Publications

PUBLICATIONS

by IFPRI | June 14, 2019

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Observability of food safety losses in maize: Evidence from Kenya
Hoffmann, Vivian; Mutiga, Samuel K.; Harvey, Jagger W.; Nelson, Rebecca J.; Milgroom, Michael G.. Article in press

Demand for aflatoxin‐safe maize in Kenya: Dynamic response to price and advertising
Hoffmann, Vivian; Moser, Christine; Herrman, Timothy J.. Article in press

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In countries where regulatory enforcement is weak, voluntary third‐party verification of firms' food safety processes can allow concerned consumers to select safer products. However, due in part to their legal ambiguity, and the potential to attract additional regulatory scrutiny, food safety claims are rarely made by firms. As a result, the impact of such claims on consumer demand is not well understood. We examine how labeling maize as tested for aflatoxin, a carcinogen also associated with stunting in children, affects sales. By randomly varying the timing and intensity of a marketing campaign to promote the first maize flour brand in Kenya labeled as tested for aflatoxin, we characterize dynamic consumer response to information about food safety. We find an immediate response in sales to marketing alone, which disappears as soon as marketing ceases. Sales remain elevated in the weeks after a temporary discount is offered, but this effect also fades over time and is not associated with greater awareness of the firm's food safety claims. These results suggest that it is unrealistic to expect for‐profit firms serving mass markets in low‐ and middle‐income countries to invest heavily in marketing based on food safety claims.
Food safety consciousness and consumers’ milk purchasing behavior: Evidence from a developing country
Thapa, Ganesh; Kumar, Anjani; Roy, Devesh; Joshi, Pramod Kumar. Article in press

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We study the effects of food safety awareness on consumers’ milk purchasing behavior in Nepal. We conducted consumer survey and employed an instrumental variable regression. We find education, income, and social network to influence food safety consciousness (FSC). Our results indicate the positive impact of FSC on weekly milk expenditure and probability of purchasing milk from milk cooperatives. Any policy that helps to improve the FSC levels will likely increase the purchase of safe milk from the modern market outlet, and lack of such awareness raising policies has prevented the market for safe food from evolving and expanding.
Incidence correction factors for moderate and severe acute child malnutrition from two longitudinal cohorts in Mali and Burkina Faso
Barba, Francisco M.; Huybregts, Lieven; Leroy, Jef L.. Article in press

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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.
Effects of dose and duration of zinc interventions on risk factors for Type 2 Diabetes and Cardiovascular Disease: A systematic review and meta-analysis
Pompano, Laura M.; Boy, Erick. Article in press

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No meta-analysis has examined the effect of dose and duration of zinc interventions on their impact on risk factors for type 2 diabetes (T2D) or cardiovascular disease (CVD). This study aimed first to compare the effects of zinc interventions dichotomized as low versus high dose (<25 mg/d and ≥25 mg/d, respectively) and short versus long duration (<12 wk and ≥12 wk, respectively) on risk factors for T2D and CVD. Second, it discusses the results from the low-dose and long-duration meta-analyses as a foundation for understanding what impact a zinc-biofortification intervention could have on these risk factors. The PubMed and Cochrane Review databases were searched through January 2020 for full-text, human studies providing zinc supplements (alone) at doses ≤75 mg/d and a placebo. Data on study and sample characteristics and several T2D and CVD risk factors were extracted. There were 1042 and 974 participants receiving zinc and placebo, respectively, from 27 studies. Low-dose zinc supplementation (<25 mg/d) significantly benefited fasting blood glucose, insulin resistance, triglycerides, total cholesterol, and LDL cholesterol. High-dose zinc supplementation (≥25 mg/d) benefited glycated hemoglobin and insulin resistance. Short-duration interventions (<12 wk) benefited fasting blood glucose, insulin resistance, and triglycerides, while long-duration studies (≥12 wk) benefited fasting blood glucose, triglycerides, and total and LDL cholesterol. Effect sizes for low-dose and long-duration interventions were of equal or greater magnitude to those from high-dose or short-duration interventions. Low-dose and long-duration zinc supplementation each improved more risk factors for T2D and CVD than high-dose and short-duration interventions, respectively. It is currently unknown whether low doses of zinc delivered over long durations via a biofortified crop would similarly impact these risk factors. However, this review suggests that low-dose, long-duration zinc intake from supplements, and potentially biofortification, can benefit risk factors for T2D and CVD.
Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)
Tang, Alice M.; Chung, Mei; Dong, Kimberly R.; Bahwere, Paluku; Bose, Kaushik; Nguyen, Phuong Hong. Article in press

Impact of COVID-19 on agricultural markets: Assessing the roles of commodity characteristics, disease caseload and market reforms
Varshney, Deepak; Roy, Devesh; Meenakshi, J. V.. Article in press

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This paper assesses the impact of the spread of COVID-19 and the lockdown on wholesale prices and quantities traded in agricultural markets. We compare whether these impacts differ across non-perishable (wheat) and perishable commodities (tomato and onion), and the extent to which any adverse impacts are mitigated by the adoption of a greater number of agricultural market reform measures. We use a granular data set comprising daily observations for 3 months from nearly 1000 markets across five states and use a double- and triple- difference estimation strategy. Expectedly, our results differ by type of commodity and period of analysis. While all prices spiked initially in April, they recovered relatively quickly, underscoring the importance of time duration for analysis. Wheat prices were anchored in large part by the minimum support price, while tomato prices were lower in some months. Supply constraints began easing in May with greater market arrivals perhaps reflecting distress sales. Market reform measures did help in insulating farmers from lower prices, but these effects are salient for the perishable goods, and not so much for wheat where the government remained the dominant market player. Taken together, these results point to considerable resilience in agricultural markets in dealing with the COVID-19 shock, buffered by adequate policy support.
Income variability, evolving diets, and elasticity estimation of demand for processed foods in Nigeria
de Brauw, Alan; Herskowitz, Sylvan. Article in press

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We present evidence on evolving dietary patterns in Nigeria using six rounds of household consumption data from the Nigerian General Household Survey panel between 2011 and 2016. First, following conventional definitions in the literature, we show that Nigeria has not shown any aggregate increase in consumption of highly processed foods over this period, contrary to patterns observed elsewhere in the region. In fact, consumption of highly processed foods at home has declined, while food consumed away from home, often assumed to be highly processed, has risen substantially. We then show that estimates of food expenditure elasticities of different food types are highly sensitive to different estimation approaches and raise concerns about some frequently used methods in the literature. In the absence of credible exogenous variation, we argue for the importance of panel methods and household fixed effects to control for time invariant factors likely to confound cross‐sectional estimates. Finally, we examine semiparametric Engel curves for different food groups and find that apparent curvature in the relationships between food budget shares and overall food expenditure levels in the raw data become nearly linear when removing variation explained by time‐invariant household factors.
Conflict of interest in nutrition: Where’s the power? Comment on “Towards preventing and managing conflict of interest in nutrition policy? An analysis of submissions to a consultation on a draft WHO tool”
Harris, Jody; Nisbett, Nicholas; Gillespie, Stuart. Article in press

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Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.
Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh
Wable, Gargi; Dickin, Katherine; Kanbur, Ravi; Menon, Purnima; Rasmussen, Kathleen M.; Hoddinott, John F.. Article in press

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Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women's dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women's dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.
Affordability of nutritious diets in rural India
Raghunathan, Kalyani; Headey, Derek D.; Herforth, Anna. Article in press

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In 2015–16 some 38% of preschool children in India were stunted, 21% wasted, and more than half of Indian mothers and young children were anemic. Though widely studied, surprisingly little research on malnutrition in India explores the role of diets, particularly the affordability of nutritious diets given low wages and the significant structural problems facing India’s agricultural sector. To explore this we used nationally representative rural price and wage data to estimate the least cost means of satisfying India’s national dietary guidelines, referred to as the Cost of a Recommended Diet (CoRD), and assessed the affordability of this diet relative to male and female wages for unskilled laborers. Although we find that dietary costs have increased substantially for both men and women, rural wage rates increased more rapidly, implying that nutritious diets became substantially more affordable over time. However, in absolute terms nutritious diets in 2011 were still expensive relative to unskilled wages, constituting approximately 80–90% of female and 50–60% of male daily wages. Overall, we estimate that 63–76% of the rural poor could not afford a recommended diet in 2011. Achieving nutritional security in India requires a much more holistic focus on improving the affordability of the full range of nutritious food groups (not just cereals), a reappraisal of social protection schemes in light of the cost of more complete nutrition, ensuring that economic growth results in sustained income growth for the poor, and more timely and transparent monitoring of food prices, incomes and dietary costs.
Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: A randomized controlled trial in rural Ethiopia
Argaw, Alemayehu; Bouckaert, Kimberley P.; Wondafrash, Mekitie; Kolsteren, Patrick W.; Lachat, Carl; De Meulenaer, Bruno; Hanley-Cook, Giles; Huybregts, Lieven. Article in press

Daily consumption of pro-vitamin A biofortified (yellow) cassava improves serum retinol concentrations in preschool children in Nigeria: A randomized controlled trial
Afolami, Ibukun; Mwangi, Martin N.; Samuel, Folake; Boy, Erick; Ilona, Paul; Talsma, Elise F.; Feskens, Edith J.; Melse-Boonstra, Alida. Article in press

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Background: Vitamin A deficiency is a public health problem in sub-Saharan Africa. Pro-vitamin A biofortified (yellow) cassava has the potential to contribute significantly to improve vitamin A status, especially in populations that are difficult to reach with other strategies.
Objectives: The study aimed at determining the efficacy of biofortified cassava to improve vitamin A status of Nigerian preschool children.
Methods: An open-label randomized controlled trial was conducted in southwestern Nigeria. In total, 176 preschool children (aged 3–5 y) were randomized into 2 parallel arms comprising an experimental group (n = 88), fed foods prepared from biofortified (yellow) cassava, and a control group (n = 88), fed foods prepared from white cassava, twice a day, 6 d a week for 93 d.
Results: A total of 159 children completed the trial (yellow cassava group, n = 80; white cassava group, n = 79). Children consumed 221 and 74 µg/d retinol activity equivalents from intervention foods in the yellow and white cassava groups, respectively. The treatment effect on serum retinol concentrations at the end of the feeding trial was 0.06 µmol/L (95% CI: 0.004, 0.124 µmol/L), after adjustment for baseline retinol concentrations, inflammation, and asymptomatic malaria status. No significant treatment effects were detected for serum β-carotene (adjusted effect: 3.9%; 95% CI: −0.6%, 8.6%) and gut permeability (adjusted effect: 0.002; 95% CI: −0.089, 0.092), but a significant effect was detected for hemoglobin concentrations (adjusted effect: 3.08 g/L; 95% CI: 0.38, 5.78 g/L).
Conclusions: Daily consumption of β-carotene from biofortified cassava improved serum retinol and hemoglobin concentrations modestly in Nigerian preschool children. This study was registered with clinicaltrials.gov as NCT02627222.
Quantitatively evaluating the cross-sectoral and one health impact of interventions: A scoping review and application to antibiotic resistance
Naylor, Nichola R.; Lines, Jo; Waage, Jeff; Wieland, Barbara; Knight, Gwenan M.. Article in press

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Current published guidance on how to evaluate antibiotic resistance (ABR) from a One Health perspective has focussed on the evaluation of intervention design and of the implementation process. For efficient resource allocation, it is also important to consider quantitative measures of intervention impact. In particular, there has been little discussion of how to practically evaluate ABR-related agri- and aquaculture interventions from a public health perspective. Lessons can be learned from other One Health and cross-sectoral intervention impact evaluations. WebofScience, EconLit, PubMed and grey literature were searched for literature quantitatively evaluating interventions across humans, animals and/or the environment. The review included 90 studies: 73 individual evaluations (from 72 papers) and 18 reviews, all including some measure of human impact, but only 29 papers covered all three One Health perspectives (human, animal and environmental). To provide decision makers with expected outcome estimates that are related to their objective, evaluations should provide outcome estimates from multiple different perspectives; individual, microeconomic and/or macroeconomic perspectives across the One Health system should be taken into account. Based on the methods found in this review, a multi-level compartmental modelling approach for ABR-related intervention evaluation is proposed. The outcomes of such models can then feed into multi-criteria-decision analyses that weigh outcomes alongside other chosen outcome estimates (for example equity or uncertainty). It is key that future quantitative evaluation models on ABR-related interventions are shared (for example through open source code sharing websites) to avoid duplication of effort and to enable more comprehensive estimates of intervention impact to be modelled in the future.
Predictors of intention to integrate biofortified orange-fleshed sweetpotato in child feeding: A field information experiment in rural Kenya
Lagerkvist, Carl Johan; Mutiso, Janet Mwende; Okello, Julius Juma; Muoki, Penina; Oluoch-Kosura, Willis; Heck, Simon. Article in press

Can household dietary diversity inform about nutrient adequacy? Lessons from a food systems analysis in Ethiopia
Mekonnen, Daniel Ayalew; Talsma, Elise F.; Trijsburg, Laura; Linderhof, Vincent; Achterbosch, Thom; Nijhuis, Aafke; Ruben, Ruerd; Brouwer, Inge D.. Article in press

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This study examined the use of the household dietary diversity score (HDDS) to assess household nutrient adequacy in Ethiopia. It also examined the correlates of HDDS following the food systems framework. Results show that the average nutrient consumption in Ethiopia varies by place of residence and by income profile, where households in urban areas and those in the higher income quintiles rank favorably. Among 13 nutrients under study, we found nutrient inadequacy for fat, calcium, zinc, riboflavin, niacin, folate, vitamin C and vitamin A ranging between 46% and 89%, and the prevalence of inadequacy for vitamin B12 to be up to 100%. Econometric results showed that HDDS is a strong predictor of a household’s mean probability of nutrient adequacy (MPA), and that an HDDS of 10 is the minimum threshold at which HDDS can improve household MPA. We found suggestive evidence within the food systems that improving household-incomes, access to health and transport services are beneficial to improve HDDS and nutrient consumption in Ethiopia.
Evaluating parliamentary advocacy for nutrition in Tanzania
te Lintelo, D. J. H.; Pittore, K.. Article in press

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The global nutrition community is currently putting significant efforts into supporting parliamentary advocacy, aiming to bring nutrition higher up on political agendas in low-income countries with high burdens of malnutrition. Evaluating the effects of parliamentary advocacy is fraught with methodological challenges and case studies are scarce. This article adopts a contribution analysis and process tracing procedure to evaluate whether parliamentary advocacy influenced political party manifestos in Tanzania in the run up to the 2015 general election. We present a rare and empirically rich application of this systematic qualitative evaluative method. We find that configurations of activities, actors and outputs can be plausibly understood to have had a contributory role in achieving increased attention to nutrition in the party manifesto of the election winner. We further identify key risks and assumptions that mediated parliamentary advocacy and development evaluators’ ability to evaluate its outcomes, including: targeting; timing; circulation; intelligibility; power; elites; resources; and political space.
Assessing factors influencing adolescents’ dietary behaviours in urban Ethiopia using participatory photography
Trübswasser, Ursula; Baye, Kaleab; Holdsworth, Michelle; Loeffen, Megan; Feskens, Edith J. M.; Talsma, Elise F.. Article in press

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Objective: To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia. Design: Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discussions and photographs were coded for thematic analysis. Setting: One private and one public school located in the same, central neighbourhood in Addis Ababa, Ethiopia to explore how school populations of different socio-economic status experience the same neighbourhood environment. Participants: Twenty-six adolescents aged 14–19 years old, of which there were seventeen girls and nine boys. Results: Findings from the current study indicate that food safety concerns appear to be the major influencing factors for adolescents’ dietary choices. Unhealthy and unsafe foods appear to be widely available and/or affordable in adolescents’ neighbourhoods and almost half of the photographs taken by adolescents depicted poor hygiene conditions related to food vendors. Participants considered foods available in their environments as generally unsafe, calling for more packaged food. Conclusions: Concerns for food safety, hygiene and affordability are the dominating factors for adolescents’ food choices. These concerns, together with limited nutrition knowledge and preference for packaged foods, could make cheap, ultra-processed packaged foods more desirable.