PoSHAN Community Studies: Finding Pathways to Accelerate Nutritional Impacts

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PoSHAN Community Studies: Finding pathways to accelerate nutritional impacts

Rolf Klemm, DrPH

Keith P. West Jr, DrPH

Swetha Manohar, RD, MSPH

Multi‐Sectoral Nutrition Research and Implementation:A year of progress and lessons

2nd Annual Scientific Symposium, Kathmandu, Nepal, August 13-14, 2013

Agriculture-to-Nutrition Pathways: Moving the research agenda forward

Key Recommendations1. Organize annual forum for

policy makers2. Organize annual scientific

symposia and publish proceedings

3. Establish community-based surveillance sites

4. Form cross-disciplinary working group to identify key research questions

5. Conduct efficacy and effectiveness research on promising interventions

First Annual Scientific Symposium Proceedings-

March 2012

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Nat’l policy makers& District officials, front-

line workers & program implementers

Focus

Lead

CollaboratorsValley

Research

Understand agriculture-to-nutrition linkages thru population-based assessments

Population-based: Communities, Households, Mothers and Children<5 yrs

Goal Understand policy and programming processes

IOM, NARC, New Era,

NTAG

PoSHAN StudyPolicy and Science for Health, Agriculture and Nutrition Process Community

Goal: PoSHAN Community Studies

Assess health & nutrition well-being of the rural Nepali population in relation to agriculture, nutrition and health program interventions across ecological zones in ways that can inform policies and programs.

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Nutritional Status

Diet

Household Food Security

Agricultural Production

Markets

Infection

Hygiene

Lifestyle (workload, smoking).

Exposure to anti-nutritionals

Access to Access to health

services

Household Capital

Household Expenditure

HH resources

Decision-making about HH resources

Household Income

Environmental Factors

Exposure to Agriculture, Nutrition & Health Interventions

Study Design

• Annual Panel Surveys in a representative sample of VDCs in each major agro-ecological zone

• In-depth Seasonal Follow-up in “Sentinel” VDCs

VDC=Village Development Committee

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Mountains543 VDCs

Hills2,034 VDCs

Terai1,394 VDCs

7 VDCs 7 VDCs 7 VDCs

21 Wards 21 Wards 21 Wards

Annual assessment of all consenting households & eligible individuals with children<5 yrs & married women (married <2 yrs)

Randomly select 7 VDCs using systematic random sampling

Randomly select 3 wards per VDC using PPS

Study Design: Annual Panel Surveys

Mountains7 VDCs

Hills7 VDCs

Terai7 VDCs

1 VDCs 1 VDCs 1 VDCs

3 Wards 3 Wards 3 Wards

Seasonal assessments (Aug-Oct & Jan-Mar)

Study Design:Seasonal Follow-up in Sentinel Sites

33rd – 66th percentile for a variety of indicator variables

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DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

DANG

BANKE

ACHHAM KALIKOT

JHAPA

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADIBAJURA

MA

HO

TT

AR

I

CHITWAN

KASKI

TANAHU

PALPA

GULMI

ILAM

BHOJPUR

DHANKUTA

TAPLEJUNG

OKHALDHUNGA

KHOTANG

LALIT

BKT

NUWAKOT

KAVRE

RASUWALAMJUNG

GORKHAROLPA

SALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

Mountains (n=7 VDCs)

Hills (n=7 VDCs)

Terai (n=7 VDCs)


Districts of Study VDCs

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

DANG

BANKE

ACHHAM KALIKOT

JHAPA

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADIBAJURA

MA

HO

TT

AR

I

CHITWAN

KASKI

TANAHU

PALPA

GULMI

ILAM

BHOJPUR

DHANKUTA

TAPLEJUNG

OKHALDHUNGA

KHOTANG

LALIT

BKT

NUWAKOT

KAVRE

RASUWALAMJUNG

GORKHAROLPA

SALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG


Districts of Sentinel Site VDCsAg-Eco-

zoneDistrict VDC

Mtns Jumla Mahatgaun

Hills Arghakhanchi Sitapur

Terai Banke Saigaun

Sentinel Sites

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DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

DANG

BANKE

ACHHAM KALIKOT

JHAPA

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADIBAJURA

MA

HO

TT

AR

I

CHITWAN

KASKI

TANAHU

PALPA

GULMI

ILAM

BHOJPUR

DHANKUTA

TAPLEJUNG

OKHALDHUNGA

KHOTANG

LALIT

BKT

NUWAKOT

KAVRE

RASUWALAMJUNG

GORKHAROLPA

SALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

Mountains (n=7 VDCs)

Hills (n=7 VDCs)

Terai (n=7 VDCs)


Overlap with Programs

Measuring weight Measuring height

Interviewing respondentEnumerating & addressing households

Testing Salt for Iodine

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Individual Household CommunityNutritional status,

Dietary intake, Morbidity history

Socioeconomic status, Assets, Income, Expenditure

Agriculture, Nutrition, Health personel

Receipt & use of maternal and child

health services

Land Use, Agriculture production, Animal Ownership

Community infrastructure

Health, nutrition & child care knowledge

Program Participation, Agricultural training and inputs

Market prices for keyfoods

Women’s decision making

Water, Sanitation & Hygiene Market prices foragricultural inputs

Food Security, Economicshocks

Data Domains

Study Status• First annual panel survey (21 VDCs, 63 wards)

• Data collection completed ~1 week ago (mid-May to

early August)

• Data entry on-going

• Data analyses being planned

• First seasonal follow-up at sentinel site VDCs (3 VDCs, 9 wards), September to October

• Training of data collection on-going

• Data collection to begin early September

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Planned AnalysesFirst Annual Panel Survey:

• Characterize nutritional status, dietary intake, indices of household food insecurity, agricultural productivity, income and expenditures, and participation in agricultural, health and nutrition interventions by agro-ecological zone.

• Estimate risks of undernutrition, dietary diversity and household food security, by levels and diversity of food production, program participation, SES and other potential risk factors.

2nd, 3rd…Annual Panel Surveys: Estimate annual differences & assess direction & rates of change

Seasonal Follow-ups: In-depth assessment of seasonal variation in market prices, foods, food security, diet, nut’l status

Research Brief…in your packet

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Closing thoughts……• There are trade‐offs & synergies between doing good research

& having development impact.

• Need to clearly delineate roles of the multiple players involved

in research, policy and programming.

• There is great interest in agriculture, nutrition and health for

development in Nepal and globally.

• The research communities must seize this opportunity to

create the evidence that will inform the next generation of

action.

Adapted from LCIRAH 3rd Annual Conference, 2013

AcknowledgementsFunding: through Feed the Future Innovation Lab for Collaborative Research on Nutrition

Management Entity: Tufts University

Co-Investigators: Dr. Devendra Gauchan, Dr. Ramesh Adikhara, Swetha Manohar, Dr. Shibhani Ghosh, Dr. Patrick Webb

Data Collectors: New Era Pvt Ltd; NTAG

PoSHAN-JHU Technical Team: Ruchita Rajbhandary, Abhigyana Bhattarai, Dr. Raman Shrestha, Hari Krishna Shah, Dr. Sudeep Shrestha

PoSHAN-Tufts Technical Team: Diplov Sapkota

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Thank You!

For more information contact: Swetha ManoharEmail: [email protected]: Suite 402, Oasis Complex,Patan Dhoka, Patan, Lalitpur, NepalPhone: +(977) 9818911865

Documents

PoSHAN Community Studies: Finding Pathways to Accelerate Nutritional Impacts