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Archive for the ‘Under-nutrition’ Category

2018 Global food policy report

In Over-nutrition, Under-nutrition on July 13, 2018 at 9:50 pm

from IFPRI web-page

Free Book on global – Pages: 150
IFPRI’s flagship report reviews the major food policy issues, developments, and decisions of 2017, and highlights challenges and opportunities for 2018 at the global and regional levels. This year’s report looks at the impacts of greater global integration—including the movement of goods, investment, people, and knowledge—and the threat of current antiglobalization pressures. Drawing on recent research, IFPRI researchers and other distinguished food policy experts consider a range of timely topics:

 

■ How can the global food system deliver food security for all in the face of the radical changes taking place today?

■ What is the role of trade in improving food security, nutrition, and sustainability?

■ How can international investment best contribute to local food security and better food systems in developing countries?

■ Do voluntary and involuntary migration increase or decrease food security in source countries and host countries?

■ What opportunities does greater data availability open up for improving agriculture and food security?

■ How does reform of developed-country farm support policies affect global food security?

■ How can global governance structures better address problems of food security and nutrition?

■ What major trends and events affected food security and nutrition across the globe in 2017?

The 2018 Global Food Policy Report also presents data tables and visualizations for several key food policy indicators, including country-level data on hunger, agricultural spending and research investment, and projections for future agricultural production and consumption.  In addition to illustrative figures, tables, and a timeline of food policy events in 2017, the report includes the results of a global opinion poll on globalization and the current state of food policy.

Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials

In Over-nutrition, Under-nutrition on July 11, 2018 at 7:58 am

source: NY times web page

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly.Based on decades of research, the resolution says that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes.Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.
American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs.The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

The showdown over the issue was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the United States.

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States.

“We were astonished, appalled and also saddened,” said Patti Rundall, the policy director of the British advocacy group Baby Milk Action, who has attended meetings of the assembly, the decision-making body of the World Health Organization, since the late 1980s.

“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health,” she said.In the end, the Americans’ efforts were mostly unsuccessful. It was the Russians who ultimately stepped in to introduce the measure — and the Americans did not threaten them.

During the deliberations, some American delegates even suggested the United States might cut its contribution to the W.H.O., several negotiators said. Washington is the single largest contributor to the health organization, providing $845 million, or roughly 15 percent of its budget, last year.

The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

In talks to renegotiate the North American Free Trade Agreement, the Americans have been pushing for language that would limit the ability of Canada, Mexico and the United States to put warning labels on junk food and sugary beverages, according to a draft of the proposal reviewed by The New York Times.

During the same Geneva meeting where the breast-feeding resolution was debated, the United States succeeded in removing statements supporting soda taxes from a document that advises countries grappling with soaring rates of obesity.

The Americans also sought, unsuccessfully, to thwart a W.H.O. effort aimed at helping poor countries obtain access to lifesaving medicines. Washington, supporting the pharmaceutical industry, has long resisted calls to modify patent laws as a way of increasing drug availability in the developing world, but health advocates say the Trump administration has ratcheted up its opposition to such efforts.

The delegation’s actions in Geneva are in keeping with the tactics of an administration that has been upending alliances and long-established practices across a range of multilateral organizations, from the Paris climate accord to the Iran nuclear deal to Nafta.

Ilona Kickbusch, director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, said there was a growing fear that the Trump administration could cause lasting damage to international health institutions like the W.H.O. that have been vital in containing epidemics like Ebola and the rising death toll from diabetes and cardiovascular disease in the developing world.

“It’s making everyone very nervous, because if you can’t agree on health multilateralism, what kind of multilateralism can you agree on?” Ms. Kickbusch asked.
Image

The opening of the World Health Assembly in May. After American officials pressured Ecuador, it was Russia that introduced a resolution in support of breast-feeding.CreditPeter Klaunzer/EPA, via Shutterstock
A Russian delegate said the decision to introduce the breast-feeding resolution was a matter of principle.“We’re not trying to be a hero here, but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world,” said the delegate, who asked not to be identified because he was not authorized to speak to the media.He said the United States did not directly pressure Moscow to back away from the measure. Nevertheless, the American delegation sought to wear down the other participants through procedural maneuvers in a series of meetings that stretched on for two days, an unexpectedly long period.In the end, the United States was largely unsuccessful. The final resolution preserved most of the original wording, though American negotiators did get language removed that called on the W.H.O. to provide technical support to member states seeking to halt “inappropriate promotion of foods for infants and young children.”

The United States also insisted that the words “evidence-based” accompany references to long-established initiatives that promote breast-feeding, which critics described as a ploy that could be used to undermine programs that provide parents with feeding advice and support.

Elisabeth Sterken, director of the Infant Feeding Action Coalition in Canada, said four decades of research have established the importance of breast milk, which provides essential nutrients as well as hormones and antibodies that protect newborns against infectious disease.

A 2016 study in The Lancet found that universal breast-feeding would prevent 800,000 child deaths a year across the globe and yield $300 billion in  savings from reduced health care costs and improved economic outcomes for those reared on breast milk.

Scientists are loath to carry out double-blind studies that would provide one group with breast milk and another with breast milk substitutes. “This kind of ‘evidence-based’ research would be ethically and morally unacceptable,” Ms. Sterken said.

Abbott Laboratories, the Chicago-based company that is one of the biggest players in the $70 billion baby food market, declined to comment.

Nestlé, the Switzerland-based food giant with significant operations in the United States, sought to distance itself from the threats against Ecuador and said the company would continue to support the international code on the marketing of breast milk substitutes, which calls on governments to regulate the inappropriate promotion of such products and to encourage breast-feeding.

In addition to the trade threats, Todd C. Chapman, the United States ambassador to Ecuador, suggested in meetings with officials in Quito, the Ecuadorean capital, that the Trump administration might also retaliate by withdrawing the military assistance it has been providing in northern Ecuador, a region wracked by violence spilling across the border from Colombia, according to an Ecuadorean government official who took part in the meeting.

The United States Embassy in Quito declined to make Mr. Chapman available for an interview.

“We were shocked because we didn’t understand how such a small matter like breast-feeding could provoke such a dramatic response,” said the Ecuadorean official, who asked not to be identified because she was afraid of losing her job.

Designing programs to improve diets for maternal and child health: estimating costs and potential dietary impacts of nutrition-sensitive programs in Ethiopia, Nigeria, and India

In Under-nutrition on July 10, 2018 at 6:21 am

from: Health Policy and Planning, Volume 33, Issue 4, 1 May 2018, Pages 564–573

William A Masters Katherine L Rosettie Sarah Kranz Goodarz Danaei Patrick Webb Dariush Mozaffarianthe Global Nutrition and Policy Consortium.

(download here)

Abstract

Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and impacts, especially for interventions designed to improve diet quality.

This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India.

These potential interventions included conditional livestock and cash transfers, media and education, complementary food processing and sales, household production and food pricing programs. Components and costs of each program were identified through a novel participatory process of expert regional consultation followed by validation and calibration from literature searches and comparison with actual budgets. Impacts on child diets were determined by estimating of the magnitude of economic mechanisms for dietary change, comprehensive reviews of evaluations and effectiveness for similar programs, and demographic data on each country.

Across the 12 programs, total cost per child reached (net present value, purchasing power parity adjusted) ranged very widely: from 0.58 to 2650 USD/year among five programs in Ethiopia; 2.62 to 1919 USD/year among four programs in Nigeria; and 27 to 586 USD/year among three programs in India.

When impacts were assessed, the largest dietary improvements were for iron and zinc intakes from a complementary food production program in Ethiopia (increases of 17.7 mg iron/child/day and 7.4 mg zinc/child/day), vitamin A intake from a household animal and horticulture production program in Nigeria (335 RAE/child/day), and animal protein intake from a complementary food processing program in Nigeria (20.0 g/child/day).

These results add substantial value to the limited literature on the costs and dietary impacts of nutrition-sensitive interventions targeting children in resource-limited settings, informing policy discussions and serving as critical inputs to future cost-effectiveness analyses focusing on disease outcomes.

Key message

Existing evidence on cost-effectiveness for nutrition improvement focuses on interventions to address specific diseases. We provide a novel participatory approach to assembling cost and impact data for 12 nutrition-sensitive interventions to improve diet quality in three countries: Ethiopia, Nigeria and India. Programs designed by stakeholders often use resource transfers to influence diets despite their high cost; programs altering food access have lower cost. Future work using these data will analyse net cost-effectiveness.

Big cities, small towns, and poor farmers: Evidence from Ethiopia

In Under-nutrition on July 10, 2018 at 6:06 am

World Development – Volume 106, June 2018, Pages 393-406

JoachimVandercasteelen, Seneshaw TemruBeyene, BartMinten, JohanSwinnen.

LICOS – Center for Institutions and Economic Performance, Department of Economics, University of Leuven, Waaistraat 6, Box 3511, B-3000 Leuven, Belgium
Ethiopia Strategy Support Program, Ethiopian Development Research Institute, International Food Policy Research Institute, PO Box 5689, Addis Ababa, Ethiopia

Highlights

  • Urban population in medium sized cities has doubled in the last decade in Africa.
  • Secondary towns have clear effects for rural migrants, but unclear how they affect rural producers.
  • The paper analyses the impact of city types (primate vs. secondary) and urban proximity on agricultural intensification outcomes of rural teff producers in Ethiopia.
  • Secondary towns affect the proximity relationship between the primate city and the teff prices and modern input use of rural producers.
  • Selling teff in primate cities results in higher teff intensification while (instrumented) urban distance has a negative effect.

 

Abstract

Urbanization is happening fast in the developing world and especially so in sub-Saharan Africa where growth rates of cities are among the highest in the world. While cities and, in particular, secondary towns, where most of the urban population in sub-Saharan Africa resides, affect agricultural practices in their rural hinterlands, this relationship is not well understood.

To fill this gap, we develop a conceptual model to analyze how farmers’ proximity to cities of different sizes affects agricultural prices and intensification of farming. We then test these predictions using large-scale survey data from producers of teff, a major staple crop in Ethiopia, relying on unique data on transport costs and road networks and implementing an array of econometric models.

We find that agricultural price behavior and intensification is determined by proximity to a city and the type of city. While proximity to cities has a strong positive effect on agricultural output prices and on uptake of modern inputs and yields on farms, the effects on prices and intensification measures are lower for farmers in the rural hinterlands of secondary towns compared to primate cities.

Prenatal malnutrition and adult cognitive impairment: a natural experiment from the 1959–1961 Chinese famine

In Under-nutrition on May 10, 2018 at 8:39 pm

from British Journal of Nutrition – link

by Ping He, Li Liu, J. M. Ian Salas, Chao Guo, Yunfei Cheng, Gong Chen and Xiaoying Zheng 

Abstract

The current measures of cognitive functioning in adulthood do not indicate a long-term association with prenatal exposure to the Dutch famine. However, whether such association emerges in China is poorly understood.

We aimed to investigate the potential effect of prenatal exposure to the 1959–1961 Chinese famine on adult cognitive impairment. We obtained data from the Second National Sample Survey on Disability implemented in thirty-one provinces in 2006, and restricted our analysis to 387 093 individuals born in 1956–1965.

Cognitive impairment was defined as intelligence quotient (IQ) score under 70 and IQ of adults was evaluated by the Wechsler Adult Intelligence Scale – China Revision. Famine severity was defined as excess death rate. The famine impact on adult cognitive impairment was estimated by difference-in-difference models, established by examining the variations of famine exposure across birth cohorts.

Results show that compared with adults born in 1956–1958, those who were exposed to Chinese famine during gestation (born in 1959–1961) were at greater risk of cognitive impairment in the total sample. Stratified analyses showed that this effect was evident in males and females, but only in rural, not in urban areas.

In conclusion, prenatal exposure to famine had an enduring deleterious effect on risk of cognitive impairment in rural adults.

Impact on birth weight and child growth of Participatory Learning and Action women’s groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal

In Under-nutrition on May 10, 2018 at 8:31 pm

from PlosOne website

(download)

Abstract

Background

Undernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0–16 months of community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers to pregnant women.

Methods

We randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10–49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya ‘Super Cereal’, n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0–16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed.

Results

In PLA plus food/cash arms, 94–97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0–16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms.

Interpretation

Food supplements in pregnancy with PLA women’s groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition interventions throughout the thousand-day period are recommended.

Trial registration

ISRCTN75964374

Child growth monitor app: a game-changer?

In Over-nutrition, Under-nutrition on May 9, 2018 at 12:52 am

from Welt Hunger Hilfe webpage

Food Environment Working Group (FEWG): An introduction to food environments research

In Over-nutrition, Under-nutrition on April 25, 2018 at 4:44 am

from Agriculture, Nutrition and Health Academy web site.

TED Talk: ‘What if we incentivized doctors (and nutritionists) to keep us healthy instead of paying them only when we’re already sick?’

In Over-nutrition, Under-nutrition on April 5, 2018 at 11:46 am

from TED talk

November 2017

528,506 views

 

 

NO WASTED LIVES: the research agenda

In Under-nutrition on April 3, 2018 at 8:20 pm

from the webpage of No Wasted Lives

Screen Shot 2018-04-03 at 10.17.59 PM.png

The No Wasted Lives Coalition is investing in cutting edge ideas to drive forward global learning and action on acute malnutrition. As part of this effort, in 2018, No Wasted Lives and the Council of Research & Technical Advice (CORTASAM) launched the global Research Agenda for Acute Malnutrition and a call for Expressions of Interest from organisations working in research and programming for acute malnutrition and who want to support this effort. Our aim is to support coordination and concrete action across the sector, filling critical gaps and scaling-up evidence-based prevention and treatment of acute malnutrition.

 

Prioritising Research for Impact

The Council for Research and Technical Advice on Acute Malnutrition (CORTASAM) was assembled under No Wasted Lives with the goal to drive the use of evidence for action, in order to ultimately reach more children with effective treatment and prevention programmes.

Over the course of 2017, CORTASAM and No Wasted Lives launched a research prioritisation exercise, with the involvement and contribution of over 300 individuals from national governments, NGOs, academia, UN agencies and technical experts from around the world. In line with the priority research areas identified and a review of the existing evidence, CORTASAM has identified the following research areas with high potential impact on the effective management of acute malnutrition at scale but where further research and evidence generation is critically needed in order to achieve this:

  1. Effective approaches to detect, diagnose, and treat acute malnutrition in the community: taking community detection using mid-upper arm circumference (MUAC) to scale while building the evidence on diagnosis and treatment of acute malnutrition in the community across contexts and health platforms.
  2. Appropriate entry and discharge criteria for treatment of acute malnutrition to ensure optimum outcomes: building the evidence base on expanded MUAC thresholds for treatment to improve treatment outcomes for all children with acute malnutrition. Also needed is research to explore different options to identify high-risk children not selected by MUAC<115mm and analysis on the impact on burden estimates and operational feasibility, including supply and supply chain.
  3. Optimum dosage of ready-to-use food (RUF) for treatment of acute malnutrition:  investigating the safety, effectiveness, and cost-effectiveness of reduced dosage of RUF for treatment of acute malnutrition.
  4. Effective treatment of diarrhoea in children with severe acute malnutrition (SAM): using evidence to streamline guidance and generating implementation research to understand how the operational application of guidelines can inform improved practice and better treatment outcomes.
  5. Rates and causal factors of post-treatment relapse across contexts: understanding the burden of relapse post-treatment and, if found to be high, effective solutions to reduce relapse across contexts.
  6. Identification and management of at-risk mothers and of infants <6 months of age: generating the evidence required to influence country-level policies and implementation at scale.
  7. Alternative formulations for ready-to-use foods for acute malnutrition: continuation of the large amount of ongoing research to investigate the effectiveness, and cost-effectiveness, of formulas using alternative and local ingredient.

More details about the evidence gaps and CORTASAM’s call for more research can be found in the Research Agenda. Download it below.

 

 

In January 2018 we ran a call for Expressions of Interest in response to the Research Agenda. The call closed in February 2018 and applications are now being considered for possible donor funding. Download an overview of the submissions received here.

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