Intrahousehold Food Distribution Research Articles

Seasonal Variations in Food Insecurity Prevalence of Mother-Child Dyads in Seme Sub-County, Kisumu, Kenya

Food insecurity remains a major impediment to the attainment of adequate health outcomes among the population. This is attributable to the adverse implications that food insecurity poses on the nutritional status of the populations. Globally, in the year 2021, an estimated population of 3.1 billion people (42%) faced unprecedented food crisis evident by inability to afford a healthy meal. Meanwhile, global rates of stunting attributable to food insecurity among children under the age of sixty months was 22.3%. In Kenya, close to 32% of the populations are acutely food insecure and require urgent food insecurity interventions. Kisumu County is a food import county; hence, decline in food supplies in the counties depends on for food supply results in food crisis amongst its populace. Women and children are disproportionately affected by food insecurity due to gender and age-related factors. Rural populations are often worse affected by food insecurity as evident by high rates of stunting experienced in rural areas when compared to overweight rates that are more in urban areas. It is on this basis that we sought to assess the prevalence of food insecurity among mother-child dyads drawn from Seme Sub-County, a rural area in the County of Kisumu, Kenya. We used a longitudinal study design adopting repeated cross-sectional measures to assess food security status of a sample of 201 mother-child pairs during planting and harvesting seasons. Food security status of mothers was assessed quantitatively using Household Food Insecurity Access Scale. Children’s food security status was assessed using Prevalence of Undernourishment as indicated by the anthropometric measurements. Qualitative data were further synthesized using Key Informant Interviews and Focus Group Discussions to complement quantitative data on prevalence of food insecurity among mother-child dyads. Data was analysed descriptively to indicate proportions of mothers and children depicting various food insecurity classifications. The mean HFIAS score for season I; 11.22 (± 5.36 SD) was statistically significantly different (higher) than mean HFIAS score for season II; 9.63 (± 5.18 SD) at α ≤ 0.05 (t-test: p=0.003). During planting season, a majority of the mothers; 134 (70.9%) experienced severe food insecurity prevalence and during harvesting season, a majority of the mothers; 117 (61.9%) experienced severe food insecurity prevalence. In planting season, almost three-quarters of the children; 137 (72.5%) were food secure as they had normal weight-for-age Z score (were not underweight). On the other hand, slightly higher than average; 102 (54.0%) of the children were food secure during harvesting season. These findings demonstrate suboptimal variations in prevalence of food insecurity across the two seasons. Mothers were more likely to experience severe food insecurity prevalence than children. Thus, there is a need to develop adequate interventions aimed at optimizing intra-household food distribution dynamics as means of ensuring adequate food security for both mothers and children in the study area

Integrating nutrition in the Sasakawa Africa Association extension services: Knowledge, attitude and practices among smallholder farmers

This survey aimed to establish nutrition-related knowledge, attitudes and practices, and to observe how gender influences household food-related decision-making processes in the Sasakawa Africa Association (SAA) intervention areas in the Oromia and Southern Nation Nationalities and People regions of Ethiopia. The findings would inform implementation of communication for nutrition social and behaviour change among small-holder farmers as part of the SAA corporate strategy on nutrition-sensitive agriculture. The study population was smallholder farmers supported by SAA from which 311 respondents were selected through multistage sampling. Data were collected via a mixed methods approach consisting of a household survey, focus group discussions (FGDs) and key informant interviews (KIIs). Quantitative data were analysed using descriptive statistics while qualitative data was analysed using a narrative and content approach. The study focused on knowledge, attitudes and practices related to production and consumption of micronutrient-rich foods. Majority (59.5%) of the respondents were male. Men were the main decision makers on staple or commercial food crop production and proportion of produced crops to be consumed at home or sold in the market. Women mainly made decisions regarding production and consumption of fruits and vegetables, intra-household food distribution, preservation and storage. There was a lack of knowledge on iron and vitamin A fortified or biofortified sources of food. Nearly three quarters (72%) of women did not meet the minimum dietary diversity for women, a proxy indicator of adequacy of micronutrient intake and diet quality. The mean dietary diversity score was 3.8 with animal source foods being the least consumed. Not having sufficient money to buy food, unavailability of different food groups and poor intra-household food distribution were among the key reasons for lack of diverse diets. Majority of the respondents were aware of the importance of production and consumption of micronutrient-rich foods. However, there was a gap in practice and awareness about biofortified and fortified foods. While most of the respondents had produced fruits and vegetables in home gardens in the three months prior to this survey, more than half (54%) of the respondents thought it was not likely that they would produce fruits and vegetables for home consumption. More targeted nutrition campaigns are required to increase the ability of small-holder farmers to adopt best practices while reducing the barriers associated with access and consumption. Promotion of fruit and vegetable production in home gardens could be considered as option for improving household dietary quality as well as empowering women to make more decisions. Key words: Sasakawa Africa Association, Small-holder farmers, Nutrition, Knowledge, Practices

Is Responsive Feeding Difficult? A Case Study in Teso South Sub-County, Kenya.

Responsive infant and young child feeding as a reciprocal relationship between the child and his or her caregiver is recommended by the WHO but has received less attention than dietary diversity or meal frequency up to now. The current study assessed common (non)responsive child feeding practices and factors that facilitate or hinder caregivers to improve feeding practices in rural Teso South Sub-County, Western Kenya. The qualitative study used focus group discussion (n = 93) and Trials of Improved Practices (TIPs) (n = 48) to identify challenges and opportunities in household food distribution and feeding practices. Overall, the implementation of responsive feeding practices was feasible for the caregivers. Parents reported mainly positive experiences in terms of the child's feeding behavior and effects on child health. Traditional beliefs, practices, and cultural norms hindered some households to change intrahousehold food distribution. Households who manage to implement responsive feeding even in food insecure regions should be consulted to (a) improve existing nutrition education messages that acknowledge these cultural norms, (b) to include more responsive feeding information in nutrition education material, and (c) to address gender norms to create awareness of the importance of responsive feeding practices and the need for adequate time allocation for infant and young child feeding.

Comparative Analysis of Food Security Measures by Vitamin A-rich Food Consumption Among Mother-Child Dyads in Uganda

ObjectivesThis study examined mother-child differences in vitamin A-rich food consumption and conduct a comparative analysis of three food security indicators on household vitamin A-rich food consumption for 375 mother-child dyads from selected sweet potato growing households in Uganda. MethodsThis study examined baseline data collected by the International Potato Centre (IPC) for an initiative on the development and delivery of biofortified crops in Uganda. Dietary intake and livelihoods data was collected from women residing in households that grew sweet potatoes in selected regions in Uganda. Eligibility criteria included women who were pregnant or lactating and/or had children 6–24 months. The analytical dataset had 375 woman-child dyads. An adjusted Hellen Keller International (HKI) guide was used to examine data on vitamin A consumption. Scores were weighted for animal- and plant-based sources of vitamin A. Data were stratified by woman or child to allow for within- and between-person variances in vitamin A-rich food consumption. Dependent sample Student’s t-tests, Pearson’s correlation analysis and a repeated measure analysis of covariance (ANCOVA) tested for differences in the vitamin A-rich food consumption mother-child dyads. ResultsThere was a statistically significant difference in the mean consumption of vitamin A-rich foods for women and children (F (1,370) = 6.51, p = .011). Women had a higher vitamin A consumption (M = 2.08, SD = 2.11) than children in the same household (M = 1.39, SD = 2.17). This was qualified by a significant interaction with the household wealth index (F (1,370) = 4.31, p = .039), however not with household dietary diversity (F (1,370) = 3.16, p = .07), and household food insecurity access (F (1,370) = 0.32, p = .57). HDDS and the wealth index were associated with the mother’s consumption of vitamin A-rich food but not with the children’s. ConclusionsInitiatives that target mother-child dyads should be aware of factors such as intrahousehold food distribution and cultural practices that may differentially impact child consumption of vitamin A-rich and other micronutrient-rich foods. Child-friendly initiatives are recommended to maximize nutritional benefits for children under five years. Funding SourcesInternational Potato Center and the University of Massachusetts Amherst.

Nutritional Status and Intra-household Food Distribution Among Reproductive-Age-Group Women in a Slum Area of Hooghly District, West Bengal: A Mixed-Methods Approach.

IntroductionMalnutrition among women of reproductive age (WRA), especially those living in slum areas, is one of the most concerning nutritional issues because of the extreme nutritional stress they face in the form of inequitable intra-household food distribution (IHFD). This study aimed to assess the nutritional status (NS) and its association with IHFD among reproductive-age-group women along with exploring the perspectives of the stakeholders regarding inequitable food distribution.Materials and methodsThe quantitative part of the convergent parallel mixed-methods design study was conducted among 150 WRA, selected by cluster random sampling from 15 slum areas of Hooghly District, between December 2020 and May 2021. Data were collected using a predesigned pretested schedule with anthropometric measurements. IHFD was quantified by the relative dietary energy adequacy ratio (RDEAR). Ordinal logistic regression was performed to obtain adjusted-proportional odds ratios (aPOR) for higher categories of NS (underweight: reference category). Stratified subgroup analysis was done to assess the influencers of IHFD. For the qualitative part, in-depth interviews were conducted with eight purposively selected in-laws of study participants, and the data were interpreted by thematic analysis.ResultsThe mean age of the study participants was 28.6±6.3 years. The proportion of malnutrition and inequitable IHFD (RDEAR<1) among them was 50% and 46%, respectively. Higher categories of NS were found to be significantly associated with an increase in RDEAR (aPOR=22.6, 95% CI: 2.75-185.45, p-value=0.004). Among underweight and normal NS women, those who were earning members and directly involved in food preparation/production had a greater allocation of food within their households. Physiological intolerance, incapacity of earning, and traditional customs were the most recurring themes transcribed as the barriers to equitable food distribution.ConclusionA high magnitude of malnutrition and its association with inequitable IHFD among WRA warrant policy-level support to increase women's employment opportunities and address gender-based inequities through comprehensive information education communication (IEC) techniques as well.

Improving Diets Requires a Shift in Attitudes Related to Gender Roles and Relations: Formative Research to Inform Social Behaviour Change Initiatives in Sri Lanka

ObjectivesWith all forms of malnutrition remaining problematic in Sri Lanka, evidenced-based social behaviour change (SBC) interventions have been identified as an underutilized entry point to help improve food security and nutrition outcomes. In this study, we describe formative research findings derived from a qualitative ethnographic approach to inform gender-responsive nutrition SBC interventions. MethodsThis study was conducted in six regions of Sri Lanka, capturing diverse population segments. Data collection used focus group discussions, in-depth interviews, and kitchen audits to understand food environments and consumption habits as well as attitudes toward, and perceptions of, food and nutrition. Participants included women of reproductive age, adolescent girls and boys, male and female influencers, and health care workers. ResultsDeep-rooted patriarchal structures continue to prevail in Sri Lanka and gender differences in, and influence on, nutrition-related behaviours were evident throughout this study. These traditional roles and expectations are reinforced by the media. Men were typically responsible for providing economic resources to procure food, while women continue to bear the responsibility of acquiring and preparing it. Although women, who overall had relatively good knowledge about healthy eating, made most decisions related to food, the influence of men and children’s preferences, which tended to be based on taste rather than nutritional value, took precedence. Gender inequalities related to the intra-household distribution of food favouring men and boys, both in terms of quality and quantity were highlighted. Important geographical differences in the barriers and facilitators to nutrition-related behaviour were also identified (e.g., media habits, social perceptions, lifestyle changes, and access to information and food). Education and communication initiatives tailored to challenging local gender stereotypes and notions of masculinity, especially as they related to food and nutrition, will be critical in efforts to build a movement to promote healthier diets. ConclusionsThe findings from this study should be integrated into the design and dissemination of tailored SBC messages in Sri Lanka. Failing to do so has the potential to further exacerbate nutrition and gender inequalities. Funding SourcesWFP

A Child with Chronic Severe Malnutrition in a Tribal Village of Maharashtra– A Case Study

The first 1000 days of a child’s life are important for his/her long-term physical, mental and emotional development especially from a nutritional perspective. Inadequate nutrition during this phase can have severely negative consequences like impaired intellectual development.1General under-nutrition is more prevalent amongst rural children, scheduled castes and tribes, and amongst children with illiterate mothers. The contributing factors among these children are household food insecurity and intra-household food distribution, poor diets, inadequate preventative and curative health services and insufficient knowledge of care and infant feeding practices.

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (<7% and <3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (< 7% and < 3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Ethiopia's high childhood undernutrition explained: analysis of the prevalence and key correlates based on recent nationally representative data.

To examine the contribution of child, maternal and household factors in stunting, wasting and underweight among children under 5 years in Ethiopia. Quantitative cross-sectional design based on nationally representative data. Urban and rural areas of Ethiopia.ParticipantsYounger (0-24 months; n 4199) and older age groups (25-59 months; n 5497), giving a total of 9696 children. Among the younger age group, 29 % were stunted, 14 % were wasted and 19 % were underweight; and among the older age group, the prevalence of stunting, wasting and underweight was 47, 8 and 28 %, respectively. Being female, intake of multiple micronutrients, household having a piped source of drinking-water, high maternal BMI, higher household wealth and higher maternal education were associated with decreased odds of at least one form of undernutrition in both groups. On the other hand, children who were anaemic, had low birth weight, drank from a bottle, and children of stunted or wasted or working mothers were more likely to be stunted, wasted or underweight in both groups (P&lt;0·05). While most predictors and/or risk factors followed a similar pattern across the two age groups, child factors had higher leverage in the younger than the older group across the three forms of undernutrition. Multiple set of factors predicted childhood undernutrition in Ethiopia. The study underscores the importance of intervening in the first 1000 days through promoting maternal education, maternal-child health services, mother's nutrition and improving intrahousehold food distribution.

Gender and nutrition security.

Abstract Many studies on nutrition that include gender do not take it further than observing male-female differences. In this review, I use the concept in the sociological sense and I conceptualize nutrition as embedded in household food security and pertaining to (gendered) performances that require resources. Using both quantitative data on associations and trends as well as qualitative findings that reveal mechanisms and subjectivities, I structure the discussion along three subject clusters of gender-nutrition interfaces, i.e. 'women's nutrition and gender inequalities'; 'food care'; and 'sons and daughters'. Regarding the first cluster, I found that because of women's hegemonic role in family food care and their often being relationally defined as mothers, their own nutritional needs tend to be considered instrumentally rather than as a matter in its own right. Gender inequalities affect women's nutrition through unfavourable intra-household food distribution patterns and poor access to crucial resources such as safe water and health care. They have an impact on women's care-giving abilities, and cause unequal treatment of sons and daughter. There is ample evidence that gender inequalities can propel an intergenerational cycle of female undernutrition. Because of the inequalities' entrenchment in daily life and in institutional frameworks, there are no easy solutions. However, female education (typically referred to as 'maternal' education) has been proven to alleviate the undernutrition of women and children. Finally, I conclude that gender inequality is a neglected aspect in defining sustainable nutrition and the relationship between women's nutrition and their reproductive rights a missing topic in the literature.

Intra-household nutrient inequity in rural Ethiopia

BackgroundFood assistance interventions directed at households may miss undernourished individuals if intra-household equity in nutrient allocation is assumed. A recent study from Ethiopia revealed that, while all age groups consumed calories in proportion to their fair share, iron and protein were inequitably allocated among household members. Further exploration of individual and household characteristics associated with these allocation patterns is necessary to gain a more complete understanding of existing disparities. ObjectiveThis paper sought to quantify energy, protein, and iron allocation inequity between four age and sex groups of household members (children and adults) commonly assumed to be disadvantaged versus preferentially treated in intra-household resource distribution. It then sought to identify individual and household factors that explained the inequity of intra-household nutrient allocation among these paired groups. MethodsData from a survey of 1185 households located in rural Oromiya and SNNPR regions of Ethiopia. A single quantitative 24-hour household-level dietary recall was collected from the primary food preparer who reported the proportion of household food distributed to each household member. Continuous ratios of relative calorie, protein, and iron adequacy for four pairs of age-sex groups (any child vs. any adult, any child vs. adult male, female child vs. male child, and adult female vs. adult male) in the household were computed and compared, along with a binary indicator of inequity. Logistic regressions and standard linear regression with Huber-White heteroscedasticity-adjusted standard errors were run to determine the predictors of household inequity for each pair-group and nutrient, on the full sample as well as on nutrient inadequate households. ResultsCommon assumptions about inequitable distribution of nutrients within households were not consistently supported by this analysis. Significant intra-household nutrient inequities did exist in these rural Ethiopian households for certain nutrients, but household subgroups commonly presumed to be nutritionally vulnerable in the Ethiopian context were not always affected by detrimental inequity. Generally, household inequity favored children over adults or adult males, and female children over male children for protein consumption. Inequities were greatest against presumed vulnerable groups (adult women, children) for ‘invisible’ nutrients (iron) rather than calories or protein. There were relatively few households in which one of the interest groups (groups presumed vulnerable) experienced inequitable nutrient allocation and nutrient inadequacy. The number of households where inequity was present for a subgroup who also experienced nutrient inadequacy while the reference group (group presumed to be preferred) was nutrient adequate was negligible, suggesting that in very few of these household are there members who are “haves”, benefiting nutritionally to the nutritional detriment of “have nots”. The analysis of determinants did not reveal any single, consistent set of factors driving decisions across all pair groups and nutrients, but these factors were not substantially different for households that were and were not nutrient adequate. Household dependency ratio, higher relative male education, female household headship, and women’s decision-making power provided mixed results for pairwise comparisons. ConclusionsThe variable pattern of nutrient inequities underscores the risk of overlooking intra-household nutrient allocation disparity or making assumptions about a particular intra-household food and nutrient distribution pattern in any context where programs are intended to benefit particular household members.

Cultural Norms and Son Preference in Intrahousehold Food Distribution: A Case Study of Two Asian Rural Economies

Based on the cost and content of individual calorie intake, I find evidence of son preference in food distribution in rural Bangladesh but not in the rural Philippines, which is consistent with the contrasting cultural norms of these two agrarian societies. Unlike in the Philippines, few females in Bangladesh, a male‐dominated patriarchal society with the strong presence of dowry and purdah systems, seem to participate in the labor market. Gender differences in wage rates appear to be prominent in Bangladesh as well, and the transfer at marriage from a bride's family seems to exceed that from a groom's family. In Bangladesh, the village wage rate of adult females is positively associated with a girl's allocation from the animal food group, while village wage rates of adult males are negatively associated. However, no such association is observed in the Philippines, which is characterized by egalitarian values between the sexes. In recent marriages in Bangladesh, a village's average value of transfers from grooms' families is also positively associated with a girl's allocation. While higher birth order children fare worse than lower birth order children in both economies, in Bangladesh a higher birth order girl does worse than a higher birth order boy, whereas this is not the case in the Philippines. The son preference does not seem to be associated with scarcity, as it is prominent in non‐poor Bangladeshi households but not in poor ones; the preference does not appear in either category in the Philippines. A Bangladeshi village's access to television, which I use as a proxy for liberal values, is positively associated with girls' calorie allocations.

The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial.

BackgroundNutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition.MethodsNEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2–5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child’s height-for-age z-score (HAZ) and maternal body mass index (BMI).DiscussionBecause previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy may be enhanced through vicarious and active mastery of experiences gained during six sessions of nutrition education and verbal persuasion during home visits.Trial registrationThe Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is allocated the registration number: ACTRN12615001243505 on 12 November 2015.

Relationship between intra-household food distribution and coexistence of dual forms of malnutrition.

BACKGROUND/OBJECTIVESThe relationship between food intake and nutritional status has been clearly established. Yet, there are only limited studies on food intake among family members and their nutritional status. The study examined the relationship between intra-household food distribution and coexistence of dual forms of malnutrition (DFM) in the same household.SUBJECTS/METHODSHouseholds with a malnourished child and overweight mother were categorized as DFM. Intra-household food distribution among family members was reported using ratios, which are a measure of individual intakes as compared to all household member intakes adjusted to RDA.RESULTSA 1,899 families were included in the study. The prevalence of DFM was 29.8% (95%CI 26.5-31.2). Children consumed lower amounts of energy (OR 1.34; 95%CI 1.06-1.69, P = 0.011), carbohydrates (OR 1.2; 95%CI1.03-1.61, P = 0.022), protein (OR 1.3; 95%CI 1.03-1.64, P = 0.026), and fat (OR 1.3; 95%CI 1.05-1.66, P = 0.016) than their mothers and other family members. In contrast, mothers consumed more carbohydrates than children and other family members (OR1.24; 95%CI 1.02-1.51, P = 0.03).CONCLUSIONSThis study is the first to report on the food distribution among family members and its relationship with occurrence of DFM in Indonesia. The results confirm the occurrence of an unequal food distribution between children and mothers, which increases risk of DFM in the household. The results also demonstrate that nutritional education at the household level is important to increase awareness of the impact of DFM.

Exploring Vulnerability of Undernutrition among Wives

Generally, at household level, cultural norms and practices regarding intra-household food allocation and distribution, and other demographic and socio-economic factors determine the extent of nutritional status among women. Arguably, husbands’ background attributes such as educational attainment, employment, nutritional status and health habits such as smoking and drinking could also contribute in determining their wives’ nutritional status. It was hypothesized that risk of undernourishment is higher among wives whose husbands are less educated, engaged in low-paid jobs, undernourished and possessing unhealthy lifestyle. Using data from the third round of National Family Health Survey, 2005–06, a nationally representative cross-sectional survey that provided information on BMI level of 34,062 couples, the present study found that the prevalence of undernutrition among wives was high cutting across husbands’ differential attributes as well as other social, economic and cultural covariates. Protective factors include husbands’ tertiary employment, husbands’ well nourishment and healthy lifestyle, high social and economic status and living in urban areas. Programmes and policies should focus on the issues related to household nutritional status instead of focusing only women and children of a household.

Estimating the impact of vitamin A-fortified vegetable oil in Bangladesh in the absence of dietary assessment data.

Vitamin A deficiency is a serious health problem in Bangladesh. The 2011-12 Bangladesh Micronutrient Survey found 76·8% of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative--household income and expenditure survey data--to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh. Items in the household income and expenditure survey were matched to food composition tables to estimate households' usual vitamin A intakes. Then, assuming (i) the intra-household distribution of food is in direct proportion to household members' share of the household's total adult male consumption equivalents, (ii) all vegetable oil that is made from other-than mustard seed and that is purchased is fortifiable and (iii) oil fortification standards are implemented, we modelled the additional vitamin A intake due to the new fortification initiative. Nationwide in Bangladesh. A weighted sample of 12,240 households comprised of 55,580 individuals. Ninety-nine per cent of the Bangladesh population consumes vegetable oil. The quantities consumed are sufficiently large and, varying little by socio-economic status, are able to provide an important, large-scale impact. At full implementation, vegetable oil fortification will reduce the number of persons with inadequate vitamin A intake from 115 million to 86 million and decrease the prevalence of inadequate vitamin A intake from 80% to 60%. Vegetable oil is an ideal fortification vehicle in Bangladesh. Its fortification with vitamin A is an important public health intervention.

English

In spite of being the principal producers of food, women and child girls are often suffer from malnutrition and hunger. Most of the discussions regarding their food insecurity have focused so far on the intra-household access and distribution of food. This article analyzes the broader spectrum of gender dimensions of inter and intra-household entitlement to food. This study conducted in the far-western region of Nepal, which is established as a resource poor region, shows the institutions such as patrilinearity, patriarchal inheritance law, patrilocality and early marriage, the cultural norms, discriminatory food distributional practices, caste and ethnicity still function among some categories women in terms of land ownerships, share tenancy, acquiring sufficient and nutritious food, wage and employment, and credit, resulting their entitlement failure. At a time, this article discusses how new initiatives such as market, women’s self-help agencies, Government’s new policy and NGOs have been playing crucial role to change in the institutions that resulted into women’s capability enhancement.

Intrahousehold Distribution of Food: A Review of the Literature and Discussion of the Implications for Food Fortification Programs

The selection of food vehicles and fortification levels in food fortification programs may be made on the assumption of equitable intrahousehold distribution of food. There are concerns that biased intrahousehold distribution of food will make food-based interventions ineffective or unsafe. To review available data documenting intrahousehold energy intake (as a proxy for food distribution) in low- and middle-income countries, and discuss the relevance for food fortification programs. A literature search was done, selecting reports from low- and middle-income countries that included dietary data from adults and children. The references of relevant reports and all citations of relevant reports were scanned. Intrahousehold distribution of dietary energy was compared with individual energy requirements. Twenty-eight studies were identified covering 18 countries with as few as 20 and as many as 3,000 households per study. Intrahousehold distribution of food in most countries is relatively equitable, within a 20% margin. Within the limits of the available data, and in the absence of contrary data, it is reasonable to assume equitable intrahousehold distribution of food when designing food fortification programs; however, for program evaluation, individual assessment of intake is still needed.

Estimating Micronutrient Intakes from Household Consumption and Expenditures Surveys (HCES): An Example from Bangladesh

Globally, there is a scarcity of national food consumption data that could help to assess food patterns and nutrient intakes of population groups. Estimates of food consumption patterns and apparent intakes of energy and nutrients could be obtained from national Household Consumption and Expenditures Surveys (HCES). To use the HCES conducted in Bangladesh in 2005 (HIES2005) to estimate apparent intakes of vitamin A, iron, and zinc. Food acquisition data from HIES2005, which surveyed 10,080 households, were transformed into standard measurement units. Intrahousehold food and nutrient distribution was estimated with Adult Male Equivalent (AME) units. Adequacy of intake was assessed by comparing individual nutrient intakes with requirements and was then aggregated by households. The weighted mean energy intake for the population was 2,151 kcal/person/day, with a range among divisions from 1,950 in Barisal to 2,195 in Dhaka division. The apparent intakes of vitamin A and iron were insufficient to satisfy the recommended intakes for more than 80% of the population in Bangladesh, while apparent intakes of zinc, adjusted by bioavailability, satisfied the requirements of approximately 60% of the population. Using the HIES2005, we were able to produce estimates of apparent food consumption and intakes of some key micronutrients for the Bangladeshi population and observed wide differences among divisions. However, the methodological approaches reported here, although feasible and promising, need to be validated with other dietary intake methods.