Nutrition-sensitive Interventions Research Articles

Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria

BackgroundNational programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states.MethodsA validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it.ResultsOf the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively).ConclusionsThe final roadmap comprises of actions that are appropriate for the state’s context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.

A qualitative analysis of perceptions of various stakeholders on nutrition-sensitive agricultural interventions, including the taxation on sugar-sweetened beverages (SSBs), to improve overall health and nutrition in South Africa

BackgroundAs a low-middle income country, South Africa has seen an upsurge in the double burden of malnutrition (DBM). Owing to the rising costs of obesity on healthcare in South Africa, the National Treasury implemented a fiscal policy for the taxation of SSBs, known as the Health Promotion Levy, in line with the WHO recommendation. Potential negative impacts of the policy on the sugar cane industry and economic and rural development have been voiced by different sectors. By including a subsection in the SSBs fiscal policy and aligning the goals with existing policies, government could have made provisions for sugar cane farms to substitute crops with alternatives, including nutritional alternatives where possible, while supporting existing small-scale farms to produce nutrient-dense, local and culturally acceptable crops. Thus, the purpose of the study is to understand the perceptions of the various stakeholders on combining nutrition-sensitive agricultural interventions with the taxation on sugar-sweetened beverages (SSBs) to improve overall health and nutrition in South Africa.MethodsSemi-structured, in-depth interviews were conducted with each participant. The interviews were audio-recorded, transcribed intelligent verbatim, and cross-checked against the audio-recordings by the principal researcher. ATLAS.ti 8 software was used to navigate the data and assist with thematic analysis.ResultsPerceptions of combining SSB taxation with agricultural policies to improve food and nutrition security were positive. The participants found it to be an innovative idea in theory but questioned the feasibility of combining policies. Participants highlighted education as an essential element for successfully changing behaviour to ensure a positive impact of the combined policy approach. Participants believed that before government could scale up nutrition-sensitive agricultural interventions, basic services and government functions would first need to run optimally.ConclusionOverall, perceptions with regard to combining the taxation on SSBs with nutrition-sensitive agricultural policies to improve overall health and nutrition in South Africa were positive. Although participants questioned the feasibility of combining these policies, it was viewed as a way to combat alleged collateral damage linked to the tax, with a specific focus on developing small-scale farmers. More research into these combined policy approaches in a South African context is required.

A Review of Leadership and Capacity Gaps in Nutrition-Sensitive Agricultural Policies and Strategies for Selected Countries in Sub-Saharan Africa and Asia

Agriculture policies and strategies designed, purposefully, to address malnutrition are considered nutrition-sensitive and are a critical component of global efforts to address malnutrition in all its forms. However, limited evidence exists on extent and how nutrition is being integrated into agriculture sector policies, strategies, and programs. A review was conducted to address 2 questions: How nutrition-sensitive are agriculture policies, plans, and investments in selected Sub-Saharan African (SSA) and Asian countries? and Which capacity and leadership gaps limit scale up of nutrition-sensitive agriculture policy and programs? The review of existing policies was conducted for 11 selected focus countries (9 in SSA and 2 from Asia) of the CGIAR (Consultative Group on International Agricultural Research) Collaborative Research Programme on Agriculture for Nutrition and Health led by the IFPRI (International Food Policy Research Institute). The Food and Agriculture Organization (FAO)'s 10-point key recommendations for designing nutrition-sensitive agricultural interventions was used as an analytical framework. Additionally, a rapid systematic review of published peer-reviewed and grey literature was carried out to identify capacity gaps based on the United Nations Development Program's capacity assessment framework. We found that there is nutrition sensitivity of the policies and strategies but to varying degrees. There is limited capacity for optimum implementation of these policies, programs, and strategies. For most of the countries, there is capacity to articulate what needs to happen, but there are important capacity limitations to translate the given policy/program instruments into effective action. The gaps identified constitute important evidence to inform capacity strengthening of nutrition-sensitive actions for desired nutrition and health outcomes in Africa and Asia.

Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

Safety nets are expanding in African countries as a policy instrument to alleviate poverty and food insecurity. Whether safety nets have improved household food security and child diet and nutrition in sub-Saharan Africa has not been well documented. This paper takes the case of Ethiopia's Productive Safety Net Program (PSNP) and provides evidence of the impact of safety nets on household food security and child nutritional outcomes. Prior studies provide inconclusive evidence as to whether PSNP has improved household food security and child nutrition. These studies used analytical approaches that correct for selection bias but have overlooked the effect of time-varying confounders that might have resulted in biased estimation. Given that household food security status is both the criteria for participation and one of the desirable outcomes of the program, estimating the causal impact of PSNP on household food security and child nutrition is prone to endogeneity due to selection bias and time-varying confounders. Therefore, the objectives of this paper are (1) to examine the impacts of PSNP on household food security, child meal frequency, child diet diversity, and child anthropometry using marginal structural modeling approach that takes into account both selection bias and time-varying confounders and (2) to shed some light on policy and programmatic implications. Results show that PSNP has not improved household food insecurity, child dietary diversity, and child anthropometry despite its positive impact on child meal frequency. Household participation in PSNP brought a 0.308 unit gain on child meal frequency. Given the consequence of food insecurity and child undernutrition on physical and mental development, intergenerational cycle of poverty, and human capital formation, the program would benefit if it is tailored to nutrition-specific and nutrition-sensitive interventions.

Food and Nutritional Security through Nutrition-Sensitive Interventions in the Hills of Uttarakhand, India

Food and Nutritional Security through Nutrition-Sensitive Interventions in the Hills of Uttarakhand, India

“In the past, the seeds I planted often didn’t grow.” A Mixed-Methods Feasibility Assessment of Integrating Agriculture and Nutrition Behaviour Change Interventions with Cash Transfers in Rural Bangladesh

Combining agriculture with behaviour change communication and other nutrition-sensitive interventions could improve feeding practices to reduce maternal and child undernutrition. Such integrated intervention requires rigorous design and an appropriate implementation strategy to generate an impact. We assessed feasibility and acceptability of an intervention package that combines nutrition counselling, counselling and support for home-gardening, and unconditional cash transfers delivered to women on a mobile platform for improving maternal and child nutrition behaviours among low-income families in rural Bangladesh. We used mixed-methods including in-depth interviews with women (20), key-informant interviews with project workers (6), and a cross sectional survey of women (60). Women well-accepted the intervention and reported to be benefited by acquiring new skills and information on home gardening and nutrition. They established homestead gardens of seasonal vegetables successfully and were able to find a solution for major challenges. All women received the cash transfer. Ninety-one percent of women spent the cash for buying foods, 20% spent it on purchasing seeds or fertilizers and 57% used it for medical and livelihood purchases. Project staff and mobile banking agent reported no difficulty in cash transfer. Combining nutrition-specific and -sensitive interventions is a feasible and acceptable approach. Using mobile technologies can provide additional benefits for the intervention to reach the disadvantage families in rural settings.

Predictors of Program Participation in a Nutrition-Sensitive Agroecological Intervention in Singida, Tanzania

Abstract Objectives Nutrition-sensitive agricultural interventions are theorized to improve child's diet through asset provision and program participation. Although some programs measure participation, predictors of participation are understudied. We therefore investigated predictors of men's and women's program participation in Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876). Methods In SNAP-Tz, ‘mentor farmers’ led their peers (smallholder farmers with children < 1 year at baseline) in learning about agroecology, nutrition, and gender equity through meetings and household visits. At baseline, we collected data on demographics, Household Food Insecurity Access Scale (0–27), men's involvement in 7 household tasks (0–7), and Abbreviated Women's Empowerment in Agriculture Index (AWEAI). Participating men (n = 262) and women (n = 283) were asked to recall their program participation biannually. Predictors of high participation, defined as attendance in ≥60% participant meetings and household visits, were identified using multiple logistic regressions, controlling for clustering at the village level. Results Only 59% and 37% of women and men, respectively, had high participation. Women's high participation was associated with their spouse's participation (OR = 4.23, P < 0.01), greater food insecurity (OR = 1.03, P = 0.03), years of education (OR = 1.13, P = 0.02), and being empowered (OR = 5.88, P < 0.01). Men's high participation was associated with their spouse's participation (OR = 4.22, P < 0.01), greater food insecurity (OR = 2.23, P = 0.01), involvement in household tasks (OR = 1.25, P = 0.04), and age (OR = 1.03, P < 0.01). Conclusions Associations between an individual's and their spouse's participation indicate the importance of spousal dynamics. The association between participation and baseline gender equity (i.e., women's empowerment, men's involvement in household tasks) highlights the challenges of gender programming in nutrition-sensitive interventions. Analysis of program participation was simple and revealed valuable lessons for program implementation and design; more programs should therefore analyze participation. Funding Sources This study was funded by the McKnight Foundation, the Borlaug Fellowship in Global Food Security Research, and NIH K01 Award.

Participatory Exploration of the Heterogeneity in Household Socioeconomic, Food, and Nutrition Security Status for the Identification of Nutrition-Sensitive Interventions in the Rwandan Highlands

Food insecurity and malnutrition are challenges in rural Rwanda that are presumed to be affected by differential household socioeconomic status, but the relationship between food and nutrition security and socioeconomic status is not well-understood. We used a participatory and multidisciplinary study comprising nutrition survey, focus group discussion (FGD), detailed household/farm characterization, and interviews to construct a participatory household typology and to determine differences in the socioeconomic, food, and nutrition security status of 17 households representing the identified household types in Nyabihu District of Western Province. Strategies to improve household food and nutrition security were identified by the case study households themselves. During the FGDs, it was hypothesized that financial, physical, and natural capitals varied, resulting in high, medium, and low resource endowed households, abbreviated as HRE, MRE, and LRE, respectively. The HRE households had the most educated household heads, largest landholdings (~1 ha), and highest agricultural biodiversity and total farm income per annum. This probably resulted in better diets for women, children higher household food consumption relative to the other households. In contrast, the LRE households were the least food-secure, with poor household food consumption and low dietary diversity across seasons, probably due to limited physical and economic access to food. However, anthropometry of women and children did not differ with household type. Half of the children were stunted, including some from the more food-secure HRE households. Undiversified, nutritionally inadequate diets and bouts of illness likely contributed to chronic malnutrition in children. Making agricultural programs more nutrition-sensitive, creating diverse employment opportunities, and sensitizing communities to nutrition and adequate feeding practices of children could complement the interventions identified by households to improve their food and nutrition security.

Child Undernutrition and Convergence of Multisectoral Interventions in India: An Econometric Analysis of National Family Health Survey 2015-16.

In India and worldwide, there has been increased strategic focus on multisectoral convergence of nutrition-specific and nutrition-sensitive interventions to attain rapid reductions in child undernutrition. For instance, a Convergence Action Plan in India has been formed to synchronize and converge various nutrition-related interventions across ministries of union and state governments under a single umbrella. Given the large variation in number, nature and impact of these interventions, this paper aims to quantify the contribution of each intervention (proxied by relevant covariates) toward reducing child stunting and underweight in India. The interventions are classified under six sectors: (a) health, (b) women and child development, (c) education, (d) water, sanitation, and hygiene, (e) clean energy, and (f) growth sector. We estimate the potential reduction in child stunting and underweight in a counterfactual scenario of “convergence” where all the interventions across all the sectors are simultaneously and successfully implemented. The findings from our econometric analysis suggests that under this counterfactual scenario, a reduction of 18.37% points (95% CI: 16.77; 19.95) in stunting and 20.26% points (95% CI: 19.13; 21.39) in underweight can be potentially achieved. Across all the sectors, women and child development and clean energy were identified as the biggest contributors to the potential reductions in stunting and underweight, underscoring the importance of improving sanitation-related practices and clean cooking fuel. The overall impact of this convergent action was relatively stronger for less developed districts. These findings reiterate a clear role and scope of convergent action in achieving India's national nutritional goals. This warrants a complete outreach of all the interventions from different sectors.

Dietary diversity and fish consumption of mothers and their children in fisher households in Komodo District, eastern Indonesia.

Small-scale coastal fisheries contribute directly and indirectly to the food and nutrition security of marine-dependent households. Fishers can apportion part of their catch for household consumption or use the income earned to purchase staples and other desired foods. Fish are an important animal-source food rich in micronutrients essential for cognitive development of children and for adult health, and a valuable addition to rice-based diets. Furthermore, the engagement of women in fisheries value chains and increased control over income may facilitate decision-making which improves nutrition outcomes for women and their children. Despite these contributions, food insecurity remains prevalent in many low and middle income fish-producing countries. This paper reports findings from an exploration of the interplaying factors leading to food and nutrition insecurity in three marine-dependent coastal communities in eastern Indonesia, focusing on the consumption pathway, that is, the contribution of fish to the diets and nutrition of women and children. The research was undertaken as a mixed-methods case study. The study found that over 50% of mother-child pairs failed to meet the minimum recommended dietary diversity, and, while fish was the main animal-source food in diets, the introduction of fish to infant and young child diets was delayed due to fears of allergies and illnesses. Moreover, access to nutrient-dense foods was affected by variable and insufficient income from fisheries-based livelihoods, isolation from markets, and the broader food environment. Given the shift towards ‘nutrition-sensitive interventions’ to improve the livelihoods and well-being of fisher households, these results highlight the need for analysis of the intra-household sharing of fish within fisher households, culturally-appropriate strategies to improve the quality of family and especially complementary foods, and efforts to increase physical access to nutrient-dense foods.

Forest Conservation: A Potential Nutrition-Sensitive Intervention in Low- and Middle-Income Countries

Childhood undernutrition yearly kills 3.1 million children worldwide. For those who survive early life undernutrition, it can cause motor and cognitive development problems that translate into poor educational performance and limited work productivity later in life. It has been suggested that nutrition-specific interventions (e.g., micronutrient supplementation) that directly address the immediate determinants of undernutrition (e.g., nutrient intake) need to be complemented by nutrition-sensitive interventions that more broadly address the underlying determinants of undernutrition (e.g., food insecurity). Here, we argue that forest conservation represents a potentially important but overlooked nutrition-sensitive intervention. Forests can address a number of underlying determinants of undernutrition, including the supply of forest food products, income, habitat for pollinators, women’s time allocation, diarrheal disease, and dietary diversity. We examine the effects of forests on stunting – a debilitating outcome of undernutrition – using a database of household surveys and environmental variables across 25 low- and middle-income countries. Our result indicates that exposure to forest significantly reduces child stunting (at least 7.11% points average reduction). The average magnitude of the reduction is at least near the median of the impacts of other known nutrition interventions. Forest conservation interventions typically cover large areas and are often implemented where people are vulnerable, and thus could be used to reach a large number of the world’s undernourished communities that may have difficult access to traditional nutrition programs. Forest conservation is therefore a potentially effective nutrition-sensitive intervention. Efforts are needed to integrate specific nutrition goals and actions into forest conservation interventions in order to unleash their potential to deliver nutritional benefits.

Designing integrated interventions to improve nutrition and WASH behaviors in Kenya

BackgroundChild stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya.MethodsThis intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility.ResultsUsing authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages.ConclusionsThis study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.

Individual-level predictors of practices of nutrition-specific and nutrition-sensitive interventions for infants and young children in West and Central Africa: a cross-sectional study

ObjectivesTo explore the role of individual-level and household-level characteristics for practice of nutrition-specific and nutrition-sensitive interventions.DesignSecondary data analysis (cross-sectional).SettingWest and Central Africa.ParticipantsData are from the Demographic and Health Surveys in...

Impact of agricultural interventions on food and nutrition security in Ethiopia: Uncovering pathways linking agriculture to improved nutrition

Achieving sustainable food and nutrition security calls for multi-sectoral coordination mechanisms in implementing, among others, nutrition-sensitive agricultural interventions. Despite progresses ...

Stunting of Growth in Developing Countries.

Introduction In 2019, 144 million children were stunted i.e. length for age more than 2 standard deviations below the median for the World Health Organisation (WHO) growth reference standards. The rate of decline required to meet the target of reducing the number of under 5’s who are stunted globally to 100 million by 2025 has not been achieved [1]. Progress has been particularly slow in sub-Saharan Africa that remains one of the regions with the highest burden of the problem. In 2020, this will be compounded by the impact of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V2) pandemic that has diminished livelihoods in many already vulnerable communities and significantly reduced access to, and coverage of, maternal and child health services particularly in low- and middle-income countries (LMICs), therefore increasing both poverty and food insecurity [2]. Stunting is an indicator of chronic malnutrition that is associated with adverse health and cognitive outcomes during childhood that persist into adulthood. Greater efforts are therefore required to understand the complex mechanisms of early childhood stunting, factors that influence its persistence in certain populations despite apparent reductions in poverty within regions and countries, to inform the design and implementation of future interventions. In this chapter, we have selected recently published papers on stunting and growth in childhood based on research that seeks to elucidate the mechanisms of early childhood stunting and its impact on adolescent growth and pubertal development. We also include recent data on regional patterns of childhood stunting highlighting how between and within country inequities influence the trends that are observed over time. In addition, we include studies that explore the impact of economic growth on childhood stunting particularly across sub-Saharan African countries. We include data on recently completed intervention trials of both nutrition-sensitive and nutrition-specific interventions targeted at various timepoints in the lifespan including preconception, pregnancy and early infancy. One of the trials goes beyond reporting of the efficacy results alone and provides data on stakeholder (including both policy makers and the caregivers) perceptions of cost-effectiveness of the intervention therefore providing key data to inform implementation. Finally, in the perspectives we have included the insights on water sanitation and hygiene (WASH) interventions from three trials conducted in countries with high rates of childhood stunting - WASH-Benefits Bangladesh, WASH-Benefits Kenya and the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) in Zimbabwe. There was no evidence from these trials that low-cost water sanitation and hygiene (WASH) interventions alone or combined with nutrition (maternal and child) interventions sufficiently improved linear growth in early childhood in LMICs. The concept of “Transformative WASH” provides opportunities for multisectoral research and implementation of programmes that could potentially lead to improvements in child health, growth and developmental outcomes. Overall, the studies that we have chosen emphasise the need for better alignment of nutrition and health system interventions to ensure that the most vulnerable mothers and children (due to poverty, adverse climate change, humanitarian crises, or disabilities/cognitive impairment) have equitable access to multilevel interventions that work synergistically to address childhood stunting.

Prevalence and correlates of the composite index of anthropometric failure among children under 5years old in Bangladesh.

The prevalence of stunting, wasting, and underweight are reported separately. However, the data of the multiple anthropometric failures combinations of these conventional indicators are scant. This study attempted to estimate the overall burden of undernutrition among children under 5 years old, using the composite index of anthropometric failure (CIAF), and to explore the correlates. The study used secondary data from the Bangladesh demographic and health surveys (BDHS), undertaken in 2014. CIAF provides an overall prevalence of undernutrition, which gives six mutually exclusive anthropometric measurements of height‐for‐ age, height‐for‐weight, and weight‐for‐age. Multivariable logistic regression was used to explore the correlates of CIAF. The overall prevalence of undernutrition using the CIAF was 48.3% (95% CI [47.1%, 49.5%]) among the children under 5 years old. The prevalence of anthropometric failure due to a combination of both stunting and underweight was 18.2%, wasting and underweight was 5.5%, and wasting, underweight, and stunting was 5.7%. The odds of CIAF were higher among young maternal age, having the poorest socio‐economic status, living in rural areas, higher order of birth, and received no vaccination compared with other counterparts. In Bangladesh, one out of two children has undernutrition, which is preventing the potential of the millions of children. Mothers who gave birth before age 20 living in the rural areas with belonging to lower socio‐economic status and whose children had a higher order of birth and receive no vaccination were observed as the main determinants of undernutrition. Nutrition sensitive interventions along with social protection programmes are crucial to deal the underlying causes of undernutrition.

A model-based exploration of farm-household livelihood and nutrition indicators to guide nutrition-sensitive agriculture interventions

Assessing progress towards healthier people, farms and landscapes through nutrition-sensitive agriculture (NSA) requires transdisciplinary methods with robust models and metrics. Farm-household models could facilitate disentangling the complex agriculture-nutrition nexus, by jointly assessing performance indicators on different farm system components such as farm productivity, farm environmental performance, household nutrition, and livelihoods. We, therefore, applied a farm-household model, FarmDESIGN, expanded to more comprehensively capture household nutrition and production diversity, diet diversity, and nutrient adequacy metrics. We estimated the potential contribution of an NSA intervention targeting the diversification of home gardens, aimed at reducing nutritional gaps and improving livelihoods in rural Vietnam. We addressed three central questions: (1) Do ‘Selected Crops’ (i.e. crops identified in a participatory process) in the intervention contribute to satisfying household dietary requirements?; (2) Does the adoption of Selected Crops contribute to improving household livelihoods (i.e. does it increase leisure time for non-earning activities as well as the dispensable budget)?; and (3) Do the proposed nutrition-related metrics estimate the contribution of home-garden diversification towards satisfying household dietary requirements? Results indicate trade-offs between nutrition and dispensable budget, with limited farm-household configurations leading to jointly improved nutrition and livelihoods. FarmDESIGN facilitated testing the robustness and limitations of commonly used metrics to monitor progress towards NSA. Results indicate that most of the production diversity metrics performed poorly at predicting desirable nutritional outcomes in this modelling study. This study demonstrates that farm-household models can facilitate anticipating the effect (positive or negative) of agricultural interventions on nutrition and the environment, identifying complementary interventions for significant and positive results and helping to foresee the trade-offs that farm-households could face. Furthermore, FarmDESIGN could contribute to identifying agreed-upon and robust metrics for measuring nutritional outcomes at the farm-household level, to allow comparability between contexts and NSA interventions.

Advancing child nutrition science in the scaling up nutrition era: a systematic scoping review of stunting research in Guatemala

IntroductionEver since the 1960s, Guatemala has been a principle site for global academic research on child growth and nutrition. Nevertheless, Guatemala still has one of the highest rates of child...

Trends in prevalence and determinants of stunting in Tanzania: an analysis of Tanzania demographic health surveys (1991\u20132016)

BackgroundTanzania has made a significant improvement in wasting and underweight indicators. However, stunting has remained persistently higher and varying between regions. We analyzed Tanzania Demographic and Health Survey (TDHS) datasets to examine (i) the trend of stunting over the period of 25 years in Tanzania and (ii) the remaining challenges and factors associated with stunting in the country.MethodsThis secondary data analysis included six TDHS datasets with data of 37,409 under-five children spreading in 1991–1992(n = 6587), 1996(n = 5437), 1999(n = 2556), 2004–05(n = 7231), 2009–10(n = 6597), and 2015–16(n = 9001) conducted in all regions of Tanzania. Variables specific to children and their caregivers were analyzed using SPSS version 22. The variables considered include child anthropometric variables, caregiver’s demographic characteristics and household’s socio-economic factors. We used frequencies and percentages to compare stunting prevalence across the six surveys and chi-square test and three-level hierarchical logistic regression to examine the factors associated with stunting also applying sample weighting as advised by TDHS.ResultsThe prevalence of stunting has declined by 30% over the period of 25 years in Tanzania. However, one in three children aged below five years remains stunted with overweight and obesity more than doubled (from 11 to 25%) in the same period among women of reproductive age. The factors associated with stunting included children living in female-headed households (AOR = 1.16, P = 0.014), aged 24–35 months (AOR = 1.75, P = 0.019), born with low birth weight (AOR = 2.14, P < 0.001) and with inconsistent or without breastfeeding (AOR = 3.46, P < 0.001 and AOR = 4.29, P = 0.001) respectively. The risk of stunting among children living in urban area (AOR = 0.56, P < 0.001), with higher caregiver’s education (AOR = 0.56, P = 0.018), obese mother (AOR = 0.63, P < 0.001), households with highest wealth index (AOR = 0.42, P < 0.001), and among girls (AOR = 0.77, P < 0.001).ConclusionsThe burden of stunting in Tanzania has declined by 30% in the past 25 years, but still affecting one in every three children. Efforts are needed to increase the pace of stunting decline especially among boys, children in rural areas, from poor, uneducated, and female-headed households, and through improving infant and young feeding practices. Effective and tailored nutrition-sensitive and specific interventions using multisectoral approaches should be considered to address these important determinants.

Food Access Deficiencies in Sub-saharan Africa: Prevalence and Implications for Agricultural Interventions

Our understanding of food security in sub-Saharan Africa (SSA) has been hampered by limitations in the temporal and spatial representativeness of data. Food balance sheets provide scalable estimates of per capita food availability, but fail to represent food access, stability and their causal linkages. In contrast, rural household surveys represent detailed conditions for one or multiple points in time, but are influenced by survey timing and are often limited in geographical coverage. This study draws on a large sample of rural land-holding households in SSA (n = 6,353) to identify household level food access deficiencies and to understand the associations with rural livelihoods and food sourcing behavior throughout the year. Food access deficiencies were identified using food security of access and diet diversity indicators. Dietary diversity and channel of access (farm or purchased) were enumerated for the “flush” and “lean” periods and food security of access was enumerated for the lean period only - making the results of this study independent of survey timing. As many as 39% of households were classified as severely food insecure (in terms of food access) and as many as 49% of households were likely to be deficient in micronutrients in the lean period. Vulnerability to food insecurity and micronutrient deficiencies differed by household composition, agricultural livelihood characteristics and agro-ecological zone. Dairy, fruit and vitamin A-rich produce were predominantly accessed through the farm channel. Households with a livestock component to their farm had a lower prevalence of severe food insecurity and higher diet diversity scores. These findings have implications for the development of nutrition-sensitive and nutrition-specific interventions. Interventions need to be tailored to agro-ecological zone, household composition, scale of operation and production mix. Increasing income will not necessarily result in improved diet diversity or healthy dietary choices. Interventions focused on income generation should monitor and promote crop and livestock production diversity and provide nutrition education.