Program & Policy Processes

How can large-scale programs best incorporate knowledge about agriculture’s support for nutrition into cost-effective multi-sectoral interventions aimed at improved nutrition?

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Understanding pathways to better nutrition at district level: Lessons from Uganda

Authors: Edgar Agaba; Jeffrey Griffiths November 2017
For countries looking to implement multisectoral nutrition plans, it is critical to understand what works and how programs should be delivered and scaled-up in each context. Programs can learn from each other on how to adapt to new information, evidence and events related to scaling-up and district stakeholders can play important roles in implementation of this multisectoral plan. As part of “Pathways-to-Better Nutrition” (PBN) case study conducted by USAID/SPRING Project, this research set out to explore district leaders’ perceptions of the nutrition situation, programs and Continue reading →

Pre-earthquake national patterns of preschool child undernutrition and household food insecurity in Nepal in 2013 and 2014

Authors: Sudeep Shrestha; Andrew Thorne-Lyman; Swetha Manohar; Binod Shrestha; Sumanta Neupane; Ruchita Rajbhandary; Raman Shrestha; Rolf Klemm; Bareng Nonyane; Ramesh Adhikari; Patrick Webb; Keith West Jr. September 2017
Preschool undernutrition remains a burden in Nepal. This paper reports results of surveys in 2013 and 2014, examining patterns of child nutritional status across the country, associations with household food insecurity and antecedent comparative national data for subsequent evaluations of nutritional status following the earthquake in Nepal in 2015.

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; Jena Hamadani; Susan Horton; Julia Hussein; Stephen Lye; Rafael Perez-Escamilla; Kofi Marfo; Vanessa Mathews-Hanna; Atif Rahman; Karlee Silver; Patrick Webb; Zulfiqar 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 time Continue reading →

Charting the cost of nutritionally-adequate diets in Uganda, 2000-2011

Authors: George Omiat; Gerald Shively March 2017
Although malnutrition rates have been on the decline in Uganda over the past two decades, they remain high. Challenges to achieving nutritional improvements result, in part, from high staple foods prices, which raise the cost of the food basket and increase the risk of food and nutrition insecurity, especially for poor households who are net buyers of staple foods. Nearly two-thirds of Ugandan households are net buyers of staples, a pattern that highlights the potential importance of food prices as a key driver of food Continue reading →

Optimizing the Multisectoral Nutrition Policy Cycle: A Systems Perspective

Authors: Sascha Lamstein; Amanda Pomeroy-Stevens; Patrick Webb; Eileen Kennedy December 2016
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutrition policy cycle, including how governance and financing support that process. It also Continue reading →

Implementing Multisector Nutrition Programs in Ethiopia and Nepal: Challenges and Opportunities From a Stakeholder Perspective

Authors: Eileen Kennedy; Habtamu Fekadu; Shibani Ghosh; Kedar Baral; Dale Davis; Diplav Sapkota; Patrick Webb December 2016
Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The Continue reading →

Prioritizing and Funding the Uganda Nutrition Action Plan

Authors: Amanda Pomeroy-Stevens; Alexis D'Agostino; Hannah Foehringer Merchant; Abel Muzoora; Ezekiel Mupere; Lidan Du December 2016
In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. We tracked the UNAP’s influence on the process of priority setting and funding for nutrition from 2013 to 2015 and this study used a longitudinal mixed methods design to track qualitative and budgetary changes related to UNAP processes nationally as well as in 2 study districts. Continue reading →

Assessing Progress in Implementing Uganda’s Nutrition Action Plan: District-Level Insights

Authors: Edgar Agaba; Shibani Ghosh; Jeffrey K. Griffiths December 2016
The 2011 Uganda Nutrition Action Plan (UNAP) established 2016 maternal and child nutrition targets. However, there is a lack of routine district-level data collection to assess UNAP implementation.  The Nutrition Innovation Lab collected serial household-level survey data (n = 3600) in 6 districts, including 2 UNAP implementation districts, in 2012 and 2014. Questionnaires focused on food security, nutrition, and health, among others, and included specific indicators relevant to UNAP’s targets.

Prioritizing and Funding Nepal’s Multisector Nutrition Plan

Authors: Amanda Pomeroy-Stevens; Kusum Hachhethu; Indu Sharma; Jolene Wun December 2016
Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed. This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation Continue reading →

Measuring Nutrition Governance: An Analysis of Commitment, Capability, and Collaboration in Nepal

Authors: Patrick Webb; Grace Namirembe; Sabi Gurung; Diplav Sapkota; Winnie Fay Bell; Eileen Kennedy; Shailes Neupane; Swetha Manohar; Kedar Baral December 2016
Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts. This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals.

Overcoming the Limits of Evidence on Effective Multisectoral Nutrition Policy

Authors: Madhu Kumar Marasini; Ssansa Mugenyi December 2016
The multisectoral approach has evolved as a popular instrument to attain nutrition goals and targets. But as policy makers, we need timely, relevant, and accurate information in order to effectively support these plans. This commentary comes from the members of the nutrition secretariats at the National Planning Commission in Nepal and the Office of the Prime Minister in Uganda on availability and use of evidence and the nutrition policy cycle. As has been highlighted in this supplement, some of the challenges we have faced include Continue reading →

The Nutrition Transition and Agricultural Transformation: a Preston curve approach

Authors: William A. Masters; Anaya Hall; Elena M. Martinez; Peilin Shi; Gitanjali Singh; Patrick Webb; Dariush Mozaffarian November 2016
The nutrition transition in diets and health is closely tied to other aspects of economic development, including agricultural transformation and urbanization as well as demographic change and epidemiological transition from infectious to noncommunicable disease. Over time, dietary patterns typically shift from widespread inadequacy of many foods and nutrients, especially for children and mothers, into surplus energy intake and rising obesity with continued inadequacy of healthier foods. Diet-related diseases remain the largest single cause of premature death and disability in all regions. This article combines food Continue reading →

Nutrient composition of premixed and packaged complementary foods for sale in low‐ and middle‐income countries: Lack of standards threatens infant growth

Authors: William A. Masters; Marc D. Nene; Winnie Bell November 2016
Premixed flours for infant porridge are increasingly produced and sold in developing countries to complement continued breastfeeding. Such complementary food (CF) products have known efficacy against malnutrition in children from 6 to 24 months of age, but ingredient ratios and production processes may vary. This study provides the first systematic measurement of their actual nutrient composition. We purchased samples of 108 premixed CF products in 22 low‐ and middle‐income countries, and commissioned blind laboratory measurement of each product’s macronutrients and micronutrients. We compared measured contents Continue reading →

Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda

Authors: Gerald Shively November 2016
Incorporating agriculture into nutrition policy requires an understanding of how agricultural performance, rainfall, and the economic and physical environments in which children reside relate to linear growth and weight gain. This paper combines anthropometric data from children below the age of 5 y in Nepal and Uganda with rainfall data and other information to measure these connections. Anthropometric outcomes are positively correlated with rainfall prior to birth, during the first year, and during agricultural growing seasons preceding child measurement. High rainfall is found to be Continue reading →

PoSHAN Community Studies: Panel 3 Report

Authors: Nutrition Innovation Lab November 2016
The goal of PoSHAN Community Studies is to understand the factors that link agriculture to nutrition. This involves researching the determinants of household food security, dietary intake, and nutritional status of children under 5 years of age and their mothers in relation to changes in agriculture and exposure to agricultural and microeconomic extension, as well as nutrition and health programs in Nepal. This descriptive report summarizes the main findings of the third panel survey.

PoSHAN Community Studies: Panel 2 Report

Authors: Nutrition Innovation Lab October 2016
The goal of PoSHAN Community Studies is to understand the factors that link agriculture to nutrition. This involves researching the determinants of household food security, dietary intake, and nutritional status of children under 5 years of age and their mothers in relation to changes in agriculture and exposure to agricultural and microeconomic extension, as well as nutrition and health programs in Nepal. This descriptive report summarizes the main findings of the second panel survey conducted between May – July 2014.

Child nutrition and local food prices in Nepal

Authors: Ganesh Thapa; Gerald Shively September 2016
Abstract: This paper studies the connections between child nutrition and food prices in Nepal. Data from a number of sources are combined, including the 2006 and 2011 Nepal Demographic Health Surveys and monthly retail food price data collected over the period 2002 to 2010 from 34 districts of Nepal. A total of 4,038 children are used for the analysis (2,765 from 2006 and 1,273 from 2011). Price data are selected for six food commodities important for child nutrition outcomes: coarse rice, wheat flour, sugar, ghee, soybean Continue reading →

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 September 2016
Egypt’s emerging economy faces a dual burden wherein there is coexistence of under and over nutrition, either in the same population, community, household or same individual. The dual burden of disease can be extremely variable in its manifestation. It can, for example, be manifested as stunted children who are concurrently obese, or as stunted children who may not be currently obese but who are at risk of early onset chronic diseases. Secondary Analysis provided by the Nutrition Innovation Lab.  

Measuring Food and Nutrition Security: An Independent Technical Assessment and User’s Guide for Existing Indicators

Authors: Uma Lele; Joyce Kinabo; JV Meenakshi; Bharat Ramaswami; Winnie FL Bell; Sambuddha Goswami June 2016
The purpose of this document is to assist policy and program planners and implementers, designers and managers, evaluators and analysts to target interventions and measure progress in food security and nutrition. Indicators for concepts such as Measuring Food and Nutrition Security: Technical Assessment and User’s Guide Page 2 stunting and wasting, diet diversity and nutrient adequacy or food insecurity have proliferated in recent years, leading to widespread confusion about the best indicators for any given situation. Relatively few of the many available measures of food Continue reading →

Sustaining healthy diets: The role of capture fisheries and aquaculture for improving nutrition in the post-2015 era

Authors: Shakuntala Haraksingh Thilsted; Andrew Thorne-Lyman; Patrick Webb; Jessica Rose Bogard; Rohana Subasinghe; Michael John Phillips; Edward Hugh Allison February 2016
Fish production and trade contribute significantly to global agricultural output. Fish production in 2012 exceeded 158 million metrictons, while the value of international fish trade amounted to USD129 billion. An increasingly large share of fish entering global markets derives from aquaculture (the farming of aquatic animals and plants); the world’s fastest growing food production sector for more than four decades.  Much of fish produced and traded within low-income countries derives from capture fisheries (non-fed fish harvested from undomesticated ecosystems). These two production systems have important complementary roles in meeting rising demand for Continue reading →

UNICEF: Timor-Leste Food and Nutrtion Survey 2013- Final Report

Authors: Nutrition Innovation Lab October 2015
UNICEF Report: The data collection for this survey was carried out between May and September 2013 among children aged 0-59 months and their non-pregnant mothers (aged 14 – 60 years). The survey assessed the risk factors for undernutrition based on Conceptual Framework of Malnutrition (UNICEF, 1990) which is being used for nutrition programming worldwide for the past 25 years. The prevalence of micronutrient deficiencies (vitamin A, iron, zinc, and iodine deficiency), and the iodine content of household iodised salt and aflatoxin exposure among children (aged 6 – 59 Continue reading →

Does Ethiopia’s Productive Safety Net Program improve child nutrition?

Authors: Bethelhem Legesse Debela; Gerald Shively August 2015
In this paper, we use data from Northern Ethiopia to study the links between a social protection program and child nutrition. Child malnutrition is one of the many challenges that pose a threat to economic growth in developing countries. It undermines educational attainment, lowers non-cognitive skills, leads to low labor productivity during adulthood, and  diverts attention and resources away from other development objectives. Ultimately, under-nutrition during childhood can lead to intergenerational poverty.

Urbanization, market development and malnutrition in farm households: evidence from the Demographic and Health Surveys, 1986–2011

Authors: Amelia Darrouzet-Nardi; William Masters May 2015
A principal effect of agricultural productivity growth is to accelerate urbanization by supplying food, labor and other resources to urban services and industry. Towns and cities may also grow for their own reasons, pulling food and resources out of rural areas. Whether pushed or pulled, the development of markets creates new opportunities for agricultural households. This study tests whether, on balance, proximity to older towns and cities has improved or worsened malnutrition among farm households in 43,850 survey clusters in 46 developing countries between 1986 Continue reading →

Agricultural policy for improved nutrition in Africa and Asia: evidence to guide the US Government’s investments in food security

Authors: William Masters; Katherine Dennison; Jeff Hill; Elizabeth Jordan-Bell; Ahmed Kablan; Melanie Thurber; Lorraine Weatherspoon; James Oehmke May 2015
The roundtable process was designed to complement numerous past and ongoing efforts to assemble and disseminate rigorous evidence on how agricultural change can best help to improve international nutrition, beginning with the first Lancet Maternal and Child Nutrition series in 2008 and its follow-up in 2013 and other systematic reviews (Webb and Kennedy 2014), as well as assessments from private groups such as the Copenhagen Consensus (2014) and the Global Panel on Agriculture and Food Systems for Nutrition (2014), international organizations such as the World Continue reading →

UNICEF: Timor-Leste Food and Nutrtion Survey 2013- Summary of Key Findings and Recommendations

Authors: Nutrition Innovation Lab April 2015
UNICEF Report: The data collection for this survey was carried out between May and September 2013 among children aged 0-59 months and their non-pregnant mothers (aged 14 – 60 years). The survey assessed the risk factors for undernutrition based on Conceptual Framework of Malnutrition (UNICEF, 1990) which is being used for nutrition programming worldwide for the past 25 years. The prevalence of micronutrient deficiencies (vitamin A, iron, zinc, and iodine deficiency), and the iodine content of household iodised salt and aflatoxin exposure among children (aged 6 – 59 Continue reading →

How strong is our evidence for effective management of wasting? A review of systematic and other reviews

Authors: Patrick Webb March 2015
A need for improved empirical evidence for the effectiveness of interventions used in the management of child wasting (moderate and/or severe acute malnutrition) has recently been highlighted. There is no lack of published studies in this field, but when examined through the lens of systematic review protocols, few of these studies stand up to rigorous methodological critique. This paper summarizes the current state of knowledge, as supported by high-quality research included in multiple systematic reviews. It also elaborates on the criteria and standards used in such reviews. The paper highlights Continue reading →

The 3rd Annual Scientific Symposium: Agriculture, Food Systems, and Nutrition: Connecting the Evidence To Action

Authors: Nutrition Innovation Lab December 2014
Briefing from the 3rd Annual Scientific Symposium The Nutrition Innovation Lab’s partner, Johns Hopkins University, in collaboration with the Institute of Medicine and the Nepal Agriculture Research Council, hosted its 3rd annual Scientific Symposium in Kathmandu, Nepal on November 18-20, 2014. The question driving this symposium was simple: how can agriculture improve household food security and nutrition outcomes? Yet the work of understanding the agriculture to nutrition pathway is complex. Building sustainable systems that promote food security, nutrition, and health in Nepal requires the utilization of high-quality, empirical evidence. The Continue reading →

The Dynamics of Nutrition Program Implementation in Ethiopia: Facilitators and Constraints at National and Sub-National Level

Authors: Masresha Tessema June 2014
The Government of Ethiopia (GOE) is committed to improving the nutritional status of the population. The GOE has made significant progress in reducing malnutrition since 2000. The revised National Nutrition Program is aimed at accelerating the decrease in under nutrition through a multi sector nutrition plan. This study assessed the facilitators and constraints to adopting the NNP at the national and sub national level. Key issues were identified including leadership, coordination, awareness, capacity and budget. A series of recommendations derived from the study data are Continue reading →
Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively April 2014
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownership or proximity, plays Continue reading →
Cover Image: The prize and the price of good nutrition

The prize and the price of good nutrition

Authors: Patrick Webb December 2013
The global burden of disease is shifting rapidly. While in 1990, the top-ranked contributor to the global burden was child underweight, twenty years later we find that cancers and circulatory diseases contribute the most– accounting for 19% of global disability-adjusted life years (DALYs), with about a third of the total deriving from other non- communicable diseases (NCDs), including chronic respiratory, digestive, neurological, mental, endocrine, and other disorders1. By 2010, child underweight had dropped to 8th place in the ranking of contributors to the overall disease Continue reading →

Comprehensive Assessment of the Peanut Value Chain for Nutrition Improvement in Ghana

Authors: Shibani Ghosh; William Masters September 2013
The goal was to identify opportunities for new investment and interventions to improve nutrition and livelihoods on a commercial scale (through agriculture linking to commercial enterprises). This enhances our understanding of crop value chains particularly relevant to women, and to the issues around value chains involving aflatoxin-free foodstuffs.

Impact Pathways from Agricultural Research to Improved Nutrition and Health: Literature Analysis and Research Priorities

Authors: Patrick Webb June 2013
This paper contributes to ongoing work at many institutions aimed at identifying priority knowledge gaps, determining the best research approaches needed to fill those gaps, and exploring how to better support policy and programme implementation with sound empirical evidence of ‘what works’.

A Review Stock Taking Report Nepal’s Private Sector Initiatives, Strategies and Interests in Nutrition

Authors: J. Adhikari October 2011
There is growing interest of private sector in food industries. This has come because of growing urbanization and better transportation opportunities as food now can be sent from one location to another at a fast rate than in the past. Moreover, the knowledge of food processing and quality is growing, and private sector has cashed this desire through establishing food processing industries. Agricultural industries have been the focus of the government since the start of planning for development started from the mid 1950s. The interest Continue reading →

A Review of Food Security and Human Nutrition Issues in Nepal

Authors: Gerald Shively September 2011
Nepal faces multiple development challenges, including chronic and wide spread food insecurity and adult and child malnutrition. Due to population growth, agricultural stagnation and a range of institutional failures, the threat of a serious food crisis in Nepal is substantial. The recent scaling back of WFP assistance means that food security conditions in some parts of Nepal will undoubtedly worsen in the near future. This paper presents a brief review of topics and available evidence regarding food security, malnutrition and related subjects in Nepal. It is intended to document important source Continue reading →

Stock taking Report Nutrition Sensitive Interventions for Agricultural Sector

Authors: J. Adhikari July 2011
Vulnerabilities to food insecurity are growing in Nepal. These vulnerabilities come from various factors – namely general decline in food production or agricultural growth, food price rise, seasonality in agricultural production, higher poverty rate in the food deficit areas, changes in food habits consuming junk food, especially in urban areas, lack of income and employment opportunities, lack of effective transportation for food distribution, especially in the hills and mountains, and chronic utilization problems such as inadequate access to health services, water and sanitation. Climate change Continue reading →

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