All Publications

The Nutrition Innovation Lab provides support for research in Asia and Africa devoted to implementing effective interventions that integrate agriculture and nutrition activities to achieve a significant reduction in stunting among children less than 24 months of age and undernutrition in mothers. Our specific goals include: i) generation of empirical evidence of what works at scale (through applied research), and ii) support for enhanced institutional and human capacity to conduct research and implement effective nutrition activities at scale in future years.

Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms

Authors: Renee Sharma; Michelle Gaffey; Harold Alderman; Diego Bassani; Kimber Bogard; Gary Darmstadt; Jai Das; Joseph E de Gaft-Johnson; Jena Hamadani; Susan Horton; Luis Huicho; Julia Hussein; Stephen Lye; Rafael Pérez–Escamilla; Kerrie Proulx; Kofi Marfo; Venessa Matthews-Hanna; Mireille S Mclean; Atif Rahman; Karlee Silver; Daisy Singla; Patrick Webb; Zulfiqar A Bhutta June 2017
Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe Continue reading →
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Design and Baseline Characteristics of a Study Comparing Four Supplementary Foods in the Prevention of Stunting and Wasting Among Children 6–23 Months in Burkina Faso

Authors: Ilana Cliffer; Breanne Langlois; Devika Suri; Shelley Walton; Laetitia Ouedraogo; Augustin Zeba; Hermann Lanou; Franck Garanet; Patrick Webb; Beatrice Rogers January 1970
The Food Aid Quality Review (FAQR), a study implemented by Tufts University, recommended improvements in the formulations and programming of existing Title II supplementary foods. To test these recommendations, we are examining the effectiveness and cost-effectiveness of four different supplementary foods in the prevention of stunting and wasting in children age 6 to 23 months in Burkina Faso. The objective of this report is to describe the study methods and baseline characteristics of the sample, including baseline measures of stunting and wasting.
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Exploring Aflatoxin Prevention and Control Practices in Banke, Nepal

Authors: Johanna Andrews-Trevino; Shibani Ghosh; Beatrice Rogers; Gerald Shively; Dale Davis; Kedar Prasad Baral; Patrick Webb April 2017
Aflatoxins are harmful to animals and humans. Much is unknown about the determinants of aflatoxin exposure, and how specific agricultural practices may lead to, or help limit, food contamination and diet exposure. Based on prior studies, chronic consumption of aflatoxins may be a public health concern in Nepal.
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Factors associated with mid upper arm circumference in pregnant women in Banke, Nepal

Authors: Shibani Ghosh; Johanna Andrews Trevino; Dale Davis; Robin Shrestha; Abhiygna Bhattarai; KC Anushree; Ashish Pokharel; Bishnu Dulal; Sabi Gurung; Krishna Paudel; Kedar Baral; Patrick Webb April 2017
Rates of weight gain in pregnancy are associated with infant weight for age, length for age and weight for length and are predictive of postnatal growth at 6 months of age. The study examines factors linked with low mid upper arm circumference (MUAC) in pregnant women in Banke Nepal.
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Factors associated with anemia in pregnant women in Banke, Nepal

Authors: Shibani Ghosh; Johanna Andrews Trevino; Dale Davis; Robin Shrestha; Abhiygna Bhattarai; KC Anushree; Ashish Pokharel; Bishnu Dulal; Sabi Gurung; Krishna Paudel; Kedar Baral; Patrick Webb April 2017
Anemia through pregnancy is highly correlated with poor birth outcomes, especially low birth weight (LBW). The Nepal DHS 2011 reports prevalence of anemia in pregnant women at 48%.
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Relationship of Stunting and Overweight in Egyptian children under five years of age: Trends and associated risk factors

Authors: Shibani Ghosh; Grace Namirembe; Marwa Moaz; Ashish Pokharel; Elizabeth Marino- Costello; Jeffrey Griffiths; Patrick Webb April 2017
In Egypt, rates of child overweight and obesity are consistently increasing. While progress has been made in the reduction of stunting, Egypt’s rate of 21% is still higher than countries in the region that have the same GDP.
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Nutritional Resilience Following the 2015 Earthquake in Nepal

Authors: Andrew Thorne-Lyman; Swetha Manohar; Binod Shrestha; Sumanta Neupane; Bareng Nonyane; Sudeep Shrestha; Patrick Webb; Rolf Klemm; Keith West Jr. April 2017
The earthquake that hit Nepal in April, 2015, caused considerable structural damage and loss of life but little is known about the longer term impacts of the earthquake on nutritional status of preschool children and related risk factors. This analysis provides the first systematic national estimate of the nutritional situation in Nepal following the earthquake.
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A multi-level risk factor assessment for stunting: Evidence from a national sample in Nepal

Authors: Jamie Dorsey; Swetha Manohar; Sumanta Neupane; Binod Shrestha; Andrew Thorne-Lyman; Patrick Webb; Rolf Klemm; Keith West Jr. April 2017
Despite marked improvement in child undernutrition, especially stunting, in Nepal over the past decade, stunting prevalence remains high at 41% thus generating an urgent need to understand factors associated with childhood stunting.
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins Continue reading →
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Chapter 2.2 The Economic Causes of Malnutrition

Authors: William Masters October 2016
From the book Good Nutrition: Perspectives for the 21st Century
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Cross-sectional but not Longitudinal Measures of Food Insecurity are Associated with the Rate of Weight Gain during Pregnancy in Northern Uganda

Authors: Barnabas Natamba; Francoise Vermeylen; Elizabeth Widen; Shibani Ghosh; Patsy Brannon; Sera Young April 2016
Food insecurity (FI) during pregnancy may lead to adverse health outcomes for affected women. However, little is known on whether such effects are due to short-term within person changes (longitudinal effects) in FI or long-term between person differences (cross-sectional effects) in this exposure. Therefore, the aim of this study was to assess whether differences in cross-sectional measures of FI between women (defined as the mean prenatal IFIAS score) and/or longitudinal changes in FI within women
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Progression of antepartum depression differs by level of perceived social support and food insecurity

Authors: Barnabas Natamba; Francoise Vermeylen; Rebecca Joyce Stoltzfus; Jeffrey Griffiths April 2016
Antepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI
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HIV-Infected Pregnant and Lactating Women have Higher Serum Aflatoxin levels than HIV–Uninfected Women and Aflatoxin Levels are Higher during Early Postpartum than during Pregnancy among HIV-Infected Women

Authors: Barnabas Natamba; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins are carcinogenic and may affect linear growth. Prior cross-sectional data from Ghana have shown that aflatoxin levels are ~ 20% higher among HIV-infected than HIV-uninfected post-partum women. It is not known if HIV-infected pregnant women have elevated serum aflatoxin levels during pregnancy, or if aflatoxin levels change during the perinatal period. We therefore studied these relationships among a cohort of 246 women recruited in Gulu, Uganda, and followed through pregnancy and early infant life. All HIV-positive women received HIV antiretroviral therapy for free from Continue reading →
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HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

Authors: Barnabas Natamba; Jeffrey Griffiths; Patsy Brannon; Saurabh Mehta April 2016
Adequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub-Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth.
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High levels of food insecurity were observed among HIV, TB, and HIV/TB co-infected outpatients in northern Uganda

Authors: Mia Monique Blakstad; Barnabas Natamba April 2016
Food insecurity among individuals living with HIV is well-recognized globally. Since comorbidity with TB is common, particularly in sub-Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.
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Effect of Nutrition-Sensitive Agricultural Extension Program on Nutrition Knowledge and Dietary Practices of Farming Households in Mukono District, Central Uganda

Authors: Elizabeth Asiimwe April 2016
This poster presentation discusses the outcomes of an extension program implemented in the Mukono District of Central Uganda. It was investigating the knowledge levels of nutrition among men and women, as well as factors that influenced diet diversity among farming households.
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Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV-Infected Pregnant Women and Reduced Linear Growth of HIV-Exposed Infants

Authors: Barnabas Natamba; Jia-Sheng Wang; Sera Young; Shibani Ghosh; Jeffrey Griffiths April 2016
Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda.
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the Continue reading →
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To end malnutrition, we must step up to the plate with data on what people eat

Authors: Lawrence Haddad; Patrick Webb October 2015
Food systems are increasingly recognized as the driving force behind malnutrition in all its forms. Healthy diets are as fundamental to resolving stunting and vitamin and mineral deficiencies as they are to preventing obesity and diet-related non-communicable diseases. And healthy diets are made possible through healthy food systems.
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Florence Turyashemererwa; Bernard Bashaasha; Annet Kawuma; Nassul Kabunga; Jeffrey Griffiths; Shibani Ghosh October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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Risk Factors for Anemia in Non-pregnant Women across the Agroecological Zones of Nepal

Authors: Swetha Manohar; Raman Shrestha; Ruchita Rajbhandary; Devendra Gauchan ; Ramesh Adhikari; Shibani Ghosh; Patrick Webb; Keith P.W. West Jr August 2015
Abstract- Objectives: Describe the prevalence of anemia in Nepali non-pregnant women of reproductive age by agroecological zone and potential risk factors.
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Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

Authors: David Pelletier; Barnabas Natamba; Dia Sanou; Jackson Tumwine August 2015
Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Underlying Vitamin A Status Affects the Association between Dark Green Leafy Vegetable Intake and Serum Retinol and β-Carotene Concetrations among Pregnant Women in Nepal

Authors: Jamie Dorsey July 2015
This poster presentation examines levels of Vitamin A and B Carotene in pregnant women in Kathmandu Nepal.
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Understanding Pathways of Better Nutrition: Poster Presentation

Authors: Edgar Agaba June 2015
This poster is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab.  The poster was presented at the LCIRAH Research Conference, June 03-04, 2015.  
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Combining public datasets to explore global trends in dietary quality, undernutrition and chronic disease 1980-2009

Authors: Rosemary Green; Jenny Sutherland; Alan Dangour; Patrick Webb April 2015
Combining public datasets to explore global trends in dietary quality, undernutrition and chronic disease 1980-2009 Agricultural production, commodity marketing and food consumption patterns have changed significantly over the past 30 years the world over, as have national epidemiological profiles.
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Understanding Pathways of Better Nutrition

Authors: Edgar Agaba April 2015
This presentation is a result of Edgar Agaba’s ALE-(Applied Learning Experience) research work that was completed last year in Uganda’s 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab. It was originally presented it to  Faculty and students on Wednesday, April 29th 2015: Sackler Room 316, 4:00 – 7:30 p.m as part of the ALE Presentations.
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Maternal HIV Infection, but not Food Insecurity, Predicts the Pattern of Weight Gain in Pregnant Women Attending Antenatal Services in Northern Uganda

Authors: Barnabas Natamba; Elizabeth Widen; Patsy Brannon; Sautabh Mehta April 2015
In Sub-Saharan Africa, the differential impact of maternal HIV infection and/or food insecurity on the pattern of weight gain among pregnant women is unknown. To fill this gap, data on 402 pregnant women (33% HIV+ & participating in antiretroviral treatment) enrolled in a perinatal cohort study at Gulu Regional Referral Hospital in northern Uganda were analyzed.
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Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

Authors: Barnabas Natamba; Shibani Ghosh; Sera Young April 2015
To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Mycotoxin Exposure among Pregnant Women: Examining Knowledge, Practices, Diet Quality and Effects on Birth Outcomes in Banke, Nepal

Authors: Johanna Andrews Chavez January 2015
The goal of aim 1 is to qualitatively assess existing agricultural and food storage knowledge and practices and quantitatively assess if knowledge and practices are associated with maternal aflatoxins exposure levels.
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Chapter 7: Childhood Threats to Adult Cognition in Sub- Saharan Africa: Malaria, Anemia, Stunting, Enteric Enteropathy, and the Microbiome of Malnutrition

Authors: Jeffrey Griffiths; Joyce Kikafunda December 2014
Many common childhood conditions are associated with cognitive deficits. While some causes of impaired cognition, such as lead exposure, are well understood, other common conditions in countries such as Uganda – malnutrition, anemia and malaria – are not sufficiently recognized. In this chapter we discuss stunting and its root causes of undernutrition, a lack of sanitation and its relationship to environmental enteropathy and the intestinal microbiome. We also review information about iron-deficiency anemia and malaria, and their neurological and cognitive consequences. We believe that cognitive declines later in life, Continue reading →
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Nutrition Innovation Lab Annual Reports- Year 4

Authors: Nutrition Innovation Lab October 2014
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2014 starting October 2013 through September 2014 (“Y4”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the Continue reading →
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Challenges to Turning Nutrition & Agriculture Research into Action: A Case Study of NGO Research Uptake in Nepal

Authors: E. Biehl August 2014
In Nepal, despite improvements in poverty reduction and health services, malnutrition persists. 41% of children under age five are stunted, 29% of children are underweight, and 18% of women of reproductive age are malnourished1. The Government of Nepal, research institutions, and local and international non-governmental organizations (NGOs) are working to improve nutrition through nutrition-specific and nutrition-sensitive interventions such as agricultural programs that increase production, productivity and income; improving water, sanitation, and hygiene practices; and encouraging more equitable food allocation within the household2. The involvement of Continue reading →
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A Qualitative Look at the Barriers to Interdisciplinary Collaboration in Agriculture and Nutrition Research in Nepal

Authors: C. Fitch July 2014
Nepal’s burden of malnutrition and the dominance of agricultural livelihoods highlight the importance of understanding the pathways from agricultural production to nutritional outcomes and employing interventions that incorporate food production and consumption. A need for improved understanding of such pathways and the impacts of nutrition-sensitive interventions has encouraged related research initiatives in Nepal. Agriculture research has often been conducted separately from nutrition research, despite the inherent relationship between agriculture and nutrition in rural Nepal’s food-producing households and increasing recognition that agricultural production directly influences food Continue reading →
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2014 Scientific Symposium

Authors: Various July 2014
2014 Scientific Symposium Poster Presentations Abhishek Khadha Change in anti-nutritional and reducing sugar value during germination in some varieties of finger millet in Nepal Adam Richter Non-timber forest products and childhood undernutrition: A review of the literature Amrit Prasad Poudel Evaluation of quality protein maize for food and nutritional security in the western hills of Nepal Madhusudhan Ghimire Roles of Cooperatives in Household Food Security: Insights from Rupandehi, Lalitpur, Kabhrepalanchowk and Sindhupalchowk Claire Fitch Is diversity in agriculture production linked to dietary diversity in among Continue reading →
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Determinants of Nutritional Outcomes Among Children below Five Years of Age in Uganda

Authors: Happy Providence June 2014
 This thesis presents findings of a study that sought to understand determinants of nutritional outcomes of children below five years of age in Uganda. Understanding these determinants was vital because in the Ugandan situation, most of the determinants are not ade8uately understood.  Even for those that are known, the magnitude of their impact and or the relative strengths of their impact on nutritional outcomes across regions is not well known.
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Factors Associated with Complementary Feeding Practices Among Children age 6-23 months in Pader District

Authors: Caroline Nambafu June 2014
Infant and young child feeding has been known to compromise the health of children among which complementary  feeding plays a major part. Even communities that have performed adequately in breast feeding have had  their  efforts undermined by complementary feeding hence causing malnutrition among their children.  This study was conducted with the aim of finding out factors that are associated with complementary feeding among the children in Pader district.
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Factors Associated with Dietary Diversity Among Women of Reproductive Age (15-49 yrs) in Agago District

Authors: Ray Oroma June 2014
Despite the internationally accepted recommendation that eating a diversity of foods leads to a healthy diet, and is associated with positive health outcomes such as reduced mortality, little information exists on what factors influence dietary diversity among women of reproductive age in Agago district.  The objective of this study is to determine dietary diversity among women of reproductive age (15-49 years) in Agago district.
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Maternal food insecurity, anemia, and social support are independently associated with prenatal depression among HIV-positive and -negative women attending antenatal services in northern Uganda

Authors: Barnabas Natamba; Thomas Oyok; Sophie Mou; Shibani Ghosh; Rebecca Stoltzfus; Jeffrey Griffiths; Sera Young April 2014
Limited data exist on prenatal depression in in high HIV burden resource-poor settings. Population: 403 pregnant clinic attendees at Gulu Hospital, Uganda. HIV (+) women were oversampled in a ratio of 1 HIV (+): 2 HIV
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Nutrition Innovation Lab Annual Reports- Year 3

Authors: Nutrition Innovation Lab October 2013
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2013 starting October 2012 through September 2013 (“Y3”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring Continue reading →
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2nd Annual Scientific Symposium Proceedings, August 13-14, 2013

Authors: Raman Shrestha; Swetha Manohar; Rolf Klemm August 2013
The Nutrition Innovation Lab‘s 2nd Annual Scientific Symposium held in Kathmandu, Nepal on August 13-14, 2013 under the theme “Science and Policy for Health, Agriculture and Economic Growth” facilitated the sharing of new research findings along the agriculture to nutrition pathway.
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring Continue reading →
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Risk Factors for Anemia in Non-Pregnant Women across the Agroecological Zones of Nepal

Authors: S. Manohar ; R. Shrestha; R. Rajbhandary; R. Klemm; Gauchan D; Adhikari R; Webb P; Ghosh S; West KPW Jr April 2012
Objective: Describe the prevalence of anemia in Nepali non-pregnant women of reproductive age by agroecological zone and potential risk factors.
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Nutrition Innovation Lab Annual Reports- Year 1

Authors: Nutrition Innovation Lab October 2011
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2011 starting October 2010 through September 2011 (“Y1”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring Continue reading →
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Association between household food insecurity and infant growth in rural Bangladesh

Authors: Muzi Na; Sucheta Mehra; Rolf Klemm; Parul Christian April 2011
Food insecurity is a global concern, yet its association with child growth is not fully understood. This study in rural Bangladesh explored associations between household food insecurity, using standardized questions, and infant growth. We asked a published 10-item, 6-mo household food insecurity questionnaire at 6 and 12 mo postpartum to 6,333 mothers participating in an antenatal micronutrient supplementation trial.
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