regional dialect. Use of Nepali as the national language does limit opportunities for certain groups that do not speak this language, and has been a source of debate over the years (2).


According to the most recent estimates, the population is approximately 27.8 million, with 700,000


residing in the Kathmandu Valley (2,3). More than 70% of the total population works in the agricultural sector (4). As the poorest country in South Asia and 17th poorest in the world, approximately 25% of the population experiences poverty (3). Many farmers struggle with undernourishment (50% undernourished and 5% chronically malnourished) because of the limited access to better farming technologies, strategies, and sales opportunities. Recently, the Nepalese government began to prioritize food security and sustainable agriculture. Further, nutrition education has been initiated for hygiene, safer water, and the need to consume nutrient dense foods (5).


The rate of infant mortality is quite high in Nepal, but still the population continues to grow because


fertility rates are high. Most of the population is young, with approximately 41% under 15 years of age and 13% under five years of age. There are an estimated 89 males for every 100 females (6). The total life expectancy of the Nepali is 68 years (3).


The increase in population has led to migration to farmlands in rural areas and an influx of people into


urban areas as migrants seek job opportunities. There are approximately 5 people (3.3 children per woman) per household in rural areas, and 4.4 per household (2.1 children per woman) in more urban areas (6). The overcrowding in the cities has created issues with pollution. About 51% of households have electricity, but the majority of those are in urban areas. Nearly all households (90% urban, 80% rural) have access to improved drinking water. However, half of households have no toilet facilities (6).


The majority of children (83%) are immunized. Common childhood illnesses include acute respiratory


infections and diarrhea. Nearly all children, are breastfed at some point, but only 53% of children under six months are exclusively breastfed. Approximately 50% of children under age five are considered short for their age, or stunted, 13% are too thin for their height, or wasted, and 39% are underweight (6). Malnourishment is more prevalent in rural, impoverished areas, but has begun to improve.


In general, food is influenced by Indian and Tibetan cooking styles. Newari and Thakai cuisines


represent the most authentic Nepalese flavors. The majority of Nepalese eat with their right hand without the use of utensils. Those who practice Hinduism do not eat beef (1).


The various cuisines of Nepal are dependent on the region. Traditional meals consist mainly of dal-bhat (lentils and boiled rice), sometimes paired with tarkari (curried vegetables) and a side of achar (pickled vegetables). (In English bhat may be spelled bhat or bhaat.) Less frequently, and for special occasions, a meal may include masu (spiced or curried meat) (7). Other typical side items include momos (steamed and fried dumplings), rotis (flat bread), and dhedo (boiled flour) (1).


A typical day starts in the early morning with tea served with milk and sugar. Because it is thought to


provide instant energy, tea is rarely accompanied by food. The first or complete meal is served around 9 AM or 10 AM. Main meals are eaten twice daily, consisting of a cereal, legumes, vegetables, milk or ghee, and pickles (8). Dal-bhat-tarkari is the most frequently consumed primary meal (7). At about 6 or 7 PM, after sunset, the second primary meal is eaten. It is only served after all daily activities are completed to allow for proper digestion (9). Secondary meals, khaja, are lighter snacks are served in the morning and midday to those expected to return home late in the evening. These snacks may be bread, chuira (beaten rice), roti (flat bread), yogurt, fried potatoes, or tea (8).


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