International Development Research Centre Research Articles

Evaluating the integration of strategic priorities within a complex research-for-development funding program

This paper examines the application of Complexity Theory constructs to a research-for-development program evaluation and presents an overview of the implications and promising approaches for evaluating complex programs. We discuss lessons learned from an evaluation completed for the International Development Research Centre’s Food, Environment and Health (FEH) program, which investigated the integration and outcomes of five strategic program priorities: partnerships, southern leadership, gender and equity, scale, and environmental sustainability. We present interpretations from a secondary, thematic content analysis that categorized evaluation findings across four complexity constructs: emergence, unpredictability, contradiction and self-organization. Viewing the evaluation through these constructs surfaced some important features of the FEH program to date, specifically its evolving approach, adaptiveness to emergent issues, non-linear outcomes, and self-organizing agents, which had several implications for the evaluative process. We conclude that the most appropriate evaluation designs for complex funding programs are participatory (to explore all stakeholders' influence), adaptive (to capture the unexpected) and assess external contexts. The application of complexity constructs may be useful for evaluators to gain a deeper understanding of how program contexts change in the face of complexity and why some evaluation methods work more effectively than others.

Changes in food purchases after the Chilean policies on food labelling, marketing, and sales in schools: a before and after study

In 2016, Chile implemented a unique law mandating front-of-package warning labels, restricting marketing, and banning school sales for products high in calories, sodium, sugar, or saturated fat. We aimed to examine changes in the calorie, sugar, sodium, and saturated fat content of food and beverage purchases after the first phase of implementation of this law. This before and after study used longitudinal data on food and beverage purchases from 2381 Chilean households from Jan 1, 2015, to Dec 31, 2017. Nutrition facts panel data from food and beverage packages were linked to household purchases at the product level using barcode, brand name, and product description. Nutritionists reviewed each product for nutritional accuracy and categorised it as high-in if it contained added sugar, sodium, or saturated fat and exceeded phase 1 nutrient or calorie thresholds, and thus was subject to the labelling, marketing, and school regulations. Using fixed-effects models, we examined the mean nutrient content (overall calories, sugar, saturated fat, and sodium) of purchases in the post-policy period compared to a counterfactual scenario based on pre-policy trends. Compared with the counterfactual scenario, overall calories purchased declined by 16·4 kcal/capita/day (95% CI -27·3 to -5·6; p=0·0031) or 3·5%. Overall sugar declined by 11·5 kcal/capita/day (-14·6 to -8·4; p<0·0001) or 10·2%, and saturated fat declined by 2·2 kcal/capita/day (-3·8 to -0·5; p=0·0097) or 3·9%. The sodium content of overall purchases declined by 27·7 mg/capita/day (-46·3 to -9·1; p=0·0035) or 4·7%. Declines from high-in purchases drove these results with some offset by increases in not-high-in purchases. Among high-in purchases, relative to the counterfactual scenario, there were notable declines of 23·8% in calories purchased (-49·4 kcal/capita/day, 95% CI -55·1 to -43·7; p<0·0001), 36·7% in sodium purchased (-96·6 mg/capita/day,-105·3 to -87·8; p<0·0001), and 26·7% in sugar purchased (-20·7 kcal/capita/day, -23·4 to -18·1; p<0·0001). The Chilean phase 1 law of food labelling and advertising policies were associated with reduced high-in purchases, leading to declines in purchased nutrients of concern. Greater changes might reasonably be anticipated after the implementation of phases 2 and 3. Bloomberg Philanthropies, International Development Research Center, and Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

Exploring intersections between gender-based violence and adolescent sexual and reproductive health and rights in West Africa: A review of the literature produced in the sub-region.

This review, commissioned by the Canadian International Development Research Centre (IDRC), explores the intersection between gender-based violence (GBV) and adolescent sexual and reproductive health and rights (ASRHR) in the Economic Community of West African States. It is imperative to understand this intersection for research, policy, and practice purposes in a sub-region characterized by high youthful populations with significant reproductive health challenges. A mapping exercise, literature review, and gap analysis were conducted. Findings indicate that several stakeholders and organizations exist, though few are youth-led or centred. Legislation and policies are not comprehensive or necessarily enforced in a context of legal pluralism where institutions and infrastructure in place for providing services are weak. There was minimal knowledge production from the region on the GBV-ASRHR intersections, uneven attention to the issues among countries, and intersections mainly focused on female genital mutilation and child marriage. Opportunities for addressing gaps and implications for research, policy, and practice, arising from the findings are discussed.

Maternal Participation in a Nutrition-Sensitive Agriculture Intervention Matters for Child Diet and Growth Outcomes in Rural Ghana

ObjectivesLittle is known about how level of participation affects nutrition outcomes in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention (NSA) and children’s diet and anthropometric outcomes. MethodsThe Nutrition Links was a 2016–17 cluster RCT (clinicaltrials.gov NCT01985243) which enrolled caregivers with children < 18 mo in rural Ghana. Women in the intervention communities self-selected to receive poultry layers for egg production as part of a loan package, garden inputs, and nutrition education. Weekly meetings were used for education, for the staff to document egg production, and for the women to repay their loan and purchase feed. After endline, project participation was evaluated with a summative score that reflected 5 criteria: 1) egg productivity 2) timely and complete payment for feed and loan 3) meeting attendance 4) answering questions and making comments during the meetings and 5) attentiveness and helpfulness with the group. The field staff evaluated all criteria – from 1 (very poor) to 5 (excellent) – for each intervention woman who received poultry. Their participation was classified as high, medium, or low, based on tertiles. The participation of intervention women who never received poultry was ‘none’. Logistic and linear regressions tested the likelihood of consuming eggs and having a minimum diverse diet (MDD) and changes in anthropometric indices for the participation levels compared to those of the controls, who received standard-of-care services. ResultsIn comparison to the control group, only a high participation level was significant for having a MDD (aOR = 3.1, 95% CI [1.1, 8.8]). Both medium and high participation levels were associated with an increased likelihood in egg consumption (aOR = 2.1, 95% CI [1.0, 4.1]; aOR = 2.7, 95% CI [1.3, 5.4]), and length-for-age (LAZ)/height-for-age (HAZ) z-scores (β = 0.4, 95% CI [0.2, 0.6]; β = 0.4, 95% CI [0.2, 0.7]), and weight-for-age (WAZ) (β = 0.2, 95% CI [0.0, 0.4]; β = 0.2, 95% CI [0.0, 0.5]), respectively. ConclusionsThese results show the potential effect of NSA interventions and highlight the importance of facilitating high participation of beneficiaries. Funding SourcesGlobal Affairs Canada, Heifer International, World Vision, McGill University, International Development Research Centre.

Promises and perils of mobile health in Burkina Faso

Mobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here [email protected], an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Revitalising global social medicineWhat is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. Full-Text PDF Mutual aid, pandemic politics, and global social medicine in BrazilIn the face of persistent neglect and denial of the severity of COVID-19 by the administration of President Jair Bolsonaro, residents in many of Brazil's favelas have been left to organise their own responses to the pandemic. Community leaders have raised funds and volunteers are going door-to-door to distribute food, masks, and hygiene kits, using megaphones to educate residents about mask use, physical distancing, and handwashing. Local journalists are also using social media to counter fake news, and activists are converting schools into isolation wards, facilitating cash transfers, and fighting for the accurate documentation of COVID-19 deaths. Full-Text PDF Climate disasters and global social medicineHenry suffered a stroke in 2008, 3 years after Hurricane Katrina destroyed his home in New Orleans's Lower 9th Ward, a historic Black community. His diabetes had worsened in the aftermath of Katrina as he struggled to find pharmacies with insulin and other necessary supplies. His wife, Gladys, blamed the stroke on the receipt of a second denial-of-funds letter from the Road Home Program; without that assistance, they could not rebuild their home. The stroke left him paralysed. Gladys did her best to care for him, but she saw Katrina as the disaster that never ended. Full-Text PDF The social in psychiatries: depression in Myanmar, China, and JapanIn the wake of new ways of calculating disease burdens through disability-adjusted life-years, depression emerged as the world's second most common disorder after cardiovascular disease, affecting more than 264 million people worldwide. In Asia, depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases (ICD) has also become far more recognised and diagnosed over the past two decades. On the surface, this change seems to underline the universality of the neurobiological model of depression. Full-Text PDF Infant mental health in southern Africa: nurturing a fieldThe promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability. Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in Africa – Authors' replyWe thank Yap Boum for taking the time to respond to our Perspective.1 Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in AfricaIn their Perspective,1 N Hélène Sawadogo and colleagues highlight the challenges of mobile health care in Africa with the [email protected] project, which provided medical support to pregnant women but ran out of funding 3 years into operation. Securing longer-term funding to sustain mobile health is a challenge in Africa.2 Social innovations such as BIMA (Ghana), AccesAfya (Kenya), Idocta (Cameroon), and Healthforce (South Africa) use telemedicine to improve access to quality health care but have not managed to scale up. Full-Text PDF

Mutual aid, pandemic politics, and global social medicine in Brazil

In the face of persistent neglect and denial of the severity of COVID-19 by the administration of President Jair Bolsonaro, residents in many of Brazil's favelas have been left to organise their own responses to the pandemic. Community leaders have raised funds and volunteers are going door-to-door to distribute food, masks, and hygiene kits, using megaphones to educate residents about mask use, physical distancing, and handwashing. Local journalists are also using social media to counter fake news, and activists are converting schools into isolation wards, facilitating cash transfers, and fighting for the accurate documentation of COVID-19 deaths. Revitalising global social medicineWhat is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. Full-Text PDF Climate disasters and global social medicineHenry suffered a stroke in 2008, 3 years after Hurricane Katrina destroyed his home in New Orleans's Lower 9th Ward, a historic Black community. His diabetes had worsened in the aftermath of Katrina as he struggled to find pharmacies with insulin and other necessary supplies. His wife, Gladys, blamed the stroke on the receipt of a second denial-of-funds letter from the Road Home Program; without that assistance, they could not rebuild their home. The stroke left him paralysed. Gladys did her best to care for him, but she saw Katrina as the disaster that never ended. Full-Text PDF Promises and perils of mobile health in Burkina FasoMobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here [email protected], an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Full-Text PDF The social in psychiatries: depression in Myanmar, China, and JapanIn the wake of new ways of calculating disease burdens through disability-adjusted life-years, depression emerged as the world's second most common disorder after cardiovascular disease, affecting more than 264 million people worldwide. In Asia, depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases (ICD) has also become far more recognised and diagnosed over the past two decades. On the surface, this change seems to underline the universality of the neurobiological model of depression. Full-Text PDF Infant mental health in southern Africa: nurturing a fieldThe promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability. Full-Text PDF

Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysis

SummaryBackgroundEffective Aedes aegypti control is limited, in part, by the difficulty in achieving sufficient intervention coverage. To maximise the effect of vector control, areas with persistently high numbers of Aedes-borne disease cases could be identified and prioritised for preventive interventions. We aimed to identify persistent Aedes-borne disease hotspots in cities across southern Mexico.MethodsIn this spatial analysis, geocoded cases of dengue, chikungunya, and Zika from nine endemic Mexican cities were aggregated at the census-tract level. We included cities that were located in southern Mexico (the arbovirus endemic region of Mexico), with a high burden of dengue cases (ie, more than 5000 cases reported during a 10-year period), and listed as high priority for the Mexican dengue control and prevention programme. The Getis-Ord Gi*(d) statistic was applied to yearly slices of the dataset to identify spatial hotspots of each disease in each city. We used Kendall's W coefficient to quantify the agreement in the distribution of each virus.Findings128 507 dengue, 4752 chikungunya and 25 755 Zika clinical cases were reported between Jan 1, 2008, and Dec 31, 2016. All cities showed evidence of transmission heterogeneity, with a mean of 17·6% (SD 4·7) of their total area identified as persistent disease hotspots. Hotspots accounted for 25·6% (SD 9·7; range 12·8–43·0) of the population and 32·1% (10·5; 19·6–50·5) of all Aedes-borne disease cases reported. We found an overlap between hotspots of 61·7% for dengue and Zika and 53·3% for dengue and chikungunya. Dengue hotspots in 2008–16 were significantly associated with dengue hotspots detected during 2017–20 in five of the nine cities. Heads of vector control confirmed hotspot areas as problem zones for arbovirus transmission.InterpretationThis study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control.FundingUSAID, the US Centers for Disease Control and Prevention, the Canadian Institutes of Health Research, International Development Research Centre, Fondo Mixto CONACyT (Mexico)-Gobierno del Estado de Yucatan, and the US National Institutes of Health.TranslationFor the Spanish translation of the abstract see Supplementary Materials section.

Benefit-Cost Analysis of Introducing Double Fortified Salt for Control of Iron Deficiency Anemia in India

Background: The alleviation of iron deficiency through iron supplementation has not effectively reduced anemia in India, mainly due to low compliance. Food fortification with iron is now considered a viable alternative, and the provision of double fortified salt (DFS, with iron and iodine) has been mandated in public health programs. Still, there is limited evidence on its benefit-cost ratio. Methods: The economic benefit, in terms of wages earned, of introducing DFS in India was derived using a series of mathematical, statistical and econometric models using data from national surveys capturing earnings and dietary iron intake of the population. Anemia status was predicted from data on dietary intake, sanitation and for women, menstrual losses. The association of iron deficiency anemia (IDA) and wages was estimated using a Heckman Selection model, followed by estimation of the benefit of DFS through increased wages attributed to anemia reduction compared to its cost. Findings: Men and women with IDA had lower wages (by 25·9%, 95%CI: [11·3,38·1] and by 3·9%, 95%CI: [0·0,7·7] respectively) compared to those without IDA. Additional iron intake through DFS was predicted to reduce the prevalence of IDA (from 10·6% to 0·7% in men; 23·8% to 20·9% in women). The economic benefit-to-cost ratio of introducing DFS at a national level was estimated at 4·2:1.InterpretationIron fortification delivered through DFS under a universal program, can improve wages and be sufficiently cost-effective for its implementation at scale in India. Funding: International Development Research Centre [grant number-108123]. Declaration of Interest: We declare no competing interests. Ethical Approval: For the primary study from Jharkhand, institutional ethics approval was obtained from both St. John’s Medical College, Bangalore, Karnataka, India and Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India. Informed consent was obtained from all the participants.

Slow Sand Filtration for Cercariae Removal in Rural Egypt.(Dept.C)

In 1990, El-Mansoura University signed a contract with the international Development research Center IDRC to conduct an integrated research to field test the process of slow filtration. A pilot plant was constructed and installed in Sandoop Compact Water Treatment Plant in El-Mansoura City. The pilot plant consists of an intake, Up flow Roughing Filter (URF), and four SSP's. The raw water source was El-Bahr El-Saghier Canal, a branch of the Nile River. A slug of 10000 cercariae units in one liter was dropped on the water surface at each of three filters, no presence of cercariae at the final effluent of the SSF were detected. At some depths across the sand layer positive samples were identified. During this study twenty samples from the effluent of the tested slow sand filters; the URF, and the compact treatment plant were collected. Out of the 20 samples positive results showed nil after the SSF, 5 after the URF and, 3 after the compact unit. These results indicated the efficiency of the SSF in removing cercariae.

Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study

SummaryBackgroundIn 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation.MethodsWe used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status.FindingsMean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80–16·70) to 14·26 (13·85–14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22–11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90–531·08) to 492·16 (481·28–503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10–456·56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34–293·56) pre-announcement to 312·94 (296·29–329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented.InterpretationThe announcement and introduction of South Africa’s HPL were followed by reductions in the sugar, calories, and volume of beverage purchases.FundingBloomberg Philanthropies, International Development Research Centre, South African Medical Research Council, and the US National Institutes of Health.

Hibridación digital en el Cono Sur: Consumo de medios tradicionales, digitales y uso de redes sociales

&nbsp;This work offers an exploratory approach to the consumption of traditional and digital media and the use of social networks in Argentina, Chile and Uruguay. In the first place, a brief theory is offered that contextualizes the advance of new information technologies. Subsequently, with data from the International Telecommunication Union (ITU) and surveys with national probabilistic samples financed by the International Development Research Center (IDRC) of Canada, a descriptive analysis is carried out on the consumption of politicak information and the use of digital social networks. These three countries have high Internet penetration rates, broadband subscriptions and mobile Internet compared to other Latin American countries. Despite this, traditional channels such as television continue to predominate in the consumption of political information. Finally, the average age of digital media and network users is lower and there are certain sociodemographic differences by country. For example, Chile and Uruguay show greater concentration in their metropolitan areas, and a socioeconomic gap can be seen in Internet consumption in Argentina and Chile.

The Duration of Unemployment in Sub-Saharan Africa: Study Using Microeconomic Data from the Republic of Congo

The Duration of Unemployment in Sub-Saharan Africa: Study Using Microeconomic Data from the Republic of Congo Ndombi Avouba Fabrice-gilles, Kouika Bouanza Jean Roméo Félix, Ganga Zandzou Ulrich Jeanin Aymar Abstract This article aims to analyze the factors explaining the duration of unemployment in Congo. To do so, we opted for a logit model with a limited dependent variable. Using data from a survey conducted by the Laboratoire de recherches et d'études économiques et sociales du Congo (LARES) in partnership with the International Development Research Centre (IDRC) in 2018), we show that the duration of unemployment in Congo is explained in part by job search intensity.This finding has implications for economic policy. Moreover, this result can be further developed in the future by conducting an analysis of the gender determinants of unemployment duration. Full Text: PDF DOI: 10.15640/jeds.v9n1a3

AJRH gets new numbers and a social science editor.

AJRH gets new numbers and a social science editor.

The Kurds of Northern Syria: Governance, Diversity, and Conflicts: Book Review

The purpose of this paper is to present a review of The Kurds of Northern Syria: Governance, Diversity, and Conflicts written by Harriet Allsopp and Wladimir van Wilgenburg, granted by the International Development Research Center, (IDRC), Ottawa, Canada Iraq Studies (IIST), First Published in Great Britain, 2019.

Quinoa value chain, adoption, and market assessment in Morocco.

Agriculture faces many challenges such as climate change, droughts, and salinity, which requires urgent interventions for fast adaptation and diversification of the sector. In this context, introduction of new crops that tolerate stresses and generate high added value such as quinoa would allow simultaneously to address two interlinked challenges: abiotic stresses that limit agricultural production and poverty that impacts negatively the rural people. The quinoa Rehamna project funded by the International Development Research Centre aims to contribute to the development the quinoa value chain toward achieving food and nutritional security of rural poor communities. The obtained results from the farmer's survey show that 14% of surveyed farmers already grow quinoa and 2/3 never heard about quinoa, among them 96% are interested to grow quinoa. The marketing study reveals that the psychological price that satisfies most of consumers is ranging between 2 and 2.6 USD/500 g of processed quinoa seeds. The findings indicate that quinoa has a great potential for both producers and consumers in Morocco and can be a judicious solution toward achieving food and nutritional security.

Reflections from the Think Tank Initiative and their relevance for Canada

ABSTRACT From 2009–2019, the International Development Research Centre (IDRC) managed the Think Tank Initiative (TTI) as a contribution to strengthening applied research systems in Latin America, East and West Africa and South Asia. TTI’s experience supporting these organisations yielded interesting insights into how collaborations between researchers and civil society organisations can be made more effective. If we wish to see greater benefits from researcher-civil society collaborations in Canada in support of international development policy and programming, it might be time again to reflect on how to address the gap created after the closure of the North–South Institute.

Introduction to a Landscape Analysis of Multisectoral Approaches for Prevention and Control of Infectious and Vector-Borne Diseases.

The Swiss Development Cooperation, Canada’s International Development Research Centre, the Swiss Tropical Public Health Institute, and the UNICEF/United Nations Development Programme (UNDP)/World Bank/World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR) collaborated on a project to review, understand and promote the use of multisectoral approaches (MSAs) in the prevention and control of vector-borne diseases (VBDs). The objectives of the project were to support a landscape analysis of how MSAs have been used in the prevention and control of VBDs; to develop a theoretical framework for guiding the implementation of interventions; and to test the recommendations in real-life conditions. To realize these objectives, the project supported several activities, including commissioning a series of scientific reviews on MSAs in 5 thematic areas, sharing the key findings of these reviews in workshops and events, and developing a guidance framework for the implementation of MSAs. These activities have produced the theoretical framework that will be tested in real-life conditions through the support of case studies. The collaboration on implementing multisectoral activities against VBDs will continue among TDR, the Swiss Tropical Public Health Institute, and new partners such as the WHO Water Sanitation and Hygiene Group, UNDP, and UN-Habitat, in order to face the challenges identified and propose solutions tailored to specific contexts. The prevention and control of VBDs require strong and adapted MSAs with the full participation of all relevant sectors.

The health and economic burden of smoking in 12 Latin American countries and the potential effect of increasing tobacco taxes: an economic modelling study

Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. International Development Research Centre (IDRC), Canada.

Do Sugary Drink Policies Increase Purchases of Non-Calorically Sweetened Beverages? Evidence from Chile

Abstract Objectives Chile's 2016 on food labeling and advertising reduced household (HH) sugary drink purchases by 24%. However, it is unclear if this regulation was also associated with a subsequent increase in non-calorically sweetened (NCS) beverage purchases, nor who is most likely to be a top consumer of NCS beverages. Methods We used longitudinal monthly-level data from Kantar WorldPanel Chile 2015–2017 (HH = 2383) linked to yearly updated nutrition facts panel data to examine changes in NCS beverage purchases from the pre-implementation period (January 2015-June 2016) to the post-implementation period (July 2016-December 2017). Beverages were categorized into 4 mutually exclusive groups: CS: sweetened with caloric sweeteners, NCS: sweetened with non-caloric sweeteners, CS + NCS: sweetened with both sweeteners, and unsweetened. For the pre-implementation period, we used multinomial logistic regression to model HH sociodemographic predictors (head of HH educational level, HH assets, HH composition and region) of being in tertiles of NCS beverages volume purchased. We estimated the changes in beverage volume purchases between pre- and post-implementation using linear regression models adjusted for HH sociodemographic characteristics and month of data collection to account for seasonality. Results HH with higher education (35%) and HH assets (38%) were more likely to be high NCS beverages purchasers, while HH with lower education (37%) and HH assets (42%) were more likely to be low NCS beverages purchasers. After policy implementation, volume of purchases of NCS beverages increased by 6.2 mL/capita/day (95% CI: 4.7, 7.6), while volume of CS, CS + NCS and unsweetened beverages purchases decreased by 24.6 mL (95% CI: −27.5, −21.7), 4.3 mL (95% CI: −6.4, −2.2) and 16.4 mL (95% CI: −20.8, −12.1), respectively. Conclusions In Chile, people of high SES purchase more NCS beverages. After policy implementation, the volume of CS, NCS + CS and unsweetened beverages decreased while the volume of NCS sweetened beverages increased. Funding Sources Bloomberg Philanthropies, International Development Research Centre, and Chilean National Agency of Research and Development. This project was also supported by the Carolina Population Center.

Prevalence of Health and Nutrient Content Marketing Strategies on Breakfast Cereal Packages Before and After a Countrywide Marketing and Labeling Regulation: A Focus on Chile

Abstract Objectives Chile's Food Labeling Law requires packaged foods that exceed certain thresholds for sugars, saturated fats, sodium, and calories to use one or more front of package warning logos identifying the excessive nutrient, and restricts the use of nutrient claims (e.g., lower sugar) contradicting its warning (e.g., high in sugar). We examined health- and nutrition-related marketing on breakfast cereals packages that did vs. did not qualify for a “high in” logo in packages photographed before and after the law implementation. Methods Photographs were taken in 6 supermarkets in Santiago before (n = 168) and after (n = 146) implementation. Breakfast cereals were classified by whether or not they had high levels of sugar, sodium, saturated fat, or calories according to the regulation, and thus were required to carry a warning label. Packages were analyzed for the presence of low-in and high-in nutrient claims and the following health appeals: health benefits, general healthiness, healthy habit recommendations, and medical endorsements. Results About 79% of products at pre-implementation and 59% of products at post-implementation qualified as “high in.” Of the post-implementation “high in” products, 93% displayed at least one warning logo. Comparing pre-implementation vs. post-implementation, the percentage of “high in” products that used at least one nutrient claim (92% vs. 86%) or health appeal (81% vs. 77%) did not change significantly. However, low-in claims (51% vs. 29%) and health benefit claims (10% vs. 1%), specifically, decreased after implementation, P &amp;lt; .05. Among “non high in” packages, the percentage of products that used health appeals (75% vs. 95%) increased post-implementation, P &amp;lt; .05. Medical endorsements, specifically, were less prevalent at post-implementation among both “high in” (from 23% to 0%) and “non high in” products (from 25% to 5%), P &amp;lt; .05. Conclusions After implementation of the Chilean law, 93% of “high in” breakfast cereal packages complied with the use of warning logos. Featuring these warnings appears to have reduced the prevalence of “low in” claims among “high in” cereals. However, the law did not appear to affect the prevalence of other health- and nutrient-related marketing strategies. Funding Sources Bloomberg Philanthropies, International Development Research Center, and Chilean National Agency of Research and Development.