Safety nets can help address the risks to nutrition from increasing climate variability

Rising atmospheric carbon dioxide concentrations increase gaps of rice yields between low- and middle-to-high-income countries

The rising carbon dioxide concentrations are expected to increase future rice yields. However, variations in the CO2 fertilization effect (CFE) between rice subspecies and the influence of concurrent global warming introduce uncertainty in future global rice yield projections. Here we conducted a meta-analysis of rising carbon dioxide field experiments and employed crop modelling to assess future global rice yields for the top 14 rice producing countries. We found a robust parabolic relationship between rice CFE and temperature, with significant variations between rice subspecies. Our projections indicate that global rice production in the 2050s is expected to increase by 50.32 million tonnes (7.6%) due to CFE compared with historical production. Because low-income countries will experience higher temperatures, the gaps (difference of Δyield) between middle-to-high-income and low-income countries are projected to widen from the 2030s to the 2090s under elevated carbon dioxide. These findings underscore the critical role of CFE and emphasize the necessity to increase investments in research and technology for rice producing systems in low-income countries.

Food inflation and child undernutrition in low and middle income countries

The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.

Impact of the Productive SafetyNet Program on the minimum acceptable diet in the rural community of South Gondar Zone, Northwest Ethiopia

Background

Even though numerous factors contribute to undernutrition, it can happen immediately due to poor intake and illness. A minimum acceptable diet is one of the proxy measures for adequate consumption, which is an impact indicator for the Productive SafetyNet Program (PSNP). As a result, this study aimed to assess the impact of PSNP on the minimum acceptable diet among rural infants in the South Gondar Zone, Northwest Ethiopia.

Methods

A community-based cross-sectional study design was employed in the selected woredas (districts) of South Gondar Zone, Northwest Ethiopia, from 1 December 2017 to 30 January 2017. A total of 442 participants' data were collected during this time period through interviews with their mothers or caregivers. A multistage sampling technique was employed to select study subjects and interviewees using a structured questionnaire. Stata version 16 (MP) was employed to carry out a statistical analysis. A binary logistic regression model was employed to identify significant variables. The statistical significance was declared at a p-value of more than 0.05.

Results

The highest proportion of adequate diet diversity scores (261 [59.05%]) was from households who graduated (not part of it) from PSNPs. In this study, the magnitude of adequate dietary diversity, meal frequency, and minimum acceptable diet was 79.86, 82.58, and 66.52%, respectively. Marital status (AOR = 3.98, 95% CI: 1.39, 11.40), child age (AOR = 2.82, 95% CI: 1.78, 4.47), the educational status of the father (AOR = 0.56, 95% CI: 0.35, 0.89), the wealth index (AOR = 0.27, 95% CI: 0.12, 0.64), and the place of delivery (AOR = 3.14, 95% CI: 1.47, 6.73) were significant predictors for minimum acceptable diet uptake by children.

Conclusion

In this study, two-thirds of the infants had/received a minimum acceptable diet. Furthermore, infants from households with Productive SafetyNet users had a low minimum acceptable diet. Marital status, the educational status of the father, child age, the wealth index, and the place of delivery were associated factors with having an adequate intake of minimum acceptable diet by the children. Therefore, efforts to address sociodemographic and child-related factors during routine care are crucial.

Climate change and child health: a scoping review and an expanded conceptual framework

Climate change can have detrimental effects on child health and wellbeing. Despite the imperative for a fuller understanding of how climate change affects child health and wellbeing, a systematic approach and focus solely on children (aged <18 years) has been lacking. In this Scoping Review, we did a literature search on the impacts of climate change on child health from January, 2000, to June, 2019. The included studies explicitly linked an alteration of an exposure to a risk factor for child health to climate change or climate variability. In total, 2970 original articles, reviews, and other documents were identified, of which 371 were analysed. Employing an expanded framework, our analysis showed that the effects of climate change on child health act through direct and indirect pathways, with implications for determinants of child health as well as morbidity and mortality from a range of diseases. This understanding can be further enhanced by using a broader range of research methods, studying overlooked populations and geographical regions, investigating the costs and benefits of mitigation and adaptation for child health, and considering the position of climate change and child health within the UN Sustainable Development Goals. Present and future generations of children bear and will continue to bear an unacceptably high disease burden from climate change.

The effect of productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone, Northwest Ethiopia

BACKGROUND

Undernutrition is a significant public health problem in a developing country like Ethiopia. Even if the cause of malnutrition is multifactorial, it is mainly related to socioeconomical, political, and health-related problems. All these problems will lead to more severe nutrient deficiencies among households without assets. The Productive SafetyNet program is implemented for beneficiaries in the rural community to prevent household assets depletion. So, this study aimed to assess the effect of a Productive SafetyNet program on wasting among under-five children in the rural community of South Gondar Zone.

METHODS

A community-based cross-sectional study was done among 803 children paired with their mother/caregivers. Particepnts were selected by a simple random sampling technique. The data were collected by using a structured and pre-tested questionnaire. AnthroPlus software was used to analyse anthropometric data. The data entry employed by EpiInfo version 7.0 software for Windows. Then, the data exported to SPSS version 20.0 to carryout further statistical analysis. The anthropometric index (weight for height) was constructed to determine wasting. Both binary and multivariable logistic regression models were used to identify associated factors. Finally, P-Value ≤0.05 was used to declare statistical significance.

RESULTS

In this study, the response rate was 95.76%. Of the total participants, 195(25.36%) children were from SafetyNet program beneficiaries. The overall prevalence of wasting was 29.9% (95% CI: 26.6, 33.2%). More than One-fourth of the children from SafetyNet beneficiary households were wasted. While considering all other variables constant, Productive SafetyNet Program reduce wasting by 46% (COR = 0.54. 95% CI (0.37, 0.79)). Wasting were significantly associated with marital status (divorced and/or separated: AOR = 3.33, 95% CI (1.71, 6.45)), being on the SafetyNet program (AOR: 0.63, 95% CI (0.40, 0.99)), family size (AOR = 0.13, 95% CI (0.09, 0.21)), father educational status (AOR: 0.25, 95% CI (0.09, 0.66)), age of the child (AOR = 0.51, 95% CI (0.33, 0.77)), and child dietary diversity score (AOR = 2.99, 95% CI (1.67, 5.35)).

CONCLUSION

Wasting was a severe public health problem. In this study, the Productive SafetyNet Program reduce wasting significantly. Marital status, SafetyNet program status, family size, father educational status, age of the child, and dietary diversity were factors associated with wasting among children. Early detection of household asset depletion and SafetyNet program implementation is vital with the usual nutritional assessment and counseling.

Climate exposures and child undernutrition: Evidence from Indonesia

Global climate change has the potential to disrupt agricultural systems, undermine household socioeconomic status, and shape the prevalence and distribution of diseases. Each of these changes may influence children's nutritional status, which is sensitive to food availability, access, and utilization, and which may have lasting consequences for later-life health and socioeconomic outcomes. This paper contributes to the emerging literature on climate and child health by studying the effects of temperature and precipitation exposures on children's height and weight in Indonesia. Drawing on five rounds of the Indonesian Family Life Survey (IFLS) implemented between 1993 and 2015, we estimate fixed-effects regression models of height-for-age (HFA) and weight-for-height (WFH) among samples of children ages 24-59 months and 0-23 months, respectively. We test for heterogeneity in these effects across sub-populations expected to vary in their vulnerability. Results show that delays in monsoon onset are consistently associated with worse child health outcomes. Delays in monsoon onset during the prenatal period are associated with reduced child height among children age 2-4 years. The weight of young (<2 years) children is adversely affected by delays in the most recent monsoon season, and this relationship is particularly strong among residents of Java. Overall, our results underline the need for interventions that protect children's nutrition and underlying health against the effects of climate change.

Coping through a drought: the association between child nutritional status and household food insecurity in the district of iLembe, South Africa

OBJECTIVE

To assess and compare the association between household food insecurity and child nutritional status over two time-points taking into consideration the effects of a severe drought.

DESIGN

The study used two cross-sectional household surveys during and after a severe drought, consistent with a natural experiment design.

SETTING

The study took place in the district of iLembe, KwaZulu-Natal, South Africa.

PARTICIPANTS

Households with children aged <5 years were invited to participate in the survey. Anthropometric measures were taken for the respective children in each of the participating households.

RESULTS

The results indicated that all forms of poor nutritional status increased over the two time-points, with the most significant increases being for stunting (P < 0·016) and obesity (P < 0·001). There was evidence of an association between increasing food insecurity and stunting (P < 0·003) at the end of the drought, but not wasting, underweight or overweight. The results indicated a strong link between chronic food insecurity and chronic undernutrition. The results also showed stronger evidence of an association between food insecurity and stunting for urban households (P < 0·001) compared to their rural counterparts (P < 0·019).

CONCLUSIONS

The negative effects of drought appear to contribute to increased rates of child stunting through higher levels of household food insecurity. Future research should assess this relationship through longitudinal studies. Interventions aimed at improving food security may assist in reducing child malnutrition, but policymakers should consider urban-rural differences as well as climatic and environmental events.

Which practices co-deliver food security, climate change mitigation and adaptation, and combat land degradation and desertification?

There is a clear need for transformative change in the land management and food production sectors to address the global land challenges of climate change mitigation, climate change adaptation, combatting land degradation and desertification, and delivering food security (referred to hereafter as "land challenges"). We assess the potential for 40 practices to address these land challenges and find that: Nine options deliver medium to large benefits for all four land challenges. A further two options have no global estimates for adaptation, but have medium to large benefits for all other land challenges. Five options have large mitigation potential (>3 Gt CO2 eq/year) without adverse impacts on the other land challenges. Five options have moderate mitigation potential, with no adverse impacts on the other land challenges. Sixteen practices have large adaptation potential (>25 million people benefit), without adverse side effects on other land challenges. Most practices can be applied without competing for available land. However, seven options could result in competition for land. A large number of practices do not require dedicated land, including several land management options, all value chain options, and all risk management options. Four options could greatly increase competition for land if applied at a large scale, though the impact is scale and context specific, highlighting the need for safeguards to ensure that expansion of land for mitigation does not impact natural systems and food security. A number of practices, such as increased food productivity, dietary change and reduced food loss and waste, can reduce demand for land conversion, thereby potentially freeing-up land and creating opportunities for enhanced implementation of other practices, making them important components of portfolios of practices to address the combined land challenges.

Mapping the effects of drought on child stunting

As climate change continues, it is expected to have increasingly adverse impacts on child nutrition outcomes, and these impacts will be moderated by a variety of governmental, economic, infrastructural, and environmental factors. To date, attempts to map the vulnerability of food systems to climate change and drought have focused on mapping these factors but have not incorporated observations of historic climate shocks and nutrition outcomes. We significantly improve on these approaches by using over 580,000 observations of children from 53 countries to examine how precipitation extremes since 1990 have affected nutrition outcomes. We show that precipitation extremes and drought in particular are associated with worse child nutrition. We further show that the effects of drought on child undernutrition are mitigated or amplified by a variety of factors that affect both the adaptive capacity and sensitivity of local food systems with respect to shocks. Finally, we estimate a model drawing on historical observations of drought, geographic conditions, and nutrition outcomes to make a global map of where child stunting would be expected to increase under drought based on current conditions. As climate change makes drought more commonplace and more severe, these results will aid policymakers by highlighting which areas are most vulnerable as well as which factors contribute the most to creating resilient food systems.

Welfare effects of weather variability: Multi-country evidence from Africa south of the Sahara

Climate change and weather variability pose serious threats to food and nutrition security as well as ecosystems, especially when livelihoods depend heavily on natural resources. This study examines the effect of weather variability (shock) occurring up to three planting and growing season prior on per capita monthly household expenditure in rural Tanzania, Uganda, and Ghana. The analyses combine monthly temperature (1950-2013) and precipitation (1981-2013) data with data from several rounds of household surveys conducted between 1998 and 2013. Substantial spatial and temporal heterogeneity is documented in the incidence of shocks, with effects dependent on both the study and lag period considered. Analysis of short panel data shows the cumulative effect of above-average precipitation on expenditure to be negative in Uganda -while positive in Tanzania-, but the relationship does not persist when pooling survey data spanning over a decade. The evidence from pooled data suggests a positive association between above-average temperature (heat wave) and expenditure in (historically cooler) Uganda, with the opposite effect observed in (the relatively warmer) Tanzania. For Ghana, the association between heat wave and expenditure is positive. There is no evidence of heterogeneous effects along several dimensions, except by agro-ecological condition. Further research into the effects of shocks on more direct outcomes-such as agricultural practices, yields, and dietary intake-is therefore recommended to shed light on possible impact pathways and appropriate localized adaptation strategies.

Tackling the health impacts of climate change in the twenty-first century

The turn of the twenty-first century has borne witness to the seemingly relentless march of climate change, with global mean temperatures and sea levels projected to rise significantly in the near future. Despite considerable improvements in healthcare, mortality rates and life expectancy worldwide over the past few decades, there is increasing evidence postulating the potentially adverse impacts of environmental alterations on health in more ways than one. These not only involve direct and indirect climatic-related health impacts, but also those modulated by human aspects. Undeniably, there is a pressing need to recognize these issues and come up with appropriate solutions to address them as much as possible. Fortunately, this has led to the development of a wide range of measures encompassing both adaptation and mitigation strategies, alongside the recent Paris accords which highlight renewed global resolve in tackling these challenges in a collaborative and coordinated manner. However, progress has been relatively muted, and whether these prove to be the turning point remains very much to be seen. Nonetheless, taking the above into consideration, there is little doubt about the gravity of the situation, and that much more needs to be done to integrate and bring society forward in this new era.

Systematic review of current efforts to quantify the impacts of climate change on undernutrition

Malnutrition is a challenge to the health and productivity of populations and is viewed as one of the five largest adverse health impacts of climate change. Nonetheless, systematic evidence quantifying these impacts is currently limited. Our aim was to assess the scientific evidence base for the impact of climate change on childhood undernutrition (particularly stunting) in subsistence farmers in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Fifteen manuscripts were reviewed. Few studies use primary data to investigate the proportion of stunting that can be attributed to climate/weather variability. Although scattered and limited, current evidence suggests a significant but variable link between weather variables, e.g., rainfall, extreme weather events (floods/droughts), seasonality, and temperature, and childhood stunting at the household level (12 of 15 studies, 80%). In addition, we note that agricultural, socioeconomic, and demographic factors at the household and individual levels also play substantial roles in mediating the nutritional impacts. Comparable interdisciplinary studies based on primary data at a household level are urgently required to guide effective adaptation, particularly for rural subsistence farmers. Systemization of data collection at the global level is indispensable and urgent. We need to assimilate data from long-term, high-quality agricultural, environmental, socioeconomic, health, and demographic surveillance systems and develop robust statistical methods to establish and validate causal links, quantify impacts, and make reliable predictions that can guide evidence-based health interventions in the future.

Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

Acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions. We reviewed evidence of nutritional effects of programmes in four sectors--agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women's empowerment. However, evidence of the nutritional effect of agricultural programmes is inconclusive--except for vitamin A from biofortification of orange sweet potatoes--largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some effects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefits. Combined early child development and nutrition interventions show promising additive or synergistic effects on child development--and in some cases nutrition--and could lead to substantial gains in cost, efficiency, and effectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the effectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women's nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specific interventions and create a stimulating environment in which young children can grow and develop to their full potential.

Climate variability and child height in rural Mexico

We examine the impacts of weather shocks, defined as rainfall or growing degree days, a cumulative measure of temperature, more than a standard deviation from their respective long run mean, on the stature of children between 12 and 47 months of age in Mexico. We find that after a positive rainfall shock children are shorter regardless of their region or altitude. Negative temperature shocks have a negative impact on height in the central and southern parts of the country as well as in higher altitudes. Although on average there are no statistically significant impacts from positive temperature shocks, certain sub-populations - namely boys, children between 12 and 23 months at the time of measurement, and children of less educated mothers - in some of the regions are negatively impacted. The results also suggest that potentially both agricultural income and communicable disease prevalence contribute to the effects.

Preventing food crises using a food policy approach

A food crisis occurs when rates of hunger and malnutrition rise sharply at local, national, or global levels. This definition distinguishes a food crisis from chronic hunger, although food crises are far more likely among populations already suffering from prolonged hunger and malnutrition. A food crisis is usually set off by a shock to either supply or demand for food and often involves a sudden spike in food prices. It is important to remember that in a market economy, food prices measure the scarcity of food, not its value in any nutritional sense. Except in rare circumstances, the straightforward way to prevent a food crisis is to have rapidly rising labor productivity through economic growth and keep food prices stable while maintaining access by the poor. The formula is easier to state than to implement, especially on a global scale, but it is good to have both the objective, reducing short-run spikes in hunger, and the deep mechanisms, pro-poor economic growth and stable food prices, clearly in mind. A coherent food policy seeks to use these mechanisms, and others, to achieve a sustained reduction in chronic hunger over the long run while preventing spikes in hunger in the short run.

Household dietary diversity and food expenditures are closely linked in rural Bangladesh, increasing the risk of malnutrition due to the financial crisis

In Bangladesh, rice prices are known to be positively associated with the prevalence of child underweight and inversely associated with household nongrain food expenditures, an indicator of dietary quality. The collection of reliable data on household expenditures is relatively time consuming and requires extensive training. Simple dietary diversity scores are increasingly used as measures of food security and as proxies for nutrient adequacy. This study examines associations between a simple dietary diversity score and commonly used indicators of socioeconomic status in Bangladesh. Data representative of rural Bangladesh was collected from 188,835 households over 18 rounds of bi-monthly data collection from 2003-2005. A simple household dietary diversity score was developed by summing the number of days each household consumed an item from each of 7 food groups over a 7-d period. The dietary diversity score was associated with per capita nongrain food expenditures (r = 0.415), total food expenditures (r = 0.327), and total household expenditures (r = 0.332) using Spearman correlations (all P < 0.0001). The frequency of meat and egg consumption showed greater variation across quintiles of total monthly expenditure than other items contributing to the dietary diversity score. After controlling for other measures of socioeconomic status in multiple linear regression models, the dietary diversity score was significantly associated with monthly per capita food and total expenditures. Low dietary diversity during the period prior to major food price increases indicates potential risk for worsening of micronutrient deficiencies and child malnutrition in Bangladesh.

Macronutrient supplementation and food prices in HIV treatment

Infection caused by HIV and malnutrition have a complex interaction and often coexist geographically. Malnutrition has synergistic immune effects and HIV affects nutritional status. HIV care and treatment programs are compelled to confront this dual burden to optimize HIV outcomes. In this article, we review the published literature concerning intervention studies in adults and children and the effect of food prices on HIV treatment programs. While the evidence base is relatively incomplete for specific macronutrient interventions in the context of HIV treatment, it is clear that a new standard of care is needed, guided by experience, rationale, and existing data, in which malnourished patients may easily access nutritional therapies within HIV treatment. From this clinical foundation, we may both treat patients and evaluate novel therapies. Some HIV care and treatment programs provide food-based supplements; however, rising food costs and economic instability may jeopardize the success of these programs. HIV treatment programs may struggle to meet the needs of patients with potential increased rates of malnutrition and food insecurity in the setting of high food prices.

Vitamin A intake and status in populations facing economic stress

Dietary quality and diversity reflect adequacy of vitamin A. Both can deteriorate in response to economic crises. Although the nutritional consequences of the 2008 world food price crisis remain unclear, past studies of diet, status, and socioeconomic standing under usual (deprived) and unusually disruptive times suggest dietary quality and vitamin A status decline in mothers and young children. This is presumably the result of shifting diets to include less preformed vitamin A-rich animal source foods and, to a lesser extent, vegetables and fruits. Cross-sectional assessments of diet, deficiency, and socioeconomic status in a number of countries and surveillance data collected during the Indonesian economic crisis of 1997-8 indicate that the prevalence of vitamin A deficiency, night blindness, and other related disorders (e.g., anemia) may have increased during the 2008 crisis, and that it might not have necessarily recovered once food prices waned later in 2008. Lost employment may be a factor in slow nutritional recovery, despite some easing of food prices. Vitamin A deficiency should still be preventable amid economic instabilities through breast feeding promotion, vitamin A supplementation, fortification of foods targeted to the poor, and homestead food production that can bolster income and diversify the diet.

Castel Gandolfo workshop: an introduction to the impact of climate change, the economic crisis, and the increase in the food prices on malnutrition

The global food supply system is facing serious new challenges from economic and related crises and climate change, which directly affect the nutritional well-being of the poor by reducing their access to nutritious food. To cope, vulnerable populations prioritize consumption of calorie-rich but nutrient-poor food. Consequently, dietary quality and eventually quantity decline, increasing micronutrient malnutrition (or hidden hunger) and exacerbating preexisting vulnerabilities that lead to poorer health, lower incomes, and reduced physical and intellectual capabilities. This article introduces the series of papers in this supplement, which explore the relationships between crises and their cumulative impacts among vulnerable populations, particularly through hidden hunger.

Medium- to long-run implications of high food prices for global nutrition

The combined food, fuel, and financial crises of 2007-2009 had severe and widespread negative impacts around the world. Two key questions challenging governments were: how long would the high prices last and with what effects on food security and nutrition over the longer run? This paper considers the drivers of the crisis and explores if, unlike past shocks, the recent price increases reflect structural changes in food price formation that will have lasting global implications. New cross-commodity relationships allowed prices to spike, although there was no shortage of food at the global level nor indeed a significant downturn in recent yields. Yet recent record levels of farm production were also mirrored by growing numbers of people chronically undernourished and/or micronutrient deficient. The gap between supply and need was underpinned by growing urban demand, consumption of processed and higher-value foods (including meat), biofuel policy, and purchasing power erosion, but also by short-term market-distorting policies implemented by governments responding to perceived shortages of food. Thus, the impact of future food price crises will depend largely on what policymakers chose to do in response to the peaks and what they do not do during the troughs. Appropriate investments are urgently needed not just in smallholder developing country agriculture, but in effective food policies and targeted programming that can reverse the recent negative trends in nutrition and that support access globally to improved diet quality as well as food quantity.

Maternal and young child nutrition adversely affected by external shocks such as increasing global food prices

Rising food prices, resulting from the ongoing global economic crisis, fuel price volatility, and climate change, have an adverse impact upon the poor, especially those in food-importing, resource-limited countries. The conventional approach by large organizations has been to advocate for increased staple crop yields of mainly cereals. High food prices are predicted to continue to at least 2015. Past shocks and their known impacts upon nutrition were reviewed. Price instability and increases have long been an existing global problem, which has been exacerbated by recent macroeconomic shocks such as acute emergencies due to war and civil strife, acute climatic events, increase in food prices, fuel price volatility, dysfunction of the global financial systems, long-term climate change, and the emergence of failed states. The FAO estimated that there were 815 million "hungry" people in 2006, with a now additional 75-135 million with increased vulnerability, and currently it is estimated that there are one billion people at risk of food insecurity. The shocks initially compromise maternal and child nutrition, mainly through a reduction in dietary quality and an increase in micronutrient deficiencies and concomitant increases in infectious disease morbidity and mortality. A further reduction in the quantity of diet may follow with greater underweight and wasting. Recent macroeconomic shocks have greatly increased the number of people who are vulnerable to hunger in developing countries. Nutritional surveillance systems need to be strengthened and expanded to inform policy decisions.

Higher household expenditure on animal-source and nongrain foods lowers the risk of stunting among children 0-59 months old in Indonesia: implications of rising food prices

Because the global financial crisis and high food prices affect food consumption, we characterized the relationship between stunting and nongrain food expenditure at the household level among children 0-59 mo old in Indonesia's rural and urban poor population. Expenditure and height-for-age data were obtained from a population-based sample of 446,473 children in rural and 143,807 in urban poor areas in Indonesia. Expenditure on food was grouped into categories: animal, plant, total nongrain, and grain. The prevalence of stunting in rural and urban poor areas was 33.8 and 31.2%, respectively. In rural areas, the odds ratios (OR) (5th vs. first quintile) for stunting were similar for proportion of household expenditure on animal (0.87; 95% CI = 0.85-0.90; P < 0.0001), plant (0.86; 95% CI = 0.84-0.88; P < 0.0001), and total nongrain (0.85; 95% CI = 0.83-0.87; P < 0.0001). In urban poor areas, the relationship between stunting and proportion of household expenditure on animal sources was stronger than in rural areas (OR 0.78; 95% CI = 0.74-0.81; P < 0.0001), whereas the relationship with nongrain was similar to rural areas (OR 0.88; 95% CI = 0.85-0.92; P < 0.0001) and no relationship was observed with plant sources (OR 0.97; 95% CI = 0.93-1.01; P = 0.13). For grain expenditure, OR for stunting in highest vs. lowest quintile was 1.21 (95% CI = 1.18-1.24; P < 0.0001) in rural and 1.09 (95%CI = 1.04-1.13; P < 0.0001) in urban poor areas. Thus, households that spent a greater proportion on nongrain foods, in particular animal source foods, had a lower prevalence of child stunting. This suggests potential increased risk of malnutrition associated with reductions of household expenditure due to the current global crises.

Household rice expenditure and maternal and child nutritional status in Bangladesh

In Bangladesh, poor rural families often deal with high food costs by purchasing primarily rice. Our objective was to characterize the relationship between household expenditure on rice and nonrice foods with maternal and child malnutrition. Food expenditure data and anthropometry were obtained in a population-based sample of 304,856 households in the Bangladesh Nutrition Surveillance Project, 2000-2005. Food expenditures were categorized as rice and nonrice foods and expressed as quintiles of proportional food expenditure. Of children aged 6-11, 12-23, and 24-59 mo, the prevalence of stunting was 33.5, 56.3, and 53.1%, respectively. The prevalence of maternal underweight (BMI < 18.5 kg/m(2)) was 37.3%. Among children aged 6-11, 12-23, and 24-59 mo, rice expenditures were associated with stunting [odds ratio (OR) 1.11, 95% CI 1.02-1.20, P = 0.01; OR 1.09, 95% CI 1.04-1.13, P < 0.0001; OR 1.13, 95% CI 1.08-1.18, P < 0.0001), respectively, among families in the highest compared with the lowest quintile, adjusting for potential confounders, and nonrice food expenditures were associated with stunting (OR 0.87, 95% CI 0.80-0.95, P = 0.002; OR 0.86, 95% CI 0.83-0.90, P < 0.0001; OR 0.89, 95% CI 0.85-0.94, P < 0.0001) among families in the highest compared with the lowest quintile, adjusting for potential confounders. In the highest compared with the lowest quintile, rice expenditures (OR 1.12, 95% CI 1.08-1.15, P < 0.0001) and nonrice food expenditures (OR 0.93, 95% CI 0.90-0.96, P < 0.0001) were associated with maternal underweight. Households that spent a greater proportion on nonrice foods and less on rice had a lower prevalence of maternal and child malnutrition.

The role of expanded coverage of the national vitamin A program in preventing morbidity and mortality among preschool children in India

Higher food prices increase the risk of vitamin A deficiency among preschool children in poor families, because a larger part of the household food budget is spent on grain foods and less on vitamin A-rich foods. Vitamin A supplementation is an important source of vitamin A for children. Our objective was to characterize coverage of the India national vitamin A program for preschool children and identify risk factors for not receiving vitamin A. Anthropometric and demographic data were examined in 23,008 children aged 12-59 mo in the India National Family Health Survey, 2005-2006. Within the last 6 mo, 20.2% of children received vitamin A supplementation. The prevalence of stunting, severe stunting, underweight, and severe underweight was higher among children who did not receive vitamin A compared with those who received vitamin A (P < 0.0001). In families with a child who did and did not receive vitamin A, respectively, the proportion with a history of under-5 child mortality was 8.4 vs. 11.4% (P < 0.0001). By state, vitamin A program coverage was inversely proportional to the under-5 child mortality rate (r = -0.51; P = 0.004). Maternal education of > or =10 y [odds ratio (OR) 2.22; 95% CI 1.69-2.91], 7-9 y (OR 1.99; 95% CI 1.57-2.53), or 1-6 y (OR 1.65; 95% CI 1.28-2.13) compared with no education was an important factor related to receipt of vitamin A. Poor coverage of the vitamin A supplementation program in India has serious implications in the face of rising food prices. Expanded coverage of the vitamin A program in India will help protect children from morbidity, mortality, and blindness.

Impact of the economic crisis and increase in food prices on child mortality: exploring nutritional pathways

The current economic crisis and food price increase may have a widespread impact on the nutritional and health status of populations, especially in the developing world. Gains in child survival over the past few decades are likely to be threatened and millennium development goals will be harder to achieve. Beyond starvation, which is one of the causes of death in famine situations, there are numerous nutritional pathways by which childhood mortality can increase. These include increases in childhood wasting and stunting, intrauterine growth restriction, and micronutrient deficiencies such as that of vitamin A, iron, and zinc when faced with a food crisis and decreased food availability. These pathways are elucidated and described. Although estimates of the impact of the current crisis on child mortality are yet to be made, data from previous economic crises provide evidence of an increase in childhood mortality that we review. The current situation also emphasizes that there are vast segments of the world's population living in a situation of chronic food insecurity that are likely to be disproportionately affected by an economic crisis. Nutritional and health surveillance data are urgently needed in such populations to monitor both the impacts of a crisis and of interventions. Addressing the nutritional needs of children and women in response to the present crisis is urgent. But, ensuring that vulnerable populations are also targeted with known nutritional interventions at all times is likely to have a substantial impact on child mortality.

How to ensure nutrition security in the global economic crisis to protect and enhance development of young children and our common future

The global economic crisis, commodity price hikes, and climate change have worsened the position of the poorest and most vulnerable people. These crises are compromising the diet and health of up to 80% of the population in most developing countries and threaten the development of almost an entire generation of children ( approximately 250 million), because the period from conception until 24 mo of age irreversibly shapes people's health and intellectual ability. High food prices reduce diversity and nutritional quality of the diet and for many also reduce food quantity. Poor households are hit hardest, because they already spend 50-80% of expenditures on food, little on medicines, education, transport, or cooking fuel, and cannot afford to pay more. Reduced public spending, declining incomes, increased food and fuel prices, and reduced remittance thus impede and reverse progress made toward Millenium Development Goals 1, 4, and 5. Investments in nutrition are among the most cost-effective development interventions because of very high benefit:cost ratios, for individuals and for sustainable growth of countries, because they protect health, prevent disability, boost economic productivity, and save lives. To bridge the gap between nutrient requirements, particularly for groups with high needs, and the realistic dietary intake under the prevailing circumstances, the use of complementary food supplements to increase a meal's nutrient content is recommended. This can be in the form of, e.g., micronutrient powder or low-dose lipid-based nutrient supplements, which can be provided for free, in return for vouchers, at subsidized, or at commercial prices.

The food, fuel, and financial crises affect the urban and rural poor disproportionately: a review of the evidence

The vulnerability of the urban poor to the recent food and fuel price crisis has been widely acknowledged. The unfolding global financial crisis, which brings higher unemployment and underemployment, is likely to further intensify this vulnerability. This paper reviews the evidence concerning the disproportionate vulnerability of the urban compared with the rural poor to these types of shocks. It reviews some of the unique characteristics of urban life that could make the urban poor particularly susceptible to price and financial shocks and summarizes the evidence regarding the disproportionate vulnerability of the urban poor. The focus is on impacts on poverty, food insecurity, and malnutrition. The review shows that although the urban poor are clearly one of the population groups most affected by the current (and previous) crises, the rural poor, landless, and net buyers are in no better position to confront the crisis without significant suffering. The poorest of the poor are the ones who will be most affected, irrespective of the continent, country, or urban or rural area where they live. The magnitude and severity of their suffering depends on their ability to adapt and on the specific nature, extent, and duration of the coping strategies they adopt. A better understanding of how these coping strategies are used and staggered is critical to help design triggers for action that can prevent households from moving to more desperate measures. Using these early coping strategies as early warning indicators could help prevent dramatic losses in welfare.

High food prices and the global financial crisis have reduced access to nutritious food and worsened nutritional status and health

A global economic and financial crisis is engulfing the developing world, coming on top of high food and fuel prices. This paper assesses the impact of the crises on food consumption, nutrition, and health. Several methods were applied, including risk analysis using the cost of the food basket, assessment surveys, simulations, regression analysis using a food consumption score (FCS), reflecting diet frequency and diversity, and a review of the impact of such dietary changes on nutritional status and health. The cost of the food basket increased in several countries, forcing households to reduce quality and quantity of food consumed. The FCS, which is a measure of diet diversity, is negatively correlated with food prices. Simulations show that energy consumption declined during 2006-2010 in nearly all developing regions, resulting potentially in an additional 457 million people (of 4.5 billion) at risk of being hungry and many more unable to afford the dietary quality required to perform, develop, and grow well. As a result of the crises, large numbers of vulnerable households have reduced the quality and quantity of foods they consume and are at risk of increased malnutrition. Population groups most affected are those with the highest requirements, including young children, pregnant and lactating women, and the chronically ill (particularly people with HIV/AIDS and tuberculosis). Because undernutrition during the first 2 y of life has life-long consequences, even short-term price rises will have long-term effects. Thus, measures to mitigate the impact of the crises are urgently required.