evidence-based blog of Filippo Dibari

Knowledge, Food Vouchers, and Child Nutrition: Evidence from a Field Experiment in Ethiopia

In Under-nutrition on January 26, 2020 at 8:31 pm

by Seollee Park, Yae Eun Han, and Hyuncheol Kim.

Current Developments in Nutrition, Volume 3, Issue Supplement_1, June 2019, nzz048.P11–116–19, https://doi.org/10.1093/cdn/nzz048.P11-116-19




Young children in developing countries often maintain poor diets, evidenced by strikingly low dietary diversity. Through formative research, we identified the lack of knowledge and affordability as key barriers to improved infant and young child feeding (IYCF) practices in Ethiopia. The aim of this study is to investigate ways to promote healthy IYCF by analyzing the impacts of an IYCF behavior change communication (BCC) program and food vouchers on mother’s IYCF knowledge and practices, and child growth.


Using a clustered randomized design, we compare the effects of two independent interventions—IYCF BCC program and food vouchers—on four study groups: BCC only (BCC), voucher only (Voucher), BCC and voucher (BCC + Voucher), and the control group. The BCC program offered weekly group IYCF sessions to mothers who has children between 4 to 20 months of age for 16 weeks, employing participatory learning methods. The voucher program provided food vouchers worth approximately 10 USD per month for four months, which could be used at nearby markets for purchasing a wide variety of food items. We identified 641 eligible households residing in 79 villages in Ejere through census. As shown in Figure 1, 79 villages were randomly assigned to one of the four study groups: BCC, Voucher, BCC + Voucher, and control. All eligible mothers living in treatment villages were invited to participate in the program to which the village she lives in was assigned.


We show that BCC improves maternal knowledge of nutrition and IYCF behaviors, while food vouchers alone do not (Figure 2). Impacts are largest when both knowledge and income constraints are addressed simultaneously through BCC + Voucher (Table 1). Only in this group do we see these treatments reducing stunting by 9 percentage points (Figure 3). Moreover, we show that BCC + Voucher prevented stunting from occurring during this critical age range rather than reversing it (Figure 4).


Our results suggest that, when both knowledge and income are intertwined challenges for improved child-feeding practices, addressing both constraints simultaneously may augment the positive impacts due to their complementary relationship.Funding


Africa Future Foundation.

IPCC: special report on Climate Change and Land

In Over-nutrition, Under-nutrition on January 5, 2020 at 3:19 pm

(download the Policy and the Technical Briefings)

An IPCC Special Report on climate change, desertification, land degradation, sustainable land management, food and nutrition security, and greenhouse gas fluxes in terrestrial ecosystems.

This Special Report on Climate Change and Land responds to the Panel decision in 2016 to prepare three Special Reports during the Sixth Assessment cycle, taking account of proposals from governments and observer organizations. This report addresses greenhouse gas (GHG) fluxes in land-based ecosystems, land use and sustainable land management  in relation to climate change adaptation and mitigation, desertification , land degradation and food security . This report follows the publication of other recent reports, including the IPCC Special Report on Global Warming of 1.5°C (SR15), the thematic assessment of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) on Land Degradation and Restoration, the IPBES Global Assessment Report on Biodiversity and Ecosystem Services, and the Global Land Outlook of the UN Convention to Combat Desertification (UNCCD). This report provides an updated assessment of the current state of knowledge while striving for coherence and complementarity with other recent reports.

This Summary for Policy makers (SPM) is structured in four parts: A) People, land and climate in a warming world; B) Adaptation and mitigation response options; C) Enabling response options; and, D) Action in the near-term.

Confidence in key findings is indicated using the IPCC calibrated language; the underlying scientific basis of each key finding is indicated by references to the main report.

Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence

In Under-nutrition on June 3, 2019 at 9:49 am

by Jef L LeroyEdward A Frongillo on Advance in Nutrition journal

Advances in Nutrition, Volume 10, Issue 2, March 2019, Pages 196–204,


The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition.

Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting.

Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting.

First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker.

Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value.

In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy.

We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.

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