Knowledge, Food Vouchers, and Child Nutrition: Evidence from a Field Experiment in Ethiopia

by Seollee Park, Yae Eun Han, and Hyuncheol Kim.

Current Developments in Nutrition, Volume 3, Issue Supplement_1, June 2019, nzz048.P11–116–19, https://doi.org/10.1093/cdn/nzz048.P11-116-19

(download)

Abstract

Objectives

Young children in developing countries often maintain poor diets, evidenced by strikingly low dietary diversity. Through formative research, we identified the lack of knowledge and affordability as key barriers to improved infant and young child feeding (IYCF) practices in Ethiopia. The aim of this study is to investigate ways to promote healthy IYCF by analyzing the impacts of an IYCF behavior change communication (BCC) program and food vouchers on mother’s IYCF knowledge and practices, and child growth.

Methods

Using a clustered randomized design, we compare the effects of two independent interventions—IYCF BCC program and food vouchers—on four study groups: BCC only (BCC), voucher only (Voucher), BCC and voucher (BCC + Voucher), and the control group. The BCC program offered weekly group IYCF sessions to mothers who has children between 4 to 20 months of age for 16 weeks, employing participatory learning methods. The voucher program provided food vouchers worth approximately 10 USD per month for four months, which could be used at nearby markets for purchasing a wide variety of food items. We identified 641 eligible households residing in 79 villages in Ejere through census. As shown in Figure 1, 79 villages were randomly assigned to one of the four study groups: BCC, Voucher, BCC + Voucher, and control. All eligible mothers living in treatment villages were invited to participate in the program to which the village she lives in was assigned.

Results

We show that BCC improves maternal knowledge of nutrition and IYCF behaviors, while food vouchers alone do not (Figure 2). Impacts are largest when both knowledge and income constraints are addressed simultaneously through BCC + Voucher (Table 1). Only in this group do we see these treatments reducing stunting by 9 percentage points (Figure 3). Moreover, we show that BCC + Voucher prevented stunting from occurring during this critical age range rather than reversing it (Figure 4).

Conclusions

Our results suggest that, when both knowledge and income are intertwined challenges for improved child-feeding practices, addressing both constraints simultaneously may augment the positive impacts due to their complementary relationship.Funding

Sources

Africa Future Foundation.

IPCC: special report on Climate Change and Land

(download the Policy and the Technical Briefings)

An IPCC Special Report on climate change, desertification, land degradation, sustainable land management, food and nutrition security, and greenhouse gas fluxes in terrestrial ecosystems.

This Special Report on Climate Change and Land responds to the Panel decision in 2016 to prepare three Special Reports during the Sixth Assessment cycle, taking account of proposals from governments and observer organizations. This report addresses greenhouse gas (GHG) fluxes in land-based ecosystems, land use and sustainable land management  in relation to climate change adaptation and mitigation, desertification , land degradation and food security . This report follows the publication of other recent reports, including the IPCC Special Report on Global Warming of 1.5°C (SR15), the thematic assessment of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) on Land Degradation and Restoration, the IPBES Global Assessment Report on Biodiversity and Ecosystem Services, and the Global Land Outlook of the UN Convention to Combat Desertification (UNCCD). This report provides an updated assessment of the current state of knowledge while striving for coherence and complementarity with other recent reports.

This Summary for Policy makers (SPM) is structured in four parts: A) People, land and climate in a warming world; B) Adaptation and mitigation response options; C) Enabling response options; and, D) Action in the near-term.

Confidence in key findings is indicated using the IPCC calibrated language; the underlying scientific basis of each key finding is indicated by references to the main report.

Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence

by Jef L LeroyEdward A Frongillo on Advance in Nutrition journal

Advances in Nutrition, Volume 10, Issue 2, March 2019, Pages 196–204,

Abstract

The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition.

Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting.

Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting.

First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker.

Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value.

In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy.

We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

source: BMJ webpage

By Sheila Isanaka1, Dale A Barnhart2, Christine M McDonald3, Robert S Ackatia-Armah4, Roland Kupka5, Seydou Doumbia6, Kenneth H Brown4, Nicolas A Menzies7

Abstract

Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Affiliation of the authors:

1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
2. Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
3. Children’s Hospital Oakland Research Institute, Oakland, California, USA
4. Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
5. United Nations Children’s Fund, Nutrition Section, New York, NY, USA
6. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
7. Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
8. ^{Correspondence to}Dr Sheila Isanaka; sisanaka@hsph.harvard.edu

WHO/Cochrane/Cornell Summer Institute for Systematic Reviews in Nutrition for Global Policy Making

source: Cornell Uni webpage.

July 15 – July 26, 2019, Cornell University, Ithaca campus

Overview

This unique institute on the Cornell University campus brings together experts from the World Health Organization (WHO), Cochrane, and Cornell University to train participants in the development of systematic reviews of nutrition interventions in populations.

Systematic reviews following the Cochrane methodology are used to ensure that WHO recommendations are based on sound evidence. Participants will learn to apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the overall quality of evidence.

Who should attend

The institute is intended for nutrition scientists and practitioners with interest in the application of scientific evidence in policy making. Candidates must have a university degree in health or social sciences with interest in nutrition interventions for public health and be willing to be registered as authors in a Cochrane Group.

Applications from women and from nationals of low- and middle-income countries are particularly encouraged.

Program benefits

In this program, you will:

• update and develop your technical skills and knowledge in systematic reviews of nutrition and nutrition-sensitive interventions;
• build understanding of the process for global policy making, nutrition, and evidence assessment and its challenges;
• complete hands-on training in the development of Cochrane systematic reviews on a topic of immediate global health relevance in nutrition and public health; and
• develop confidence with the review methods and foster development of professional networks with fellow participants and faculty

In the news

Summer course trains experts in WHO policies, Institute launched in 2014

The following article from the Cornell Chronicle, published July 8, 2014, describes our experiences in the first year of the Institute. The 2018 Summer Institute was our 5th Institute.

More than 30 nutrition experts from around the globe gathered at Cornell July 7-18, 2014, for hands-on training in World Health Organization (WHO) procedures to retrieve, summarize and assess reliable, current evidence to inform WHO’s recommendations for nutrition and public health policy.

Institute focuses on global nutrition policy impact

When the Division of Nutritional Sciences at Cornell University hosted the 4th annual Summer Institute for Systematic Reviews in Nutrition for Global Policy Making  from July 24 to August 4, 2017, its participants included 29 experts from around the world, and 10 faculty members from the World Health Organization (WHO), Cornell University and Cochrane.

Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

Published: January 16, 2019 on The Lancet

Executive Summary 

Food systems have the potential to nurture human health and support environmental sustainability, however our current trajectories threaten both. The EAT–Lancet Commission addresses the need to feed a growing global population a healthy diet while also defining sustainable food systems that will minimise damage to our planet.   

The Commission quantitively describes a universal healthy reference diet, based on an increase in consumption of healthy foods (such as vegetables, fruits, whole grains, legumes, and nuts), and a decrease in consumption of unhealthy foods (such as red meat, sugar, and refined grains) that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals.

This is set against the backdrop of defined scientific boundaries that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet.  

The EAT–Lancet Commission is the first of a series of initiatives on nutrition led by The Lancet in 2019, followed by the Commission on the Global Syndemic of obesity, undernutrition, and climate change. Find out more in our Editorial.

Concurrent wasting and stunting among under‐five children in Niakhar, Senegal

by Garenne M, Myatt M, Khara T, Dolan C, Briend A.

Matern Child Nutr. 2018 Oct 26:e12736

(download)

Abstract

Senegal; anthropometry; child survival; concurrent wasting & stunting; stunting; wasting

The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6-59 months living in the 1980s in Niakhar, a rural area of Senegal under demographic surveillance.

Wasting and stunting were defined by z scores lower than -2 in weight for height and height for age. Both conditions were found to be highly prevalent, wasting more so before age 30 months, stunting more so after age 30 months. As a result, concurrent WaSt peaked around age 18 months and its prevalence (6.2%) was primarily the product of the two conditions, with an interaction term of 1.57 (p < 10^-6 ).

The interaction was due to the correlation between both conditions (more stunting if wasted, more wasting if stunted). Before age 30 months, boys were more likely to be concurrently wasted and stunted than girls (RR = 1.61), but the sex difference disappeared after 30 months of age.

The excess susceptibility of younger boys could not be explained by muscle mass or fat mass measured by arm or muscle circumference, triceps, or subscapular skinfold.

Concurrent WaSt was a strong risk factor for child mortality, and its effect was the product of the independent effect of each component, with no significant interaction.

 

 

Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries

from BioMedCentral

By: Mark Myatt, Tanya Khara, Simon Schoenbuchner, Silke Pietzsch, Carmel Dolan, Natasha Lelijveld and André Briend.

Archives of Public Health201876:28

(download)

Background

Wasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of disability-adjusted life years lost in young children. Wasting and stunting tend to be addressed as separate issues despite evidence of common causality and the fact that children may suffer simultaneously from both conditions (WaSt). Questions remain regarding the risks associated with WaSt, which children are most affected, and how best to reach them.

Methods

A database of cross-sectional survey datasets containing data for almost 1.8 million children was compiled. This was analysed to determine the intersection between sets of wasted, stunted, and underweight children; the association between being wasted and being stunted; the severity of wasting and stunting in WaSt children; the prevalence of WaSt by age and sex, and to identify weight-for-age z-score and mid-upper arm circumference thresholds for detecting cases of WaSt. An additional analysis of the WHO Growth Standards sought the maximum possible weight-for-age z-score for WaSt children.

Results

All children who were simultaneously wasted and stunted were also underweight. The maximum possible weight-for-age z-score in these children was below − 2.35. Low WHZ and low HAZ have a joint effect on WAZ which varies with age and sex. WaSt and “multiple anthropometric deficits” (i.e. being simultaneously wasted, stunted, and underweight) are identical conditions. The conditions of being wasted and being stunted are positively associated with each other. WaSt cases have more severe wasting than wasted only cases. WaSt cases have more severe stunting than stunted only cases. WaSt is largely a disease of younger children and of males. Cases of WaSt can be detected with excellent sensitivity and good specificity using weight-for-age.

Conclusions

The category “multiple anthropometric deficits” can be abandoned in favour of WaSt. Therapeutic feeding programs should cover WaSt cases given the high mortality risk associated with this condition. Work on treatment effectiveness, duration of treatment, and relapse after cure for WaSt cases should be undertaken. Routine reporting of the prevalence of WaSt should be encouraged. Further work on the aetiology, prevention, case-finding, and treatment of WaSt cases as well as the extent to which current interventions are reaching WaSt cases is required.

Composition and Properties of Aquafaba: Water Recovered from Commercially Canned Chickpeas.

by Shim YY¹, Mustafa R², Shen J², Ratanapariyanuch K², Reaney MJT³.

J Vis Exp. 2018 Feb 10;(132). doi: 10.3791/56305.

Abstract

Chickpea and other pulses are commonly sold as canned products packed in a thick solution or a brine. This solution has recently been shown to produce stable foams and emulsions, and can act as a thickener.

Recently interest in this product has been enhanced through the internet where it is proposed that this solution, now called aquafaba by a growing community, can be used a replacement for egg and milk protein.

As aquafaba is both new and being developed by an internet based community little is known of its composition or properties. Aquafaba was recovered from 10 commercial canned chickpea products and correlations among aquafaba composition, density, viscosity and foaming properties were investigated.

Proton NMR was used to characterize aquafaba composition before and after ultrafiltration through membranes with different molecular weight cut offs (MWCOs of 3, 10, or 50 kDa). A protocol for electrophoresis, and peptide mass fingerprinting is also presented. Those methods provided valuable information regarding components responsible for aquafaba functional properties.

This information will allow the development of practices to produce standard commercial aquafaba products and may help consumers select products of superior or consistent utility.

Aquafaba, wastewater from chickpea canning, functions as an egg replacer in sponge cake

by Rana Mustafa, Yue He, Youn Young Shim, Martin J. T. Reaney

First published: 07 May 2018, https://doi.org/10.1111/ijfs.13813

from Wiley Online Library

Summary

Aquafaba, the viscous liquid resulting from cooking chickpeas in water is typically discarded. However, this solution is now widely used by the vegan community as an egg replacement that adds texture to food products, such as mayonnaise, pudding, ice cream and baked goods.

Sponge cake was prepared with either egg white or aquafaba derived from ten different brands of canned chickpea and the texture and colour were compared. Aquafaba obtained from each chickpea can produced foam which differed in both properties and stability.

In addition, aquafaba from some brands provided comparable foam volume and stability to that achieved with egg white.

The colour and texture of sponge cake made with either egg white or aquafaba were similar and acceptable, but cakes prepared with aquafaba were less springy, and less cohesive than cake that included egg white.

Based on our results, it appears that aquafaba has potential to replace egg white in eggless cake recipes.