Agriculture, Climate and Child Nutrition in Nepal

Background: Prevalence of poor nutrition among children under five is concentrated among impoverished rural farming households in South Asia and Sub-Saharan Africa. Changes in local agriculture could affect these children's nutrition outcomes through multiple interrelated pathways, calling for more empirical evidence on specific ways to leverage local agriculture for improved nutrition. Climate trends and fluctuations pose a particularly serious threat to agriculture and hence child nutrition, especially for communities reliant on rain-fed agriculture. To improve resilience, we need to identify the times and places where children are most vulnerable, identify protective factors that limit harm from climatic variations on nutrition outcomes, and strengthen the evidence base on mediators associated with better nutrition at each time and place.;Methods: This dissertation uses a combination of datasets for Nepal and a range of regression models including ordinary least squares (OLS), multinomial logit, and logit with fixed effects to investigate three inter-related aims. Aim 1 focuses on attained heights as a summary measure of nutritional status, using randomness in birth months to identify which children are most vulnerable to climatic variations by combining Nepal Demographic and Health Surveys (2006 and 2011), Nepal Living Standards Survey (2003-2004 and 2010-2011), and NASA satellite observations of variation in the Normalized Difference Vegetation Index (NDVI) (n=6,127 children). The next two aims focus on dietary intake, using differences within villages to identify links between household food production and children's food consumption by pooling all observations (n= 5,978 children) from the two waves of panel data obtained from the Policy and Science of Health, Agriculture, and Nutrition (PoSHAN) survey in 2013 and 2014: Aim 2 is to identify the mediating effects of household wealth, and aim 3 is to identify mediating effects of child age. Taken together, these aims could guide future interventions by identifying potentially causal mechanisms behind agriculture-nutrition linkages.;Results: Boys and girls have different periods of vulnerability to NDVI fluctuations on attained heights. Exposure to NDVI fluctuations during the second trimester of pregnancy (p< 0.01) for boys, and in the first three months after birth for girls (p< 0.05) is the most vulnerable periods to climatic variations. But the effect of NDVI fluctuations on attained heights disappears for both boys and girls when households have access to toilets (p< 0.01) and are situated in a commercialized district (p< 0.01) as compared to households without toilets or in a non-commercialized district, respectively. In turning to household food production and consumption decisions, there is a positive association between agricultural production diversity and child dietary diversity but only among farming and poor households (p< 0.05), and among children between the ages of 18-59 months (p< 0.01). Children are more likely to eat food that households grow, but this only applied to households at lower wealth levels. In particular, when households grow dark green leafy vegetables, or vitamin-A rich fruits and vegetables, or raise livestock for eggs or dairy, those are likely to enter children's diets but only for older children (≥ 18 months).;Implications: New avenues for interventions aiming to remedy the causes of stunting and low dietary diversity could be devised, particularly regarding the timing and targeting of interventions to help the most vulnerable children. Findings from aim 1 identify opportunities to build climate resilience through antenatal care, sanitation, and access to food markets. Results of aims 2 and 3 suggest that farm-diversifying programs intended to improve child dietary diversity are likely to see maximum benefits by targeting the poorest rural farming households and the most nutrient-dense foods, and be accompanied by other policies to reach younger children (<18 months). These findings corroborate and add to previous research on mechanisms and mediating factors linking agriculture to nutrition, with methods and nationally-representative results for Nepal that could potentially generalize to other settings.