Sumanta Neupane

What adults in rural South Asia eat and when they eat it: Evidence from Bangladesh, India, and Nepal

What adults in rural South Asia eat and when they eat it: Evidence from Bangladesh, India, and Nepal

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.

Identifying measures for coverage of nutrition-sensitive social protection programs: Learnings from India

Optimal child growth requires a combination of nutrition-specific and sensitive interventions in the first 1,000 days. There is limited guidance on how to measure the population-level coverage of nutrition-sensitive social protection (NSSP), which is designed with explicit nutrition goals and often provides food or cash transfers and co-coverage with nutrition and health intervention. In this study in India, we designed a questionnaire that captures seven core NSSP program elements (transfer type, size, modality, population, timing, provider, conditionalities), then used cognitive testing to refine the questionnaire, and then implemented the questions as part of a telephone survey. Cognitive testing indicated variability in understanding the terms used to specify NSSP programs, including the need to use regional program names. Respondents also had difficulty recalling the timing of the benefit receipt. We included the refined NSSP coverage questions in a phone-based survey with 6,627 mothers with children <2 years across six states. Coverage of subsidized food was 73% across all households. Women were more likely to report receiving food than cash transfers during pregnancy (89% vs. 60%) and during lactation (75% vs. 13%). Co-coverage of NSSP with nutrition and health interventions during pregnancy (16%) and early childhood (3%) was low. It was feasible to measure coverage of NSSP investments in these populations; however, further research is needed to comprehensively assess all the dimensions of the NSSP benefits, including benefit adequacy and the validity of these questions when administered in person and by phone.