Effective nutrition governance is correlated with better nutrition outcomes in Nepal

Grace Namirembe,Kedar Baral,Shibani Ghosh,Gerald Shively,Patrick Webb,Robin Shrestha,Julieta Mezzano,Dale Davis,Lynne M Ausman

doi:10.1186/s12887-021-02898-4

Abstract

BackgroundThe public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth.MethodsData were collected from two nationwide studies in Nepal to determine the relationship between a metric of nutrition ‘governance’ (the Nutrition Governance Index), derived from interviews with 520 government and non-government officials responsible for policy implementation and anthropometry measured for 6815 children in 5556 households. We employed Generalized Estimating Equation (GEE) and multilevel regression models.ResultsA higher NGI (more effective nutrition governance) is positively associated with height-for-age as well as weight-for-height in children over 2 years of age compared to younger children (HAZ; β = 0.02, p < 0.004, WHZ; β = 0.01, p < 0.37). Results from the hierarchical model show that a one-point increase in the NGI is significantly associated with a 12% increase in HAZ and a 4% increase in WHZ in older children (> 24 months old). Mothers’ education, child’s age, BMI and no fever in the past 30 days were also protective of stunting and wasting. Seven percent and 17% of the overall variance in HAZ and WHZ, respectively, are accounted for by variations across the 21 district locations in which sampled households were located. Mean HAZ differs considerably across districts (intercept = 0.116, p < 0.001).ConclusionsThese results highlight the importance of effective management of policy-based programming and resource use to bring about nutrition gains on the ground. The NGI explained a non-negligible amount of variation in HAZ and WHZ, which underscores the fundamental role that good governance plays in promoting child nutrition and growth, and the value of seeking to measure it to assist governments in moving policies from paper to practice.

Highlights

The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal
The prevalence of stunting and wasting was estimated at 34.0% (95% CL: 33–35%) and 14.0% (95% CL: 13–15%) respectively
Because height-for-age Z-scores (HAZ) variation across Village Development Communities (VDC) was small (Fig. 1a and b) and the VDC-level analysis must be based on a small set of observations (21 VDCs), we investigated VDC-level effects using only one community-level variable, Nutrition Governance Index (NGI)

Summary

Introduction

The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth. The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal, where rates are still very high, in certain subgroups of the population [1]. Few studies have examined metrics of political will and quality of policy implementation relevant to nutrition, and their potential to support actions targeting factors associated with stunting. Given the enormous dependence of the public sector on health and nutrition services in Nepal, it is critical to elucidate whether the quality and intensity of government-supported actions aimed at improving nutrition play any measurable role in outcomes at the household level

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