Assessment of Food Environment in Public Facilities of Urban Municipalities in Nepal: A Baseline Study for Municipal-Level Healthy Food Procurement and Service Policy Development.

Introduction: Food environments in public facilities, particularly schools, influence dietary behaviours yet often lack healthy eating standards, particularly in low-resource contexts, contributing to the rising burden of non-communicable diseases. This study assessed the current food environment in public facilities within four urban municipalities of Bagmati Province, Nepal, as a baseline survey for developing a healthy food procurement and service policy. Methods: We conducted a cross-sectional study from May to December 2022 in 355 public facilities, including schools, healthcare facilities, and care homes. We collected data on food procurement, food availability, cooking practices, food advertisement, and hygiene through inperson interviews and observations, and analyzed using STATA 17. Results: Out of 355 public facilities, 349 (98.30%) were schools. Vegetables were available as a healthy option with a median of 12 items per week (IQR: 9-16), followed by fruits 1 (IQR: 0-6) and whole grains 0 (IQR: 0-1). Among unhealthy options, refined grains were available with a median of 14 (IQR: 1021), followed by deep-fried foods 2 (IQR: 0-6) and sugar-sweetened beverages 0 (IQR: 0-1). There were 22 (6.19%) facilities with measures to limit junk food, while 95 (26.76%) had monitoring mechanisms, mainly by facility committees. Conclusions: The findings highlight a concerning imbalance in public facility canteens, where unhealthy food options are more prevalent. Facilities also have limited canteen monitoring mechanisms and initiatives for promoting a healthy food environment.