2Helen Keller International, New York, NY, USA

3PoSHAN Study Team, Johns Hopkins University, Kathmandu, Nepal

4New Era (P.) Ltd, Kathmandu, Nepal

5Biodiversity International, Kathmandu, Nepal

6Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

7Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA

Pub. Date: August 28, 2018

Cite this paper:
Klemm RDW, Manohar S, Rajbhandary R, Shrestha K, Gauchan D, Adhikari R, Thorne-Lyman AL, KC A, Nonyane BAS, Ghosh S, Webb P and West KP Jr. Pathways from Agriculture-to-Nutrition: Design and Conduct of the National PoSHAN Surveys of Nepal. Journal of Food Security. 2018; 6(2):79-89. doi: 10.12691/jfs-6-2-5


Pathways through which agricultural production may influence markets, household food security, dietary patterns and nutritional status remain incompletely understood. While cross-sectional surveys are common, national, population-based, standardized data collection systems that annually monitor markets, local services, food security, dietary intake and nutritional status may be needed to understand time trends and relationships. We describe the design and methods of an annual nationally representative series of surveys of households with preschool aged children in 7 Village Development Committees (VDCs) sampled across each agroecological zone (mountains, hills and plains) in Nepal. Our sampling methodology yielded 21 VDCs, 63 wards (3 per VDC) and 40 markets in 2013, 2014 and 2016. Each year between ~ 4286-5097 consenting households were assessed for agricultural practices, socioeconomic conditions and food security; diet by 7-day food frequency and nutritional status by anthropometry (weight, height and arm circumference) of women (n=4509-5458) and children (n=5401-5468) using standardized procedures. Due to a major earthquake in April 2015, a truncated sample (wards n=27) was reached in 2015. Three VDCs, each representing a centroid of surveyed VDCs in each zone, served as year-round sentinel sites in which we conducted six surveys of seasonal conditions from 2013-2015. Representative, same-season, same-site surveys offer a feasible national framework for assessing annual status and trends in agricultural, food security and nutritional conditions to identify opportunities for policy and program interventions and observe population responses along a continuum leading from agriculture to nutrition.

survey surveillance undernutrition food insecurity agriculture sentinel sites

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[1]  Ruel, M. T., Alderman, H., & Maternal Child Nutrition Study Group (2013). Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536-551.
[2]  Webb, P., & Kennedy, E. (2014). Impacts of agriculture on nutrition: nature of the evidence and research gaps. Food and Nutrition Bulletin, 35(1), 126-132.
[3]  Herforth, A., & Harris, J. (2014). Understanding and applying primary pathways and principles. In S. P. JSI Research and Training Institute, Results, and Innovations in Nutrition Globally [SPRING] (Ed.). Washington, DC.
[4]  Masset, E., Haddad, L., Cornelius, A., & Isaza-Castro, J. (2012). Effectiveness of agricultural interventions that aim to improve nutritional status of children: systematic review. BMJ, 344, d8222.
[5]  Ruel, M. T., Quisumbing, A. R., & Balagamwala, M. (2017). Nutrition-sensitive agriculture: What have we learned and where do we go from here? (Vol. 1681): International Food Policy Research Institute.
[6]  Pandey, V. L., Dev, S. M., & Jayachandran, U. (2016). Impact of agricultural interventions on the nutritional status in South Asia: A review. Food Policy, 62, 28-40.
[7]  Warren, E., Hawkesworth, S., & Knai, C. (2015). Investigating the association between urban agriculture and food security, dietary diversity, and nutritional status: A systematic literature review. Food Policy, 53, 54-66.
[8]  Brink, E., Khan, I., Splitter, J., Staehling, N., Lane, J., & Nichaman, M. (1976). Nutritional status of children in Nepal, 1975. Bulletin of the World Health Organization, 54(3), 311.
[9]  Shrestha S, Thorne-Lyman. AL, Manohar S, Shrestha B, Rajbhandary R, Shrestha R, Klemm RDW, Nonyane BAS, Adhikari RK, Webb P, West Jr, KP (2017). Patterns of preschool child undernutrition in Nepal in 2013 and 2014 and associations with household food insecurity. Asia Pacific Journal of Clinical Nutrition. 27(3) 624-637.
[10]  Ministry of Health and Population, N., New ERA, and ICF International Inc. (2017). Nepal Demographic and Health Survey 2016.
[11]  Schulze, K. J., Christian, P., Wu, L. S.-F., Arguello, M., Cui, H., Nanayakkara-Bind, A., et al. (2014). Micronutrient deficiencies are common in 6-to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation. The Journal of Nutrition, 144(6), 979-987.
[12]  Bhandari, S., & Banjara, M. R. (2015). Micronutrients deficiency, a hidden hunger in Nepal: prevalence, causes, consequences, and solutions. International Scholarly Research Notices, 2015.
[13]  Joshi, N. P., & Maharjan, K. L. (2007). Assessment of food self-sufficiency and food security situation in Nepal.
[14]  Food and Agricultural Organization and Government of Nepal. (2016). Food and Nutrition Security in Nepal: A Status Report. Ministry of Agricultural Development and Central Bureau of Statistics.
[15]  Food Security Monitoring Task Force. (2010). The Food Security Atlas of Nepal, First Edition. National Planning Commission, Government of Nepal.
[16]  National Planning Commission of the Government of Nepal (2013). Multi-sector nutrition plan for accelerating the reduction of maternal and child under-nutrition in Nepal 2013-2017.
[17]  CIA (2018). The World Factbook: South Asia Nepal. Accessed May 4 2018.
[18]  Central Bureau of Statistics, N. (2012). National population and housing census 2011. National Report.
[19]  Unicef (1990). Strategy for improved nutrition of children and women in developing countries: Unicef.
[20]  Kennedy, E. T., & Bouis, H. E. (1993). Linkages between agriculture and nutrition: implications for policy and research: International Food Policy Research Institute.
[21]  Fuller, J. A., Villamor, E., Cevallos, W., Trostle, J., & Eisenberg, J. N. (2016). I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador. International Journal of Epidemiology, 45(2), 460-469.
[22]  Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development, 34.
[23]  Bilinsky, P., & Swindale, A. (2007). Months of adequate household food provisioning (MAHFP) for measurement of household food access: indicator guide: Food and Nutritional Technical Assistance Project, Academy for Educational Development.
[24]  Maxwell, D., Watkins, B., Wheeler, R., & Collins, G. (2003). The coping strategies index: A tool for rapidly measuring food security and the impact of food aid programs in emergencies. Nairobi: CARE Eastern and Central Africa Regional Management Unit and the World Food Programme Vulnerability Assessment and Mapping Unit.
[25]  Campbell, R. K., Talegawkar, S. A., Christian, P., Leclerq, S. C., Khatry, S. K., Wu, L. S., et al. (2015). Evaluation of a novel single-administration food frequency questionnaire for assessing seasonally varied dietary patterns among women in rural Nepal. Ecology of Food and Nutrition, 54(4), 314-327.
[26]  Merritt, M. W., Labrique, A. B., Katz, J., Rashid, M., West Jr, K. P., & Pettit, J. (2010). A field training guide for human subjects research ethics. PLoS Medicine, 7(10), e1000349.