Characteristics and determinants of child nutritional status in Nepal

World Bank Reprint Series: Number 309 Reynaldo Martorell, Joanne Leslie, and Peter R. Moock &,aracderistics and Dieteriisat of .ld Nutritional tatus in Nepal Reprinted with permission from The American Journal of Clinical Nutition, vol. 39 (January 1984), pp. 74-86.  World Bank Reprints No. 269. James R. Follain, Jr., Gill-Chin Lim, and Bertrand Renaud, "Housing Crowding in Developing Countries and Willingness to Pay for Additional Space: The Case of Korea," Joumal of Development Economics No. 270. Bela Balassa, "Policy Responses to Extemal Shocks in Sub-Saharan African Countries," Journal of Policy Modeling No. 271. Jaime de Melo and Sherman Robinson, "Trade Adjustment Policies and Income Distribution in Three Archetype Developing Economies," Journal of Development Economics No. 272. J. B. Knight and R. H. Sabot, "The Role of the Firm in Wage Determination: An African Case Study," Oxford Economic Papers No. 273. William G. 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Chenery, "Interaction between Theory and Observation in Development," IAbrld Development  Characteristics and determinants of child nutritional status in Nepal' 2 Reynaldo Martorell,3 PhD, Joanne Leslie, DSc, and Peter R Moock, PhD ABSTRACT Herein, we examine characteristics and determinants of child malnutrition in the districts of Bara and Rautahat of the Terai region of Nepal. The sample studied consists of 510 rural children ranging in age from 3 to 10 yr. The Nepali children were found to have one of the highest reported prevalences of stunting (65% were <90% National study for Health Statistics median height for age). The study children were also I to 1.5 kg lighter when compared to US children of the same height. Fat deposits, as measured by anthropometric variables and Hb levels were also very low. Multiple regression analysis showed that age, district of residence, household income, breast-feeding, and several specific food items were significant predictors of nutritional status. Association with other factors such as caste and parental schooling, were not evident in multiple regressions. Boys were as likely to be malnourished as girls. Prolonged breast- feeding was associated with greater fat stores, but with reduced stature and low Hb values. Both landholdings and household income were found to be positively and significantly associated with almost all -measures of nutritional status, Am J Clin Nuir 1983;39:74-86. KEY WORDS Nutritional status, anthropomnetry, growth, socioeconomic status Introduction children that included anthropometry and Hb determinations (4). The objective herein to report on the anal- Nepal is one of the poorest nations of the ysis of health and nutrition data obtained as world. For example, the repored average part of a World Bank research project un- per capita income was only $140/yr as Of dertaken in the Terai region of Nepal. The 1980 (1). Infant mortality has been esti- data are regional in scope but their richness mated to be about 165 per thousand for the allows for an in-depth characterization of Terai region of Nepal using 1974 child sur- the growth pattern of Nepalese children and vivorship data (2). Other development indi- for the identification of some of the key cators are as follows: adult literacy is 19% determinants of nutritional status in this (1977 estimate), life expectancy at birth is population. 44 yr (1980 estimate), 9% of the population has access to safe water (1975 estimate), and Methods the average per capita daily supply of food This research was approved by the Bureau of Plan- energy is 2002 cal or 89% of the requirement ning Commission of His Majesty's Government of Ne- (1977 estimate) (1). ' From the Food Research Institute (RM), Stanford Data on health and nutrition in Nepal are University, Stanford, CA 94305; the Economic Devel- limited. The first comprehensive health sur- opment Institute, (JL), Washington, DC 20433; and vey was carried out in 1965 by the Univer- Teachers College (PRM), Columbia University, New sity of Hawaii (3). Dietary but no anthro- York, NY 10027. pomericdat wee clleced n tis lin- IThis paper was prepared as part of World Bank pometic data were collected in this clini- Research Project RPO 672- 1 0, "Health and Rural De- cally oriented study. Recently, the Centers velopment in Nepal." The World Bank, Washington, for Disease Control (CDC) and the United Dc. States Agency for International Develop- 3Autlior to whom requests for reprints should be addressed. ment assisted the government of Nepal in Received May 2, 1983. carrying out a national nutrition survey on Accepted for publication July 26, 1983. 74 The American Journal of Clinical Nutrition 39: JANUARY 1984, pp 74-86 Printed in U.S.A.