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The Himalayas' Hidden HungerCathy Shufro

The Himalayas' Hidden Hunger (cont'd)

No Time to Waste
Enumerators will return to Sitapur and the other 62 communities in spring 2014 and again in spring 2015. To track seasonal fluctuations in nutrition, they will also conduct surveys each September (after the monsoons) and each January in three representative "sentinel" communities-one in the mountains, one in the plains and one in the hills (in Sitapur, in fact).

For Sitapur and other hill communities, preliminary results are in: 36 percent of children under 5 are moderately or severely stunted. That's slightly better than the national average of 41 percent.

Analyzing the data further will allow the PoSHAN researchers to look for associations between good nutrition and the many factors that affect it. For instance, perhaps the surveys will show that families have fewer stunted children if they build toilets or have cleaner sources of drinking water. Perhaps it will show that one program promoting hygiene and sanitation was associated with improved nutrition, while another was not.

"We get at least a snapshot of these kinds of patterns," says West, " and returning next spring to the same homes will give us a longer-term view. This will help us find ways to guide programs toward greater impact, to favor the good influences while always trying to lower costs."

Nepal's Ministry of Health would value that kind of recommendation, says Raj Kumar Pokharel, MPH, chief of the child nutrition section. "Experts come and give ideas, for example, small fish farming or a sweet potato hybrid," says Pokharel. "Some say, 'Oh, golden rice is a very good source of vitamin A and micronutrients.' We don't know what to adopt. … The agricultural sector wants to increase productivity and variety. But it's dietary diversity within the household that we want to cultivate."

That applies to both the poor and the (relatively) rich: Not only were 81 percent of Nepal's poorest children stunted in 2011, but so were 32 percent of the richest. Pokharel blames poor nutrition partly on fast foods like the instant noodles whose bright packages occupy the front racks in urban food shops and village markets alike. He likens noodle manufacturers to American tobacco companies because they are pushing harmful products, "deteriorating the health status of our children."

Pokharel looks forward to finding out what the PoSHAN household surveys show about what people actually eat, day to day. The government will use that information to advocate for crops that will support or improve diets in the various ecological zones, and to fine-tune programs that educate people about what to grow and what to eat. Declines in stunting will signal success.

There's no time to waste, says Pokharel. Nepal did manage to reduce stunting by 8 percentage points between 2006 and 2011. But at that rate, it will take a generation to bring it below 5 percent.

"Stunting reduces IQ levels and the capacity of the brain," says Pokharel. "If you can calculate it in terms of daily losses, in terms of how much we are losing every day, every minute, every month and every year, we cannot wait."



    Montgomery Village, Maryland 04/09/2014 02:37:07 PM

    Last July I was in the Hemachal Predesh in norther India with a medical group. I saw the same issues, abundant water, tillable land, active farming with a wide variety of produce and stunting, even some Kwashiorkor in two children. Rickets and night blindness cases presented themselves. I applaud your study and the article. This June I return closer to the Indo-Tibitian border and expect will see the same. I will share this article with my students and preceptors. The caloric requirements at high elevation and modest to lower temperatures also pull on needs for growth. Endemic worms in the pediatric population is another. Again thanks for this essential work and timely documentation. Very readable Judy Thierry, DO, MPH JHSPH 2005

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