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Reflections from 6th Annual Scientific Symposium on Agriculture- Nutrition Pathways

By Charulatha Banerjee on 13 December 2018

My winter began in Kathmandu last week where I attended the 6th Annual Scientific Symposium on Agriculture- Nutrition Pathways organised by Feed the Future Innovation Lab for Nutrition. I have attended the Annual event 3 years in a row and this year was extra special as the event also was celebrating 25 years of Nepal’s Progress in Nutrition. What makes this event unique is that it attracts students and young researchers in equal numbers as persons from academia, policy makers and programme implementors in the field of agriculture- nutrition research relevant to Nepal.

To set the scene let me share some data on Nepal.

The symposium covered a multitude of topics – from the country’s policy environment and efforts to reduce undernutrition, new technologies in testing for and improving food safety and evidence on the linkages between diet, nutrition and health.

This piece is not an attempt to capture all that transpired – I present what made an impression on me and left me thinking at the end of the sessions.

Lessons from scale up of 2 successful programmes – Vitamin A Supplementation and Salt Iodisation

The success of the Vitamin A supplementation programme in Nepal is well known. The programme began in the early 1990’s and now reaches 2.6 million children every 6 months through the FCHV. The programme is now fully funded by the Government of Nepal and has averted 88,000 deaths of preschool children till date. A few reasons for success have been noted which include

Despite its successes some important concerns were raised. The recent MICS does not show an increase in consumption of Vitamin A rich diet, regardless of the level of food security. Some questions were raised if it is time to review the programme as near universal coverage has been achieved and clinical cases of Vitamin A deficiency are being reported less.

The story of Salt Iodisation to me was a compelling piece of history which has had lasting impacts on the people of this mountainous country which produces no salt. It is a story of collaboration across countries, across sectors to ensure that this very critical commodity reaches every household. The recognition of endemic goitre as a public health programme was as early as 1965 where goitre prevalence rates were reported to be as high as 55%, in children and adults older than 13 years. Various interventions were begun with support of the Indian government from where all the iodised salt is supplied. A survey in 1998 showed that only about 50% of households consumed salt with adequate iodine and a little over 80% of households had salt with any iodine in them. Achieving universal salt iodisation was set as a national goal in 1998 and the Iodized Salt (Production, Sale and Distribution) Act was passed. With sustained regulatory efforts and information campaigns involving branding of iodised salt, more than 90% of households are now reported to use refined salt and nearly 90% of households have salt with adequate iodine as per the 2016 National Micronutrient Survey.

Food System Improvements and Challenges

Furthermore, the symposium brought attention to various aspects of the food system. The aspect of achieving dietary diversity in the country was presented by numerous researchers. Related to this were papers which looked at dietary patterns; the relationship between extra income in households and spending patterns on food and how behaviours can be changed on food intake in households. Attention was drawn in numerous posters and presentations to increasing consumption of ultra-processed foods- commonly called junk foods or unhealthy snacks.

Some key points which emerged were

Broadening the use of technology for nutrition improvements

Technology in various forms and ranging from simple to complex featured strongly in discussions. Simple solutions like hermetic bags to store maize to prevent dampness and mycotoxin contamination, solar panel dryers for maize, cool rooms created with household air conditioners to store vegetables till they can be taken to the market after harvesting and floating gardens to grow  vegetables in ponds even in dry seasons were shared with improvements significant enough to consider uptake on a larger scale where applicable. There was a study shared on the choice of lab testing techniques to measure levels of aflatoxin – this study was done as part of the USAID-supported Aflatoxin (AflaCohort) Birth Cohort Study in Banke, Nepal which has brought attention to this widespread problem. Use of mobile phone technology to send messages to mothers, watch videos, enter real time data in surveys and as part of monitoring systems replacing old fashioned means of sharing information also featured in discussions frequently.

Taking stock and evaluating interventions and programmes

An interesting panel discussion on Evaluations of Agricultural and Nutrition Interventions threw up some points to ponder:

The symposium ended with a session where some of the prominent researchers and specialists presented what they thought was necessary for Nepal to achieve the SDGs. Emphasis was laid on ending child marriage and preventing adolescent pregnancies to improve Adolescent and Women’s nutrition. This is truly an important observation – women’s nutrition often gets subsumed (but neglected) within the larger discussion on Maternal and Child Health.

The importance of social safety nets to ensure that the poorest can benefit from the overall development in the country was stressed. It was pointed out that new interventions often increase inequity – the disadvantaged often do not take to new interventions easily unless supported to do so.

The process of development of MSNP2 by the Government of Nepal in collaboration with UN and external development partners was applauded and an appeal made to the Government that support for research must be continued; there is need for evidence on how to scale up proven interventions. The need for longitudinal studies was raised by many researchers in the event.

Nepal is one of the focus countries for ENN in Asia – we will be following the progress of MSNP 2 implementation and the symposium gave me an opportunity to identify some very interesting posters and presentations for publication in Field Exchange and Nutrition Exchange in the coming months. A great way to end the year for me looking back at some of the achievements of Public health programmes in this country. Wishing all readers, a joyous festive season and a wonderful start to 2019.

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