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Background Many national and international organizations are working to improve maternal and child nutrition in countries with high malnutrition prevalence and burdens. While there has been progress in strengthening multi-organizational networks on nutrition at country and global levels, the regional level has received much less attention. We conducted a study to 1) determine the existing relationships and levels of engagement between international organizations working to improve nutrition at the regional level or in at least two countries in South Asia; and 2) examine the experiences and perspectives of international organizations on regional-level communication, coordination or collaboration on nutrition in South Asia. Methods  A mixed methods approach involving organizational network analysis (ONA) and semi-structured interviews was used to develop an understanding of the existing network and relationships between international organizations working on nutrition in South Asia. ONA data from 43 international organizations was analysed using a social network analysis software (UCINET) to systematically quantify and visualize the patterns of relationships between organizations. Results We found a high degree of connectivity between most of the international organizations in South Asia, but there were gaps between the many organizations that knew each other and the work they did together regionally on nutrition. Most organizations worked together only ‘rarely’ or ‘sometimes’ on nutrition at the regional level and high-intensity (collaborative) working relationships were uncommon. Organizations of the same type tended to cluster together, and a small number of UN agencies and multilateral organizations were central brokers in the nutrition working relationships. Perceived constraints to the nutrition working relationships included organizations’ agenda and mandate, threats to visibility and branding, human and financial resources, history, trust and power relations with other organizations, absence of a regional network for cooperation, and donor expectations. There was high demand to remedy this situation and to put network mechanisms in place to strengthen communication, coordination and collaboration on nutrition. Conclusions Opportunities are being missed for organizations to work together on nutrition at the regional level in South Asia. The effectiveness of regional nutrition networks in influencing policy or programme decisions and resources for nutrition at country level should be explored.

A conceptual framework is presented for enhancing food security and nutrition in urban areas in low- and middle-income countries, highlighting key influencing factors, including food supply chains, community food environments, community infrastructure and services, and numerous underlying individual and household determinants, such as behaviours and dietary practices.

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large‐scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum‐dwellers in large‐scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN. Maternal, infant and young child nutrition (MIYCN) indicators were generally worse for those living in urban slum households compared to those in nonslum urban areas. The MIYCN data collected were highly variable across surveys and countries of the Asia‐Pacific region. This paper highlights that data are missing/not collected from numerous countries in the region which limited analysis to 13 countries. Slum populations are underrepresented in large‐scale surveys. More data are needed on the poorest urban slum populations for more countries in the region to enable resources to be allocated appropriately to support optimal MIYCN.

Undernutrition-before, during and after pregnancy endangers the health and well-being of the mother and contributes to sub-optimal fetal development and growth. A non-randomized controlled evaluation was undertaken to assess the impact of engaging federations of women's group on coverage of nutrition interventions and on nutrition status of women in the designated poverty pockets of three Indian states-Bihar, Chhattisgarh, and Odisha. The impact evaluation is based on two rounds of cross-sectional data from 5 resource poor blocks across 3 States, assigning 162 villages to the intervention arm and 151 villages to the control arm. The cross-sectional baseline (2016-17) and endline survey (2021-22) covered a total of 10491 adolescent girls (10-19 years), 4271 pregnant women (15-49 years) and 13521 mothers of children under age two years (15-49 years). Exposure was defined based on participation in the participatory learning and action meetings, and fixed monthly health camps (Adolescent Health Days (AHDs) and Village Health Sanitation and Nutrition Days (VHSNDs)). Logistic regression models were applied to establish the association between exposure to programme activities and improvement in coverage of nutrition interventions and outcomes. In the intervention area at endline, 27-38% of women participated in the participatory learning and action meetings organized by women's groups. Pregnant women participating in programme activities were two times more likely to receive an antenatal care visit in the first trimester of pregnancy (Odds ratio: 2.55 95% CI-1.68-3.88), while mothers of children under 2 were 60% more likely to receive 4 ANC visits (Odds ratio: 1.61, 95% CI- 1.30-2.02). Odds of consuming a diversified diet was higher among both pregnant women (Odds ratio: 2.05, 95% CI- 1.41-2.99) and mother of children under 2 years of age (Odds ratio: 1.38, 95% CI- 1.08-1.77) among those participating in programme activities in the intervention arm. Access to commodities for WASH including safe sanitation services (Odds ratio: 1.80, 95% CI- 1.38-2.36) and sanitary pads (Odds ratio: 1.64, 95% CI- 1.20-2.22) was higher among adolescent girls participating in programme activities. Women's groups led participatory learning and action approaches coupled with strengthening of the supply side delivery mechanisms resulted in higher coverage of health and nutrition services. However, we found that frequency of participation was low and there was limited impact on the nutritional outcomes. Therefore, higher frequency of participation in programme activities is recommended to modify behaviour and achieve quick gains in nutritional outcomes.

Children between the ages of 6 and 23 months require the age‐appropriate introduction of complementary foods alongside breastfeeding to meet their nutritional needs, but in humanitarian settings children frequently do not receive appropriate diets. Using data from 9193 children aged 6–23 months in the Afghanistan Multiple Indicator Cluster Survey 2022–2023, this paper provides nationally representative estimates of the percentage of children meeting key IYCF indicators and assesses the child, maternal and household determinants of receiving minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) using multivariable logistic regression. Results showed that 85%, 65% and 93% of children were not fed a diet that met MDD, MMF or MAD criteria, respectively. Older children (18–23 months) had significantly higher odds of meeting all three criteria compared to younger children (6–11 months) (MDD aOR = 2.46, 95% CI: 1.93–3.12; MMF aOR = 1.29, 95% CI: 1.11–1.50; MAD aOR = 2.00, 95% CI: 1.51–2.65), as did children from the richest households (vs. poorest) (MDD aOR = 2.85, 95% CI: 1.72–4.70; MMF aOR = 1.82, 95% CI: 1.35–2.46; MAD aOR = 3.88, 95% CI: 2.14–7.04). There was substantial variation in the odds of all outcomes by region. Rural residence (vs. urban) was also associated with higher odds of receiving MMF (aOR = 1.60, 95% CI: 1.25–2.05) and MAD (aOR = 1.69, 95% CI: 1.18–2.42) but not MDD. Overall, alarmingly few children in Afghanistan are receiving appropriate complementary diets amidst a context of concurrent political, economic and environmental crises. Reversals to funding reductions are vital to ensure proven interventions responding to the determinants identified here continue to be delivered to support nutrition among Afghanistan's infants and young children. Alarmingly few children aged 6–23 months in Afghanistan are receiving appropriate complementary diets. Older child age, higher household wealth, and region of residence were significant determinants of receiving adequate complementary diets, but the proportion of children receiving adequate nutrition was low across all sociodemographic groups. Summary Afghanistan has experienced concurrent political, economic and environmental crises since 2020 that have left 90% of families unable to afford sufficient food. Complementary feeding practices in Afghanistan are poor. Only 7% of children received a minimally acceptable diet, 15% received a diet with minimum dietary diversity and 35% were fed with minimum meal frequency. Half of children had ‘very low dietary diversity’ and consumed from no more than two of eight key food groups on the previous day. Older child age, higher household wealth, region and rural residence were significant determinants of receiving adequate complementary feeding.

Information on malnutrition for school‐age children and adolescents (5–19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5–19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%–88.8%), wasting (3%–48%), underweight (9.5%–84.4%) and stunting (3.7%–71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast‐food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large‐scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia. Information on malnutrition for school‐age children and adolescents in South Asia is fragmented and inconsistent, limiting the prioritization of nutrition policies, programmes and research. This scoping review synthesized existing evidence on the burden of malnutrition for children and adolescents in South Asia, and on interventions to improve their nutritional status. Key messages A triple burden of malnutrition (undernutrition, overweight/obesity and micronutrient deficiencies) is affecting children and adolescents (5–19 years) in South Asia, with heterogeneity within, and between, countries. In most countries, nationally representative data on the nutritional status of children and adolescents is absent and should be prioritized. Interventions targeting children and adolescents are primarily limited to small‐scale trials and focused predominantly on undernutrition and micronutrient deficiencies despite rapidly rising rates of overweight and obesity. Further research is needed to inform the scalability and sustainability of nutrition interventions across different contexts and to understand the effectiveness of policies and programmes that address overnutrition.

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems. Growing rates of malnutrition, both under‐ and overnutrition, continue to threaten the South Asia region. Our study examined national policies, programmes, and data availability on nutrition interventions in eight South Asian countries. Results revealed a strong policy focus, but data gaps limit progress tracking. Multisectoral collaboration and strengthened nutrition data systems are required to overcome nutrition problems in the region. Key messages Most South Asian countries had several policies and programmes in place which considered or addressed nutrition interventions across the life course. Nationally representative surveys provide coverage data for evidence‐based recommendations to improve policy and programme actions. Significant coverage data gaps remain in nationally representative surveys around counselling during pregnancy, interventions targeted for newborns, infant, and young child feeding, and counselling on and identification and treatment of severe and moderate acute malnutrition. Mobilising political commitment and increasing multisectoral collaboration are required for an enabling environment in support of nutrition data systems in South Asia.

In India, 66% of 8 million married adolescents (~5.3 million) are nulliparous and likely to conceive soon. Among married young women aged 20-24 years about 9.1 million are nulliparous. This group remains relatively less reached in maternal nutrition programs. Current estimates of their nutritional status and predictors of body mass index (BMI) are unavailable. Thinness (BMI <18.5 kg/m2), severe thinness (BMI <16 kg/m2), overweight or obesity (BMI ≥ 23kg/m2) prevalence estimates are presented based on a sample of 11,265 married nulliparous adolescents (15-19 years, married, no parity) and 15,358 young women (20-24 years, married, no parity) drawn from the National Family Health Surveys 2005-06 and 2015-16. Trends by age, time and state were analysed. Predictors of BMI were investigated using linear regression. Using BMI for age z score (BAZ) as standard reference, BMI cut-off was calculated for thinness (-2SD) and overweight or obesity (+1SD) among married nulliparous adolescents as recommended for population under 19 years. 35% sampled adolescents and 26% young women were thin; 4%-5% severely thin. Overweight or obesity was higher among married nulliparous young women than married nulliparous adolescents (21% versus 11%). Eight in 1000 were short, thin and young and six in 1000 were short, thin, anemic and young. At 15 years of age, prevalence of thinness based on BMI was 46.5% while based on BAZ, 7.6%. At 24 years of age thinness was 22.5%. Decadal reduction in thinness was half among married nulliparous adolescents (4% points) compared with married nulliparous young women (8% points). Decadal increase in overweight/ obesity ranged from 4% to 5% in both age groups. Western states had high prevalence of thinness; Tamil Nadu had highest prevalence of overweight or obesity. Incremental increase in age and wealth increased BMI among young women more than adolescents. BMI was lower among adolescents and young women wanting a child later than soon [β -0.28 (CI -0.49- -0.07), β -0.33(CI -0.56- -0.093), respectively]. BMI cut-off 16.49 kg/m2 and 24.12 kg/m2 had a high sensitivity (100%, 99.7%) and specificity (98.9%, 98.5%) to screen thin and overweight or obese adolescents, respectively. Owing to the high prevalence of both thinness and overweight/obesity among nulliparous married adolescents and women, nutritional anthropometry based screening should be initiated for this target group, along with a treatment package in states with high and persistent malnutrition. Family planning services should be integrated in nutrition programs for this target group to achieve normal nutritional status before conception.

In-country jurists remain an untapped resource for strengthening legal measures to support breastfeeding in South Asia, write Vani Sethi and Zivai Murira

Aim The links between poor complementary feeding and child malnutrition in South Asia argue for greater attention to improving young children’s diets. This study examined the status of policy and programme actions to support complementary feeding across four systems in South Asia: food, health, social protection, and water, sanitation, and hygiene (WASH). Methods We conducted a review to assess the status of national policy and programme actions to improve complementary feeding in children aged 6–23 months in eight South Asian countries across four systems, including the comprehensiveness of the enabling environment and the geographic scale of programmes. Results All countries have policy and programme commitments to improving complementary feeding; however, no country has a comprehensive set of legislation, policies, strategies, and plans that fully incorporate relevant global recommendations and guidance. The health system has the strongest enabling environment for complementary feeding, but the lack of supportive legislation, policies, strategies, and plans in other systems may hinder multisystem action. There are few examples of nationwide programmes to improve complementary feeding beyond the health system. Conclusion Governments should mobilize their institutions and resources to enable a coherent and multisystem response to complementary feeding that addresses the gaps in legislation, policies, and programmes and the barriers and bottlenecks to implementation at scale, with a focus on the food, health, social protection, and WASH systems. Further operational research is needed on the factors and processes that enable multisystem action to secure nutritious, safe, affordable, and sustainable diets for young children in South Asia.