{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:56:13Z","timestamp":1763358973639,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T00:00:00Z","timestamp":1717891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Undernutrition is a particularly acute problem in middle- and low-income countries. The \u201cSuaahara\u201d program is a 5-year community-focused program in Nepal, aimed at improving the health and nutrition of pregnant and lactating women and their children under the age of 2 years. This research contributes to evidence on the impact of the \u201cSuaahara\u201d program in 41 treated districts compared to 34 control districts. Using the difference-in-differences method, we found that the weight-for-height z-score and body mass index z-score of children under the age of 2 in the treated districts significantly increased by 0.223 standard deviations (SDs) and 0.236 SDs, respectively, compared with the control districts 5 years before and after the program. The number of antenatal care visits (at least four visits) and safe deliveries significantly increased for pregnant women by 10.4% and 9.1%, respectively, in the treated districts compared with the control districts. The prevalence of fever in children under 2 years of age was significantly reduced by 6.2% in the treated districts. The results show the significance of a policy evaluation with transparent indicators on public health, which is necessary for policymakers so that they can propose evidence-based policy.<\/jats:p>","DOI":"10.3390\/ijerph21060754","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T10:45:56Z","timestamp":1718016356000},"page":"754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of a Community-Based Nutrition Program for Women and Children in Nepal Using Demographic and Health Survey"],"prefix":"10.3390","volume":"21","author":[{"given":"Gauri","family":"Joshi","sequence":"first","affiliation":[{"name":"Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan"},{"name":"National Statistics Office, Kathmandu 44600, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1707-7659","authenticated-orcid":false,"given":"Masaru","family":"Ichihashi","sequence":"additional","affiliation":[{"name":"Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan"},{"name":"The IDEC Institute, Hiroshima University, Higashihiroshima 739-8529, Japan"},{"name":"Graduate School of Innovation and Practice for Smart Society, Hiroshima University, Higashihiroshima 739-8529, Japan"},{"name":"Network for Education and Research on Peace and Sustainability (NERPS), Hiroshima University, Higashihiroshima 739-8529, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7292-1229","authenticated-orcid":false,"given":"Chalise","family":"Binaya","sequence":"additional","affiliation":[{"name":"Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,9]]},"reference":[{"key":"ref_1","unstructured":"(2022, January 01). Jean-Louis Arcland, Undernourishment and Economic Growth, 2001, Rome: FAO, 1\u201363. Available online: https:\/\/www.fao.org\/4\/X9280E\/x9280e02.htm#b."},{"key":"ref_2","unstructured":"International Food Policy Research Institute (IFPRI), and United Nations System Standing Committee on Nutrition (2022, January 01). Nutrition: A Foundation for Development, 2002, 1\u201352. Available online: https:\/\/www.unscn.org\/layout\/modules\/resources\/files\/Brief1-12EN.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1159\/000510595","article-title":"Maternal Undernutrition before and during Pregnancy and Offspring Health and Development","volume":"76","author":"Young","year":"2020","journal-title":"Ann. Nutr. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mbuya, N.V.N., Demombynes, G., Faye, S., Piza, A., Jillian, A., and Adona, V. (2022, January 01). Undernutrition in the Philippines: Scale, Scope, and Opportunities for Nutrition Policy and Programming. Available online: https:\/\/openknowledge.worldbank.org\/handle\/10986\/35530.","DOI":"10.1596\/978-1-4648-1701-4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1365-3016.2012.01278.x","article-title":"Nutrition Education and Counselling Provided during Pregnancy: Effects on Maternal, Neonatal and Child Health Outcomes","volume":"1","author":"Girard","year":"2012","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Adhikari, N., Acharya, K., Upadhya, D.P., Pathak, S., Pokharel, S., and Pradhan, P.M.S. (2021). Infant and young child feeding practices and its associated factors among mothers of under two years children in a western hilly region of Nepal (2021). PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0261301"},{"key":"ref_7","unstructured":"Joshi, G.B., and Chitekwe, S. (2022, January 01). A Road Map to Nepal\u2019s Multi Sector Nutrition Plan (MSNP) II 2018\u20132022. Available online: https:\/\/scalingupnutrition.org\/wp-content\/uploads\/2019\/07\/A-Road-Map-to-MSNP-II-in-Nepal.pdf."},{"key":"ref_8","unstructured":"(2022, January 01). MSNP II, 2020. National Planning Commission. Nutrition Profile (2014), USAID. Available online: https:\/\/extranet.who.int\/ncdccs\/Data\/NPL_B11_MSNP%20ii.pdf."},{"key":"ref_9","unstructured":"(2022, January 01). SUAAHARA, 2014. AID-367-A-11-00004 Annual Report, August 1, 2013\u2013July 31, 2014 Submitted to USAID\/Nepal by Save the Children Submitted August 29. Suaahara: A Multi-Level Approach to SBCC in Nepal, Available online: https:\/\/pdf.usaid.gov\/pdf_docs\/PA00KC2M.pdf."},{"key":"ref_10","unstructured":"(2022, January 01). Suaahara Project: Good Nutrition, Available online: https:\/\/2012-2017.usaid.gov\/nepal\/fact-sheets\/suaahara-project-good-nutrition."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jhealeco.2018.09.011","article-title":"Impact and spill-over effects of an asset transfer program on child undernutrition: Evidence from a randomized control trial in Bangladesh","volume":"62","author":"Raza","year":"2018","journal-title":"J. Health Econ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.jand.2021.04.002","article-title":"A Home Garden Intervention Improves Child Length-for-Age Z-Score and Household-Level Crop Count and Nutritional Functional Diversity in Rural Guatemala","volume":"122","author":"Alajajian","year":"2022","journal-title":"Acad. Nutr. Diet. Nutr. Res. Netw."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/mcn.12173","article-title":"Adding multiple micronutrient powders to a homestead food production programme yields marginally significant benefit on anaemia reduction among young children in Nepal","volume":"11","author":"Osei","year":"2015","journal-title":"Matern. Child Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.3945\/jn.114.203539","article-title":"A 2-Year Integrated Agriculture and Nutrition and Health Behavior Change Communication Program Targeted to Women in Burkina Faso Reduces Anemia, Wasting, and Diarrhea in Children 3\u201312.9 Months of Age at Baseline: A Cluster-Randomized Controlled Trial","volume":"145","author":"Olney","year":"2015","journal-title":"J. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.3945\/ajcn.117.160515","article-title":"Eggs early in complementary feeding increase choline pathway biomarkers and DHA: A randomized controlled trial in Ecuador","volume":"106","author":"Iannotti","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1108\/NFS-05-2018-0134","article-title":"Impact of nutrition education intervention on nutritional status of undernourished children (6\u201324 months) in East Mamprusi district of Ghana","volume":"49","author":"Awuuh","year":"2018","journal-title":"Nutr. Food Sci."},{"key":"ref_17","first-page":"026010602110567","article-title":"Effects of nutrition education and counseling intervention on maternal weight and obstetric outcomes among pregnant women of Gedeo Zone, Southern, Ethiopia: A cluster randomized control trial","volume":"29","author":"Sisay","year":"2021","journal-title":"Nutr. Health"},{"key":"ref_18","unstructured":"Alzua, M.L., Pickering, A.J., Djebbari, H., Lopez, C., Lopera, M.A., and Coulibaly, M. (2022, January 01). Final Report: Impact Evaluation of Community-Led Totalsanitation (CLTS) in Rural Mali. Available online: https:\/\/www.susana.org\/_resources\/documents\/default\/3-2300-16-1439734509.pdf."},{"key":"ref_19","unstructured":"(2022, January 01). The DHS Program. Available online: https:\/\/dhsprogram.com\/Methodology\/Survey-Types\/DHS.cfmnepal.savethechildren.net\/sites\/nepal.savethechildren.net\/files\/library\/Voices%20from%20the%20Community.compressed.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Huntington-Klein, N. (2022, January 01). The Effect: An Introduction to Research Design and Causality. Available online: https:\/\/theeffectbook.net\/ch-DifferenceinDifference.html.","DOI":"10.1201\/9781003226055"},{"key":"ref_21","unstructured":"World Health Organization (WHO) Multicentre Growth Reference Study Group (2006). WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/924154693X."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4103\/jfmpc.jfmpc_1161_23","article-title":"Effectiveness of nutritional awareness in child diet among mothers of under five in anganwadi in Mysuru: A quasi-experimental study","volume":"13","author":"Hegde","year":"2024","journal-title":"J. Fam. Med. Prim. Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/6\/754\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:56:08Z","timestamp":1760108168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/6\/754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,9]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["ijerph21060754"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21060754","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2024,6,9]]}}}