The Implementation Patterns and Endline Nutrition, WASH, and Food-System Practices of an Integrated NERP–LANN+ Programme in Nepal’s Eastern Terai: A Mixed-Methods Evaluation

Malnutrition in Nepal’s Eastern Terai is shaped by food access, caregiving, water and sanitation, agricultural livelihoods, and local institutions. This mixed-methods evaluation describes the implementation patterns and endline nutrition, WASH, and food-system practices of an integrated Nutrition Education and Rehabilitation Program (NERP) and Linking Agriculture and Natural Resource Management towards Nutrition (LANN+) programme implemented in Karjanha, Kalyanpur, and Siraha municipalities from 2021 to 2024. The final evaluation included a household survey of 365 participating households, six focus group discussions with 69 participants, 19 key informant interviews, document review, and a partner reflection workshop. Because endline households were selected sequentially from accessible participating households until municipality/community quotas were met, municipality comparisons are presented descriptively rather than as population-level statistical inference. Project-supported community screening conducted by health-facility staff used MUAC and weight-for-height criteria for children aged 6–59 months. The Phase II evaluation source records reported a GAM prevalence of 20.0% at the initial project screening and 8.38% (1038/12,392 screening records) at the final screening; because the initial numerator/denominator, individual anthropometric records, exact screening coverage, and seasonal comparability were not available for secondary verification, these values are not interpreted as a verified longitudinal reduction. At endline, MDD-W was 79.3% (242/305), and the project-defined SIFS criterion was met by 92.7% (294/317) and the project-defined hygiene criterion by 95.6% (349/365). After correcting age-inconsistent breastfeeding records, a breastfeeding-related project criterion was met by 84.5% (125/148) of households with children aged 0–59 months; a corrected complementary-feeding criterion was met by 73.8% (104/141) of households with children aged 6–59 months. The qualitative findings indicated that nutrition gardens, diversified production, nutrition learning, women’s economic participation, and municipal planning were perceived as mutually reinforcing, while COVID-19 disruptions, procurement delays, seasonal water constraints, and weak routine water treatment constrained implementation. This study provides descriptive implementation evidence; climate resilience and planetary-health benefits remain plausible pathways rather than directly measured outcomes.