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Vulnerability of agriculture to climate change increases the risk of child malnutrition: Evidence from a large-scale observational study in India

Introduction: The impact of climate change on agriculture and food security has been examined quite thoroughly by researchers globally as well as in India. While existing studies provide evidence on how climate variability affects the food security and nutrition, research examining the extent of effect vulnerability of agriculture to climate change can have on nutrition in India are scarce. This study examined a) the association between the degree of vulnerability in agriculture to climate change and child nutrition at the micro-level b) spatial effect of climate vulnerability on child nutrition, and c) the geographical hotspots of both vulnerability in agriculture to climate change and child malnutrition. Methods: The study used an index on vulnerability of agriculture to climate change and linked it to child malnutrition indicators (stunting, wasting, underweight and anaemia) from the National Family Health Survey 4 (2015–16). Mixed-effect and spatial autoregressive models were fitted to assess the direction and strength of the relationship between vulnerability and child malnutrition at macro and micro level. Spatial analyses examined the within-district and across-district spill-over effects of climate change vulnerability on child malnutrition. Results: Both mixed-effect and spatial autoregressive models found that the degree of vulnerability was positively associated with malnutrition among children. Children residing in districts with a very high degree of vulnerability were more like to have malnutrition than those residing in districts with very low vulnerability. The analyses found that the odds of a child suffering from stunting increased by 32%, wasting by 42%, underweight by 45%, and anaemia by 63% if the child belonged to a district categorised as very highly vulnerable when compared to those categorised as very low. The spatial analysis also suggested a high level of clustering in the spatial distribution of vulnerability and malnutrition. Hotspots of child malnutrition and degree of vulnerability were mostly found to be clustered around western-central part of India. Conclusion: Study highlights the consequences that vulnerability of agriculture to climate change can have on child nutrition. Strategies should be developed to mitigate the effect of climate change on areas where there is a clustering of vulnerability and child malnutrition.

Better living through nutrition: How tackling malnutrition can transform Africa’s development

Despite the will, many developing countries lack the resources to deal with a problem that ravages at both the national and individual level. We need smarter, context-specific solutions on nutrition that can catalyze sustainable change.

Ending hunger, malnutrition, and poverty

The combination of IFPRI’s cutting-edge research and Japan’s advanced technologies and know-how enable our work with Japan to not only address the current emergencies but also build resilience to future crises and support sustainable development. Throughout its work, IFPRI conducts rigorous evaluations, using innovative methods such as randomized controlled trials (RCT), to measure the impact of interventions and develop clear evidence to inform policymaking.

The processed food revolution in African food systems and the double burden of malnutrition

African consumers have purchased increasing amounts of processed food over the past 50 years. The opportunity cost of time of women and men has increased as more of them work outside the home, driving them to buy processed food and food prepared away from home to save arduous home-processing and preparation labor. In the past several decades, this trend has accelerated with a surge on the supply side of the processing sector and small and medium enterprises (SMEs) and large private companies making massive aggregate investments. Packaged, industrialized, ultra-processed foods and sugar-sweetened beverages (SSBs) are a growing proportion of the processed food consumed. Also, in the past several decades, overweight and obesity have joined the long-standing high levels of stunting and wasting among children and extreme thinness among women of childbearing age. Together these phenomena have formed a double burden of malnutrition (DBM). The DBM has emerged as an important health problem in sub-Saharan Africa. The rise of the DBM and the increase in ultra-processed food consumption are linked. makers face a dilemma. On the one hand, purchases of processed food are driven by long-term factors, such as urbanization, increased income, and employment changes, and thus cannot change the pursuit of convenience and labor-saving food. Moreover, much processed food, like packaged milk, is a boon to nutrition, and the processed food system is a major source of jobs for women. On the other hand, the portion (some 10–30%) of processed food that is ultra-processed is a public health challenge, and must address its detrimental effects on disease burden. The global experience suggests that double duty actions are most important as are selected policies focused on healthy weaning foods for addressing stunting and taxes on SSBs, nutrition labeling, and other measures can steer consumers away from unhealthy ultra-processed foods to addressing obesity and possibly child nutrition and stunting. We recommend that African governments consider these options, but that the current extreme fragmentation of the processing sector, consisting of vast numbers of informal SMEs in sub-Saharan Africa, and the limited administrative/implementation capacity of many African governments require pursuing this path only gradually.

The double burden of malnutrition in India: Trends and inequalities (2006–2016)

Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7–8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.

The double burden of malnutrition: Further perspective: Authors' reply

We thank Saskia Osendarp and colleagues, Mohammad Sorowar Hossain and colleagues, and Christine Stewart and colleagues for their responses to the Lancet Series on the double burden of malnutrition. They make some relevant points that we would like to address here.

Biofortified pearl millet cultivars offer potential solution to tackle malnutrition in India

Dietary deficiency of micronutrients (iron, zinc, vitamin A), leading to micronutrient malnutrition or hiden hunger, has been recognized as a widespread food-related health problem, affecting more than 2 billion people worldwide (White and Broadley, 2009; Stein 2010; fao,2015; Darnton-Hill and Mkparu, 2015). This is primarily attributable to lack of affordability and access to diversified diet, such as fruits, vegetables and livestock products. As a consequence, women, children and infants, belonging to the poorer section of society are malnourished. In particular, deficiencies of iron and zinc are widespread, leading to numerous adverse health consequences , as they play a vital role in various physiological body functions.

Tracking India’s progress on addressing malnutrition and enhancing the use of data to improve programs

Data systems and their usage are of great significance in the process of tracking malnutrition and improving programs. The key elements of a data system for nutrition include (1) data sources such as survey and administrative data and implementation research, (2) systems and processes for data use, and (3) data stewardship across a data value chain. The nutrition data value chain includes the prioritization of indicators, data collection, curation, analysis, and translation to policy and program recommendations and evidence based decisions. Finding the right fit for nutrition information systems is important and must include neither too little nor too much data; finding the data system that is the right fit for multiple decision makers is a big challenge. Developed together with NITI Aayog, this document covers issues that need to be considered in the strengthening of efforts to improve the availability and use of data generated through the work of POSHAN Abhiyaan, India’s National Nutrition Mission. The paper provides guidance for national-, state-, and district-level government officials and stakeholders regarding the use of data to track progress on nutrition interventions, immediate and underlying determinants, and outcomes. It examines the availability of data across a range of interventions in the POSHAN Abhiyaan framework, including population-based surveys and administrative data systems; it then makes recommendations for the improvement of data availability and use. To improve monitoring and data use, this document focuses on three questions: what types of indicators should be used; what types of data sources can be used; and with what frequency should progress on different indicator domains be assessed.

Malnutrition, hypertension risk, and correlates: An analysis of the 2014 Ghana Demographic and Health Survey data for 15–19 years adolescent boys and girls

The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

Incidence correction factors for moderate and severe acute child malnutrition from two longitudinal cohorts in Mali and Burkina Faso

Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor K⁠, obtained from the few available cohorts that measured AM. We estimated K factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from two cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using a complete (weight-for-length z score, mid-upper arm circumference (MUAC), edema) and partial (MUAC, edema) definition of SAM and MAM. K estimates ranged from 9.4 and 5.7 for SAM, and from 4.7 and 5.1 for MAM in Burkina Faso and Mali, respectively. The MUAC and edema-based definition of AM did not lead to different K estimates. Our results suggest that K can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality

The unprecedented global social and economic crisis triggered by the COVID-19 pandemic poses grave risks to the nutritional status and survival of young children in low-income and middle-income countries (LMICs). Of particular concern is an expected increase in child malnutrition, including wasting, due to steep declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services. One in ten deaths among children younger than 5 years in LMICs is attributable to severe wasting because wasted children are at increased risk of mortality from infectious diseases. Before the COVID-19 pandemic, an estimated 47 million children younger than 5 years were moderately or severely wasted, most living in sub-Saharan Africa and south Asia.

Progress towards ending hunger and malnutrition: A cross-country cluster analysis

This report provides a quantitative assessment of progress made towards the sustainable development goal of ending hunger and all forms of malnutrition since 1990. Using a cluster analysis, it categorizes country performance along three dimensions: (1) food security and nutrition outcomes; (2) structural drivers of food security and nutrition; and (3) past and present policy interventions in support of food security and nutrition. Key findings show that much progress has been made towards the goal of ending hunger. Yet, many countries continue to face moderate to high degrees of undernourishment, especially where economies made least progress in transitioning towards high-productivity, modern agriculture and non-farm economic development and where policy stances have been weak in promoting agricultural development, reducing gender inequalities, and improving infrastructure and basic social services. The decline in undernourishment has come with a rise in the prevalence in overweight and obesity. The spread of this form of malnutrition has come with dietary shifts towards the consumption of more animalsourced and processed foods that have accompanied urbanization and income growth. By 2015, the vast majority of countries faced moderate to high prevalence of adult overweight, and this form of malnutrition is also on the rise in countries with still significant rates of child undernourishment. No country in the world is showing declines in the rate of adult overweight.

The impacts of the COVID-19 crisis on maternal and child malnutrition in Myanmar: What to expect, and how to protect

The COVID-19 crisis in Myanmar poses a very serious risk to the nutritional status of vulnerable populations, notably women and children, as well as poor urban populations and internally displaced persons. The COVID-19 crisis will hit vulnerable groups through multiple mechanisms.

Malnutrition and epidemics are intertwined: That makes fixing food systems crucial

Malnutrition is by far the biggest driver of ill-health and premature mortality in every region of the world. A slow-burn attritional problem, it does enormous damage. The COVID-19 epidemic that’s sweeping the world, meanwhile, brings a series of massive short-wave shocks. Both the epidemic and malnutrition will generate long-wave impacts, for years to come. They are also likely to interact with each other – badly. This will be particularly true in countries in sub-Saharan Africa and South Asia. Many of these countries’ governments, health and food systems, communities and households have limited capacity to respond to nutritional challenges or to an epidemic. This means that the potential exists for malnutrition to exacerbate the health consequences of the COVID-19 epidemic, and vice versa.

Tracking India’s progress on addressing malnutrition: What will it take?

India has a robust policy framework for nutrition that covers most evidence-based interventions (Vir et al. 2013), and it has in place large-scale national program platforms – the Integrated Child Development Services and the National Rural Health Mission – with the mandate to deliver diverse nutrition interventions (Avula et al. 2013). The National Nutrition Strategy (NITI Aayog 2017) and POSHAN Abhiyaan, India’s national nutrition mission launched in early 2018, provide an updated strategic framework for action to improve nutritional outcomes for children, pregnant women, and lactating mothers. The mission-mode approach provides an impetus to strengthen not only the implementation but also the monitoring and measurement of progress. The mission explicitly notes that NITI Aayog has a mandate to lead on the monitoring and evaluation of POSHAN Abhiyaan. This Policy Note, developed jointly with NITI Aayog and IDinsight, aims to provide guidance to national, state, and district level government officials/stakeholders on issues to consider on the use of data to track progress on nutrition interventions, immediate and underlying determinants, and outcomes. It proposes an indicator framework for POSHAN Abhiyaan and examines availability of data on these indicators across both population-based surveys and administrative data systems. Finally, it lays out issues to be considered in strengthening efforts to improve the use of data in the context of POSHAN Abhiyaan and makes key recommendations on improving data availability and improving the use of currently available data.

Double-duty actions: Seizing programme and policy opportunities to address malnutrition in all its forms

The double burden of malnutrition: Need for urgent policy action

Last year was a remarkable one for nutrition in India. After years of slow and somewhat tentative action to acknowledge, understand and act on the challenge of undernutrition, India’s National Nutrition Mission brought focus and ambition and a range of actions followed. National and State governments were mobilised, district administrators engaged, the private sector mobilised in its own way, while civil society continued to push for accountability and action. As researchers committed to evidence-informed policies and programmes, we welcome India’s nutrition efforts. We call for even stronger systems to support the use of data and science to inform India’s efforts, to track progress and to learn from both successes and failures.

Impact on child acute malnutrition of integrating a preventive nutrition package into facility-based screening for acute malnutrition during well-baby consultation: A cluster-randomized controlled trial in Burkina Faso

Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM’s effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM.

Impact on child acute malnutrition of integrating small-quantity lipid-based nutrient supplements into community-level screening for acute malnutrition: A cluster-randomized controlled trial in Mali

Community-based management of acute malnutrition (CMAM) has been widely adopted to treat childhood acute malnutrition (AM), but its effectiveness in program settings is often limited by implementation constraints, low screening coverage, and poor treatment uptake and adherence. This study addresses the problem of low screening coverage by testing the impact of distributing small-quantity lipid-based nutrient supplements (SQ-LNSs) at monthly screenings held by community health volunteers (CHVs). Screening sessions included behavior change communication (BCC) on nutrition, health, and hygiene practices (both study arms) and SQ-LNSs (one study arm). Impact was assessed on AM screening and treatment coverage and on AM incidence and prevalence.

Biofortified staples may hold the key to India’s rural malnutrition

The National elections in India may well be over, but the persistent issue of malnutrition still holds the nation in its tight grip. And yet, of the myriads of topical issues that comprised political propaganda, including caste, religion, employment, farmer upliftment, and even social transfers, none of the political parties raised this critical issue. The twin problems of malnutrition and nutritional insecurity are particularly severe in rural India.

Stories of change: How Rwanda created an enabling environment for reducing malnutrition (P22-011-19)

Eliminating malnutrition is on many countries’ political agendas but knowledge of how enabling environments are created and used is needed. We assessed the drivers of change in stunting reduction among children <5 y of age in Rwanda and contributors to differential reduction over 10–25 y.

Double burden of malnutrition: The role of framing in development of political priority in the context of rising diet-related non-communicable diseases in Tamil Nadu, India (P22-005-19)

In low- and middle-income countries, non-communicable disease (NCD) prevalence is increasing while undernutrition persists, resulting in a double-burden of malnutrition. How policy actors frame malnutrition may shape policy, programming, and investment. In India, where NCDs are rising rapidly and undernutrition persists throughout the country, much of food and health policy is decentralized, but little is known of how the double burden of malnutrition is understood at the state level. This study aimed to identify and compare frames and priorities for nutrition used by relevant policy actors to help understand the narrative emerging around policy solutions for the double burden of malnutrition.

Double duty actions to tackle all forms of malnutrition (P10-053-19)

Most countries are now experiencing a double burden of malnutrition (DBM), characterized by the coexistence of nutritional deficiencies (underweight, wasting, stunting, micronutrient deficiencies) and overweight/obesity and diet-related non-communicable diseases (obesity/DR-NCDs). Actions to address the two sides of the DBM are typically managed by separate communities, policies, programs, governance structures, and funding streams. Double duty actions, defined as actions that simultaneously address nutritional deficiencies and obesity/DR-NCDs, have been proposed as a win-win solution to tackling malnutrition in all its forms. The objective of the work was to explore opportunities—and make recommendations—for double duty actions to be delivered by programs and policies in key sectors such as health, social protection, education, and agriculture.

Effect of conflict and food price shocks on calorie intake and acute malnutrition in Nigeria: A micro-panel data analysis

Food insecurity and malnutrition are being worsened in countries that are exposed to armed conflict. Nigeria has witnessed a decade of protracted armed conflict and civil unrest. Many civilians have died and some farming communities have been sacked as a result. This study uses fixed-effect and random-effect models on a nationally-representative household panel data– Nigeria Living Standard Measurement Survey and Armed Conflict and Event Location Data, to examine the linkages between conflict, food price shocks, and calorie intake and acute malnutrition (wasting) among children. The prevalence of calorie intake inadequacy and wasting increase across the years in conflict-prone areas. Empirical results suggest that increases in food prices, especially staples have a depressing effects on calorie intake and increasing influence on wasting prevalence. Surprisingly, there appears to be a decrease likelihood of wasting among households in conflict-prone areas despite relatively low level of calorie intake. This result may be indicative of access to certain nutrition-related non-food factors capable of reinforcing the available calorie intake in the areas. Although sensitively guided food pricing policy and prevention of conflicts are critical for improve calorie intake and nutrition outcome, greater reduction in wasting prevalence may be achieved if other nutrition-related factors are considered.

Effects of multiannual, seasonal unconditional cash transfers on food security and dietary diversity in rural Burkina Faso: The Moderate Acute Malnutrition Out (MAM’Out) cluster-randomized controlled trial

To evaluate the impact of multiannual, seasonal unconditional cash transfers (UCT) provided within the Moderate Acute Malnutrition Out (MAM’Out) research project on households’ food security and children’s and caregivers’ dietary diversity.A two-arm cluster-randomized controlled trial with sixteen villages in the intervention group and sixteen others in the control group. A monthly allowance of 10 000 XOF was transferred to caregivers of eligible children via a personal mobile phone account from July to November 2013 and 2014.Tapoa province in the eastern region of Burkina Faso.Data on household food access (monthly adequate household food provisioning (MAHFP); household food insecurity access scale (HFIAS)) and maternal and child dietary diversity were analysed for 1143 households, 1219 caregivers of reproductive age (15–49 years) and 1247 under-5 children from both intervention and control groups.The mean women dietary diversity score in intervention caregivers and the mean dietary diversity score (DDS) in intervention children with inadequate minimum DDS at baseline were respectively 7 % (95 % CI 2, 11 %;P= 0·002) and 17 % (95 % CI 11, 23 %;P<0·001) higher compared with the control group. However, no difference was found in the intervention effect on household food security measured with HFIAS (relative risk = 1·03; 95 % CI 0·92, 1·15;P= 0·565) and MAHFP (relative risk = 0·98; 95 % CI 0·96, 1·01;P= 0·426).Multiannual, seasonalUCT increased dietary diversity in children and their caregivers. They can be recommended in actions aiming to improve maternal and child diet diversity.

Responding to conflict: Does “Cash Plus” work for preventing malnutrition? New evidence from an impact evaluation of Yemen’s Cash for Nutrition Program

An impact evaluation of Yemen’s Cash for Nutrition program provides new evidence of the benefits of “cash plus” transfer programs to meet nutritional needs in conflict situations. Conflict has become a major driver of humanitarian crises globally, requiring responses that not only meet people’s immediate need for calories, but also ensure that aid recipients, especially children and pregnant women, receive adequate diet to avoid long-term impacts of malnutrition. The program in Yemen combined cash transfers with nutritional education using soft conditionality, with significant positive impacts on maternal and child dietary diversity, children’s height and weight measures, and the likelihood of children being diagnosed with moderate or severe acute malnutrition.

Poverty, hunger, and malnutrition: Challenges and breakthroughs for rural revitalization

The first two Sustainable Development Goals call to end poverty, hunger, and malnutrition by 2030. This chapter looks at trends in rural poverty, hunger, and malnutrition, and the potential to put the world on course to meet these SDGs. The global rural poverty rate is currently 17 percent; the urban poverty rate is 7 percent. Rural areas lag behind in reducing the prevalence of child stunting and underweight among children. Investment in food and nutrition security is insufficient to address these problems, and the international trade and investment climate increases the challenge. Breakthroughs will require not only greater investment but also better data and a systems approach to addressing rural needs that integrates natural resources and other critical sectors. A systemwide transformation and revitalization is needed to raise rural incomes, improve rural food security and nutrition, safeguard environmental resources, and lift living conditions in rural areas.

Unraveling India's malnutrition dilemma: A path toward nutrition-sensitive agriculture

In this chapter, we make the case for India to shift to a nutrition-focused agricultural sector that goes beyond staple grain productivity to emphasize the production and consumption of micronutrient-rich foods. The chapter first reviews the nutrition trends in India, characterized by slow progress in addressing high and variable rates of malnutrition. It then assesses the policies that have influenced agricultural growth trajectories and safety-net programs to highlight the major challenges and disconnects in agriculture and nutrition policy. Finally, it calls for integrating some elements that a food-systems approach would consider, such as income, availability of nutritious food, intra-household distribution, and the health environment, as a way forward in addressing India’s malnutrition dilemma.

Accelerating the end of hunger and malnutrition: A global event: Synopsis

The world faces a fast-approaching due date: 2030 is the year by which 193 countries have committed themselves to ending hunger and malnutrition as part of the Sustainable Development Goals (SDGs). This commitment is supported by the UN Decade of Action on Nutrition (2016–2025), designed to promote the achievement of SDG2—a necessary condition for most other SDGs—and the Compact2025 initiative, which was established to use data, research-based evidence, best practices, and South-South learning to accelerate progress in ending hunger and malnutrition. These efforts, however, represent only the first step along the path toward achieving a world free of hunger and malnutrition. Success depends on following up commitments with concerted actions that produce measurable and sustainable results. So far, the evidence shows that the world is moving far too slowly along this path. Despite the political will expressed in the SDGs, hunger persists, and malnutrition is climbing. These realities—and the conviction that the world could move faster—were the impetus and the backdrop for an international three-day conference—organized by the International Food Policy Research Institute (IFPRI) and the Food and Agriculture Organization of the United Nations (FAO)—in Bangkok in November 2018. At the conference, more than 600 distinguished decisionmakers, practitioners, and other stakeholders—from across governments, NGOs, civil society, research organizations, and the private sector— gathered to discuss how to speed up progress. In a wide-ranging set of keynote addresses, panel discussions, and side events, they shared evidence and lessons learned from around the world on transforming food systems to reduce hunger and malnutrition. They explored opportunities for scaling up successful actions and innovations that can disrupt business-as-usual to build momentum and accelerate progress.

IFPRI-FAO Bangkok Conference. 28-30 November 2018. Bangkok, Thailand

Can unconditional cash transfers mitigate the impact of civil conflict on acute child malnutrition in Yemen?: Evidence from the national social protection monitoring survey

Hunger and acute child malnutrition are increasingly concentrated in fragile countries and civil conflict zones. According to the United Nations, Yemen’s civil war has caused the world’s worst humanitarian crisis in recent history. We use high-frequency panel data and district fixed-effects and household fixed-effects models to estimate the impact of civil conflict on child nutrition. Our results indicate that an increase by one standard deviation in civil conflict intensity translates into an increase in the prevalence of acute child malnutrition by at least 0.7 percentage points if measured by weight-for-height z-scores and by at least 1.7 percentage points if measured by mid-upper arm circumference z-scores. In mid-December 2018, Yemen’s main warring parties agreed to a ceasefire for the contested port city of Hodeida and to allow humanitarian aid to be shipped in and distributed through protected corridors. While the recent agreements are an important, first step to tackle the humanitarian crisis, the road to a sustainable peace agreement will certainly be long and bumpy. Relative stability could soon open a window of opportunity for targeted interventions to support recovery in Yemen. Against this background, our analysis suggests that unconditional cash transfers can be an effective tool in situations of complex emergencies. Our estimation results show that cash transfers can mitigate the detrimental impact of lingering civil conflict on child nutritional status in Yemen on a large scale. Our results also reveal that the regularity of transfer payments influence the magnitude of the mitigation effect, as regular assistance allows beneficiary households to smoothen their food consumption and other demands influencing child nutrition outcomes.

From small farms to big cities: Leveraging food systems and rural-urban linkages for ending hunger and malnutrition

Two 2017 IFPRI and FAO reports suggest that strengthening food supply chains can immensely contribute to ending malnutrition and reducing poverty. Our author explains the complex interdependencies between rural and urban regions.

Accelerators to eliminate hunger and malnutrition

Progress in eliminating hunger and malnutrition is too slow. Despite some periods of significant progress, reductions in hunger and undernutrition on a global scale have stagnated since 2000, and progress has varied widely across countries. In 2017, the number of undernourished people worldwide rose to nearly 821 million from around 804 million in 2016, and 151 million children remain stunted. At the same time, overweight, obesity, and associated noncommunicable diseases are rising faster than undernutrition is declining. Rapid urbanization, climate change, and continued conflict pose further threats to our global food system. If the world is to end hunger and malnutrition by 2030—the target year to achieve the Sustainable Development Goals (SDGs)—it is time to pick up the pace.

Cost study of the preventing malnutrition in children under 2 years of age approach in Burundi and Guatemala

Cost studies were conducted in conjunction with the impact evaluations of these two PM2A (Preventing Malnutrition in Children under 2 Approach) programs to provide information on the total cost of the programs and estimate the cost of alternative versions of the programs. Providing cost-related information along with the benefits of alternative program versions can be useful for informing future programming activities. It is important to note that the cost analysis took into account the full scope of each program and not just the program costs related to the communities where the impact evaluations were conducted.

Strengthening and evaluating the preventing malnutrition in children under 2 years of age approach: Guatemala follow-up report

This report presents the findings from the impact evaluation of Programa Comunitario Materno Infantil de Diversificación Alimentaria (PROCOMIDA) (Community Maternal and Child Food Diversification Program), a Preventing Malnutrition in Children under Two Years of Age (PM2A) program that was implemented in Alta Verapaz region, Guatemala, from 2011 to 2015. The report assesses the impact of PROCOMIDA on mothers and their children at key time points from early gestation until the child reached 24 months old.

SDG 2.1 and SDG 2.2: Why open, transparent, and equitable trade is essential to ending hunger and malnutrition sustainably

During the past years there have been several noteworthy global pledges on eliminating hunger, achieving food security and improved nutrition, and moving to environmentally sustainable patterns of production and consumption of food and agricultural goods. These pledges include the commitment to the Sustainable Development Goals (SDGs) in December 2015, followed by the entry into force of the historic Paris Agreement on climate change in November 2016, and the incremental advances at the World Trade Organization (WTO) during the 9th and 10th ministerial conferences in Bali in 2013 and in Nairobi in 2015, all of which represented important steps towards building a more supportive international system for the attainment of those objectives. However, as the limited results from the 11th Ministerial Conference in Buenos Aires in December 2017 suggest, much remains to be done for humanity to be able to achieve the SDGs by 2030. This paper will briefly consider the importance of trade in achieving the SDGs and transforming food systems. The paper also highlights some key policies that are critical to achieving these goals.

Study of the determinants of chronic malnutrition in northern Nigeria: Quantitative evidence from the Nigeria demographic and health surveys

Close to half of all children younger than 5 years in the Northeast and Northwest geopolitical zones were estimated to be stunted in their growth for their age in 2013 compared to 22% of children in the rest of Nigeria.We examine the drivers of chronic child undernutrition in northern Nigeria and how those drivers differ from other areas of the country.Both a standard child-level regression-based approach and decomposition analysis were used to address the determinants of stunting and decompose how drivers differ between northern Nigeria and other areas of the country using 2008 and 2013 Nigeria DHS data.There are strong differences in the levels of the determinants of undernutrition in young children between the 2 parts of the country. However, equally important, the decomposition analysis shows that there are significant differences between northern Nigeria and other areas of Nigeria in the effect of the same determinant of nutritional status in accelerating or retarding the linear growth of young children.A national program to address child undernutrition must recognize this heterogeneity in its design. To impose across Nigeria, a single set of approaches to address the factors which results in stunted children is likely to fail for large numbers of children if these strong geographical differences in how these determinants operate to affect child nutritional status are not considered. Solutions need to be developed within northern Nigeria to more closely reflect the way the determinants of nutritional status operate in this area of the country.

Seven African countries show how the battle against malnutrition can be won

A number of African countries are taking bold action to tackle malnutrition. They have successfully implemented a range of actions that have started to improve nutrition for all.

Reducing malnutrition through education actions

Synopsis: Study of the determinants of chronic malnutrition in northern Nigeria: Quantitative evidence from the Nigeria Demographic and Health Surveys

To better understand the drivers of chronic child undernutrition in northern Nigeria and how those drivers differ from those in other areas of the country, an econometric analysis was done of data from the 2008 and 2013 Nigeria Demographic and Health Surveys (NDHS). The analyses focused on children aged 6 to 23 months.

Study of the determinants of chronic malnutrition in northern Nigeria: Qualitative evidence from Kebbi and Bauchi states

The burden in northern Nigeria of chronic malnutrition, particularly undernutrition, is among the heaviest globally. Close to half of all under-fives in the Northeast and Northwest geopolitical zones were estimated to be stunted in their growth for their age in 2013, compared to 22 percent in the rest of Nigeria. To inform discussions on future programming to address drivers of undernutrition, a rapid scoping study of chronic malnutrition in northern Nigeria was conducted. This report presents findings drawn from interviews with key informants and focus group discussions in Kebbi and Bauchi states and in Abuja conducted in April and May 2017.

Nourished: How Africa can build a future free from hunger and malnutrition

The main objective of this report is to identify interventions that work and recommend options for policies and programs to eliminate hunger and malnutrition in all its forms. The report begins with a review of the African and global policy agenda, setting out the challenges and complexity of addressing all forms of malnutrition in Africa. It then offers an overview of successful interventions and innovative approaches that have been implemented in some countries and discusses critical threats—climate change and conflicts—that jeopardize progress on reducing malnutrition. Lastly, the report reviews the experiences of seven African countries that have been particularly successful in reducing malnutrition levels and draws some important lessons for other countries.

The impact of integrated prevention and treatment on child malnutrition and health: The PROMIS project, a randomized control trial in Burkina Faso and Mali

Background Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso. Methods/Design The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention. Discussion The PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025.

Study of the determinants of chronic malnutrition in northern Nigeria: Quantitative evidence from the Nigeria Demographic and Health Surveys

To better understand the drivers of chronic child undernutrition in northern Nigeria and how those drivers differ from other areas of the country, this paper presents the results of an econometric analysis of data from the 2008 and 2013 Nigeria Demographic and Health Surveys. A standard child-level regression based approach is used for the first part of the analysis using as the dependent variable whether the child aged 6 to 23 months is stunted (height-for-age z-score (HAZ) < -2.0). Separate models of the drivers of child stunting are developed for northern Nigeria (Northwest and Northeast geopolitical zones) in 2008 and in 2013 and for other areas of Nigeria in 2013. The analysis then is extended by comparing the model for northern Nigeria in 2013 to other areas of Nigeria in 2013 to decompose differences between the models. This was done to gain understanding on how the determinants of child stunting in children aged 6 to 23 months differ between the two areas to better understand how well successful approaches used elsewhere in Nigeria to reduce child stunting might work in northern Nigeria.

Smallholders and urbanization: Strengthening rural-urban linkages to end hunger and malnutrition

Rural-urban linkages—including physical, economic, social, and political connections—are crucial for ending hunger and malnutrition (SDG 2) sustainably in both rural and urban areas. Rural-urban linkages also support other Sustainable Development Goals. Urban growth increases food demand and spurs dietary changes in urban areas—new demand can create opportunities for rural producers to improve their livelihoods. Broken value chains and poor coordination weaken rural-urban links and hold back progress on food security and nutrition. Investment in rural infrastructure and intermediate towns—quality rural and feeder roads, electricity, storage facilities, communications and information—can build connections and create hubs of economic activity benefiting smallholders and cities.

Synopsis: Study of the determinants of chronic malnutrition in northern Nigeria: Qualitative evidence from Kebbi and Bauchi states

To inform discussions on future programming to improve child nutrition, a rapid scoping study of the drivers of undernutrition in northern Nigeria was conducted. This report presents insights obtained from almost 70 key informants interviews and focus group discussions conducted in April and May 2017 in Kebbi and Bauchi states and in Abuja (Figure 1). The participants in these interviews and discussions included mothers and fathers of young children, community civic and religious leaders, local medical and public health officers, state-level officials from government and non-governmental organizations (NGO), experts on human nutrition, and national-level government and NGO officials.

Inequality, hunger, and malnutrition: Power matters

The uneven distribution of hunger and nutrition reflects the unequal distribution of power in the food system. In its hourglass shape, the power at the center amplifies poverty and marginalization at both ends of the system: at one end, small-scale farmers and low-paid food producers suffer hardship; at the other end, those excluded from or adversely incorporated into globalized food markets face hunger and malnutrition. Transnational corporations’ growing control over what we eat—which often deepens existing inequalities—has generated a wide range of spaces and forms of resistance. Power analysis encourages us to look beyond the obvious and the measurable, to trace the effects of interests operating at multiple levels of the food system, to find opportunities where and when they arise, and to enter spaces where that power can be challenged, resisted, and redistributed. Achieving the Sustainable Development Goals’ aim of “leaving no one behind” demands approaches to hunger and malnutrition that are both more sensitive to their uneven distribution and more attuned to the power inequalities that amplify the effects of poverty and marginalization in all forms of malnutrition.

Unconditional cash transfers do not prevent children’s undernutrition in the Moderate Acute Malnutrition Out (MAM’Out) cluster-randomized controlled trial in rural Burkina Faso

GHI: A decade of promoting action against hunger and malnutrition

2016 will mark 11 years of the Global Hunger Index (GHI). For more than a decade, the GHI has contributed to increasing accountability to improving hunger and malnutrition at the global, regional, and national levels. Moreover, the annual GHI reports have been providing thought-provoking information on hunger and undernutrition that call all stakeholders to continued action against these complex challenges. Many country governments draw from the GHI to bring attention to the prevalence of hunger and malnutrition and, more importantly, to compel policymakers, sector leaders, and other stakeholders to work together in these issues.

Child malnutrition in Nigeria: Evidence from Kwara State

Poverty and a lack of awareness seem to be at the heart of the problem of childhood malnutrition in Nigeria. Until the socioeconomic status of the vast majority of Nigerians improves significantly, malnutrition will continue to pose a serious threat to the growth and development of Nigerian children and the future of national development. Significant variations exist in the level of child and maternal malnutrition across rural/urban settings, geopolitical zones, and agro-ecological bands in Nigeria. Malnutrition rates are higher among rural households who depend more on agriculture than on other sectors for their livelihoods. A range of socioeconomic, demographic, and public health related factors work together to influence maternal and child nutrition outcomes among rural and urban dwellers across the geopolitical zones and agro-ecological zones in Nigeria.

Malnutrition: Future challenges and lessons from the past

Addressing a neglected problem: Community-based management of acute malnutrition

SEVERE ACUTE MALNUTRITION (SAM)—extremely low weight for one’s height—is a life-threatening condition affecting mostly children under five years of age. It is caused by a combination of infection, such as diarrheal disease, and poor diets that are inadequate for nutritional needs. SAM is one of the top three nutrition-related causes of death in children under five according to the 2008 Maternal and Child Nutrition Lancet Series. A child with SAM is 11 times more likely to die than a well-nourished child. Despite the size of the problem, until the early 2000s SAM appeared to be a so-called neglected disease: little support went to large-scale treatment programs targeted toward children with SAM. Few countries-even among those with a high preva-lence of malnutrition-had a clear national pol-icy for detecting and treating SAM children.10 The development and adoption of a new approach-the community-based management of acute malnutri-tion (CMAM)-was to change the public health nutrition landscape by bringing treatment out of hospitals and into the community

Malnutrition's new frontier: The challenge of obesity

OVERWEIGHT AND OBESITY prevalence has increased substantially over the past decades, affecting 2.1 billion people worldwide and causing 3.4 million deaths globally.1 Currently, 42 million children are overweight or obese—the result of a staggering 47.1 percent rise in prevalence between 1980 and 2013.2 No longer exclusive to affluent societies, obesity has reached alarmingly high levels in many low- and middle-income countries (LMICs).3 In fact, the number of individuals who are overweight or obese (1.9 billion) has now surpassed the 794 million people who do not get enough calories.4 Nearly half of all overweight children under 5 years of age now live in Asia, and a further 25 percent are found in Africa.

How nutrition improves: Half a century of understanding and responding to the problem of malnutrition

This book is an attempt to meet for narratives of what has worked well by combining a review of various analyses and studies with a narrative approach to convey the drivers and pathways of success in nutrition in different contexts and at different times. It seeks to inspire as well as to inform. In recent years, there has been a growing focus on the potential of narrative and storytelling to inspire and promote change.4 Stories can turn the key in ways that help the reader intuitively grasp why change is needed, what it involves, how it happens, and—crucially—how it can be made to happen. Stories enable listeners to extrapolate from case studies and to see analogies with their own backgrounds, their own contexts, and their own fields of expertise. Research has shown that stories catalyze change because they are natural and easy to tell, they show connections between things, and they cut through complexity. They are memorable, non-adversarial, non-hierarchical

The new challenge: End all forms of malnutrition by 2030

It is a formidable challenge. Every country is facing a serious public health challenge from malnutrition (IFPRI 2014). One in three people is malnourished in one form or another (IFPRI 2015a). Malnutrition manifests itself in many forms: as children who do not grow and develop to their full potential, as people who are skin-and-bone or prone to infection, as people who carry too much weight or whose blood contains too much sugar, salt, or cholesterol.

Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030

Few challenges facing the global community today match the scale of malnutrition, a condition that directly affects 1 in 3 people. Malnutrition manifests itself in many different ways: as poor child growth and development; as individuals who are skin and bone or prone to infection; as those who are carrying too much weight or whose blood contains too much sugar, salt, fat, or cholesterol; or those who are deficient in important vitamins or minerals. Malnutrition and diet are by far the biggest risk factors for the global burden of disease: every country is facing a serious public health challenge from malnutrition. The economic consequences represent losses of 11 percent of gross domestic product (GDP) every year in Africa and Asia, whereas preventing malnutrion delivers $16 in returns on investment for every $1 spent. The world’s countries have agreed on targets for nutrition, but despite some progress in recent years the world is off track to reach those targets. This third stocktaking of the state of the world’s nutrition points to ways to reverse this trend and end all forms of malnutrition by 2030.

Malnutrition and climate patterns in the ASALs of Kenya: A resilience analysis based on a pseudo-panel dataset

This study showed how arid and semi-arid areas of Kenya are particularly affected by undernutrition in women and children. Despite undernutrition improving in the rest of the country, in the ASAL areas the trends appear to be negative, particularly with respect to wasting in children and women being underweight. Temperature shocks emerge as the most detrimental factor for nutrition, again especially in ASAL areas. Droughts, on the other hand, seem to play a significant role only in affecting stunting, while NDVI plays a mixed role, with some cases where more vegetation is associated with higher levels of undernutrition. Overall, the availability of a non-agricultural job within the household is positively associated with nutritional outcomes, as is women’s education, especially in ASAL counties. However, they are also associated with bigger losses in the event of temperature shocks, which raises a query on the role of non–agricultural activities in increasing resilience. Results show that expected climate change bears the potential to greatly harm the Kenyan population living in ASAL areas, and that what is currently believed to be viable solutions to increase resilience may not deliver the results promised. More investigation and research is needed to identify programming strategies to implement, which will enable populations to better cope with climate change and the associated challenges ahead.

Replication Data for "Malnutrition and Climate Patterns in the Arid and Semi-arid Lowlands of Kenya: A Resilience Analysis Based on a Pseudo-panel Dataset"

Resilience of food security in the arid and semi-arid lowlands (ASAL) in Kenya, were assessed using repeated cross-sectional data (collected in 1993, 1998, 2003, and 2008). We measure short- and long-term food security in response to changing agro-climatic conditions, using indicators of child and woman nutritional status. Since measurements over time on the same units of analysis are not available, synthetic cohorts of individuals (children and women) having similar characteristics have been reconstructed, resulted in a pseudo-panel dataset. The dataset is used to observe resilience to agro-climatic shocks, including temperature increases, drought, and changes in vegetation cover.

The Global Nutrition Report 2015: what we need to do to advance progress in addressing malnutrition in all its forms

Improving complementary feeding through community-based management of malnutrition in Rural India

A baseline survey conducted during 2012 among selected districts with extremely marginalized populations in Bihar, Chhattisgarh, Jharkhand, and Odisha revealed high rates of malnutrition and poor infant and young child feeding (IYCF) practices. Among 3,489 children surveyed, 60.2 percent were stunted, 55.1 percent were underweight, and 24.4 percent were wasted. Only 23.9 percent of the children age 6–36 months received appropriate feeding from diverse food groups (AAM Unpublished).

The double burden of malnutrition in SE Asia and the Pacific: priorities, policies and politics

Appendix 10: Coverage estimates of treatment for severe acute malnutrition

Tracking actions to address malnutrition in all its forms

To hold governments and other national stakeholders accountable for their actions to improve nutrition, it is critical to track their progress in implementing interventions, programs, and policies. This chapter reviews the degree to which these stakeholders have implemented actions to reduce malnutrition in all its forms. It also reviews some of the tools available to track implementation.

Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference: Contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh

The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC125) or a Weight-for-Height Z-score<−2 (WHZ−2), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<−2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy. Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ−2 or MUAC125 as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ−2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ<−2) but no linear growth retardation (HAZ≥−2), was modified by the contributors. Overall 23.1 % of the 14,409 children were identified as acutely malnourished by either WHZ−2 or MUAC125, but only 28.5 % of those (949/3,328) were identified by both indicators. Being stunted (+17.8 %; 95 % CI: 14.8 %; 22.8 %), being a female (+16.5 %; 95 % CI: 13.5 %; 19.5 %) and being younger than 24 months (+33.6 %; 95 % CI: 30.4 %; 36.7 %) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ−2, whereas having 'longer legs' moderately increased the diagnosis by WHZ−2 (+4.2 %; 95 % CI: 0.7 %; 7.6 %). The sensitivity to detect slim children by MUAC125 was 31.0 % (95 % CI: 26.8 %; 35.2 %) whereas it was 70.6 % (95 % CI: 65.4 %; 75.9 %) for WHZ−2. The sensitivity of MUAC125 was particularly affected by age (57.4 % vs. 18.1 % in children aged < 24 months vs. ≥ 24 months). Specificity was high for both indicators. MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ−2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition.

The MAM’Out project: a randomized controlled trial to assess multiannual and seasonal cash transfers for the prevention of acute malnutrition in children under 36 months in Burkina Faso

Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries' self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families' expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed. The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as delay in project implementation, switch to e-data collection and implementation of a supervision process. ClinicalTrials.gov, identifier: NCT01866124 , registered May 7, 2013.

Reaching the missing middle: Overcoming hunger and malnutrition in middle income countries

Eliminating hunger and malnutrition around the globe cannot be achieved without a new approach to dealing with the problem in middle income countries. Here’s why this is so, how the middle income countries should respond, and what the international community can do to help.

India’s struggle against malnutrition - Is the ICDS program the answer?

The Effect of Integrated Prevention and Treatment on Child Malnutrition and Health in Mali: A Cluster Randomized Intervention Study (PROMIS-Mali)

This project will address two critical gaps related to the integration of preventive and treatment programs: 1) screening and treatment of MAM/SAM have not yet been systematically integrated into routine health-center visits or mainstreamed into community outreach programs; and 2) screening programs do not offer any preventive services for those children found not to be suffering from MAM/SAM at the time of screening; mothers of children identified as non-MAM/SAM case are usually sent home without receiving any health or nutrition inputs and as a result, may fail to come back for screening because they do not see any tangible benefit associated with their participation in the screening. This project will specifically address these gaps by assessing the effect of an integrated approach consisting of higher screening coverage and preventive Behavior Change Communication (BCC) + Small-Quantity Lipid-based Nutrient supplementation (SQ-LNS) on both prevention and treatment of child undernutrition.

Seeking evidence-based policy solutions to poverty and malnutrition in Bangladesh: Highlights from the Policy Research and Strategy Support Program 2010-2014

Food labelling is costly. Food labelling is often demanded with the introduction of new food products such as genetically modified (GM) food. If consumers do not have trust in the label, scarce resources are wasted. This paper investigates factors affecting the trust in food labels among Ugandan consumers. The results suggest that older, less-educated individuals of smaller household sizes and with trust in government institutions have more trust in food labels. Other factors were also found to be important. The government has to consider those differences in consumer trust when designing a GM labelling policy.

Biofortification: A new tool to reduce micronutrient malnutrition