Background Micronutrient insufficiencies are a serious public health problem among women of reproductive age in Low and Middle Income Countries including India, adversely affecting maternal health and economic productivity, and child growth and educational outcomes. Fruit and vegetables are important sources of micronutrients and consumption of these foods is less than recommendations. Objective To identify perceived barriers and facilitators to fruit and vegetable consumption among women of reproductive age living in rural communities in Eastern Maharashtra, India. Methods We used qualitative methods and held 9 focus group discussions and 12 one to one interviews. The data collection was stopped when no new information emerged. We used inductive thematic coding to analyse the data. Women aged 18-40 years were recruited from eight villages surrounding the city of Wardha, Maharashtra, India. Results Women knew that fruit and vegetables were beneficial to health and expressed that they wanted to increase intakes of these foods for themselves and their children. Seven main themes were identified as being barriers or facilitators to fruit and vegetable consumption: 1) Personal factors; 2) Household dynamics; 3) Social and Cultural Norms; 4) Workload; 5) Time pressures; 6) Environmental Factors; 7) Cost. Conclusions Rural Indian women consumed fruit and vegetables infrequently and said they would like to consume more. Several potentially modifiable factors affecting intakes were identified. Value chain analyses of fruit and vegetables in these communities are important to identify opportunities to intervene to increase consumption.

Sustainably addressing the crisis of undernutrition for children and adolescents in underserved and resource-limited communities will require, among other investments, interventions aimed at optimizing the diets of these vulnerable populations. However, to date, there are substantial global gaps in the collection of dietary data in children and adolescents. This review article summarizes the challenges and opportunities in assessing diet among children and adolescents in India. National surveys in India identify the scale of the triple burden of malnutrition (undernutrition, micronutrient deficiencies and overnutrition) in children and adolescents and assess key nutrition and food security indicators for making informed policy decisions. However, national surveys do not collect data on diet, instead relying on anthropometry, biomarkers of micronutrient deficiencies, and summary measures of diet, such as the WHO infant and young child feeding summary indicators. Sub-national surveys and the scientific literature thus fill important gaps in describing the nutrient intakes of children and adolescents in India; however large gaps remain. Future research can be improved by investments in infrastructure to streamline the assessment of diet in India. The current challenges confronting the collection and analysis of high-quality dietary data occur in both the data collection and data analysis phases. Common methods for assessing diets in low-resource settings—such as 24 h recalls and food frequency questionnaires are particularly challenging to implement well in young children and adolescents due to motivation and memory issues in young respondents. Additionally, there are challenges with parental recall including children having multiple caretakers and meals outside the home. Furthermore, analysis of dietary data is hindered by the lack of affordable, accessible software for dietary data analysis relevant to the diversity in Indian diets. New technologies can address some of the challenges in dietary data collection and analysis, but to date, there are no platforms designed for population-level dietary assessment in India. Public and private sector investment in dietary assessment, as well as collaboration of researchers and the creation of open-source platforms for the sharing of data inputs (local food lists, recipe databases, etc.) will be essential to build infrastructure to better understand the diets of children and adolescents in India and improve dietary interventions in these target groups.

Background: Diets in rural India are cereal based with low intakes of micronutrient-rich foods. The value chains for nutrition approach aims to study supply and demand of such foods. This may aid in development of interventions to improve diets and livelihoods. Objectives: (1) To identify how fruit and vegetables are accessed, (2) to describe and map the structure of value chains for exemplar foods, (3) to understand how foods are priced, and (4) to explore factors that affect decisions about which crops are grown, marketed, and sold. Methods: After stakeholder consultation, we identified 2 fruits (mango and guava) and 2 vegetables (shepu and spinach) as exemplar foods. Criteria for these exemplar foods were that they should be known to participants and there should be variability in intakes. We held 24 interviews with value chain actors including farmers, wholesalers, and vendors of the exemplar foods. Data collection was stopped when no new information emerged. We used inductive thematic coding for our analysis. Results: The value chains for each of the exemplar foods were relatively simple and involved farmers, middlemen, and vendors at either city or village level. The main themes identified as being factors considered when making decisions about which foods to grow and sell were (1) farming resources and assets, (2) quality of produce, (3) environmental conditions, (4) financial factors, (5) transport availability, and (6) consumer demand. Conclusions: There are opportunities to intervene within fruit and vegetable value chains to increase availability, affordability, and access to produce in rural India. Future research is required to determine which interventions will be feasible, effective, and acceptable to the community and other stakeholders.

Objectives Maternal anemia is a critical public health problem, especially in Low- and Middle-Income Countries (LMIC) like India. Anemia during pregnancy increases the risk of poor fetal outcomes, such as low birth weight. The Indian national Iron + Initiative includes iron & folic acid (IFA) supplementation for pregnant & lactating women. We sought out to assess the effectiveness of the IFA program in Nagpur, India. Methods We conducted a prospective cohort study of 200 pregnant women from four clusters in Nagpur (Eastern Maharashtra), India. Maternal hemoglobin was assessed using Hemocue and the finger prick method. Anemia was defined as hemoglobin < 110g/L. IFA receipt and consumption was assessed via questionnaire during the 1st and 3rd trimester of pregnancy. Results Hemocue/capillary assessment revealed prevalence of anemia in the third trimester of 69.52% (N = 187), as compared to 50.0% (N = 200) in the first trimester. In the first trimester, 44.5% of women reported consuming IFA the previous day, while 84.8% reported consuming it the previous day by the 3rd trimester. In the first trimester, 61% (n = 122) of women reported receiving IFA: 43% for free from a public health facility, 14% purchased it from a store/pharmacy, and 4% from other locations. By the 3rd trimester, 99.5% of women had received IFA: 75.4% for free from a facility, 11.8% from a pharmacy/store and 8.02% from other locations. Conclusions We noted a markedly high prevalence of anemia in pregnancy that increased from the first to third trimester, characteristic of physiologic amenia, despite an increase IFA coverage and consumption. Other nutritional and non-nutritional interventions to reduce anemia in pregnancy need to be explored to prevent maternal anemia in Nagpur, India and possibly other LMIC contexts. Funding Sources This study was funded by the Thrasher Research Fund grant.

Objectives Maternal anemia during pregnancy increases the risk of a myriad of negative birth outcomes, including maternal mortality, neonatal mortality, and low birth weight. In Eastern Maharashtra, India, the prevalence of anemia among pregnant women has been reported to be > 80%. While the most common cause of anemia is iron deficiency, its relative contribution is often unknown, as are rates of other key micronutrient deficiencies including B12 and folic acid. The primary objectives of this study are 1) to determine the prevalence of micronutrient deficiencies (iron, folic acid, and B12) and 2) to quantify the contribution of these micronutrient deficiencies to anemia among pregnant women in Nagpur (Eastern Maharashtra, India). Methods We conducted a cross-sectional study of 200 women from four clusters in Nagpur. In the first trimester of pregnancy, trained nurses collected venous blood samples and we used Hemocue on blood samples collected with a finger prick. Anemia was defined as hemoglobin < 110 g/L, iron deficiency as serum ferritin < 15 µg/mL (adjusted for inflammation), folic acid deficiency as serum folic acid < 3 ng/mL, and B12 deficiency as < 203 pg/mL. Results Among women in our sample, 37.5% were anemic, 40.0% were iron deficient, 30.0% were vitamin B12 deficient, and none were folic acid deficient. Hemocue assessment of capillary blood yielded a prevalence of anemia of 50.0%. Approximately half (53.0%) of women diagnosed with anemia via Hemocue were iron deficient and 31.0% were vitamin B12 deficient. We did not find any folate deficiency in this population. Conclusions We found the prevalence of anemia in Eastern Maharashtra to be lower compared to previous studies collecting capillary blood, though still unacceptably high. Furthermore, as only half of anemia cases were associated with iron deficiency, iron and folic acid (IFA) supplementation programs may only partially ameliorate the high prevalence of anemia. Funding Sources This study was funded by the Thrasher Research Fund grant.