| Sumario: | Objectives: Safe, nutritious foods are out of reach for many consumers in South Asia. Variations in food environments across the region are not well understood. This study examines food environment infrastructure and availability of healthy foods in three South Asian countries.
Methods: An agri-food systems assessment surveyed 50 villages per district in Bangladesh (Rajshahi, Rangpur), India (Nalanda), and 25 wards per district in Nepal (Banke, Surkhet) from December 2022 to June 2023. Villages were randomly selected with a probability proportional to the number of households per village. Shops were categorized into market or retail by operational structure and types of food sold. Observations and structured interviews with vendors, shop owners, and managers were used to compare food market and retail infrastructure, healthy food availability, and food promotion.
Results: A total of 247 formal and informal markets and 3,117 retail outlets were surveyed. Semi-permanent market structures were common in all districts (67%). In Bangladesh, 62% of retail outlets were semi-permanent structures. Most retail outlets in Nepal (81%) had no structural damage; in Bangladesh, 50% had some damage. Over 60% of markets in India and Bangladesh had some structural damage. Infrastructure to facilitate safe hygiene practices (water and waste services) was 95% in Bangladesh and 56% in Nepal. Although generally low, retailer adherence to food safety and hygiene practices was highest in India (25%). Local grocery stores, with limited selections of fresh produce, were the dominant retail type in Bangladesh (71%) and India (77%). Nepal had the highest percentage (16%) and density (mean 3) of vegetable and fruit shops, with high variability (SD 4.82). Retail stores had similar ratios of healthy and unhealthy foods. Ratio of healthy food retail outlets was highest in Nepal (17%) and lowest in Bangladesh (4%). Whereas overall promotion of foods was low, all districts promoted unhealthy foods over healthy foods, with India (60%) and Bangladesh (50%) leading.
Conclusions: Retail outlets were in good structural condition, retailer adherence to food safety practices was low, healthy retail outlets were sparse, and promotion of unhealthy foods was higher than healthy foods, highlighting a need for interventions to improve availability and access to healthy foods.
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