Adolescent undernutrition is a persisting public health problem in low and lower middle income countries (LLMICs). Nutritional trajectories are complexly interrelated with socio-cultural and economic (SCE) trajectories. However, a synthesis of the SCE determinants or consequences of undernutrition in adolescents is lacking. We undertook a narrative review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in LLMICs. We identified 98 articles from PubMed, SCOPUS, and CAB-Abstracts on determinants and consequences of undernutrition as defined by stunting, underweight, thinness, and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working status, and marital status. At the household level, parental education and occupation, household size and composition, income, socioeconomic status, and resources were associated with undernutrition. Only a few determinants at the community/environmental level, including residence, sanitation, school type, and seasonality, were identified. The consequences of adolescent undernutrition were mostly related to education and cognition. This review underscores the importance of the broad range of context-specific SCE factors at several levels that influence adolescent nutritional status and shows that further research on SCE consequences of undernutrition is needed.
During the last decades, the focus of food and nutrition security research has shifted from issues of macro-level availability to problems of unequal access, and distribution within the household. Little systematic attention has however been paid to the role of family systems in household food allocation processes. This study focuses on the extent to which family relations, and particularly gender roles, in two Himalayan communities with different family systems influence intra-household food allocation, and the subsequent nutritional status of women of reproductive age (15-49). In-depth interviews were conducted with 15 Buddhist and 15 Hindu women, the latter belonging either to the higher Chhetri or lower Dalit castes. Additionally, anthropometric data of women were collected. Results show that women from Hindu families were worse off than women from Buddhist households in terms of nutritional status, which is due to different intra-household allocation patterns. Secondly, women's nutritional status varied over the reproductive life course. Women were most vulnerable during menses, pregnancy, and the post-partum period. Comparison with research conducted in the 1980s in this area suggests that the influence of family-level values and practices on women's nutritional status is slowly changing.
Anemia is regarded as major public health problem among adolescents in Low and Middle-Income Countries (LMICs) but there is limited primary data in many countries, including Nepal. This study investigated the prevalence and correlates of anemia in a nationally representative sample of adolescents within the 2014 National Adolescent Nutrition Survey in Nepal. A total of 3780 adolescents aged 10 to 19 years were selected from a cross-sectional survey through multi-stage cluster sampling. Structured interviews, anthropometric measurements and hemoglobin assessments of capillary blood were obtained. Bivariate and multivariable analyses were undertaken to compute the Adjusted Odds Ratio (aOR) for socio-demographic, behavioral and cluster characteristics. The overall prevalence of anemia was 31% (95%CI: 28.2, 33.5), 38% (95%CI: 34.0, 41.8) in female and 24% (95%CI: 20.6, 27.1) in male. The likelihood of anemia was significantly higher among older adolescents (aOR 1.75, 95%CI: 1.44, 2.13), females (aOR 2.02; 95%CI: 1.57, 2.60), among those who walk barefoot (aOR 1.78, 95%CI: 1.08, 2.94), and those residing in the Terai (aOR 1.80, 95%CI: 1.18, 2.77). Food consumption from more than four food groups (aOR 0.71, 95%CI: 0.57, 0.88) was protective against anemia. In conclusion, anemia is common in Nepali adolescents. Efforts to improve the nutritional status of this high-risk age group require nutrition that focus on eating habits, sanitation, iron supplementation and the treatment of hookworm infection.
Background The growing number of community-dwelling older adults and the increased risks of adverse health events that accompany ageing, call for health promotion interventions. Nurses often lead these interventions. The views and experiences of older adults participating in these interventions have rarely been studied. To understand the views of targeted older adults, qualitative studies are essential. The aim of this study was to investigate the views and experiences of older adults on their participation in a nurse-led intervention, taking into account their views on healthy aging. Methods In a qualitative study, nineteen Dutch older adults aged 62 to 92 years participated in semi-structured interviews. These were transcribed verbatim and coded with the Qualitative Data Analysis Miner software program. The Qualitative Analysis Guide of Leuven was used for data analysis. Results Based on the analysis of the interviews, the following main themes emerged from the data reflecting the experiences of the participants: 1) awareness of aging, 2) experienced interaction with the nurse, and 3) perception of the consultations as a check-up and/or personal support. Conclusions This study underscores the importance of nurse-led interventions that match older adults’ personal views concerning healthy living, and their views and experiences concerning these interventions. Older adults’ holistic views of healthy living were not always assessed and valued by the nurses. Also, our study shows a wide variety of expectations, views and experiences among the participating older adults. This implies that health professionals should adjust their working and communication methods to the older adult’s views on life.
1 thin, compared to 37% of boys. Undernutrition was more profound in the lowland plains (Terai) than in mountainous and hilly agroecological zones . Especially alarming is the sky-high and still rising prevalence rate of anemia among women, which has increased from 35% in 2011 up to 41% in 2016. This percentage is even higher for young women and girls aged 15-19 (44%), and in the Terai region (MoHP, et al., 2018). Nepal's Adolescent Nutrition Survey indicated that 71% of male, and 59% of female adolescents were underweight (BMI less than 18.5) . Results however vary with geographical location, socio-economic factors (e.g., ethnicity, gender, wealth), and age .Deeply rooted patriarchal norms and caste-based discrimination are still perpetuated by institutional traditions and sociocultural norms in Nepal, despite bans or regulating policies. Such norms and practices disproportionally affect girls. For instance, chaupadi, a practice that confines girls to animal sheds during menstruation because of impurity beliefs is still practiced in Western Nepal and puts girls' lives in danger. The encountering and accumulation of disadvantages during adolescence directly impact health and wellbeing, human capital and autonomy, and life opportunities, particularly of girls. This is reflected in early, forced marriage and unwanted pregnancies, skewed access to education, unequal access to employment, and limited decision-making power (UNPF, 2017). Moreover, the unequal intra-household food allocation practices that deprive girls of essential nutrients (DeRose, Das, & Millman, 2000;, and the unequal access to healthcare according to age, sex, and/or birth order, still persist (Godha, Hotchkiss, & Gage, 2013;Koolwal, 2007). In terms of education, the gender gap is closing, but girls are still more likely to drop out of secondary school due to marriage, school failure, or economic reasons. NDHS data shows a trend away from early marriage, but 27.1% of girls marry between 15-19 years, compared to only 6.4% of boys. Among girls aged 15-19, 17% have begun childbearing, a percentage which has not decreased since 2011. By the age of 19, 36% of girls have given birth to a child, often within two years of marriage. Related, only 15% of married girls aged 15-19 use a modern method of contraception, resulting in high (32%) unmet need . The Suaahara II "Good Nutrition" programThe empirical part of this study is embedded within the United States Agency for International Development (USAID)-funded large-scale multisectoral integrated nutrition program, Suaahara II "Good Nutrition" (SII) in Nepal, which runs from 2016 to 2021 in Nepal. The program is led by Helen Keller International (HKI) and aims to reduce the prevalence of stunting, wasting, and underweight among children under five years of age, and to reduce the prevalence of anemia among women and children between 6-59 months of age (HKI, 2017). In addition, the program is dedicated to work with adolescent girls, to Chapter 1 30 improve their understanding of nutrition, hygiene, and repr...
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