There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6-23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO-UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community-level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.

Many countries implement micronutrient powder (MNP) programmes to improve the nutritional status of young children. Little is known about the predictors of MNP coverage for different delivery models. We describe MNP coverage of an infant and young child feeding and MNP intervention for children aged 6–23 months comparing two delivery models piloted in rural Nepal: distributing MNPs either by female community health volunteers (FCHVs) or at health facilities (HFs). Cross-sectional household cluster surveys were conducted in four pilot districts among mothers of children 6–23 months after starting MNP distribution. FCHVs in each cluster were also surveyed. We used logistic regression to describe predictors of initial coverage (obtaining a batch of 60 MNP sachets) at 3 months and repeat coverage (≥2 times coverage among eligible children) at 15 months after project launch. At 15 months, initial and repeat coverage were higher in the FCHV model, although no differences were observed at 3 months. Attending an FCHV-led mothers’ group meeting where MNP was discussed increased odds of any coverage in both models at 3 months and of repeat coverage in the HF model at 15 months. Perceiving ≥1 positive effects in the child increased odds of repeat coverage in both delivery models. A greater portion of FCHV volunteers from the FCHV model vs. the HF model reported increased burden at 3 and 15 months (not statistically significant). Designing MNP programmes that maximise coverage without overburdening the system can be challenging and more than one delivery model may be needed.

Objective: Poor adherence to recommended intake protocols is common and a top challenge for micronutrient powder (MNP) programmes globally. Identifying modifiable predictors of intake adherence could inform the design and implementation of MNP projects. Design: We assessed high MNP intake adherence among children who had received MNP ≥2 months ago and consumed ≥1 sachet (n 771). High MNP intake adherence was defined as maternal report of child intake ≥45 sachets. We used logistic regression to assess demographic, intervention components and perception-of-use factors associated with high MNP intake. Setting: Four districts of Nepal piloting an integrated infant and young child feeding and MNP project. Subjects: Children aged 6-23 months were eligible to receive sixty MNP sachets every 6 months with suggested intake of one sachet daily for 60 d. Cross-sectional surveys representative of children aged 6-23 months were conducted. Results: Receiving a reminder card was associated with increased odds for high intake (OR = 2·18, 95 % CI 1·14, 4·18); exposure to other programme components was not associated with high intake. Mothers perceiving ≥1 positive effects in their child after MNP use was also associated with high intake (OR = 6·55, 95 % CI 4·29, 10·01). Perceiving negative affects was not associated; however, the child not liking the food with MNP was associated with lower odds of high intake (OR = 0·12, 95 % CI 0·08, 0·20). Conclusions: Behaviour change intervention strategies tailored to address these modifiable predictors could potentially increase MNP intake adherence.

Many children in low- and middle-income countries may have inadequate intake of vitamin B12 and folate; data confirming these inadequacies are limited. We used biochemical, demographic, behavioral and anthropometric data to describe the folate and vitamin B12 concentrations among six- to 23-month-old Nepalese children. Vitamin B12 (serum B12 < 150 pmol/L) and folate deficiencies (red blood cell (RBC) folate < 226.5 nmol/L) were assessed. We used logistic regression to identify predictors of vitamin B12 deficiency. The vitamin B12 geometric mean was 186 pmol/L; 30.2% of children were deficient. The mean RBC folate concentration was 13,612 nmol/L; there was no deficiency. Factors associated with vitamin B12 deficiency included: (a) age six to 11 months (adjusted odds ratio (aOR) 1.51; 95% confidence interval (CI): 1.18, 1.92) or 12–17 months (aOR 1.38; 95% CI: 1.10, 1.72) compared to 18–23 months; (b) being stunted (aOR 1.24; 95% CI: 1.03, 1.50) compared to not being stunted; (c) and not eating animal-source foods (aOR 1.85; 95% CI: 1.42, 2.41) compared to eating animal-source foods the previous day. There was a high prevalence of vitamin B12 deficiency, but no folate deficiency. Improving early feeding practices, including the consumption of rich sources of vitamin B12, such as animal-source foods and fortified foods, may help decrease deficiency.

Incorporating MNPs into the Nepal IYCF program did not harm IYCF and may have contributed to improvements in select practices. Research that uses experimental designs should verify whether integrated IYCF-MNP programs can improve IYCF practices.

Background The impact of unconditional cash transfers on child malnutrition and its determinants remains poorly understood. The aim of this study was evaluate the impact of an unconditional child cash grant on children’s nutritional status and its immediate (infant and young child feeding, dietary diversity, food consumption, and child infection and care) and underlying (household food security; Water, Hygiene and Sanitation (WASH) determinants among children younger than five years in the Karnali Zone, Nepal. Methods The five districts of the Karnali Zone received standard social welfare services in the form of targeted resource transfers for eligible families, plus an unconditional child cash payment, augmented by a capacity building and behavioural change education. Repeated cross-sectional surveys, with measures taken at baseline (2009, N =3750), midline (2013, N =3750) and endline (2015, N =3647), were carried out using a two-stage cluster sampling method. Multi-level Generalized Linear Mixed Models (GLMMs) with normal, binomial, Poisson, or multinomial link were performed to detect the unadjusted and adjusted trends. Results There was a linear growth among children, with a corresponding increase of 0.41 height-for-age Z-scores (p < 0.001), 0.50 weight-for-age Z-scores ( p <0.001), and 0.34 weight-for-height Z-scores ( p <0.001) between the study period, equating to a decline in child undernutrition of 9.4, 16.5, and 5.1 percentage points ( p <0.001) for stunting, underweight, and wasting respectively. Improvements were also observed in WASH outcomes, care and health seeking behaviours, and food availability. Conclusion Unconditional child cash grant embedded within a government sponsored cash transfer program for families and complemented by capacity building and behavioural change strategies improves child nutritional status and its determinants. Electronic supplementary material The online version of this article (10.1186/s13690-019-0352-2) contains supplementary material, which is available to authorized users.

Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height-for-age z-score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001-2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996-2016 period. Our findings indicate that most age-appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's toolfor national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle-feeding and introduction of solid, semi-solid or soft foods are rated fair. Our study also reports that a paucity of age-appropriate IYCF practices-in particular complementary feeding-are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, ageappropriate IYCF practices-in isolation-made modest statistical contributions to the rapid and sustained reduction in age-specific child linear growth faltering from 1996-2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies-integrating and advocating optimal IYCF-are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle-feeding.

Objective: The aim of this study was to evaluate the effectiveness of the synergetic effect of child sensitive social protection programs, augmented by a capacity building for social protection and embedded within existing government’s targeted resource transfers for families on child nutritional status. Design: A repeat cross-sectional quasi-experimental design with measures taken pre- (October–December 2009) and post- (December 2014–February 2015) intervention in the intervention and comparison district. The comparison district received standard social welfare services in the form of targeted resource transfers (TRTs) for eligible families. The intervention district received the TRTs plus a child cash payment, augmented by a capacity building for effective social protection outcomes. Propensity scores were used in difference-in-differences models to compare the changes over time between the intervention and control groups. Results: Propensity score matched/weighted models produced better results than the unmatched analyses, and hence we report findings from the radius matching. The intervention resulted in a 5.16 (95% CI: 9.55, 0.77), 7.35 (95% CI: 11.62, 3.08) and 2.84 (95% CI: 5.58, 0.10) percentage point reduction in the prevalence of stunting, underweight, and wasting among children under the age, respectively. The intervention impact was greater in boys than girls for stunting and wasting; and greater in girls than boys for underweight. The intervention also resulted in a 6.66 (95% CI: 2.13, 3.18), 11.40 (95% CI: 16.66, 6.13), and 4.0 (95% CI: 6.43, 1.78) percentage point reduction in the prevalence of stunting, underweight, and wasting among older children (≥24 months). No impact was observed among younger children (<24 months). Conclusions: Targeted resource transfers for families, augmented with a child sensitive social protection program and capacity building for social protection can address effectively child malnutrition. To increase the intervention effectiveness on younger children, the child cash payment amount needs to be revisited and closely embedded into infant and young child feeding initiatives, but also adjusted to equate to 20% of household expenditure or more to maximize the diversity of food available to young children.