[{"bbox": [96, 121, 1134, 175], "category": "Text", "text": "every 12 children under five with acute malnutrition) and widespread micronutrient deficiencies and overweight / obesity affecting adults and children alike."}, {"bbox": [96, 186, 1134, 453], "category": "Text", "text": "The most recent data confirms that in rural areas of Karnali Province almost one in two children under five are stunted, while in Lumbini Province wasting prevalence (16%) routinely exceeds that is typically considered to be the international threshold for emergency intervention²¹. Such outcomes are in turn driven by multiple factors including inability of families to ensure a healthy and age-appropriate diet, safe drinking water and optimal care practices. Unfortunately, exclusive breastfeeding has been on a steady decline for over a decade (with current prevalence at 56%), less than one third of all young children receive a minimally acceptable diet and 43% of children under five are anaemic²². At the same time, the rate of overweight and obesity among children between 5 - 19 has increased from 2% to almost 10% since 2000, with the trajectory set to continue rising sharply. Similarly, overweight and obesity among adults has almost doubled in the same period with more than 12% of the adult population now diabetic and 66% of all deaths now due to non-communicable diseases (NCDs)²³."}, {"bbox": [96, 464, 1134, 651], "category": "Text", "text": "In particular, 34% of women are anaemic, including 18% who are mildly anaemic, 15% who are moderately anaemic and 1% who are severely anaemic. Anaemia is a major concern among pregnant women because it can increase maternal mortality and poor birth outcomes.²⁴ The Minimum Dietary Diversity for women between the ages of 15-49 years shows that in Nepal, only 35% reported consuming food from the “meat, poultry and fish” group, while 50% achieved minimum dietary diversity.²⁵ Nearly 32% of households in Nepal are headed by women.²⁶ Despite these clear gender related inequalities, programs to address women’s concerns, priorities and needs to ensure food security and equitable food entitlements are few and far between.²⁷"}, {"bbox": [96, 662, 1134, 925], "category": "Text", "text": "The resulting nutrition difficulties in Nepal are accelerated by the steadily growing consumption of relatively low price and convenient but highly processed and unhealthy packaged snack food. A study in 2019 found that the highest consumption of unhealthy snack foods and beverages were among the poorest households rather than the better off²⁸. The resulting ‘nutrition transition’ is taking place both among rural and urban communities, as well as in rich and poor households²⁹. The negative developmental, economic, social, and medical impacts of this national triple burden of malnutrition are serious and lasting for individuals and their families, for communities – ultimately threatening to undermine progress towards inclusive and sustainable development. According to WHO, deaths due to NCDs have soared from 60% of all deaths in 2014 to 66% in 2018, with full economic impact of associated costs for treatment and management resulting in the ability of households to afford a healthy diet being further undermined."}, {"bbox": [96, 928, 1134, 982], "category": "Text", "text": "Identification of main stakeholders and corresponding institutional and/or organisational issues (mandates, potential roles, and capacities) to be covered by the action:"}, {"bbox": [96, 982, 1134, 1168], "category": "Text", "text": "Due to the persistent nutrition inequalities, the key stakeholders for this action are necessarily the most disadvantaged and vulnerable sections of society experiencing the intersection of multiple inequalities, with special attention to women, adolescent girls, children under five and persons with disabilities. In order to reinforce the evolving commitment of the government at all levels to end malnutrition, the action will focus on supporting the effective implementation of a locally driven, rights-based approach to delivering on priority areas of intervention through national systems as laid out in the MSNP-III. The Plan’s strategic basis explicitly commits to a ‘rights oriented, inclusiveness and gender equity’ approach."}, {"bbox": [96, 1179, 1134, 1286], "category": "Text", "text": "Political leaders have promoted the transition of Nepal into a federal government largely on the basis that \"shared rule\" between the national, provincial and local levels of government would allow elected leaders to better address inequality and discrimination – hence bringing greater stability to the country. The 2015 Constitution mandates the representation of marginalized groups, including women, Dalits, and minorities in the local governments,"}, {"bbox": [85, 1339, 1082, 1364], "category": "Footnote", "text": "²¹ NDHS 2022. However the majority of stunted children (both moderately and severely stunted) live in other provinces."}, {"bbox": [85, 1364, 733, 1388], "category": "Footnote", "text": "²² NDHS 2022 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9460334/"}, {"bbox": [85, 1388, 1143, 1437], "category": "Footnote", "text": "²³ WHO (2018) and Dahal, S et al (2021) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425558/ NCDs include cardiovascular disease, cancer, hypertension and diabetes."}, {"bbox": [85, 1437, 1143, 1480], "category": "Footnote", "text": "²⁴ Ministry of Health and Population, Nepal; New ERA; and ICF. Nepal Demographic and Health Survey 2022: Key Indicators Report. Kathmandu, Nepal."}, {"bbox": [85, 1480, 1143, 1523], "category": "Footnote", "text": "²⁵ FAO, IFAD, UNICEF, WFP and WHO. 2020. The State of Food Security and Nutrition in the World 2020, Transforming food systems for affordable healthy diets. Rome, FAO."}, {"bbox": [85, 1523, 1108, 1546], "category": "Footnote", "text": "²⁶ Government of Nepal, National Statistics Office. National Population and Housing Census 2021 (National Report), Katmandu, Nepal."}, {"bbox": [85, 1546, 1143, 1589], "category": "Footnote", "text": "²⁷ Government of Nepal, National Planning Commission. Nepal's Food systems Transformation: Context, Pathways and Actions. Outcomes of the National and Provincial Food Systems Dialogues as a part of the UN Food Systems Summit 2021. Singha Durbar, Kathmandu, Nepal"}, {"bbox": [85, 1589, 1031, 1613], "category": "Footnote", "text": "²⁸ Pries, A et al, *Journal of Maternal and Child Nutrition*. https://onlinelibrary.wiley.com/doi/10.1111/mcn.12775"}, {"bbox": [85, 1613, 1143, 1662], "category": "Footnote", "text": "²⁹ As confirmed by NDHS 2022, as many as 2 in 3 children under the age of 2 years had consumed unhealthy foods during the previous day (foods high in sugar, salt and unhealthy fats)"}, {"bbox": [1038, 1682, 1143, 1706], "category": "Page-footer", "text": "Page 6 of 27"}]