Purnima Menon

Monitoring children’s growth is a standard practice in paediatric care globally. It is based on the well-established understanding that excessively slow or rapid rates of weight or height gain, which are linked to multiple adverse outcomes, can serve as sensitive indicators of a child’s health. By systematically tracking anthropometric measurements such as weight, height, and […]

Background: Poor diets pose a threat to all forms of malnutrition and diet-related noncommunicable diseases (NCDs). Data on dietary patterns are scarce in South Asia. Objectives: We sought to describe overall diet quality, intake of foods and food groups, and eating occasions among adults in rural South Asia. Methods: Data were from five districts across Bangladesh (n=2,802 individuals), India (n=1,672), and Nepal (n=1,451). The Global Diet Quality Score (GDQS) application was used to measure intake of foods on the previous day, with each food tagged to an eating occasion. Diet quality and the risk of diet-related noncommunicable diseases (NCDs) were described using GDQS total (0–49), GDQS positive (0–32) and GDQS negative (0–17) metrics for overall, healthy, and unhealthy food intake respectively. Results: Diet quality was low, with similar scores across countries for GDQS total (17-19 depending on country), GDQS positive (7–8) and GDQS negative (10–12), indicating low intake of healthy foods as the main contributor to poor diets. Over 90% of adults had levels of GQDS scores associated with moderate/high risk for diet-related NCDs, with the proportion at high risk in Bangladesh being 2-3x higher than other countries. Across sites, intake of refined grains (white rice), sweets (sugar, biscuits), and white tubers (potatoes) was common. One-third of adults did not eat breakfast in Nepal, and snacking was twice as common in males (63%) versus females (33%) in Bangladesh. Conclusions: These findings highlight the need to improve diets in rural South Asia and may help inform interventions targeting food intake patterns.

Background: High coverage of nutrition-specific interventions is critical to meet global nutrition targets, and it is imperative to understand how to attain it. We examined trends and inequalities in the coverage of interventions in India and the role of the National Nutrition Mission (NNM) in achieving improvements. Methods: We conducted trends and equity analysis of 30 interventions using two rounds of National Family Health Survey data (2015–2016, n=1 78 874, and 2019–2021, n=1 70 697). We also compared coverage between states that received incentives and monitoring under NNM and those that did not. We reviewed programme documents and grey literature to construct a policy timeline to trace pathways to coverage improvement and consulted with stakeholders to confirm interpretation of findings. Findings: Between 2016 and 2021, coverage improved significantly for nearly all interventions (~1–22 percentage points (pp) during pregnancy, ~7–20 pp during delivery/postpartum and~5–17 pp during early childhood). Improvements in coverage were higher among the poor and in rural areas compared with the rich and in urban areas, respectively; wealth and residence gaps narrowed for most interventions. These improvements could be traced to community mobilisation, technology and monitoring under NNM. Improvements in coverage of growth monitoring and counselling were higher in states that received additional incentives and monitoring under NNM. Stakeholders concurred that the improvements in coverage were likely driven by NNM. Interpretation: Focused policy attention and programmatic efforts improved coverage and reduced inequities indicating an inclusive approach. Persistent coverage gaps for certain interventions require further inquiry.

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6–59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS‐4 [2015–2016] and NFHS‐5 [2019–2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference‐in‐differences (DID) approach. Utilization of ICDS increased from 58% in 2015–2016 to 71% in 2019–2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%–12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6–59 months in this period.

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems.

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors.