Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Abstract

Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law, and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100% of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg, and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an ‘energy-giving’ diet. Some foods were avoided because of religious or cultural taboos, or because they were low-status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.

A Systematic Review of Linear Programming Techniques as Applied to Diet Optimisation and Opportunities for Improvement

“…Results from reviewing the selected articles showed the versatility of applying the technique in diferent settings. Te countries where mathematical diet optimisation has been applied include Korea [27], Australia [28], Malaysia [29], Philippines [16,30], France [31,32], New Zealand [33,34], Ghana [1,35], Kenya [36], Canada [10], Malawi [37], Czech Republic [38], Brazil [39], Hungary [40], and Nepal [41].…”

“…Masset et al [10] set constraints to ensure modelled diet meets the nutritional requirement for cancer treatment. Dibari et al [44] and Ryan et al [46] also set constraints to meet the nutritional requirements for readyto-use-therapeutic foods, Brixi [59] imposed constraints that ensure that the diet modelled met the nutritional requirements necessary to treat acute malnutrition, and Morrison et al [41] set constraints to ensure that maximum iron content of modelled diets is obtained in an attempt to address anaemia among women of pregnancy age in Nepal. Other forms of nutritional constraint can be on macro and micronutrient requirements in the form of meeting recommended nutrient intakes (RNIs), as exhibited by Ferguson et al [38]; Raymond et al [75]; Verly-Jr et al [39]; and van Wonderen et al [53].…”