BackgroundThe 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas remains uncertain.MethodsTwo national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged children or newly married women. Of the 21 village development committees (VDCs) included in this sample, 7 fell within “earthquake-affected” areas. This paper presents data from 982 HH, 1015 women, and 883 children from 2014 and 1056 HH, 1083 women, and 998 children from 2016 living in these areas, with longitudinal overlap of about 55%. Prevalence estimates and 95% confidence intervals were calculated, and logistic regression was used to calculate p-values, both using robust estimates of standard errors to account for clustering.ResultsFrom 2014 to 2016, child wasting (weight-for-height z score <-2) fell from 4.5% (95% CI 3.3%– 6.1%) to 2.1% (1.4%– 3.1%) and food insecurity (assessed using the household food insecurity access scale) dropped from 17.6% (11.7%– 25.6%) to 12.4% (6.9%– 21.2%). Child stunting prevalence remained similar at both time-points. Improvements were also evident in dietary diversity and breastfeeding indicators.ConclusionsNutrition and food security conditions remained comparable or improved one year after the earthquake despite evidence of structural and other damage. Livelihood resilience to shocks and/or effective nutrition, food or health interventions may have helped buffer the impact on nutrition, although this hypothesis requires further exploration.

Background: Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. Objective: We report prevalence of preschool child stunting and wasting from a national survey in 2016 and place findings into the context of national trends and alignment for Nepal to attain its WHA 2025 goal. Methods: A representative, midyear Policy and Science for Health, Agriculture and Nutrition (PoSHAN) survey was conducted in 2016 on 5479 children <60 months in 4051 households in 21 village development committees. Child weight and height were measured, and sociodemographic factors were assessed. Data from previous surveys (Nepal Demographic Health Surveys, PoSHAN) were also acquired, and rates of stunting (<−2 height-for-age z score) and wasting (<−2 weight-for-height z score) were compared to current World Health Organization standards. Trends were expressed as average annual rates of reduction (AARR). Results: Nationally, in 2016, 34.1% of preschoolers were stunted and 13.7% wasted. Stunting was highest in the Mountains (40.6%) and wasting highest in the Tarai (18.9%). Trend analysis revealed a steady decline (3.8% AARR) in stunting from 2001 to 2013, with virtually no decline from 2013 to 2016. Wasting has been continually high and variable, at ≥8%, since 1975. Conclusions: Following a steady decline in prevalence, preschool child stunting has plateaued at ∼35% in Nepal, while wasting has changed little over time, offering the opportunity to inform, reassess, and adjust, as needed, efforts to reach WHA 2025 goals.

The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe common cognitive, behavioral, and emotional symptoms of grief. Accordingly, modifications to an existing instrument for Prolonged Grief Disorder, the PG-13, are suggested to capture grief symptoms as experienced by Nepali widows. Items in the PG-13 were translated to colloquial Nepali and adapted to maintain comprehensibility, acceptability, relevance, and completeness. Based on the grief-related issues reported in the focus group discussions, the addition of five new items and a new criterion to capture symptoms related to social discrimination are proposed. Widows perceived elevated symptoms one year after the loss to be problematic. It is thus recommended that the duration criterion in the original PG-13 be adjusted from at least six months to at least one year after the loss. These proposed modifications to the instrument should be validated through future psychometric testing.

Objectives Linear growth failure is often assessed as a height-for-age z-score (HAZ) &lt; −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali preschool children using a novel linear growth velocity (LGV) reference. Methods We assessed length/height in children under-five from 2013–16 during the same season in 21 wards across the plains (Tarai) of Nepal (n = 4439). Annualized LGVs were calculated from paired measures and stratified into interval-initiating ages of &lt;6, 6–11, 12–23, 24–35, 36–47, 48–59 mo. An annualized, age-sex-specific LGV reference was derived by combining the WHO Growth Standards (for intervals starting &lt;12 mo) and the Tanner Height Velocity Reference (for intervals starting later) using linear restricted cubic spline regression models, from which LGV z-scores (LGVZ) were derived and used to evaluate Nepali child growth. Community, household and individual risk factors were assessed during interval-initiating visits and subjected to multivariable logistic regression models to examine associations with LGVZ &lt; −2 (growth faltering) vs &gt; 2. Results LGV faltering affected 29.8% and 34.8% of boys and girls &lt;24 months, and 6.8% and 7.1% 24–60 months, respectively. Girls were at higher odds of faltering, although 95% CI excluded 1 only for the interval starting at 12–23 mo (OR: 1.77; 95% CI: 1.26, 2.50). Children &lt;24 mo whose weight-for-height z- score was &gt; the WHO median had lower odds of faltering than thinner children (OR: 0.25 - 0.40, all upper 95% CLs &lt; 1). Children of short (&lt;150 cm) mothers had higher odds of faltering, with 95% CIs excluding 1 for interval-initiating ages &lt; 6, 12–23 and 24–35 mo. Above 36 mo, community characteristics such as proximity to market, and access to roads and schools were stronger in their protective growth association than individual or household factors. Conclusions Growth faltering can be assessed across all preschool years by this WHO-Tanner linear growth velocity reference. Nepali children exhibited substantial growth faltering &lt;24 months. Females, children who were thin, and born to short mothers were at an increased risk of growth faltering. Funding Sources USAID, Sight and Life, and Procter & Gamble.