{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:51:30Z","timestamp":1792183890716,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,2,11]],"date-time":"2024-02-11T00:00:00Z","timestamp":1707609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,2,11]],"date-time":"2024-02-11T00:00:00Z","timestamp":1707609600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Suaahara<\/jats:italic>\n                    was an innovative, complex, multi\u2010sectoral, large\u2010scale, nutrition programme in Nepal to increase exposure to nutrition\u2010related information and services, improve nutrition\u2010related knowledge and practices among pregnant women and mothers of infants and young children, and improve their nutrition. This study evaluated the effectiveness of\n                    <jats:italic>Suaahara<\/jats:italic>\n                    to improve nutrition and nutrition\u2010related practices by comparing changes over 10 years between intervention and comparison districts. The samples of households at baseline in 2012 and endline in 2022 were 2040 and 2480, respectively, from 120 old wards. The impact was estimated using intent\u2010to\u2010treat regression models in which survey year, arm\u00a0and their interaction were fixed effects, accounting for district clustering, with the interaction estimating differences between arms in changes over time. The intervention, relative to comparison, reduced maternal underweight by 8.43 percentage points (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), consistent with improved maternal and fetal condition that was manifested as the greater length of 0.761\n                    <jats:italic>z<\/jats:italic>\n                    \u2010scores (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004) of infants 0\u20135.9 months. Complementary feeding practices with children between 6 and 23.9 months of age improved more in the intervention than comparison districts: child dietary diversity by 0.294 food groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.072) and minimum dietary diversity by 9.51 percentage points (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.028), feeding sick child more (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002) and administering oral rehydration solution and zinc for diarrhoea (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.057) by about 17 percentage points each, and minimum meal frequency (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004) and minimum acceptable diet (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.022) by about 15 percentage points each. Substantial impacts were demonstrated despite political restructuring, earthquakes, and other major challenges that Nepal and\n                    <jats:italic>Suaahara<\/jats:italic>\n                    faced and limitations in statistical power because of the reduced number of districts that then could be included in the study. Registered at\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n                    with identifier NCT05448287.\n                  <\/jats:p>","DOI":"10.1111\/mcn.13630","type":"journal-article","created":{"date-parts":[[2024,2,11]],"date-time":"2024-02-11T23:49:06Z","timestamp":1707695346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of\n                    <i>Suaahara<\/i>\n                    , an integrated nutrition programme, on maternal and child nutrition at scale in Nepal"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8265-9815","authenticated-orcid":false,"given":"Edward A.","family":"Frongillo","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Education, and Behavior, Arnold School of Public Health University of South Carolina Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Suresh","sequence":"additional","affiliation":[{"name":"Independent Consultant Stamford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-0837","authenticated-orcid":false,"given":"Deependra K.","family":"Thapa","sequence":"additional","affiliation":[{"name":"Nepal Public Health Research and Development Center Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4067-1349","authenticated-orcid":false,"given":"Kenda","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Pandey Rana","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0896-2074","authenticated-orcid":false,"given":"Ramesh P.","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subir","family":"Kole","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhim","family":"Pun","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indra","family":"Kshetri","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debendra P.","family":"Adhikari","sequence":"additional","affiliation":[{"name":"United States Agency for International Development Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Klemm","sequence":"additional","affiliation":[{"name":"Helen Keller International New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-019-00857-9"},{"key":"e_1_2_9_3_1","volume-title":"Unequal citizens: Gender, caste and ethnic exclusion in Nepal","author":"Anon","year":"2006"},{"key":"e_1_2_9_4_1","volume-title":"SUAAHARA: Process evaluation results from frontline worker and household surveys","author":"Anon","year":"2015"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61693-6"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13229"},{"key":"e_1_2_9_8_1","volume-title":"Trends and determinants of maternal and child nutrition in Nepal: Further analysis of the Nepal Demographic and Health Surveys, 1996\u20132011","author":"Crum J.","year":"2013"},{"key":"e_1_2_9_9_1","unstructured":"Cunningham K. &Kadiyala S.(2013).Suaahara baseline survey report. USAID pp.1\u2013135."},{"key":"e_1_2_9_10_1","first-page":"115","volume-title":"Nourishing millions","author":"Cunningham K.","year":"2016"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12415"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12286"},{"key":"e_1_2_9_13_1","volume-title":"Gender equality and social inclusion for food\u2010 and nutrition\u2010security in Nepal","author":"Devkota S.","year":"2014"},{"key":"e_1_2_9_14_1","volume-title":"Minimum dietary diversity for women","author":"Food and Agriculture Organization","year":"2021"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.18235\/0006529"},{"key":"e_1_2_9_16_1","volume-title":"Global Nutrition Report: Stronger commitments for greater action","author":"Global Nutrition Report","year":"2022"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/28.1.10"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145738"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12274"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12080"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.064584"},{"key":"e_1_2_9_22_1","volume-title":"The consequences of early childhood growth failure over the life course","author":"Hoddinott J.","year":"2011"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61100-9"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-008597"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.12.08001"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.12447"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002159"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.116.232314"},{"key":"e_1_2_9_29_1","volume-title":"Nepal demographic and health survey 2011","author":"Ministry of Health and Population (MoHP) Nepal","year":"2012"},{"key":"e_1_2_9_30_1","volume-title":"Nepal demographic and health survey 2022","author":"Ministry of Health and Population (MoHP), Nepal New ERA, & ICF International Inc","year":"2023"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60843-0"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12281"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221260"},{"key":"e_1_2_9_34_1","volume-title":"A UNICEF policy review strategy for improved nutrition of children and women in developing countries","author":"UNICEF","year":"1990"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/00031305.2019.1583913"},{"key":"e_1_2_9_36_1","volume-title":"Indicators for assessing infant and young child feeding practices: Conclusions of a consensus meeting held 6\u20138 November 2007 in Washington D.C., USA","author":"World Health Organization Department of Child and Adolescent Health and Development","year":"2008"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13630","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.13630","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:50:35Z","timestamp":1775818235000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,11]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/mcn.13630"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13630","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,11]]},"assertion":[{"value":"2023-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13630"}}