Publications

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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.

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

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Early marriage and early childbearing in South Asia: Trends, inequalities, and drivers from 2005 to 2018
Scott, Samuel; Nguyen, Phuong Hong; Neupane, Sumanta; Pramanik, Priyanjana; Nanda, Priya; Bhutta, Zulfiqar A.; Afsana, Kaosar; Menon, Purnima. Article in press

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Early marriage (EM) and early childbearing (ECB) have far‐reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever‐married women aged 20–24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of –3.8%/year), Pakistan (–2.8%/year), and Bangladesh (–1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing.

Do tradeoffs among dimensions of women’s empowerment and nutrition outcomes exist? Evidence from six countries in Africa and Asia
Quisumbing, Agnes R.; Sproule, Kathryn; Martinez, Elena M.; Malapit, Hazel Jean L.. Article in press

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Although women’s empowerment and gender equality are often linked with better maternal and child nutrition outcomes, recent systematic reviews find inconclusive evidence. This paper applies a comparable methodology to data on the Women’s Empowerment in Agriculture Index (WEAI), an internationally-validated measure based on interviews of women and men within the same household, from six countries in Africa and Asia to identify which dimensions of women’s empowerment are related to household-, woman-, and child-level dietary and nutrition outcomes. We examine relationships between women’s empowerment and household-level dietary diversity; women’s dietary diversity and BMI; and child-related outcomes, controlling for woman, child, and household characteristics. We also test for differential associations of women’s empowerment with nutrition outcomes for boys and girls. We find few significant associations between the aggregate empowerment scores and nutritional outcomes. The women’s empowerment score is positively associated only with child HAZ, while lower intrahousehold inequality is associated with a higher likelihood of exclusive breastfeeding and higher HAZ but with lower BMI. However, analysis of the subdomain indicators finds more significant associations, suggesting that tradeoffs exist among different dimensions of empowerment. Women’s empowerment accounts for a small share of the variance in nutritional outcomes, with household wealth and country-level factors accounting for the largest share of the variation in household and women’s dietary diversity. In contrast, most of the variation in child outcomes comes from child age. Improving nutritional outcomes requires addressing the underlying determinants of poor nutrition in addition to empowering women and improving gender equality.

Food for thought? Experimental evidence on the learning impacts of a large-scale school feeding program
Aurino, Elisabetta; Gelli, Aulo; Adamba, Clement; Osei-Akoto, Isaac; Alderman, Harold. Madison, WI Article in press

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There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities, and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally-disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda.

Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India
Alderman, Harold; Friedman, Jed; Ganga, Paula; Kak, Mohini; Rubio‐Codina, Marta. Article in press

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Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys.

Scaling up delivery of biofortified staple food crops globally: Paths to nourishing millions
Foley, Jennifer K.; Michaux, Kristina D.; Mudyahoto, Bho; Kyazike, Laira; Cherian, Binu; Kalejaiye, Olatundun; Ifeoma, Okonkwo; Ilona, Paul; Reinberg, Chelsea; Mavindidze, Donald; Boy, Erick. Article in press

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Background: Micronutrient deficiencies affect over one quarter of the world’s population. Biofortification is an evidence-based nutrition strategy that addresses some of the most common and preventable global micronutrient gaps and can help improve the health of millions of people. Since 2013, HarvestPlus and a consortium of collaborators have made impressive progress in the enrichment of staple crops with essential micronutrients through conventional plant breeding.
Objective: To review and highlight lessons learned from multiple large-scale delivery strategies used by HarvestPlus to scale up biofortification across different country and crop contexts.
Results: India has strong public and private sector pearl millet breeding programs and a robust commercial seed sector. To scale-up pearl millet, HarvestPlus established partnerships with public and private seed companies, which facilitated the rapid commercialization of products and engagement of farmers in delivery activities. In Nigeria, HarvestPlus stimulated the initial acceptance and popularization of vitamin A cassava using a host of creative approaches, including “crowding in” delivery partners, innovative promotional programs, and development of intermediate raw material for industry and novel food products. In Uganda, orange sweet potato (OSP) is a traditional subsistence crop. Due to this, and the lack of formal seed systems and markets, HarvestPlus established a network of partnerships with community-based nongovernmental organizations and vine multipliers to popularize and scale-up delivery of OSP.
Conclusions: Impact of biofortification ultimately depends on the development of sustainable markets for biofortified seeds and products. Results illustrate the need for context-specific, innovative solutions to promote widespread adoption.

Ready-to-eat cereal and milk for breakfast compared with no breakfast has a positive acute effect on cognitive function and subjective state in 11–13-year-olds: A school-based, randomised, controlled, parallel groups trial
Adolphus, Katie; Hoyland, Alexa; Walton, Jenny; Quadt, Frits; Lawton, Clare L.; Dye, Louise. Article in press

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Purpose: We tested the acute effect of breakfast (ready-to-eat-cereal [RTEC] and milk) versus (vs.) no breakfast on cognitive function and subjective state in adolescents.
Methods: Healthy adolescents (n = 234) aged 11–13 years were recruited to take part in this school-based, acute, randomised, controlled, parallel groups trial with two interventions; Breakfast or No Breakfast. The breakfast intervention consisted of ad libitum intake of RTEC (up to 70 g) with milk (up to 300 ml) administered in a naturalistic school breakfast programme environment. Cognitive function was assessed at baseline and + 70 and + 215 min post-intervention in a group-testing situation, similar to a school classroom context. The CANTAB test battery included: Simple Reaction Time (SRT), 5-Choice Reaction Time (5-CRT), Rapid Visual Information Processing (RVIP), and Paired Associates Learning (PAL; primary outcome). Data collection commenced January 2011 and ended May 2011. This trial was retrospectively registered at www.clinicaltrials.gov as NCT03979027 on 07/06/2019.
Results: A significant effect of the intervention (CMH[1] = 7.29, p < 0.01) was found for the number of levels achieved on the PAL task. A significant difference between interventions was found when baseline performance reached level 2 (JT, z = 2.58, p < 0.01), such that 100% of participants in the breakfast intervention reached the maximum level 4 but only 41.7% of those in the no breakfast intervention reached level 4. A significant baseline*intervention interaction (F[1,202] = 6.95, p < 0.01) was found for total errors made on the PAL task, indicating that participants who made above-average errors at baseline reduced the total number of errors made at subsequent test sessions following breakfast consumption whilst those in the no breakfast intervention did not. There was a positive effect of breakfast on reaction time and visual-sustained attention. The results also demonstrated interactions of intervention with baseline cognitive performance, such that breakfast conferred a greater advantage for performance when baseline performance was poorer. Conclusion: Consuming breakfast has a positive acute effect on cognition in adolescents.

Testing methods to increase consumption of healthy foods evidence from a school-based field experiment in Viet Nam
Nguyen, Trang; de Brauw, Alan; Van den berg, Marrit; Do, Ha Thi Phuong. Article in press

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Schools are an attractive entry point to improve children’s diets, as their eating habits can be shaped during childhood and the information disseminated from school can reach adults through children. We implemented a cluster-randomized trial in 12 schools in peri-urban Viet Nam to assess if two school-based interventions increased knowledge of healthy diets among children and their parents, as well as children’s consumption of healthy foods. First, children were given lessons about food before school lunch and encouraged to share the lessons with their parents. Second, children were provided with healthy snacks to reinforce messages about healthy eating. We found that in the short term, the nutrition lessons raised the knowledge index score of the children by 0.35 standard deviation. After six months, this intervention lost its effectiveness, emphasizing the need for linkage between knowledge and practice. By itself, free access to fruit at school increased the children’s daily fruit consumption by half a portion, but not at the expense of home fruit consumption. Access to healthy foods at school can therefore be an effective measure to raise children’s healthy consumption. Child-parent communication was not a reliable channel for knowledge dissemination in our setting.

Factor structure and equivalence of maternal resources for care in Bangladesh, Vietnam, and Ethiopia
Basnet, Sulochana; Frongillo, Edward A.; Nguyen, Phuong Hong; Moore, Spencer; Arabi, Mandana. Article in press

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Preconception micronutrient supplementation positively affects child intellectual functioning at 6 y of age: A randomized controlled trial in Vietnam
Nguyen, Phuong Hong; Young, Melissa; Tran, Lan Mai; Khuong, Long Quynh; Duong, Thai Hong. Article in press

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Although there is growing evidence on the role of preconception nutrition for birth outcomes, very few studies have evaluated the long-term effects of nutrition interventions during the preconception period on offspring cognitive outcomes.

Food consumption–production response to agricultural policy and macroeconomic change in Nigeria
Ecker, Olivier; Hatzenbuehler, Patrick L.. Article in press

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Achieving agricultural transformation and farmer resilience in resource‐dependent developing countries like Nigeria is complicated by volatile macroeconomic conditions, which disrupt agricultural supply chains through income, foreign exchange, and risk‐mitigation effects. This study examines the food consumption–production linkage in Nigeria at a time when the national Agricultural Transformation Agenda was implemented and an economic crisis was unfolding. Many farm households responded to expected shocks by planting more staple foods for own consumption at the expense of agricultural commercialization, income growth, and dietary diversification. A policy initiative to improve access to modern farm inputs appeared to mitigate these adverse effects.

Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: An agenda for action
Heidkamp, Rebecca A.; Piwoz, Ellen G.; Gillespie, Stuart; Keats, Emily C.; D'Alimonte, Mary R.; Menon, Purnima; Ruel, Marie T.. Article in press

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As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda—now amplified by the COVID-19 crisis.

Maternal preconception body size and early childhood growth during prenatal and postnatal periods are positively associated with child-attained body size at age 6–7 years: Results from a follow-up of the PRECONCEPT trial
Nguyen, Phuong Hong; Young, Melissa; Khuong, Long Quynh; Tran, Lan Mai; Duong, Thai Hong. Article in press

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Growth faltering is associated with adverse consequences during childhood and later life. However, questions remain on the relative importance of preconception maternal nutritional status (PMNS) and child growth during the first 1000 d of life.

Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda
Victora, Cesar G.; Christian, Parul; Vidaletti, Luis Paulo; Gatica-Domínguez, Giovanna; Menon, Purnima; Black, Robert E.. Article in press

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Paying for digital information: Assessing farmers’ willingness to pay for a digital agriculture and nutrition service in Ghana
Hidrobo, Melissa; Palloni, Giordano; Aker, Jenny; Gilligan, Daniel O.; Ledlie, Natasha. Article in press

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Effect of maize processing methods on the retention of minerals, phytic acid and amino acids when using high kernel-zinc maize
Gallego-Castillo, Sonia; Taleon, Victor; Talsma, Elise F.; Rosales-Nolasco, Aldo; Palacios-Rojas, Natalia. Article in press

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High kernel-zinc maize varieties are available to consumers in several countries in Latin America to contribute to increase the zinc intake of their populations. Minerals, phytic acid and amino acids retention were measured after processing six maize varieties including three high kernel-zinc, one quality protein maize and two conventional maize. Grain for each variety was processed in duplicate into tortillas, arepas and mazamorra, common maize dishes in the region. To evaluate the effect of processing kernel-zinc maize varieties on zinc retention, varieties were grouped in zinc biofortified maize (ZBM) and non-ZBM. Iron, zinc, phytic acid, tryptophan and lysine concentrations in non-processed maize were 17.1–19.1 μg/g DW, 23.9–33.0 μg/g DW, 9.9–10.0 mg/g DW, 0.06–0.08% and 0.27–0.37%, respectively. In tortillas, the iron, zinc, phytic acid and lysine content did not change (p<0.05) compared to raw grain, while tryptophan decreased by 32%. True retention of iron in arepas and mazamorra was 43.9 and 60.0%, for zinc 36.8 and 41.3%, and for phytic acid 19.3 and 25.1%. Tortillas had higher zinc retention than arepas and mazamorra due to use of whole grain in the nixtamalization process. Therefore, to contribute to higher zinc intake, nixtamalized tortilla prepared with biofortified zinc maize is recommended. Additionally, promotion of whole grain flour to prepare arepas should be explored to enhance the intake of minerals that are usually confined to aleurone layers and germ.

Differential impact of the great recession on foreign and domestic firms in China: Did processing trade play a role in export performance?
Munasib, Abdul; Roy, Devesh; Tian, Xi. Article in press

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Peer effects in the valuation and practices of food safety: Findings from the study of dairy consumers in India
Chandra, Raj; Munasib, Abdul; Roy, Devesh; Sonkar, Vinay Kumar. Article in press

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