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PUBLICATIONS

by IFPRI | June 14, 2019

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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.
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.
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.
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

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

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.
Stories of change in nutrition from Africa and Asia: An introduction to a special series in food security
Gillespie, Stuart; Harris, Jody; Nisbett, Nicholas; van den Bold, Mara. Article in press

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Malnutrition in all its forms continues to be a massive global challenge, and the past decade has seen a growing political attention to addressing malnutrition in different contexts. What has been largely missing so far, and is in growing demand from countries, is tangible, practical and rigorous insights and lessons (from other countries or contexts) on how to translate this burgeoning political momentum into effective policies and programme implementation strategies – and ultimately impact on the ground. This new climate of learning from experience and evidence led to the launch in 2015 of the Stories of Change initiative. This series presents a second wave of studies from six countries (Tanzania, Rwanda, Vietnam, Ghana, Burkina Faso, Nigeria,) and three Indian states (Chhattisgarh, Gujarat, Tamil Nadu). These provide clear evidence combined with compelling narratives on what drives success in addressing all forms of malnutrition – evidence that is necessary for turning global momentum into actual results on the ground. This introductory Opinion is published with the first set of papers. It will be followed by a thorough synthesis of papers as a conclusion of the Series. We hope that the lessons embedded in these Stories of Change will inform and inspire the deliberations and outcomes of the UN Food Systems Summit and the second Nutrition for Growth Summit to be held this year, and the actions of those in the global food and nutrition system working for positive change.
In pursuit of a better world: Crop improvement and the CGIAR
Kholova, J.; Urban, M. O.; Cock, J.; Arcos, J.; Arnaud, E.; Aytekin, Destan. Article in press

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The CGIAR crop improvement (CI) programs, unlike commercial CI programs, which are mainly geared to profit though meeting farmers’ needs, are charged with meeting multiple objectives with target populations that include both farmers and the community at large. We compiled the opinions from more than thirty experts in the private and public sector on key strategies, methodologies and activities that could help CGIAR meet the challenges of providing farmers with improved varieties while simultaneously meeting the goals of: (i) nutrition, health, and food security; (ii) poverty reduction, livelihoods, and jobs; (iii) gender equality, youth and inclusion; (iv) climate adaptation and mitigation and (v) environmental health and biodiversity. We review the crop improvement processes starting with crop choice, moving through to breeding objectives, production of potential new varieties, selection and finally adoption by farmers. The importance of multi-disciplinary teams working towards common
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.
COVID-19 disrupted provision and utilization of health and nutrition services in Uttar Pradesh, India: Insights from service providers, household phone surveys, and administrative data
Nguyen, Phuong Hong; Kachwaha, Shivani; Pant, Anjali; Tran, Lan M.; Walia, Monika; Ghosh, Sebanti; Sharma, Praveen K.; Escobar-Alegria, Jessica; Frongillo, Edward A.; Menon, Purnima; Avula, Rasmi. Article in press

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Background: The coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services.
Objectives: This study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic.
Methods: We conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children <2 y old (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. Results: Compared with prepandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home rations (∼30%). Most FLWs (68%–90%) restored service provision in July 2020, except for immunization and hot cooked meals (<10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼40%–90%), social distancing (80%), and using PPE (40%–50%) and telephones for communication (∼20%). On the demand side, service utilization reduced substantially (40–80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%). Conclusions: COVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.
Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation
Nguyen, Phuong Hong; Kachwaha, Shivani; Tran, Lan Mai; Avula, Rasmi; Young, Melissa; Ghosh, Sebanti; Sharma, Praveen K.; Escobar-Alegria, Jessica; Forissier, Thomas; Patil, Sumeet; Frongillo, Edward A.; Menon, Purnima. Article in press

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Background: Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services.
Objectives: We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices.
Methods: We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices.
Results: Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg).
Conclusions: Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.
Understanding implementation and improving nutrition interventions: Barriers and facilitators of using data strategically to inform the implementation of maternal nutrition in Uttar Pradesh, India
Young, Melissa F.; Bootwala, Ahad; Kachwaha, Shivani; Avula, Rasmi; Ghosh, Sebanti; Sharma, Praveen Kumar; Shastri, Vishal Dev; Forissier, Thomas; Menon, Purnima; Nguyen, Phuong Hong. Article in press

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Background: In response to the high levels of maternal nutrition in Uttar Pradesh, Alive & Thrive (A&T) aimed to strengthen the delivery of nutrition interventions through the government antenatal care platform, including leveraging ongoing data collection to improve program delivery and reach (clinicaltrials.gov NCT03378141). However, we have a limited understanding of providers’ experiences and challenges of collecting and using data for decision making.
Objective: To identify barriers and facilitators to the 1) collection of data and 2) use of data for decision-making.
Methods: In-depth interviews (N = 35) were conducted among block-level government staff, frontline worker (FLW) supervisors and A&T staff in two districts in Uttar Pradesh. Systematic coding of verbatim transcripts and detailed summaries were undertaken to elucidate themes related to data collection and use. FLW supervisors (N = 103) were surveyed to assess data use experiences.
Results: Data were used to understand the reach of maternal nutrition services, estimate the demand for supplements and guide identification of areas of low FLW performance. About half of supervisors reported using data to identify areas of improvement; however, only 23% reported using data to inform decision-making. Facilitators of data collection and use included collaboration between health department officials, perceived importance of block ranking and monthly review meetings with staff and supervisors to review and discuss data. Barriers to data collection and use included human resource gaps, inadequate technology infrastructure, FLW education level, political structure and lack of cooperation between FLWs and supervisors.
Conclusions: Use of data for decision-making is critical for supporting intervention planning and providing targeted supervision and support for FLWs. Despite intensive data collection efforts, the use of data to inform decision-making remains limited. Collaboration facilitated data collection and use, but structural barriers such as staff vacancies need to be addressed to improve the implementation of maternal nutrition interventions.
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.
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.
The effectiveness of biosecurity interventions in reducing the transmission of bacteria from livestock to humans at the farm level: A systematic literature review
Youssef, Dina Mohamed; Wieland, Barbara; Knight, Gwenan M.; Lines, Jo; Naylor, Nichola R.. Article in press

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Zoonotic bacterial infections are a health hazard for people who are in regular contact with livestock at the farm level. Improved biosecurity can limit zoonotic pathogen transmission within farms. The aim of this review was to summarize the effectiveness of farm‐level biosecurity interventions in reducing bacterial transmission from animals to people who lived, worked in or visited farms. A systematic literature review was conducted using Embase, Ovid Medline and Agris databases, which were searched on 7th of July 2019, limited to English language papers but with no time exclusion criteria. A narrative synthesis was undertaken utilizing the Centre for Reviews and Dissemination approach, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Risk of bias within and across the included studies was performed using established checklists. Out of 869 studies retrieved through database searches, 11 studies were selected. In addition, three studies were found through study reference lists. Fourteen studies were therefore included in this review. Biosecurity interventions were grouped into five categories: hand washing, sanitization and hygienic measures (six studies); personal protective equipment (five studies); vaccination (two studies); other interventions (e.g. air ventilation flap) (four studies); and routine farm activities (two studies). Across studies that investigated odds of human colonization or infection (three studies), odds were seen to both be increased and decreased through use of tested biosecurity measures. Large confidence intervals that often crossed the threshold of an odds ratio equal to 1 were found. Most of the studies' overall risk of bias was ‘medium risk’ (11 studies), with selection bias domains generally being scored ‘medium risk.’ Biosecurity interventions are potentially beneficial in reducing bacterial transmission from animals to humans. However, more high‐quality evidence is needed to increase certainty in which interventions, in which contexts, are most effective from the human health perspective.