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Objective To examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries. Methods We used data from the most recent (2015-2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (n = 19 632), Bangladesh (n = 5051), India (n = 184 641), Maldives (n = 2368), Nepal (n = 3998), Pakistan (n = 8285) and Sri Lanka (n = 7138). We estimated co-coverage for a set of eight health and eight nutrition interventions and assessed within-country inequalities in co-coverage by wealth and geography. We examined opportunity gaps by comparing coverage of nutrition interventions with coverage of their corresponding health delivery platforms. Findings Only 15% of 231 113 mother-child pairs received all eight health interventions (weighted percentage). The percentage of mother-child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for co-coverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points. Conclusion Co-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms. Objectif Examen des inegalites et des ecarts de perspectives dans la couverture commune des interventions en matiere de sante et de nutrition dans sept pays. Methodes Nous avons utilise les donnees des enquetes demographiques et sanitaires les plus recentes (2015-2018) aupres de meres ayant des enfants de moins de 5 ans en Afghanistan (n = 19 632), au Bangladesh (n = 5051), en Inde (n = 184 641), aux Maldives (n = 2368), au Nepal (n = 3998), au Pakistan (n = 8285) et au Sri Lanka (n = 7138). Nous avons estime la couverture commune pour un ensemble de huit interventions dans le domaine de la sante et huit autres liees a la nutrition et nous avons evalue les inegalites au sein des pays en matiere de couverture commune en fonction de la richesse et de la geographie. Nous avons examine les ecarts de perspectives en comparant la couverture des interventions en matiere de nutrition avec celle des plateformes de prestation de soins correspondantes. Resultats Seuls 15 % des 231 113 couples mere-enfant ont beneficie des huit interventions sanitaires (pourcentage pondere). Le taux de couples mere-enfant n'ayant beneficie d'aucune intervention en matiere de nutrition etait le plus eleve au Pakistan (25 %). Les ecarts de richesse (les plus riches par rapport aux plus pauvres) pour la couverture commune des interventions sanitaires etaient les plus importants au Pakistan (indice de pente des inegalites : 62 points de pourcentage) et en Afghanistan (38 points de pourcentage). Les ecarts de richesse pour la couverture commune des interventions en nutrition etaient les plus eleves en Inde (32 points de pourcentage) et au Bangladesh (20 points de pourcentage). La couverture des interventions en matiere de nutrition etait plus faible que celle des interventions sanitaires associees, avec des ecarts de perspectives s'etalant de 4 a 54 points de pourcentage. Conclusion La couverture commune des interventions en matiere de sante et de nutrition est loin d'etre optimale et affecte de maniere disproportionnee les menages pauvres d'Asie du Sud. Les efforts en matiere de politique et de programmation devraient viser a combler les ecarts en matiere de couverture, dequite et de perspective et a ameliorer la fourniture d'interventions de nutrition au travers de soins de sante et d'autres plateformes de prestation. Objetivo Analizar las desigualdades y la falta de oportunidades en la cobertura conjunta de las intervenciones sanitarias y de nutricion en siete paises. Metodos Se utilizaron los datos de las encuestas demograficas y sanitarias mas recientes (entre 2015 y 2018) de madres con hijos menores de 5 anos en Afganistan (n= 19 632), Bangladesh (n= 5051), India (n= 184 641), Maldivas (n= 2368), Nepal (n= 3998), Pakistan (n= 8285) y Sri Lanka (n= 7138). Se calculo la cobertura conjunta de un grupo de ocho intervenciones sanitarias y ocho de nutricion y se evaluaron las desigualdades en la cobertura conjunta dentro del pais segun la riqueza y la geografia. Se analizaron las diferencias de oportunidad al comparar la cobertura de las intervenciones de nutricion con la cobertura de sus correspondientes plataformas de prestacion de servicios sanitarios. Resultados Solo el 15 % de 231 113 parejas madre e hijo recibieron las ocho intervenciones sanitarias (porcentaje ponderado). El porcentaje de parejas madre e hijo que no recibieron ninguna intervencion de nutricion fue mayor en Pakistan (25 %). Las diferencias de riqueza (los mas ricos frente a los mas pobres) para la cobertura conjunta de las intervenciones sanitarias fueron mayores en Pakistan (indice de desigualdad de la pendiente: 62 puntos porcentuales) y en Afganistan (38 puntos porcentuales). Las diferencias de riqueza para la cobertura conjunta de las intervenciones de nutricion fueron mayores en India (32 puntos porcentuales) y en Bangladesh (20 puntos porcentuales). La cobertura de las intervenciones de nutricion fue menor que la de las intervenciones sanitarias asociadas, con diferencias de oportunidad que iban de 4 a 54 puntos porcentuales. Conclusion La cobertura conjunta de las intervenciones sanitarias y de nutricion esta lejos de ser optima y afecta de manera desproporcionada a los hogares pobres de Asia Meridional. Los esfuerzos en materia de politica y programacion deben prestar atencion a la reduccion de las diferencias de cobertura, equidad y oportunidad, y a la mejora de la prestacion de servicios de nutricion a traves de la atencion sanitaria y demas plataformas de prestacion. [phrase omitted], Introduction Universal health coverage (UHC) is fundamental to achieving the sustainable development goals (SDGs), reducing inequalities and ensuring that no one is left behind. (1) Timely delivery of a complete [...]

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. 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. [ABSTRACT FROM AUTHOR]

Background: Children, especially disadvantaged children in poor countries, were expected to be among the "biggest victims" of the Covid pandemic. Economic burdens, decreased nutritious foods, reduced medical care, school closures, and ill‐health or death of family members were predicted to increase child undernutrition and developmental delays, and diminish home child‐rearing quality. Methods: A planned nutrition intervention could not be implemented due to Covid restrictions. However, three surveys (pre‐Covid [December 2019], July 2021, and September 2021) in 280 Nepali households (309 parent‐dyads, 368 children, 6–66 months old) collected demographics, child anthropometry and development (Ages and Stages Questionnaire‐3 [ASQ‐3]), and home child‐rearing quality (caregiver engagement, learning resources, adult supervision [UNICEF's Multiple Indicator Cluster Survey]). Mixed‐effect regression models adjusted for household (wealth, maternal education) and child factors (age, gender) and survey round. Results: Height, mid‐upper‐arm circumference, and head circumference measurements improved over time. The total ASQ‐3 score did not change: Communication scores increased while fine motor and personal‐social scores declined. Girls' growth and development worsened more than boys. Caregiver engagement (especially mothers') generally declined, but learning resource availability increased. More children were left unsupervised at Round 2 than Round 1 or 3. Conclusions: In this sample, some aspects of child growth, development, and home child‐rearing quality improved while others declined. Better understanding of these changes in child well‐being and the family environment during the pandemic could provide insight on how to protect children during future crises. [ABSTRACT FROM AUTHOR]

Early marriage (EM) and early childbearing (ECB) have far‐reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever‐married women aged 20–24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of –3.8%/year), Pakistan (–2.8%/year), and Bangladesh (–1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing. [ABSTRACT FROM AUTHOR]

Objective To examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries. Methods We used data from the most recent (2015-2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (n = 19 632), Bangladesh (n = 5051), India (n = 184 641), Maldives (n = 2368), Nepal (n = 3998), Pakistan (n = 8285) and Sri Lanka (n = 7138). We estimated co-coverage for a set of eight health and eight nutrition interventions and assessed within-country inequalities in co-coverage by wealth and geography. We examined opportunity gaps by comparing coverage of nutrition interventions with coverage of their corresponding health delivery platforms. Findings Only 15% of 231 113 mother--child pairs received all eight health interventions (weighted percentage). The percentage of mother--child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for cocoverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points. Conclusion Co-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms. [ABSTRACT FROM AUTHOR]