Equity implications of rice fortification: a modelling study from Nepal

Saville, Naomi; Maharjan, Macharaja; Manandhar, Dharma S; Harris‐Fry, Helen

doi:10.1017/s1368980020001020

Cited by 8 publications

(6 citation statements)

References 50 publications

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“…Only 42% of women took the recommended dose of 180 IFA tablets, and 69% took deworming tablets during their pregnancy (Ministry of Health Nepal et al, 2017 ), indicating the need to improve these practices in order to improve anaemia. Women's consumption of iron‐rich foods is particularly low in the plains (Harris‐Fry et al, 2018 ), but iron adequacy in women's diets is low across Nepal (Saville, Maharjan, et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

“…Nepal et al, 2017), indicating the need to improve these practices in order to improve anaemia. Women's consumption of iron-rich foods is particularly low in the plains (Harris-Fry et al, 2018), but iron adequacy in women's diets is low across Nepal (Saville, Maharjan, et al, 2020).…”

Section: Gender In Nepalmentioning

confidence: 99%

“…The Nepal Micronutrient Status Survey found higher anaemia prevalence in women who had not consumed deworming tablets in the past 6 months compared with those who had (Ministry of Health and Population et al, 2018 ). Low dietary diversity among women results in inadequate consumption of iron‐rich foods and other micronutrients essential for healthy erythropoiesis and iron absorption (Gautam et al, 2019 ; Harris‐Fry et al, 2018 ; Henjum et al, 2014 ; Saville, Maharjan, et al, 2020 ). A recent analysis of DHS data found that women aged 20–29 years, with more than four children, who had experienced intimate partner violence and were from Provinces 1, 2 and 5 were at higher risk of anaemia (Rai et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study

Morrison

Giri²,

Arjyal³

et al. 2021

Maternal & Child Nutrition

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Maternal anaemia prevalence in low‐income countries is unacceptably high. Our research explored the individual‐, family‐ and community‐level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient‐rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio‐ecological framework, conducting semi‐structured interviews with recently pregnant women and key informants, and focus group discussions with mothers‐in‐law and fathers. We found that harmful gender norms restricted women's access to nutrient‐rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers‐in‐law and fathers lacked awareness about iron‐rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers‐in‐law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.

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Section: Methodsmentioning

confidence: 99%

Section: Gender In Nepalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study

Morrison

Giri²,

Arjyal³

et al. 2021

Maternal & Child Nutrition

View full text Add to dashboard Cite

show abstract

“…It was also found that administration of iron supplementation, de-worming, and morbidity profile of children do not have significant impact on the prevalence of anaemia. Saville et al (2020) interviewed 4,360 participants including pregnant women, mothers-in-law, and male household heads in Nepal who were consuming fortified rice. Fortification of purchased rice in rice-purchasing households increased (p > .9) for thiamine, niacin, pyridoxin, folate, and zinc, but Vitamin B 12 and iron remained inadequate even after fortification (p > .3-.9).…”

Section: Impact Of Supplementation Of Fortified Rice In Pds As Pilot ...mentioning

confidence: 99%

Large-scale Fortification of Rice in India and Its Distribution in Public Distribution System

Kachhawa,

Mogra

2023

Indian Journal of Public Administration

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Rice fortification with micronutrients is getting popularity in supplementation programmes as it provides cost-effective, easy and public-health-solution to treat anaemia and protein-energy-malnutrition. In India, A pilot scheme for rice- fortification and its distribution under Public Distribution System in fifteen districts was started for a period of 3 years (2019–2022). To examine effect of fortified rice on nutritional status of population, its supplementation studies in Indian government’s social safety programmes were reviewed. The reviewed studies showed that supplementation of fortified rice was significantly effective in reducing prevalence of anaemia, increase in haemoglobin level, and improvement in cognitive scores. However, all the reviewed studies were limited only to supplementation of fortified rice at mid-day meal programme. Thus, it can be inferred that fortification of rice can be a cost-effective tool to combat anaemia at community level but more conclusive evidences are still required.

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“…Women's mobility is strictly controlled after marriage and movement outside the household without permission is a common justification for intimate partner violence (36) . Restrictive gender norms limit women's share of the household's food (8,13) , and inadequate consumption of iron-rich foods and other micronutrients essential for healthy erythropoiesis and iron absorption have been reported amongst women in the terai (37)(38)(39) . This research was conducted in two terai provinces: Kapilvastu (Province 5), and Dhanusha and Mahottari (Province 2).…”

Section: Settingmentioning

confidence: 99%

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

Morrison

Giri²,

James³

et al. 2022

Br J Nutr

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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.

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Equity implications of rice fortification: a modelling study from Nepal

Abstract: Abstract Objective: To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal. Design: Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability … Show more

Cited by 8 publications

References 50 publications

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study

Large-scale Fortification of Rice in India and Its Distribution in Public Distribution System

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

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