The Agridiet Resource Centre highlights a selection of the latest research on Agriculture and Nutrition in Africa from a broad range of research organisations - not just those involved in the Agridiet project. All the documents shown are freely available to download. This service is provided in partnership with IDS Knowledge Services using open data supplied by Eldis.
Over the past two decades, many developing countries have made impressive progress in reducing undernutrition. In this paper, the authors explore potential explanations of this success by applying consistent statistical methods to multiple rounds of Demographic Health Surveys for Bangladesh, Nepal, Ethiopia, Odisha, Senegal, and Zambia.
The research finds that changes in household wealth, mother's education and access to antenatal care are the largest drivers of nutritional improvement, except for Zambia where large increases in bednet usage is the single largest factor. Other factors play a smaller role in explaining nutritional improvements with improvements in sanitation only appearing to be important in South Asia. Overall, the results point to the need for multidimensional nutritional strategies involving a broad range of nutrition-sensitive sectors.
asset accumulation and parental education are important predictor of nutritional improvement in most countries
improved sanitation is more strongly associated with height-for-age in South Asian countries
asset accumulation and parental education are important predictor of nutritional improvement in most countries
As political commitment is an essential ingredient for elevating food and nutrition security onto policy agendas, commitment metrics have proliferated. Many conflate government commitment to fight hunger with combating undernutrition. Here the authors test the hypothesis that commitment to hunger reduction is empirically different from commitment to reducing undernutrition through expert surveys in five high-burden countries: Bangladesh, Malawi, Nepal, Tanzania, and Zambia.
Findings confirm the hypothesis. The paper concludes that sensitive commitment metrics are needed to guide government and donor policies and programmatic action. Without, historically inadequate prioritisation of non-food aspects of malnutrition may persist to imperil achieving global nutrition targets.
nine key components of political commitment are identified
research uses expert perception surveys in Bangladesh, Malawi, Nepal, Tanzania, and Zambia
commitment metrics must be sensitive to these differences to better guide...
The calls for strong leadership in the fight against global and national malnutrition have multiplied during the past decade. The role of nutrition champions in advocating for nutrition, formulating policies, and coordinating and implementing action in nutrition have increasingly been recognized in such countries as Peru, Brazil, Thailand, and the Indian states of Tamil Nadu and Maharashtra. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the African Nutrition Leadership Programme, and the European Nutrition Leadership Platform have invested in building up capacity for leadership among national governments, civil society, and the private sector. The World Public Health Nutrition Association’s guide on competencies needed to build up the workforce in global public health nutrition identified leadership as key. More widely, leadership within the field of public health has been highlighted as key to moving child or maternal health higher up on the global agenda and tackling critical issues such as HIV and AIDS at the national and community levels.
This paper is a chapter in Nourishing millions: Stories of change in nutrition. Gillespie, Stuart; Hodge, Judith; Yosef, Sivan; and Pandya-Lorch, Rajul (Eds.) Ch. 18 Pp. 161-172. Washington, D.C.: International Food Policy Research Institute....
After a period of relative success in generating political momentum to address malnutrition, there is an increasing urgency to focus on implementation and impact on the ground. This requires better documentation of the experiences of policymakers, nutrition leaders, program managers and implementers in making decisions on what to do in real time, such as coordinating and implementing multisectoral nutrition plans in dynamic country contexts.
The goal of the Stories of Change (SoC) initiative is to foster and support such experiential learning by systematically assessing and analysing drivers of change in six high-burden contexts (Ethiopia, Zambia, Senegal, Bangladesh, Nepal and Odisha, India) that have had some success in accelerating improvements in nutrition. While recognising context-specificity, here the authors unpack the key pre-requisites (commitment, coherence, accountability, data, leadership, capacity and finance) that fuel and sustain progress.
Highlights of this research:
Strong leadership has been highlighted as a common element of success within countries that have made rapid progress in tackling child and maternal undernutrition. Yet little is known of what contributes to nutrition leaders’ success or lack of it in particular policy environments.
This study of 89 individuals identified as influential within child and maternal undernutrition policy and programming in Bangladesh, Ethiopia, Kenya and India sheds light on why particular individuals have been effective in contributing towards positive changes in nutrition policy, and how they operate in the wider policy/political sphere. The authors employ a framework working outwards from individual capabilities, knowledge and motivations, through to wider political economy considerations and the narratives and knowledge structuring individual capacity. The paper argues that only by locating individuals within this wider political economy can we begin to appreciate the range of strategies and avenues for influence (or constraints to that influence) that individual leaders employ and encounter.
Background: Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.
Methods: A case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.
Results: Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.
Conclusion: Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of...
Background: Ethiopia is one of the countries with the highest burden of undernutrition, with rates of stunting and underweight as high as 40% and 25%, respectively. National efforts are underway for an accelerated reduction of undernutrition by the year 2030. However, for this to occur, understanding the spatial variations in the distribution of undernutrition on a varying geographic scale, and its determinants will contribute a quite a bit to enhance planning and implementing nutrition intervention programmes.
Objectives: The aim of this thesis was to evaluate the large- and small-scale spatial variations in the distribution of undernutrition indicators, the underlying processes and the factors responsible for the observed spatial variations.
Methods: We used nationally available climate and undernutrition data to evaluate the macro-scale spatial pattern of undernutrition and its determinants. We applied a panel study design, and evaluated the effect of growing seasonal rainfall and temperature variability on the macro-scale spatial variations (Paper I). We conducted a repeated cross- sectional survey to assess the performance of the Household Food Insecurity Access Scale (HFIAS) developed internationally to measure household food insecurity. The results from this validation work were used to modify the HFIAS items for subsequent papers (Papers III and IV). We conducted a census on six randomly selected kebeles to evaluate the spatial patterns of undernutrition on a smaller scale (Paper III). For Paper IV, we conducted a cross-sectional survey on a representative sample, and employed a Bayesian geo-statistical model to help identify the risk factors for stunting, thereby accounting for the spatial structure (spatial dependency) of the data.
Results: In Paper I, we demonstrated spatial variations in the distribution of stunting across administrative zones in the country, which could be explained in part by rainfall. However, the models poorly explained the variation in stunting within an administrative zone during the study period. We indicated that a single model for all agro-ecologic zones may not be appropriate. In Paper II, we showed that the internal consistency of the HFIAS' tools, as measured by Cronbach's alpha, was adequate. We observed a lack of reproducibility in HFIAS score among rural households. Therefore, we modified the HFAIS tool, and used it for subsequent surveys in this thesis (Papers III and IV). In Paper III, spatial clustering on a smaller scale (within a kebele) was found for wasting and severe wasting. Spatial clustering on a higher scale (inter-kebele) was found for stunting and severe stunting. Children found within the identified cluster were 1.5 times more at risk of stunting, and nearly five times more at risk of wasting, than children residing outside this cluster. In Paper IV, we found a significant spatial heterogeneity in the distribution of stunting in the district. Using both the local Anselin Moran's I (LISA) and the scan statistics, we identified statistically significant clusters of high value (hotspots) and a most likely significant cluster for stunting in the eastern part of the district. We found that the risk of stunting was higher among boys, children whose mother or guardian had no education and children who lived in a food-insecure household. We showed that including a spatial component (spatial structure of the data) into the Bayesian model improved the model fit compared with the model without this spatial component.
Conclusion: We demonstrated that stunting and wasting exhibited a spatial heterogeneity, both on a large and small scale, rather than being distributed randomly. We demonstrated that there is a tendency for undernourished cases (stunting and wasting) to occur near each other than to occur homogeneously. We demonstrated a micro-level spatial variation in risk and vulnerability to undernutrition in a district with a high burden of undernutrition. Identifying such areas where a population at risk lives is central in assisting a geographical targeting of intervention. We recommend further study, possibly using a trial design or implementation research approach, to help evaluate the feasibility and benefits of geographically targeting nutritional...
This paper provides a summary of the situation of nutrition in Tanzania, and an institutional analysis of the principal actors in nutrition nationally and locally. The paper argues the need to focus on prevention of malnutrition by protecting, promoting and sustaining improved nutrition in children under...
This brief examines the status of nutrition in Tanzania. Despite improvements between 1999 and 2004/05, data clearly show that the prevalence of child undernutrition remains high in Tanzania and malnutrition begins at an early age. Based on the evidence presented, the brief concludes that a national strategy to prevent malnutrition must focus upon protecting, promoting and sustaining improved nutrition in children under two years of age. Strong advocacy for nutrition and effective coordination of interventions under national leadership are urgently required to raise the profile of nutrition and improve nutritional outcomes in...