Publications

PUBLICATIONS

by IFPRI | June 14, 2019

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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.

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.

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.

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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Agriculture-nutrition linkages, cooking-time, intrahousehold equality among women and children: Evidence from Tajikistan
Takeshima, Hiroyuki; Akramov, Kamiljon T.; Park, Allen; Ilyasov, Jarilkasin; Ergasheva, Tanzila. Article in press

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Adolescent birth and child undernutrition: An analysis of demographic and health surveys in Bangladesh, 1996–2017
Nguyen, Phuong Hong; Scott, Samuel; Khuong, Long Quynh; Pramanik, Priyanjana; Ahmed, Akhter; Rashid, Sabina Faiz; Afsana, Kaosar; Menon, Purnima. Article in press

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Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10–19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10–15 years old) were more likely to be underweight (+11 pp), have lower education (−24 pp), have less decision-making power (−10 pp), live in poorer households (−0.9 SD) with poorer sanitation (−15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (−3 to −24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height-for-age Z-scores (−0.29 SD for young and −0.10 SD for old adolescents (16–19 years old)), weight-for-age Z-score (−0.18 and −0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.

Multiple-micronutrient supplementation in pregnant adolescents in low- and middle-income countries: A systematic review and a meta-analysis of individual participant data
Keats, Emily C.; Thurairajah, Pravheen; Thurairajah, Pravheen; Cousens, Simon N.; Bhutta, Zulfiqar A.; Global Young Women’s Nutrition Investigators’ Group. Article in press

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Approximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.

Effect of parboiling conditions on zinc and iron retention in biofortified and non-biofortified milled rice
Taleon, Víctor; Hasan, Md Zakiul; Jongstra, Roelinda; Wegmüller, Rita; Bashar, Md Khairul. Article in press

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Provision and utilisation of health and nutrition services during COVID-19 pandemic in urban Bangladesh
Nguyen, Phuong Hong; Sununtnasuk, Celeste; Pant, Anjali; Tran, Lan Mai; Kachwaha, Shivani; Menon, Purnima. Article in press

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The COVID-19 pandemic is expected to have profound effects on healthcare systems, but little evidence exists on service provision, utilisation, or adaptations. This study aimed to (1) examine the changes to health and nutrition service delivery and utilisation in urban Bangladesh during and after enforcement of COVID-19 restrictions and (2) identify adaptations and potential solutions to strengthen delivery and uptake. We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children <2 years (n = 387) in February 2020 (in-person) and September 2020 (by phone). We used Wilcoxon matched-pairs signed-rank tests to compare the changes before and during the pandemic. Services delivery for women and children which require proximity were severely affected; weight and height measurements fell by 20–29 percentage points (pp) for pregnant women and 37–57 pp for children, and child immunisations fell by 38 pp. Declines in service utilisation were large, including drops in facility visitations (35 pp among pregnant women and 67 pp among mothers), health and nutrition counselling (up to 73 pp), child weight measurements (50 pp), and immunisations (61 pp). The primary method of adaptation was provision of services over phone (37% for antenatal care services, 44%–49% for counselling). Despite adaptations to service provision, continued availability of routine maternal and child health services did not translate into service utilisation. Further investments are needed to provide timely and accurate information on COVID-19 to the general public, improve COVID-19 training and provide incentives for health care providers and ensure availability of personal protective equipment for providers and beneficiaries.

Women’s empowerment and gender equality in South Asian agriculture: Measuring progress using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI) in Bangladesh and India
Quisumbing, Agnes R.; Meinzen-Dick, Ruth Suseela; Malapit, Hazel J.. Article in press

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Using cognitive interviewing to bridge the intent-interpretation gap for nutrition coverage survey questions in India
Ashok, Sattvika; Kim, Sunny S.; Heidkamp, Rebecca A.; Munos, Melinda K.; Menon, Purnima; Avula, Rasmi. Article in press

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Designing survey questions that clearly and precisely communicate the question's intent and elicit responses based on the intended interpretation is critical but often undervalued. We used cognitive interviewing to qualitatively assess respondents' interpretation of and responses to questions pertaining to maternal and child nutrition intervention coverage. We conducted interviews to cognitively test 25 survey questions with mothers (N = 21) with children less than 1 year in Madhya Pradesh, India. Each question was followed by probes to capture information on four cognitive stages—comprehension, retrieval, judgement, and response. Data were analysed for common and unique patterns across the survey questions. We identified four types of cognitive challenges: (1) retention of multiple concepts in long questions: difficulty in comprehending and retaining questions with three or more key concepts; (2) temporal confusion: difficulty in conceptualizing recall periods such as “in the last 6 months” as compared to life stages such as pregnancy; (3) interpretation of concepts: mismatch of information being asked, meaning of certain terms and intervention scope; and (4) understanding of technical terms: difficulty in understanding commonly used technical words such as “breastfeeding” and “antenatal care” and requiring use of simple alternative language. Findings from this study will be useful for stakeholders involved in survey design and implementation, especially those conducting large-scale household surveys to measure coverage of essential nutrition interventions.

Coherence for nutrition: Insights from nutrition-relevant policies and programs in Burkina Faso and Nigeria
Billings, Lucy; Pradeilles, Rebecca; Gillespie, Stuart; Vanderkooy, Anna; Diatta, Dieynab; Touré, Mariama; Diatta, Ampa Dogui; Verstraeten, Roosmarijn. Article in press

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There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence) while among programmes the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture, and social focus areas. However, none of the linked pairs were assessed to have complete external coherence suggesting that priorities at policy level are not fully realised nor translated at programme level. This study offers a new approach for assessment of policy and program coherence and specifically examines policy and program linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of nutrition investments.

Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi
Gelli, Aulo; Kemp, C. G.; Margolies, Amy; Twalibu, Aisha; Katundu, Mangani; Levin, Carol E.. Article in press

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Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.

The impact of an integrated value chain intervention on household poultry production in Burkina Faso: Evidence from a randomized controlled trial
Leight, Jessica; Awonon, Josué; Pedehombga, Abdoulaye; Ganaba, Rasmané; Martinez, Elena M.; Heckert, Jessica; Gelli, Aulo. Article in press

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Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh
Billah, Sk Masum; Ferdous, Tarana E.; Kelly, Patrick; Raynes-Greenow, Camille; Siddique, Abu Bakkar; Gillespie, Stuart; Hoddinott, John F.; Menon, Purnima. Article in press

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Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

Women’s empowerment and gender equality in agricultural value chains: Evidence from four countries in Asia and Africa
Quisumbing, Agnes R.; Heckert, Jessica; Faas, Simone; Ramani, Gayathri V.; Raghunathan, Kalyani; Malapit, Hazel J.; The pro-WEAI for Market Inclusion Study Team. Article in press

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Women play important roles at different nodes of both agricultural and off-farm value chains, but in many countries their contributions are either underestimated or limited by prevailing societal norms or gender-specific barriers. We use primary data collected in Asia (Bangladesh, Philippines) and Africa (Benin, Malawi) to examine the relationships between women’s empowerment, gender equality, and participation in a variety of local agricultural value chains that comprise the food system. We find that the value chain and the specific node of engagement matter, as do other individual and household characteristics, but in different ways depending on country context. Entrepreneurship—often engaged in by wealthier households with greater ability to take risks—is not necessarily empowering for women; nor is household wealth, as proxied by their asset ownership. Increased involvement in the market is not necessarily correlated with greater gender equality. Education is positively correlated with higher empowerment of both men and women, but the strength of this association varies. Training and extension services are generally positively associated with empowerment but could also exacerbate the inequality in empowerment between men and women in the same household. All in all, culture and context determine whether participation in value chains—and which node of the value chain—is empowering. In designing food systems interventions, care should be taken to consider the social and cultural contexts in which these food systems operate, so that interventions do not exacerbate existing gender inequalities.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: A secondary analysis of the 2003-2014 Ghana Demographic and Health Survey (GDHS) data
Azupogo, Fusta; Abizari, Abdul-Razak; Aurino, Elisabetta; Gelli, Aulo; Osendarp, Saskia J. M.; Bras, Hilde; Feskens, Edith J.; Brouwer, Inge D.. Article in press

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Fortified balanced energy-protein supplements increase nutrient adequacy without displacing food intake in pregnant women in rural Burkina Faso
de Kok, Brenda; Argaw, Alemayehu; Hanley-Cook, Giles; Toe, Laeticia Celine; Ouédraogo, Moctar; Diop, Loty; Becquey, Elodie; Huybregts, Lieven. Article in press

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Background: In many low- and middle-income countries, the prevalence of energy and nutrient deficiencies is high among pregnant women. Balanced energy-protein (BEP) supplements are a promising strategy to cover nutritional requirements during pregnancy and improve birth outcomes. However, the displacement of nutrient-dense foods by BEP might attenuate the efficacy of supplementation.
Objective: This cross-sectional study of participants in a randomized controlled trial evaluated the difference in energy and macro- and micronutrient intakes, food groups, and nutrient adequacy between a control and intervention group receiving either a daily iron–folic acid (IFA) tablet or IFA and BEP supplement during pregnancy, respectively.
Methods: We collected a single multiple-pass 24-h recall from 470 pregnant women from the MIcronutriments pour la SAnté de la Mère et de l'Enfant (MISAME) III study that investigates the efficacy of BEP supplementation on birth outcomes and infant growth. Dietary intake (median and IQR) and nutrient adequacy were assessed using individual recipes and preparation methods of mixed dishes for each participant. Linear regression models were fitted to compare energy and nutrient intakes.
Results: Dietary energy, and macro- and micronutrient intakes were significantly higher among women in the intervention group when including BEP [2329 kcal/d (1855, 3008 kcal/d) compared with 1942 kcal/d (1575, 2405 kcal/d) in the control group (all P < 0.001)]. The difference in median energy intake (448 kcal/d; 95% CI: 291, 605 kcal/d) was approximately equivalent to a daily dose of the BEP supplement (393 kcal). Nutrient adequacy ratios for both groups were low for all micronutrients (between 0.02 and 0.66), when excluding BEP (except iron and folic acid, due to standard supplemental doses) from analysis. However, nutrient intakes increased to the Estimated Average Requirement for pregnant women when including BEP supplements. Conclusions: BEP supplementation increases energy and macro- and micronutrient intakes among pregnant women and fills nutrient gaps without displacing food intake. This trial was registered at clinicaltrials.gov as NCT03533712 (https://clinicaltrials.gov/ct2/show/NCT03533712).

The ambivalent links between internal migration and food security in Uganda
Mekonnen, Daniel A.; Soma, Katrine; Ruben, Ruerd. Article in press

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This study examines the drivers for and consequences of internal migration to household food security in Uganda. Based on the Ugandan National Panel Surveys conducted between 2010/11 and 2015/16, we estimate differences in food energy adequacy of households receiving internal migrants from elsewhere. Besides food energy consumption, this study applies household food consumption score (FCS) and looks at vulnerability in terms of household’s expenditures on food. This enables to explore (a) the extent to which food insecurity is driving internal migration, and (b) whether remittances can reduce food security of the remitter. We find that households are usually worse-off when migrants join the receiving family. This seems a departure from previous studies that tend to find welfare gains to internal migration, mostly due to changes in expenditures or dietary consumption without considering any thresholds for achieving food security. Based on these findings and responding to rising youth employment challenges associated with rapidly growing urban slums in Uganda, policies that simultaneously support employment creation in both urban and rural areas are urgently needed to enable better steering of the flow of voluntary migration and to help ensuring food security.

Can it be all more simple? Manufacturing aflatoxin biocontrol products using dry spores of atoxigenic isolates of Aspergillus flavus as active ingredients
Ortega‐Beltran, Alejandro; Kaptoge, Lawrence; Senghor, Amadou L.; Aikore, Morounranti O. S.; Jarju, Patrick; Momanyi, Henry; Konlambigue, Matieyedou; Falade, Titilayo D. O.; Bandyopadhyay, Ranajit. Article in press

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Aflatoxin contamination of staple crops, commonly occurring in warm areas, negatively impacts human and animal health, and hampers trade and economic development. The fungus Aspergillus flavus is the major aflatoxin producer. However, not all A. flavus genotypes produce aflatoxins. Effective aflatoxin control is achieved using biocontrol products containing spores of atoxigenic A. flavus. In Africa, various biocontrol products under the tradename Aflasafe are available. Private and public sector licensees manufacture Aflasafe using spores freshly produced in laboratories adjacent to their factories. BAMTAARE, the licensee in Senegal, had difficulties to obtain laboratory equipment during its first year of production. To overcome this, a process was developed in Ibadan, Nigeria, for producing high‐quality dry spores. Viability and stability of the dry spores were tested and conformed to set standards. In 2019, BAMTAARE manufactured Aflasafe SN01 using dry spores produced in Ibadan and sent via courier and 19 000 ha of groundnut and maize in Senegal and The Gambia were treated. Biocontrol manufactured with dry spores was as effective as biocontrol manufactured with freshly produced spores. Treated crops contained safe and significantly (P < 0.05) less aflatoxin than untreated crops. The dry spore innovation will make biocontrol manufacturing cost‐efficient in several African countries.