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Background: Integrated school and home garden interventions can improve health outcomes in low-income countries, but rigorous evidence remains scarce, particularly for school-aged children and to reduce anemia. Objective: We test if an integrated school and home garden intervention, implemented at pilot stage, improves hemoglobin levels among school children (aged 9-13 years) in a rural district in the mid-hills of Nepal. Methods: We use a cluster randomized controlled trial with 15 schools each in the control and treatment groups (n = 680 school children). To test if nutritional improvements translate into a reduction of anemia prevalence, hemoglobin data were collected 6 months after intervention support had ended. Using structural equation modeling, we estimate the direct and indirect effects of the treatment through several pathways, including nutritional knowledge, good food and hygiene practices, and dietary diversity. Results: The integrated school and home garden intervention did not lead to a direct significant reduction in anemia. Causal positive changes of the treatment on nutritional outcomes, although significant, are not strong enough to impact hemoglobin levels. The program improved hemoglobin levels indirectly for children below 12 by increasing the use of good food and hygiene practices at home. These practices are associated with higher hemoglobin levels, particularly for girls, young children, and in households where caregivers are literate. Conclusions: Even integrated school and home garden interventions are not sufficient to reduce anemia among school children. Incorporating behavioral change components around food and hygiene practices into integrated garden interventions is important to unlocking their health impacts. Plain language title: Effect of a Joint School and Home Garden Programme on Child Health Among School-Aged Children in Nepal Plain language summary: The effects of agricultural and nutritional support programs on health are not fully understood. This article looks at school and home gardens, which are gaining attention in the research and development community, but evidence for their effects is limited, particularly for lower-income countries. We examine whether a joint school and home garden program improves blood iron levels among school children (aged 9-13 years) in rural Nepal. Low levels are an indicator for anemia—a common nutritional disorder in South Asia. Our data come from an experiment involving 30 schools and 680 children and was measured via a finger prick method 6 months after program support ended. We also evaluate if the program influenced blood iron levels through the nutritional knowledge of children and their caregivers; through the use of good food and hygiene practices at home and the children's dietary diversity. Our results indicate that the program did not lead to a direct reduction in anemia. However, for children under the age of 12, the program indirectly improved blood iron levels through behavioral changes in the use of good food and hygiene practices (e.g., washing hands before eating). We therefore argue that including education on nutrition and good food and hygiene practices as part of integrated garden support programs is key to improving children's health. [ABSTRACT FROM AUTHOR]

Background: In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained.Objective: To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal.Methods: We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters.Results: On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs.Conclusion: Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact. [ABSTRACT FROM AUTHOR]

Background: Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches. Methods: This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps. Results: We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption. Conclusions: Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere. [ABSTRACT FROM AUTHOR]

Food systems in many countries are experiencing a shift from traditional foods toward processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among children and parents in rural Nepal. It uses qualitative data collected through key informant interviews and focus group discussions with school children, parents and teachers. The study reveals substantial changes in food behavior during the past decade with increased consumption of rice, meat, and highly processed snack foods while an increased consumption of fruit and vegetables is not evident. It identifies cash availability is the main driver of increased rice, meat and snack food consumption. The second driver is the 2015 Nepal earthquake, which accelerated the transition from homegrown food to purchased food as people got habituated to eating more meat and snack foods while reconstruction tripled local wages and changed the food environment. This shows how humanitarian assistance in the wake of extreme shocks can unintentionally contribute to unhealthy eating habits. An integrated school and home garden intervention appears to contribute to healthier diets. [ABSTRACT FROM AUTHOR]

Planetary health brings together intrinsically linked issues of human health and natural systems. This paper reviews evidence of how agrobiodiversity underpins dietary diversity for current human populations in the context of fruits and vegetables, and ways to maintain and improve these for future generations. Both the conservation and sustainable use of fruit and vegetable biodiversity and the consumption of diverse diets are sub-optimal, and in many contexts getting worse. Agrobiodiversity and nutrition are linked through food availability, access, conservation and consumption, with potential win-wins but notable trade-offs for policy and action through time, place, agrobiodiversity use, and equity. We pinpoint research gaps and call for inclusive deliberation for action. • Conservation of fruit and vegetable biodiversity and consumption of diverse diets are sub-optimal. • Agrobiodiversity and nutrition are linked through food availability, access, conservation, and consumption. • There are potential win-wins and trade-offs for policy and action, building on food systems. • More research is needed, particularly in the context of fruit and vegetable biodiversity and diets in different contexts. [ABSTRACT FROM AUTHOR]