{"id":40085,"date":"2025-10-17T06:11:07","date_gmt":"2025-10-17T06:11:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjgh\/?p=40085"},"modified":"2025-10-17T06:11:07","modified_gmt":"2025-10-17T06:11:07","slug":"uncovering-bright-spots-how-karnali-province-is-leading-the-fight-against-anaemia-in-nepal","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjgh\/2025\/10\/17\/uncovering-bright-spots-how-karnali-province-is-leading-the-fight-against-anaemia-in-nepal\/","title":{"rendered":"Uncovering Bright Spots: How Karnali Province is Leading the Fight Against Anaemia in Nepal"},"content":{"rendered":"

 <\/p>\n

Anaemia affects every second adolescent girl and women aged 15\u201349 years in South Asia. Anaemia stifles potential, productivity and entire economies, costing the South Asia region US$32.5 billion each year<\/a>. Despite years of effort, progress has been uneven, with some communities still facing alarmingly high anaemia rates. Nepal is no exception. Nepal has made steady national gains, but the burden remains high affecting one third of women 15-49 years. Yet, quietly and often unnoticed, remarkable successes are unfolding in regions that face the toughest odds. Some provinces have made remarkable progress, while others have stagnated or worsened.<\/p>\n

Amid these challenges, Karnali province<\/a> has emerged as a remarkable success story. Despite its remoteness and deep poverty\u2014where nearly half the population lives in rural areas and 87% of rural households are among the poorest\u2014Karnali has achieved some of the fastest declines in anaemia nationwide. This positive outlier shows that with targeted action and local leadership, real change is possible even in the most disadvantaged settings.<\/p>\n

A Surprising Success Story<\/strong><\/h6>\n

According to the Nepal Demographic Health Survey<\/a>, between 2016 and 2022, Karnali reduced anaemia among women of reproductive age by 14 percentage points \u2013 nearly double the national average decline. In contrast, provinces like Lumbini saw no improvement over the same period. Even more striking, the decline in Karnali has been equitable with reduction by 15 percentage points in richest households and 14 percentage points among poorest households. By 2030, projections suggest that Karnali could have the lowest anaemia rates in the country, if current efforts are sustained (unpublished).<\/p>\n

What\u2019s Driving the Change?<\/strong><\/h6>\n

So, what makes Karnali different? Several factors seem to be working together to produce this remarkable progress.<\/p>\n

    \n
  1. \n
    Strong Local Dietary Practices<\/strong><\/h6>\n<\/li>\n<\/ol>\n

    In many Karnali households, green leafy vegetables are a daily staple. Local varieties like latte<\/em> (amaranth leaves), pani <\/em>(water spinach), sisnu<\/em> (stinging nettle leaf) and wild greens such as bethe<\/em>, dhokayo<\/em> are rich in iron, folic acid, and beta-carotene. Unlike other parts of Nepal, tea consumption is low, which helps because tea can block iron absorption.<\/p>\n

    \"\"
    \u00a9 UNICEF\/South Aisa\/2025\/Pun<\/small><\/em>
    Picture 1. Bethe (wild spinach) is Iron-dense and folate-rich green leafy vegetables are commonly grown and eaten in the Karnali province.<\/small><\/em><\/figcaption><\/figure>\n
    \"\"
    \u00a9 UNICEF\/South Aisa\/2025\/Pun<\/small><\/em>
    Picture 2. Sisnu (nettle), a staple green in Karnali, is valued for its iron content and commonly included in local meals<\/small><\/em><\/figcaption><\/figure>\n
    \"\"
    \u00a9 UNICEF\/South Aisa\/2025\/Pun<\/small><\/em>
    Picture 3. Amaranth leaves or latte or matye marse, as locally known in Karnali province, is one of the most consumed green leafy vegetables. Amaranth leaves are rich in iron and folates, essential for carrying oxygen in the blood and preventing anemia<\/small><\/em><\/figcaption><\/figure>\n
      \n
    1. \n
      Improved Health Services<\/strong><\/h6>\n<\/li>\n<\/ol>\n

      Between 2016 and 2022, access to health services improved dramatically. Women receiving at least four antenatal care visits rose from 47% to 79%. Institutional deliveries increased from 36% to 72%. The percentage of women taking the full course of 180 iron-folic acid tablets during pregnancy grew from 42% to 63%. Deworming coverage also increased, from 82% to 87%. These improvements mean more women are screened, treated, and supported during pregnancy.<\/p>\n

      \"\"
      \u00a9 UNICEF\/UNI825322\/Pun<\/small><\/em>
      Picture 4. Auxiliary Nurse Midwife Kamala Kumari Shahi hands Kabita Khrti a pack of Iron-Folic-Acid (IFA) tablets during her routine antenatal checkup at Badalamji Health Centre, Dailekh, Karnali Province.<\/small><\/em><\/figcaption><\/figure>\n
        \n
      1. \n
        Fewer Closely Spaced Pregnancies<\/strong><\/h6>\n<\/li>\n<\/ol>\n

        While adolescent pregnancy remains high in Karnali, the proportion of women with less than two years between pregnancies dropped from 24% to 17% between 2016 and 2022. This reduction lowers health risks for both mothers and babies<\/p>\n

          \n
        1. \n
          Focused Multi-Sector Action<\/strong><\/h6>\n<\/li>\n<\/ol>\n

          Karnali has benefited from coordinated support across sectors, thanks to Nepal\u2019s Multi-Sector Nutrition Plan (MSNP)<\/a>. MSNP adopts a multi-sectoral approach, integrating health, education, agriculture, WASH, and local governance to tackle malnutrition. MSNP started in 2013 in a few districts and is now adopted nationwide.<\/p>\n