1
|
Cooper GS, Davies-Kershaw H, Dominguez-Salas P, Fahmida U, Faye B, Ferguson E, Grace D, Häsler BN, Kadiyala S, Konapur A, Kulkarni B, Chengat Prakashbabu B, Pramesthi IL, Rowland D, Selvaraj K, Sudibya ARP, Tine RC, Yadav DMD, Zahra NL, Shankar B, Heffernan C. Investigating market-based opportunities for the provision of nutritious and safe diets to prevent childhood stunting: a UKRI-GCRF action against stunting hub protocol paper. BMJ Paediatr Open 2024; 8:e001671. [PMID: 38417923 PMCID: PMC10900371 DOI: 10.1136/bmjpo-2022-001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/13/2022] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Inadequate access to affordable, safe, desirable and convenient nutrient-dense food is one of the underlying causes of child stunting. While targeted nutrition-sensitive interventions (eg, backyard 'nutri-gardens') may increase dietary diversity within farming households, such interventions have limited scalability across the wider food system where markets remain underdeveloped. This research aims to develop and assess market-based interventions for key nutrient-dense foods to help improve the diets of women and children in the first 1000 days of life. METHODS Data collection uses four parallel approaches in each of the three study countries (India, Indonesia and Senegal). (1) A novel food environment tool will be developed to characterise the accessibility and affordability of nutrient-dense foods in the study countries. The tool will be validated through pretesting using cognitive interviewing and piloting in purposively sampled households, 10 (cognitive interviewing) and 30 (piloting) households in each country; (2) stakeholder interviews (eg, with producers, intermediaries and retailers) will be conducted to map out nutrition-sensitive entry points of key value chains (eg, animal-sourced foods), before hotspots of potential food safety hazards will be identified from food samples collected along the chains; (3) the Optifood and Agrifood tools will be used to identify foods that can address food system nutrient gaps and engage key stakeholders to prioritise market interventions to improve nutrition outcomes. Optifood and Agrifood parameters will be informed by publicly available data, plus interviews and focus groups with value chain stakeholders; (4) informed by the previous three approaches and a campaign of participatory 'group model building', a novel system dynamics model will evaluate the impact of alternative market-based solutions on the availability and affordability of nutrient-dense foods over time. ETHICS AND DISSEMINATION The study has received ethical approval in the United Kingdom, Senegal, Indonesia and India. Dissemination comprises peer-reviewed journals, international disciplinary conferences and multistakeholder dissemination workshops.
Collapse
Affiliation(s)
- Gregory S Cooper
- Institute of Sustainable Food, Department of Geography, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Paula Dominguez-Salas
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, University of Greenwich, London, UK
| | - Umi Fahmida
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Babacar Faye
- Department of Parasitology-Mycology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Delia Grace
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, University of Greenwich, London, UK
| | - Barbara N Häsler
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Archana Konapur
- Department of Population Health, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Bharati Kulkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | | | - Indriya L Pramesthi
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Dominic Rowland
- Center for International Forestry Research, Bogor Barat, Indonesia
- Centre for Environment, Development and Policy (CeDEP), SOAS, London, UK
| | | | - Arienta R P Sudibya
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Roger C Tine
- Department of Parasitology-Mycology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - D M Dinesh Yadav
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Nur L Zahra
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Bhavani Shankar
- Institute of Sustainable Food, Department of Geography, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Claire Heffernan
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
- London International Development Centre, London, UK
| |
Collapse
|
2
|
Choudhury DK, Cooper GS, Rich KM, Shankar B, Sadek S, Ratna NN, Kadiyala S, Alam MJ. Identifying value chain trade-offs from fruit and vegetable aggregation services in Bangladesh using a system dynamics approach. PLoS One 2024; 19:e0297509. [PMID: 38266005 PMCID: PMC10807782 DOI: 10.1371/journal.pone.0297509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Significant progress has been made in cereal production in Bangladesh due to an agricultural policy environment that prioritizes the productivity of staple crops over fruit and vegetables (F&V). However, many smallholder farmers remain poorly connected to markets, which may lead to a limited supply response of F&V that can reduce opportunities for sufficient intake in neglected, consumer-facing, smaller retail markets. To address this issue, aggregation schemes have been conceived that collect and transport F&Vs on behalf of multiple farmers. Given the volume of horticultural produce produced and the reliance on developed transport infrastructure, aggregation schemes tend to supply wholesale and urban markets rather than underdeveloped rural and isolated markets. To this end, we investigated how a particular aggregation intervention ('Loop') could potentially improve the distribution of F&V to smaller markets whilst improving farmer benefits. We used an innovative system dynamics modeling approach based on Loop`s aggregation services in Jashore, Bangladesh, and to identify the potential trade-offs between consumer outcomes in retail markets and farmer benefits. We find that combining aggregation with a quota at the smaller market, transport subsidy, and current price growth does not result in trade-offs between consumer purchases and farmers`benefits. However, combining aggregation with current price growth can increase demand without losing farmers`benefits. The findings emphasize that standalone and multiple market-oriented interventions generate broader win-win benefits to promote inclusive food systems.
Collapse
Affiliation(s)
- Dipok K. Choudhury
- Department of Agribusiness and Marketing, Bangladesh Agricultural University, Mymensingh, Bangladesh
- International Maize and Wheat Improvement Center (CIMMYT), Gulshan, Dhaka, Bangladesh
| | - Gregory S. Cooper
- Institute for Sustainable Food & Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Karl M. Rich
- Ferguson College of Agriculture, Oklahoma State University, Stillwater, OK, United States of America
| | - Bhavani Shankar
- Institute for Sustainable Food & Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | | | - Nazmun N. Ratna
- Faculty of Agribusiness & Commerce, Lincoln University, Lincoln, New Zealand
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Mohammad J. Alam
- Department of Agribusiness and Marketing, Bangladesh Agricultural University, Mymensingh, Bangladesh
| |
Collapse
|
3
|
Connors K, Jaacks LM, Awasthi A, Becker K, Bezner Kerr R, Fivian E, Gelli A, Harris-Fry H, Heckert J, Kadiyala S, Martinez E, Santoso MV, Young SL, Bliznashka L. Women's empowerment, production choices, and crop diversity in Burkina Faso, India, Malawi, and Tanzania: a secondary analysis of cross-sectional data. Lancet Planet Health 2023; 7:e558-e569. [PMID: 37437997 DOI: 10.1016/s2542-5196(23)00125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Bolstering farm-level crop diversity is one strategy to strengthen food system resilience and achieve global food security. Women who live in rural areas play an essential role in food production; therefore, we aimed to assess the associations between women's empowerment and crop diversity. METHODS In this secondary analysis of cross-sectional data, we used data from four cluster-randomised controlled trials done in Burkina Faso, India, Malawi, and Tanzania. We assessed women's empowerment using indicators from the Women's Empowerment in Agriculture Index. Farm-level crop diversity measures were the number of food crops grown, number of food groups grown, and if nutrient-dense crops were grown. We used a two-stage modelling approach. First, we analysed covariate-adjusted country-specific associations between women's empowerment and crop diversity indicators using multivariable generalised linear models. Second, we pooled country-specific associations using random-effects models. FINDINGS The final analytic sample included 1735 women from Burkina Faso, 4450 women from India, 547 women from Malawi, and 574 women from Tanzania. Across all countries, compared with households in which women provided input into fewer productive decisions, households of women with greater input into productive decisions produced more food crops (mean difference 0·36 [95% CI 0·16-0·55]), a higher number of food groups (mean difference 0·16 [0·06-0·25]), and more nutrient-dense crops (percentage point difference 3 [95% CI 3-4]). Across all countries, each additional community group a woman actively participated in was associated with cultivating a higher number of food crops (mean difference 0·20 [0·04-0·35]) and a higher number of food groups (mean difference 0·11 [0·03-0·18]), but not more nutrient-dense crops. In pooled associations from Burkina Faso and India, asset ownership was associated with cultivating a higher number of food crops (mean difference 0·08 [0·04-0·12]) and a higher number of food groups (mean difference 0·05 [0·04-0·07]), but not more nutrient-dense crops. INTERPRETATION Greater women's empowerment was associated with higher farm-level crop diversity among low-income agricultural households, suggesting that it could help enhance efforts to strengthen food system resilience. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Kaela Connors
- Harvard T H Chan School of Public Health, Boston, MA, USA; Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK
| | - Lindsay M Jaacks
- Harvard T H Chan School of Public Health, Boston, MA, USA; Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK
| | | | - Karoline Becker
- Department of International Development, University of Oxford, Oxford, UK
| | | | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aulo Gelli
- International Food Policy Research Institute, Washington, DC, USA
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica Heckert
- International Food Policy Research Institute, Washington, DC, USA
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Martinez
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Lilia Bliznashka
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK; International Food Policy Research Institute, Washington, DC, USA.
| |
Collapse
|
4
|
Harris-Fry H, Prost A, Beaumont E, Fivian E, Mohanty S, Parida M, Pradhan R, Sahu S, Padhan S, Mishra NK, Rath S, Rath S, Koniz-Booher P, Allen E, Kadiyala S. Intrahousehold power inequalities and cooperation: Unpacking household responses to nutrition-sensitive agriculture interventions in rural India. Matern Child Nutr 2023:e13503. [PMID: 36939121 DOI: 10.1111/mcn.13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
Nutrition-sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed-methods design to describe the links between household dynamics-specifically intrahousehold power inequalities and intrahousehold cooperation-and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster-randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross-sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision-making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family-centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate.
Collapse
Affiliation(s)
- Helen Harris-Fry
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Manoj Parida
- DCOR (Development Corner) Consulting Pvt. Ltd., Bhubaneswar, India
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | - Naba K Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | | | | | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
5
|
Bukachi SA, Ngutu M, Muthiru AW, Lépine A, Kadiyala S, Domínguez-Salas P. Gender and sociocultural factors in animal source foods (ASFs) access and consumption in lower-income households in urban informal settings of Nairobi, Kenya. J Health Popul Nutr 2022; 41:30. [PMID: 35818082 PMCID: PMC9275060 DOI: 10.1186/s41043-022-00307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Gender shapes household decision-making and access for nutritious diets, including animal source foods (ASFs) that impact on child health and nutrition status. However, research shows that the poorest households in the urban informal settlements of Nairobi have low ASFs consumption. This study was conducted to explore further from a qualitative perspective the gender, sociocultural factors affecting household ASF consumption this study. Methods To explore further on the topic of study, an exploratory qualitative study was carried out to establish the factors that influence access, allocation and consumption of animal source foods (ASFs) by households in urban informal settings of Nairobi. Nineteen focus group discussions with men and women were conducted to enable in-depth exploration of ASFs consumption. Results Gender influences decision-making of household ASFs dietary intake. Gendered power dynamics prevail with men as breadwinners and household heads often determining the food access and consumption of ASFs. Women are increasingly accessing short-term waged-based incomes in urban informal settings and now play a role in food and nutrition security for their households. This enforces the idea that women’s decision-making autonomy is an important aspect of women empowerment, as it relates to women’s dietary diversity and subsequently, better household nutritional status. As evidenced in this study, if a woman has bargaining power based on accessing incomes to support their household food needs, she will not jeopardize food security. The mobile digital money platform was key in enabling access to resources to access food. Use of trust to access food on credit and purchasing smaller packaged quantities of food were also enablers to access of food/ASFs.
Collapse
|
6
|
Deeney M, Yates J, Green R, Kadiyala S. Centring human health in the global plastics treaty: a call to action. BMJ Glob Health 2022; 7:bmjgh-2022-011040. [PMID: 36375851 PMCID: PMC9664311 DOI: 10.1136/bmjgh-2022-011040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Megan Deeney
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Joe Yates
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Rosemary Green
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|
7
|
Prost A, Harris‐Fry H, Mohanty S, Parida M, Krishnan S, Fivian E, Rath S, Nair N, Mishra NK, Padhan S, Pradhan R, Sahu S, Skordis J, Danton H, Koniz‐Booher P, Beaumont E, James P, Allen E, Elbourne D, Kadiyala S. Understanding the effects of nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutrition in rural Odisha, India: A mixed‐methods process evaluation. Maternal & Child Nutrition 2022; 18:e13398. [PMID: 35851750 PMCID: PMC9480959 DOI: 10.1111/mcn.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/14/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
A trial of three nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women's group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women's knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision‐making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women's ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition‐sensitive agriculture interventions could include additional flexibility to address families’ land, water, labour and time constraints, as well as actively engage with spouses and in‐laws. In rural eastern India, participatory videos and women's group meetings on agriculture and maternal and child nutrition increased women's knowledge, motivation and confidence to improve their and their children's diets. Given strong constraints linked to small landholdings, poor access to water and gender norms which meant that in‐laws' and husbands' assent or support were often required for cultivation decisions, many women responded to interventions by increasing rainfed homestead garden cultivation for consumption rather than cultivating for income. Women's and children's diets may have improved because of discussions about nutrition and an increase in homestead garden cultivation. These dietary changes alone were likely insufficient to improve women's and children's nutritional status. The interventions’ ability to influence the adoption of nutrition‐sensitive agriculture practices could be improved by being family‐centric: understanding women's decision‐making power in a family context, using tailored problem‐solving to address households' individual constraints to cultivation, and including women's husbands and in‐laws.
Collapse
Affiliation(s)
- Audrey Prost
- Institute for Global Health University College London London UK
| | - Helen Harris‐Fry
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Sneha Krishnan
- Jindal School of Environment and Sustainability Jindal Global University Haryana India
| | - Emily Fivian
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Naba K. Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | | | | | - Jolene Skordis
- Institute for Global Health University College London London UK
| | - Heather Danton
- JSI Research & Training Institute, Inc. Arlington Virginia USA
| | | | - Emma Beaumont
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Philip James
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Elizabeth Allen
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Diana Elbourne
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Suneetha Kadiyala
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| |
Collapse
|
8
|
Sparling TM, Deeney M, Cheng B, Han X, Lier C, Lin Z, Offner C, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Systematic evidence and gap map of research linking food security and nutrition to mental health. Nat Commun 2022; 13:4608. [PMID: 35941261 PMCID: PMC9359994 DOI: 10.1038/s41467-022-32116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research. There is a broad range of research available on the relationship between food security and mental health. Here the authors carry out a systematic mapping of evidence on food security and nutrition related to mental health and identifies trends in themes, setting, and study design over the 20 year period studied.
Collapse
Affiliation(s)
- Thalia M Sparling
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Megan Deeney
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Xuerui Han
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Chiara Lier
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Maryland, MD, USA
| | - Claudia Offner
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
9
|
Diamond‐Smith N, Puri M, Neuhaus J, Weiser S, Kadiyala S. Do changes in women's household status in Nepal improve access to food and nutrition? Matern Child Nutr 2022; 18:e13374. [PMID: 35615780 PMCID: PMC9218303 DOI: 10.1111/mcn.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Women's nutritional status remains poor in South Asia, impacting maternal and infant health outcomes. Women's household status is also low, as evidenced by eating behaviours. We started with triadic qualitative interviews with newly married women, husbands and mothers-in-law to explore the link between women's status and eating patterns, followed by longitudinal data from a cohort of 200 newly married women in rural Nepal to measure associations over time. Quantitative data were collected every 6 months for 18 months (four rounds of data) between 2018 and 2020. Interviews suggested that household relationships, women's status, and how much and what types of food she was given were intricately linked. Using mixed effects logistic regression models, we explore the association between markers of changing women's status (becoming pregnant, giving birth and working outside the home) on two outcomes (eating last always/usually and achieving minimum dietary diversity). We also explore for interaction between women's status and household food insecurity. Pregnancy increases women's dietary diversity, but this is not sustained post-partum. Women who work outside the home are less likely to eat last in the household. Food insecurity is associated with both the order of household eating and dietary diversity. Interactions between food insecurity and giving birth suggested that women who give birth in food insecure households are more likely to eat last in the household. Changes in women's household status are associated with some improvements in dietary diversity and order of household eating, but the associations are not long-lasting and depend on food security status.
Collapse
Affiliation(s)
- Nadia Diamond‐Smith
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mahesh Puri
- Center for Research on Environment, Health and Population ActivitiesKathmanduNepal
| | - John Neuhaus
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sheri Weiser
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | |
Collapse
|
10
|
Haghparast-Bidgoli H, Harris-Fry H, Kumar A, Pradhan R, Mishra NK, Padhan S, Ojha AK, Mishra SN, Fivian E, James P, Ferguson S, Krishnan S, O'Hearn M, Palmer T, Koniz-Booher P, Danton H, Minovi S, Mohanty S, Rath S, Rath S, Nair N, Tripathy P, Prost A, Allen E, Skordis J, Kadiyala S. Economic Evaluation of Nutrition-Sensitive Agricultural Interventions to Increase Maternal and Child Dietary Diversity and Nutritional Status in Rural Odisha, India. J Nutr 2022; 152:2255-2268. [PMID: 35687367 PMCID: PMC9535442 DOI: 10.1093/jn/nxac132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/01/2021] [Accepted: 06/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Economic evaluations of nutrition-sensitive agriculture (NSA) interventions are scarce, limiting assessment of their potential affordability and scalability. OBJECTIVES We conducted cost-consequence analyses of 3 participatory video-based interventions of fortnightly women's group meetings using the following platforms: 1) NSA videos; 2) NSA and nutrition-specific videos; or 3) NSA videos with a nutrition-specific participatory learning and action (PLA) cycle. METHODS Interventions were tested in a 32-mo, 4-arm cluster-randomized controlled trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) in the Keonjhar district, Odisha, India. Impacts were evaluated in children aged 0-23 mo and their mothers. We estimated program costs using data collected prospectively from expenditure records of implementing and technical partners and societal costs using expenditure assessment data collected from households with a child aged 0-23 mo and key informant interviews. Costs were adjusted for inflation, discounted, and converted to 2019 US$. RESULTS Total program costs of each intervention ranged from US$272,121 to US$386,907. Program costs per pregnant woman or mother of a child aged 0-23 mo were US$62 for NSA videos, US$84 for NSA and nutrition-specific videos, and US$78 for NSA videos with PLA (societal costs: US$125, US$143, and US$122, respectively). Substantial shares of total costs were attributable to development and delivery of the videos and PLA (52-69%) and quality assurance (25-41%). Relative to control, minimum dietary diversity was higher in the children who underwent the interventions incorporating nutrition-specific videos and PLA (adjusted RRs: 1.19 and 1.27; 95% CIs: 1.03-1.37 and 1.11, 1.46, respectively). Relative to control, minimum dietary diversity in mothers was higher in those who underwent NSA video (1.21 [1.01, 1.45]) and NSA with PLA (1.30 [1.10, 1.53]) interventions. CONCLUSION NSA videos with PLA can increase both maternal and child dietary diversity and have the lowest cost per unit increase in diet diversity. Building on investments made in developing UPAVAN, cost-efficiency at scale could be increased with less intensive monitoring, reduced startup costs, and integration within existing government programs. This trial was registered at clinicaltrials.gov as ISRCTN65922679.
Collapse
Affiliation(s)
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Naba Kishore Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | - Shibananth Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | | | - Sailendra Narayan Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | - Emily Fivian
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip James
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sneha Krishnan
- Jindal School of Environment and Sustainability, OP Jindal Global University and ETCH Consultancy Services, Mumbai, Maharashtra, India
| | - Meghan O'Hearn
- Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Tom Palmer
- University College London, Institute for Global Health, London, United Kingdom
| | | | - Heather Danton
- SI Research & Training Institute, Inc. Arlington, VA, USA
| | - Sandee Minovi
- SI Research & Training Institute, Inc. Arlington, VA, USA
| | | | | | | | | | | | - Audrey Prost
- University College London, Institute for Global Health, London, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jolene Skordis
- University College London, Institute for Global Health, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
11
|
Leroy JL, Frongillo EA, Kase BE, Alonso S, Chen M, Dohoo I, Huybregts L, Kadiyala S, Saville NM. Strengthening causal inference from randomised controlled trials of complex interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008597. [PMID: 35688484 PMCID: PMC9189821 DOI: 10.1136/bmjgh-2022-008597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/14/2022] [Indexed: 11/06/2022] Open
Abstract
Researchers conducting randomised controlled trials (RCTs) of complex interventions face design and analytical challenges that are not fully addressed in existing guidelines. Further guidance is needed to help ensure that these trials of complex interventions are conducted to the highest scientific standards while maximising the evidence that can be extracted from each trial. The key challenge is how to manage the multiplicity of outcomes required for the trial while minimising false positive and false negative findings. To address this challenge, we formulate three principles to conduct RCTs: (1) outcomes chosen should be driven by the intent and programme theory of the intervention and should thus be linked to testable hypotheses; (2) outcomes should be adequately powered and (3) researchers must be explicit and fully transparent about all outcomes and hypotheses before the trial is started and when the results are reported. Multiplicity in trials of complex interventions should be managed through careful planning and interpretation rather than through post hoc analytical adjustment. For trials of complex interventions, the distinction between primary and secondary outcomes as defined in current guidelines does not adequately protect against false positive and negative findings. Primary outcomes should be defined as outcomes that are relevant based on the intervention intent and programme theory, declared (ie, registered), and adequately powered. The possibility of confirmatory causal inference is limited to these outcomes. All other outcomes (either undeclared and/or inadequately powered) are secondary and inference relative to these outcomes will be exploratory.
Collapse
Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Bezawit E Kase
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Silvia Alonso
- Animal and Human Health Porgram, International Livestock Research Institute, Nairobi, Kenya
| | - Mario Chen
- Biostatistics and Data Sciences, FHI 360, Durham, North Carolina, USA
| | - Ian Dohoo
- Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | | | - Naomi M Saville
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
12
|
Laar AK, Addo P, Aryeetey R, Agyemang C, Zotor F, Asiki G, Rampalli KK, Amevinya GS, Tandoh A, Nanema S, Adjei AP, Laar ME, Mensah K, Laryea D, Sellen D, Vandevijvere S, Turner C, Osei-Kwasi H, Spires M, Blake C, Rowland D, Kadiyala S, Madzorera I, Diouf A, Covic N, Dzudzor IM, Annan R, Milani P, Nortey J, Bricas N, Mphumuzi S, Anchang KY, Jafri A, Dhall M, Lee A, Mackay S, Oti SO, Hofman K, Frongillo EA, Holdsworth M. Perspective: Food Environment Research Priorities for Africa-Lessons from the Africa Food Environment Research Network. Adv Nutr 2022; 13:739-747. [PMID: 35254411 PMCID: PMC9156374 DOI: 10.1093/advances/nmac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 02/03/2023] Open
Abstract
Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition-obesity and other diet-related noncommunicable diseases (DR-NCDs)-along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.
Collapse
Affiliation(s)
| | - Phyllis Addo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Richmond Aryeetey
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Krystal K Rampalli
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gideon S Amevinya
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akua Tandoh
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Silver Nanema
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Akosua Pokua Adjei
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Matilda E Laar
- Department of Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Legon, Accra, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | | | - Christopher Turner
- Department of Food and Markets, University of Greenwich, Greenwich, United Kingdom
| | - Hibbah Osei-Kwasi
- Geography Department, University of Sheffield, Sheffield, United Kingdom
| | - Mark Spires
- Centre for Food Policy, City University of London, London, United Kingdom
| | - Christine Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dominic Rowland
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Adama Diouf
- Nutrition Laboratory, Department of Animal Biology, Faculty of Science and Technology, University Cheikh Anta Diop, Dakar, Senegal
| | - Namukolo Covic
- International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Isaac M Dzudzor
- Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Reginald Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - John Nortey
- Statistics, Research, and Information Directorate, Ministry of Food and Agriculture, Accra, Ghana
| | - Nicholas Bricas
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), CIRAD, University of Montpellier, Montpellier, France
| | | | | | - Ali Jafri
- Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Meenal Dhall
- Department of Anthropology, University of Delhi, Delhi, India
| | - Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Samuel O Oti
- International Development Research Center, Nairobi, Kenya
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Sciences - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Center on Sustainable Agri-food Systems), University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, French National Research Institute for Sustainable Development (IRD), Montpellier, France
| |
Collapse
|
13
|
Turner C, Bhogadi S, Walls H, Surendran S, Kulkarni B, Kinra S, Kadiyala S. Drivers of food acquisition practices in the food environment of peri-urban Hyderabad, India: A qualitative investigation. Health Place 2022; 74:102763. [DOI: 10.1016/j.healthplace.2022.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
|
14
|
Yates J, Kadiyala S, Li Y, Levy S, Endashaw A, Perlick H, Wilde P. Can virtual events achieve co-benefits for climate, participation, and satisfaction? Comparative evidence from five international Agriculture, Nutrition and Health Academy Week conferences. Lancet Planet Health 2022; 6:e164-e170. [PMID: 35150625 PMCID: PMC8850368 DOI: 10.1016/s2542-5196(21)00355-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 05/29/2023]
Abstract
The advancement of science and evidence-based solutions for planetary health increasingly require interdisciplinary and international learning and sharing. Yet aviation travel to academic conferences is carbon-intensive and expensive, thus perpetuating planetary health and equity challenges. Using data from five annual international Agriculture, Nutrition and Health Academy Week conferences from 2016 to 2020, we explore whether moving to virtual conferencing produced co-benefits for climate, participation, attendee interaction, and satisfaction. We report on: absolute number of attendees, proportion of attendees from countries of different income levels, number of participants at social events, aviation CO2 emissions, and overall ratings of the event by participants. Transitioning online resulted in large reductions in travel-related aviation CO2 emissions, alongside increased attendance-including among attendees from low-income and middle-income countries. This was achieved without a major change in the participant rating of the event. However, the online format resulted in lower participation in conference social events. The urgency of reducing CO2 emissions in pursuit of planetary health and improving equity in scientific exchange requires new modalities of academic conferencing. This study indicates that co-benefits can be achieved when transitioning online. Challenges exist for virtual events, such as emulating the intangible facets of in-person interactions, overcoming time-zone limitations, and digital divides.
Collapse
Affiliation(s)
- Joe Yates
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Yuemeng Li
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sylvia Levy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Abel Endashaw
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hallie Perlick
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Parke Wilde
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| |
Collapse
|
15
|
Cooper GS, Shankar B, Rich KM, Ratna NN, Alam MJ, Singh N, Kadiyala S. Can fruit and vegetable aggregation systems better balance improved producer livelihoods with more equitable distribution? World Dev 2021; 148:105678. [PMID: 34866757 PMCID: PMC8520944 DOI: 10.1016/j.worlddev.2021.105678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 05/03/2023]
Abstract
The need for food systems to generate sustainable and equitable benefits for all is a global imperative. However, whilst ample evidence exists linking smallholder farmer coordination and aggregation (i.e. the collective transport and marketing of produce on behalf of multiple farmers) to improved market participation and farmer incomes, the extent to which interventions that aim to improve farmer market engagement may co-develop equitable consumer benefits remains uncertain. This challenge is pertinent to the horticultural systems of South Asia, where the increasing purchasing power of urban consumers, lengthening urban catchments, underdeveloped rural infrastructures and inadequate local demands combine to undermine the delivery of fresh fruits and vegetables to smaller, often rural or semi-rural markets serving nutritionally insecure populations. To this end, we investigate the potential for aggregation to be developed to increase fruit and vegetable delivery to these neglected smaller markets, whilst simultaneously improving farmer returns. Using an innovative system dynamics modelling approach based on an aggregation scheme in Bihar, India, we identify potential trade-offs between outcomes relating to farmers and consumers in smaller local markets. We find that changes to aggregation alone (i.e. scaling-up participation; subsidising small market transportation; mandating quotas for smaller markets) are unable to achieve significant improvements in smaller market delivery without risking reduced farmer participation in aggregation. Contrastingly, combining aggregation with the introduction of market-based cold storage and measures that boost demand improves fruit and vegetable availability significantly in smaller markets, whilst avoiding farmer-facing trade-offs. Critically, our study emphasises the benefits that may be attained from combining multiple nutrition-sensitive market interventions, and stresses the need for policies that narrow the fruit and vegetable cold storage deficits that exist away from more lucrative markets in developing countries. The future pathways and policy options discovered work towards making win-win futures for farmers and disadvantaged consumers a reality.
Collapse
Affiliation(s)
- G S Cooper
- Institute for Sustainable Food and Department of Geography, University of Sheffield, Sheffield, United Kingdom
| | - B Shankar
- Institute for Sustainable Food and Department of Geography, University of Sheffield, Sheffield, United Kingdom
| | - K M Rich
- Ferguson College of Agriculture, Oklahoma State University, Stillwater, OK, USA
- International Livestock Research Institute (ILRI), West Africa Regional Office, Dakar, Senegal
| | - N N Ratna
- Department of Global Value Chain & Trade, Faculty of Agribusiness and Commerce, Lincoln University, Christchurch, New Zealand
| | - M J Alam
- Department of Agribusiness and Marketing, Bangladesh Agricultural University (BAU), Mymensingh, Bangladesh
| | - N Singh
- Digital Green, North India Office, New Delhi, India
| | - S Kadiyala
- Department for Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| |
Collapse
|
16
|
Alao R, Nur H, Fivian E, Shankar B, Kadiyala S, Harris-Fry H. Economic inequality in malnutrition: a global systematic review and meta-analysis. BMJ Glob Health 2021; 6:e006906. [PMID: 34887302 PMCID: PMC8663078 DOI: 10.1136/bmjgh-2021-006906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition. METHODS We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses. RESULTS From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)). CONCLUSIONS There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed. PROSPERO REGISTRATION NUMBER CRD42020201572.
Collapse
Affiliation(s)
- Rotimi Alao
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hayaan Nur
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
17
|
Sparling TM, Cheng B, Deeney M, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Global Mental Health and Nutrition: Moving Toward a Convergent Research Agenda. Front Public Health 2021; 9:722290. [PMID: 34722437 PMCID: PMC8548935 DOI: 10.3389/fpubh.2021.722290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Both malnutrition and poor mental health are leading sources of global mortality, disease, and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation, especially from clinical, primary care orientations to wider, sociopolitical approaches to achieve Sustainable Development Goals. In recent years, the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes, for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However, the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore, interdisciplinary projects and programmes are gaining ground in methodology and impact, but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.
Collapse
Affiliation(s)
- Thalia M Sparling
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Megan Deeney
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne V Santoso
- Department of Anthropology, Northwestern University, Evanston, IL, United States
| | - Erin Pfeiffer
- Independent Consultant, Winston-Salem, NC, United States
| | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suneetha Kadiyala
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
18
|
Yates J, Gillespie S, Savona N, Deeney M, Kadiyala S. Trust and responsibility in food systems transformation. Engaging with Big Food: marriage or mirage? BMJ Glob Health 2021; 6:e007350. [PMID: 34819325 PMCID: PMC8614044 DOI: 10.1136/bmjgh-2021-007350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Concentration of power among transnational 'Big Food' companies has contributed to food systems that are unsustainable, unhealthy and inequitable for people and planet. Given these commercial determinants of health, if 'food systems transformation' is to be authentic-more than a passing narrative-then leveraging Big Food is paramount. To this end, researchers, practitioners and policy-makers are increasingly encouraged to engage with these powerful entities. However, given the conflicts of interest at stake, engagement relies on trust and transparency, that all stakeholders take responsibility for their actions and demonstrate commitment to do no harm. Given Big Food's track record in influencing policy, shifting costs and responsibility for their harms-and while profit primarily drives business decision making-we question whether it is logical to expect trust.This analysis explores concepts of responsibility and trust in relation to food systems transformation involving public-private partnerships. Through short cautionary case studies-looking at the United Nations Food Systems Summit, and Big Food's plastic burden-it argues that unless such companies take responsibility for their cross-cutting effects and earn authentic trust through demonstrably doing no harm, their participation in evidence generation and policy processes should be limited to responding to information requests and adhering to regulation. Any involvement in research agenda-setting or formulating policy solutions introduces conflicts of interest, legitimises corporate irresponsibility and jeopardises scientific integrity. Big Food has dynamism and power to address food system problems, but while it contributes to so many of these problems it should follow-not formulate-transformational evidence, policies and regulations.
Collapse
Affiliation(s)
- Joe Yates
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stuart Gillespie
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Megan Deeney
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
19
|
Sparling TM, White H, Boakye S, John D, Kadiyala S. Understanding Pathways Between Agriculture, Food Systems, and Nutrition: An Evidence and Gap Map of Research Tools, Metrics, and Methods in the Last 10 Years. Adv Nutr 2021; 12:1122-1136. [PMID: 33395472 PMCID: PMC8321871 DOI: 10.1093/advances/nmaa158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/26/2020] [Accepted: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
New tools, metrics, and methods in agriculture, food systems, and nutrition (A&N) research proliferated in the decade following the 2007-2008 food price crisis. We map these developments across themes derived from conceptual A&N pathways and expert consultations. We created an interactive Evidence and Gap Map (EGM) from a systematic search of published and gray literature since 2008, following Campbell Collaboration guidelines. We retrieved over 30,000 reports from published literature databases, and individually searched 20 online repositories. We systematically screened 24,359 reports by title and/or abstract, 1577 by full report, and included 904 eligible reports. The EGM consists of rows of thematic domains and columns of types of tools, metrics, and methods, as well as extensive coding applied as filters. Each cell of the map represents research surrounding a type of tool, metric, or method within a given theme. Reports in each cell are grouped by stage of development, which expand to a corresponding bibliography. Users can filter EGM reports by various characteristics. The 4 most populated domains were: diets, nutrition, and health; primary food production; water, sanitation, and hygiene; and environment and sustainability. The 4 most common types of metrics, methods, and tools were: diet metrics; footprint analysis (especially water); technology applications; and network or Bayesian analysis. Gaps represent areas of few or no reports of innovation between 2008 and 2018. There were gaps in reports and innovations related to: power or conflicts of interest; food environments; markets; private sector engagement; food loss and waste; conflict; study design and system-level tools, metrics, and methods. The EGM is a comprehensive tool to navigate advances in measurement in A&N research: to highlight trends and gaps, conduct further synthesis and development, and prioritize the agenda for future work. This narrative synthesis accompanies the EGM, which can be found at https://www.anh-academy.org/evidence-and-gap-map.
Collapse
Affiliation(s)
- Thalia M Sparling
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Samuel Boakye
- International Center for Evaluation and Development (ICED), Nairobi, Kenya
| | - Denny John
- Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, India
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
| |
Collapse
|
20
|
Bukachi SA, Ngutu M, Muthiru AW, Lépine A, Kadiyala S, Domínguez-Salas P. Consumer perceptions of food safety in animal source foods choice and consumption in Nairobi's informal settlements. BMC Nutr 2021; 7:35. [PMID: 34261518 PMCID: PMC8281509 DOI: 10.1186/s40795-021-00441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background Animal-source foods (ASFs) are high-quality nutrient-dense products key to reducing stunting and micronutrient deficiencies. However, their consumption among the poorest households in urban informal settlements is low. Several drivers beyond price, including health considerations have been reported to drive ASF choice and consumption among consumers. This current study explores consumer perceptions of food safety associated with animal source foods (ASFs) consumption in urban informal settlements with a view to unpacking the health considerations driving their choice and consumption. Methods Coupled households with children 6–59 months formed the study sample. The Food Environments Working Group (FEWG) Framework of the Agriculture and Nutrition for Health academy (ANH) was used to guide the study which utilized qualitative methods namely, 60 in-depth interviews (IDIs), 19 focus group discussions, and 19 key informant interviews (KIIs) complemented by unstructured observations. Data were transcribed and analysed according to emerging themes. Results Consumer perceptions of food safety are driven by concerns about food production, processing, handling, storage and the health risks associated with consumption of the ASFs. For all the ASFs, lack of traceability of source, unhygienic environments in which they were sold and health risks around consuming too much or improperly cooked products were key perceptions from the community. To mitigate against food safety risks, consumers used strategies such as boiling the ASFs, purchasing their products from trusted retailers, avoiding vendors in unhygienic environments and reducing the amount and frequency of consumption of ASFs or totally avoiding their consumption. These consumer perceptions are increasingly influencing the ASFs choice and consumption in low-income populations besides other drivers. Notably, given limited incomes that influence their purchasing power and the need for nutritious diets that included ASFs, the dilemma of quality vis-a-vis quantity persists and consumers still accessed and consumed these ASF products to supplement their diets. Conclusions To enhance food safety for ASFs, as well as assure consumer access to safe ASFs from informal markets, there is need to contextualize the value chain as informed by consumer perceptions on food safety as these influence their ASFs choice and consumption.
Collapse
Affiliation(s)
- Salome A Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya.
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya
| | - Ann W Muthiru
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya
| | - Aurélia Lépine
- Institute for Global Health, University College London (UCL), London, UK
| | | | - Paula Domínguez-Salas
- International Livestock Research Institute (ILRI), Nairobi, Kenya.,Natural Resources Institute, University of Greenwich, London, UK
| |
Collapse
|
21
|
Harris-Fry H, O'Hearn M, Pradhan R, Krishnan S, Nair N, Rath S, Rath S, Koniz-Booher P, Danton H, Aakesson A, Pradhan S, Mishra NK, Kumar A, Upadhay A, Prost A, Kadiyala S. How to design a complex behaviour change intervention: experiences from a nutrition-sensitive agriculture trial in rural India. BMJ Glob Health 2021; 5:bmjgh-2020-002384. [PMID: 32513863 PMCID: PMC7282327 DOI: 10.1136/bmjgh-2020-002384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022] Open
Abstract
Many public health interventions aim to promote healthful behaviours, with varying degrees of success. With a lack of existing empirical evidence on the optimal number or combination of behaviours to promote to achieve a given health outcome, a key challenge in intervention design lies in deciding what behaviours to prioritise, and how best to promote them. We describe how key behaviours were selected and promoted within a multisectoral nutrition-sensitive agriculture intervention that aimed to address maternal and child undernutrition in rural India. First, we formulated a Theory of Change, which outlined our hypothesised impact pathways. To do this, we used the following inputs: existing conceptual frameworks, published empirical evidence, a feasibility study, formative research and the intervention team’s local knowledge. Then, we selected specific behaviours to address within each impact pathway, based on our formative research, behaviour change models, local knowledge and community feedback. As the intervention progressed, we mapped each of the behaviours against our impact pathways and the transtheoretical model of behaviour change, to monitor the balance of behaviours across pathways and along stages of behaviour change. By collectively agreeing on definitions of complex concepts and hypothesised impact pathways, implementing partners were able to communicate clearly between each other and with intervention participants. Our intervention was iteratively informed by continuous review, by monitoring implementation against targets and by integrating community feedback. Impact and process evaluations will reveal whether these approaches are effective for improving maternal and child nutrition, and what the effects are on each hypothesised impact pathway.
Collapse
Affiliation(s)
- Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | | | - Sneha Krishnan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | | - Audrey Prost
- University College London Institute of Child Health, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
22
|
Cooper GS, Rich KM, Shankar B, Rana V, Ratna NN, Kadiyala S, Alam MJ, Nadagouda SB. Identifying 'win-win-win' futures from inequitable value chain trade-offs: A system dynamics approach. Agric Syst 2021; 190:103096. [PMID: 34025008 PMCID: PMC8121761 DOI: 10.1016/j.agsy.2021.103096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 05/19/2023]
Abstract
CONTEXT There is growing recognition that food systems must adapt to become more sustainable and equitable. Consequently, in developing country contexts, there is increasing momentum away from traditional producer-facing value chain upgrades towards efforts to increase both the availability and affordability of nutritious foods at the consumer level. However, such goals must navigate the inherent complexities of agricultural value chains, which involve multiple interactions, feedbacks and unintended consequences, including important but often surprising trade-offs between producers and consumers. OBJECTIVE AND METHODS Based around the 'Loop' horticultural aggregation scheme of Digital Green in Bihar, India, we develop a system dynamics modelling framework to survey the value chain trade-offs emerging from upgrades that aim to improve the availability of fruits and vegetables in small retail-oriented markets. We model the processes of horticultural production, aggregation, marketing, and retailing - searching for futures that are 'win-win-win' for: (i) the availability of fruits and vegetables in small retail markets, (ii) the profits of farmers participating in aggregation, and (iii) the sustainability of the initial scheme for Digital Green as an organisation. We simulate two internal upgrades to aggregation and two upgrades to the wider enabling environment through a series of 5000 Monte Carlo trajectories - designed to explore the plausible future dynamics of the three outcome dimensions relative to the baseline. RESULTS We find that 'win-win-win' futures cannot be achieved by internal changes to the aggregation scheme alone, emerging under a narrow range of scenarios that boost supplies to the small retail market whilst simultaneously supporting the financial takeaways of farmers. In contrast, undesirable producer versus consumer trade-offs emerge as unintended consequences of scaling-up aggregation and the introduction of market-based cold storage. SIGNIFICANCE This approach furthers ongoing efforts to capture complex value chain processes, outcomes and upgrades within system dynamics modelling frameworks, before scanning the horizon of plausible external scenarios, internal dynamics and unintended trade-offs to identify 'win-win-win' futures for all.
Collapse
Affiliation(s)
- Gregory S. Cooper
- Centre for Development, Environment and Policy (CeDEP), School of Oriental and African Studies (SOAS), London, United Kingdom
| | - Karl M. Rich
- International Livestock Research Institute (ILRI), West Africa Regional Office, Dakar, Senegal
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, United Kingdom
| | - Vinay Rana
- Transform Rural India Foundation (TRIF), Raipur, Chhattisgarh, India
| | - Nazmun N. Ratna
- Department of Global Value Chain & Trade, Faculty of Agribusiness and Commerce, Lincoln University, Christchurch, New Zealand
| | - Suneetha Kadiyala
- Department for Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Mohammad J. Alam
- Department of Agribusiness and Marketing, Bangladesh Agricultural University (BAU), Mymensingh, Bangladesh
| | | |
Collapse
|
23
|
Kadiyala S, Harris-Fry H, Pradhan R, Mohanty S, Padhan S, Rath S, James P, Fivian E, Koniz-Booher P, Nair N, Haghparast-Bidgoli H, Mishra NK, Rath S, Beaumont E, Danton H, Krishnan S, Parida M, O'Hearn M, Kumar A, Upadhyay A, Tripathy P, Skordis J, Sturgess J, Elbourne D, Prost A, Allen E. Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial. Lancet Planet Health 2021; 5:e263-e276. [PMID: 33811818 PMCID: PMC8099729 DOI: 10.1016/s2542-5196(21)00001-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Almost a quarter of the world's undernourished people live in India. We tested the effects of three nutrition-sensitive agriculture (NSA) interventions on maternal and child nutrition in India. METHODS We did a parallel, four-arm, observer-blind, cluster-randomised trial in Keonjhar district, Odisha, India. A cluster was one or more villages with a combined minimum population of 800 residents. The clusters were allocated 1:1:1:1 to a control group or an intervention group of fortnightly women's groups meetings and household visits over 32 months using: NSA videos (AGRI group); NSA and nutrition-specific videos (AGRI-NUT group); or NSA videos and a nutrition-specific participatory learning and action (PLA) cycle meetings and videos (AGRI-NUT+PLA group). Primary outcomes were the proportion of children aged 6-23 months consuming at least four of seven food groups the previous day and mean maternal body-mass index (BMI). Secondary outcomes were proportion of mothers consuming at least five of ten food groups and child wasting (proportion of children with weight-for-height Z score SD <-2). Outcomes were assessed in children and mothers through cross-sectional surveys at baseline and at endline, 36 months later. Analyses were by intention to treat. Participants and intervention facilitators were not blinded to allocation; the research team were. This trial is registered at ISRCTN, ISRCTN65922679. FINDINGS 148 of 162 clusters assessed for eligibility were enrolled and randomly allocated to trial groups (37 clusters per group). Baseline surveys took place from Nov 24, 2016, to Jan 24, 2017; clusters were randomised from December, 2016, to January, 2017; and interventions were implemented from March 20, 2017, to Oct 31, 2019, and endline surveys done from Nov 19, 2019, to Jan 12, 2020, in an average of 32 households per cluster. All clusters were included in the analyses. There was an increase in the proportion of children consuming at least four of seven food groups in the AGRI-NUT (adjusted relative risk [RR] 1·19, 95% CI 1·03 to 1·37, p=0·02) and AGRI-NUT+PLA (1·27, 1·11 to 1·46, p=0·001) groups, but not AGRI (1·06, 0·91 to 1·23, p=0·44), compared with the control group. We found no effects on mean maternal BMI (adjusted mean differences vs control, AGRI -0·05, -0·34 to 0·24; AGRI-NUT 0·04, -0·26 to 0·33; AGRI-NUT+PLA -0·03, -0·3 to 0·23). An increase in the proportion of mothers consuming at least five of ten food groups was seen in the AGRI (adjusted RR 1·21, 1·01 to 1·45) and AGRI-NUT+PLA (1·30, 1·10 to 1·53) groups compared with the control group, but not in AGRI-NUT (1·16, 0·98 to 1·38). We found no effects on child wasting (adjusted RR vs control, AGRI 0·95, 0·73 to 1·24; AGRI-NUT 0·96, 0·72 to 1·29; AGRI-NUT+PLA 0·96, 0·73 to 1·26). INTERPRETATION Women's groups using combinations of NSA videos, nutrition-specific videos, and PLA cycle meetings improved maternal and child diet quality in rural Odisha, India. These components have been implemented separately in several low-income settings; effects could be increased by scaling up together. FUNDING Bill & Melinda Gates Foundation, UK AID from the UK Government, and US Agency for International Development.
Collapse
Affiliation(s)
- Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Philip James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Naba Kishor Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Emma Beaumont
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sneha Krishnan
- Environment, Technology and Community Health Consultancy Service, Mumbai, India; Jindal School of Environment and Sustainability, Jindal Global University, Haryana, India
| | | | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
24
|
Brown KA, Srinivasapura Venkateshmurthy N, Law C, Harris F, Kadiyala S, Shankar B, Mohan S, Prabhakaran D, Knai C. Moving towards sustainable food systems: A review of Indian food policy budgets. Glob Food Sec 2021; 28:100462. [PMID: 33738184 PMCID: PMC7941605 DOI: 10.1016/j.gfs.2020.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/25/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
Moving towards sustainable food systems is a complex problem, which requires high level co-ordination, coherence, and integration of national food policy. The aim of this study is to explore where environmental sustainability is integrated into national food policy in India. A scoping review of food policies was conducted, and findings mapped to ministerial responsibility, estimated budget allocation, and relevant Sustainable Development Goals. Fifty-two policies were identified, under the responsibility of 10 ministries, and with relevance to six Sustainable Development Goals. Content analysis identified references to environmental sustainability were concentrated in policies with the smallest budgetary allocation. Resources together with political will are required to integrate environmental sustainability into food policies and avoid conflicts with more well-established health, societal, and economic priorities.
Collapse
Affiliation(s)
- Kerry Ann Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Cherry Law
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesca Harris
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Cécile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
25
|
Yates J, Deeney M, Rolker HB, White H, Kalamatianou S, Kadiyala S. A systematic scoping review of environmental, food security and health impacts of food system plastics. ACTA ACUST UNITED AC 2021; 2:80-87. [PMID: 37117403 DOI: 10.1038/s43016-021-00221-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 01/11/2021] [Indexed: 12/31/2022]
Abstract
Plastic pollution arising from food systems is driving policies for reduction, removal, reuse and recycling, but literature on plastic uses and outcomes across subsectors is fragmented. We use a systematic scoping review to describe the extent, range and nature of published evidence since 2000 on seven major plastic types used at any point within food systems and their quantifiable effects on the environment, food security and human health. Although the majority of publications focus on agricultural production, relatively fewer consider retail, household and food waste disposal plastics. Gaps in the research include evidence from low- and middle-income countries, health or food security and/or economic outcomes generated from human population studies-and the subsequent environmental and human health effects. A greater understanding of this disparate evidence landscape is essential to formulate coherent research strategies to inform potential policy actions and assess trade-offs across economic and environmental targets, human health and food security.
Collapse
|
26
|
Affiliation(s)
- Christopher Turner
- From the Natural Resources Institute, University of Greenwich, Food and Markets Department, Chatham Maritime, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| |
Collapse
|
27
|
Sørensen TB, Matsuzaki M, Gregson J, Kinra S, Kadiyala S, Shankar B, Dangour AD. Is agricultural engagement associated with lower incidence or prevalence of cardiovascular diseases and cardiovascular disease risk factors? A systematic review of observational studies from low- and middle-income countries. PLoS One 2020; 15:e0230744. [PMID: 32231387 PMCID: PMC7108743 DOI: 10.1371/journal.pone.0230744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/07/2020] [Indexed: 01/03/2023] Open
Abstract
Non-communicable diseases, such as cardiovascular diseases (CVDs), diabetes and cancer account for more than half of the global disease burden, and 75% of related deaths occur in low- and middle-income countries (LMICs). Despite large regional variations in CVD incidence and prevalence, CVDs remain the leading causes of death worldwide. With urbanisation, developing nations are undergoing unprecedented labour-force transitions out of agriculture and into types of non-agricultural employment, mainly in the industry and service sectors. There are few studies on the effect of these transitions on CVDs and CVD risk factors in LMICs. We systematically searched MEDLINE, PubMed, EMBASE and the Cochrane Library from January 1950 to January 2017 to assess the association of engaging in agriculture compared to types of non-agricultural employment (e.g. services and manufacturing) with CVD incidence, prevalence and risk factors. Studies were included if they: included participants who engaged in agriculture and participants who did not engage in agriculture; measured atherosclerotic CVDs or their modifiable risk factors; and involved adults from LMICs. We assessed the quality of evidence in seven domains of each study. Prevalence ratios with 95% confidence intervals were calculated and compared in forest plots across studies. Study heterogeneity did not permit formal meta-analyses with pooled results. There was a lack of publications on the primary outcomes, atherosclerotic CVDs (n = 2). Limited evidence of varying consistency from 13 studies in five countries reported that compared with non-agricultural workers, mainly living in urban areas, rural agriculture workers had a lower prevalence of hypertension, overweight and obesity; and a higher prevalence of underweight and smoking. High quality evidence is lacking on the associations of engaging in and transitioning out of agriculture with atherosclerotic CVDs and their modifiable risk factors in LMICs. There is a need for interdisciplinary longitudinal studies to understand associations of types of employment and labour-force transitions with CVD burdens in LMICs.
Collapse
Affiliation(s)
- Tina B. Sørensen
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mika Matsuzaki
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - John Gregson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- London Centre for Integrative Research in Agriculture and Health (LCIRAH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bhavani Shankar
- London Centre for Integrative Research in Agriculture and Health (LCIRAH), London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Development, Environment and Policy, School of Oriental and African Studies, London, United Kingdom
| | - Alan D. Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- London Centre for Integrative Research in Agriculture and Health (LCIRAH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
28
|
Harris-Fry H, Nur H, Shankar B, Zanello G, Srinivasan C, Kadiyala S. The impact of gender equity in agriculture on nutritional status, diets, and household food security: a mixed-methods systematic review. BMJ Glob Health 2020; 5:e002173. [PMID: 32337083 PMCID: PMC7170429 DOI: 10.1136/bmjgh-2019-002173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/28/2020] [Accepted: 03/15/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Undernutrition rates remain high in rural, low-income settings, where large, gender-based inequities persist. We hypothesised that increasing gender equity in agriculture could improve nutrition. Methods We conducted a systematic review to assess the associations between gender-based inequities (in income, land, livestock, and workloads) and nutrition, diets and food security outcomes in agricultural contexts of low-income and middle-income countries. Between 9 March and 7 August 2018, we searched 18 databases and 14 journals, and contacted 27 experts. We included quantitative and qualitative literature from agricultural contexts in low-income and middle-income countries, with no date restriction. Outcomes were women's and children's anthropometric status, dietary quality and household food security. We conducted meta-analyses using random-effects models. Results We identified 19 820 records, of which 34 studies (42 809 households) met the inclusion criteria. Most (22/25) quantitative studies had a high risk of bias, and qualitative evidence was of mixed quality. Income, land and livestock equity had heterogeneous associations with household food security and child anthropometric outcomes. Meta-analyses showed women's share of household income earned (0.32, 95% CI -4.22 to 4.86; six results) and women's share of land owned (2.72, 95% CI -0.52 to 5.96; three results) did not increase the percentage of household budget spent on food. Higher-quality studies showed more consistently positive associations between income equity and food security. Evidence is limited on other exposure-outcome pairings. Conclusions We find heterogeneous associations between gender equity and household-level food security. High-quality research is needed to establish the impact of gender equity on nutrition outcomes across contexts. PROSPERO registration number CRD42018093987.
Collapse
Affiliation(s)
- Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hayaan Nur
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Bhavani Shankar
- Centre for Development, Environment and Policy, SOAS University of London, London, UK
| | - Giacomo Zanello
- School of Agriculture, Policy and Development, University of Reading - Whiteknights Campus, Reading, Berkshire, UK
| | - Chittur Srinivasan
- School of Agriculture, Policy and Development, University of Reading - Whiteknights Campus, Reading, Berkshire, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
29
|
Harris-Fry H, Krishnan S, Beaumont E, Prost A, Gouda S, Mohanty S, Pradhan R, Rath S, Rath S, Pradhan S, Mishra NK, Allen E, Kadiyala S. Agricultural and empowerment pathways from land ownership to women's nutrition in India. Matern Child Nutr 2020; 16:e12995. [PMID: 32196969 PMCID: PMC7507043 DOI: 10.1111/mcn.12995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Abstract
Land size is an important equity concern for the design of ‘nutrition‐sensitive’ agricultural interventions. We unpack some of the pathways between land and nutrition using a cross‐sectional baseline survey data set of 4,480 women from 148 clusters from the ‘Upscaling Participatory Action and Videos for Agriculture and Nutrition’ trial in Keonjhar district in Odisha, India. Variables used are household ln‐land size owned (exposure) and maternal dietary diversity score out of 10 food groups and body mass index (BMI; kg/m2) (outcomes); and mediators investigated are production diversity score, value of agricultural production, and indicators for women's empowerment (decision‐making in agriculture, group participation, work‐free time and land ownership). We assessed mediation using a non‐parametric potential outcomes framework method. Land size positively affects maternal dietary diversity scores [β 0.047; 95% confidence interval (CI) (0.011, 0.082)] but not BMI. Production diversity, but not value of production, accounts for 17.6% of total effect mediated. We observe suppression of the effect of land size on BMI, with no evidence of a direct effect for either of the agricultural mediators but indirect effects of β −0.031 [95% CI (−0.048, −0.017)] through production diversity and β −0.047 [95% CI (−0.075, −0.021)] through value of production. An increase in land size positively affects women's decision‐making, which in turn negatively affects maternal BMI. The positive effect of work‐free time on maternal BMI is suppressed by the negative effect of household land size on work‐free time. Agriculture interventions must consider land quality, women's decision‐making and implications for women's workload in their design.
Collapse
Affiliation(s)
- Helen Harris-Fry
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sneha Krishnan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Shibnath Pradhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Keonjhar, India
| | - Naba Kishore Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Keonjhar, India
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
30
|
Surendran S, Selvaraj K, Turner C, Addanki S, Kannuri NK, Debbarma A, Kadiyala S, Kinra S, Walls H. Characterising the fruit and vegetable environment of peri-urban Hyderabad, India. Global Food Security 2020. [DOI: 10.1016/j.gfs.2019.100343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
31
|
Turner C, Kalamatianou S, Drewnowski A, Kulkarni B, Kinra S, Kadiyala S. Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review. Adv Nutr 2020; 11:387-397. [PMID: 31079142 PMCID: PMC7442349 DOI: 10.1093/advances/nmz031] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.
Collapse
Affiliation(s)
- Christopher Turner
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Sofia Kalamatianou
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Adam Drewnowski
- University of Washington, Department of Nutritional Sciences, Center for Public Health Nutrition, Seattle, WA
| | - Bharati Kulkarni
- National Institute of Nutrition, Tarnaka, Hyderabad, Telangana, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| |
Collapse
|
32
|
Law C, Green R, Kadiyala S, Shankar B, Knai C, Brown KA, Dangour AD, Cornelsen L. Purchase trends of processed foods and beverages in urban India. Glob Food Sec 2019; 23:191-204. [PMID: 31799110 PMCID: PMC6853021 DOI: 10.1016/j.gfs.2019.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 12/29/2022]
Abstract
•Unique dataset allows analysis of urban Indian shopping habits of processed foods.•Beyond staples, purchases of processed foods and beverages for home use are low.•Fastest rate of growth seen in sweet and salty snacks, and edible oil purchases.•Highest volume of processed foods and beverages purchased by Delhi population.•Large variations across states in level and trends of purchases over time.
Collapse
Affiliation(s)
- Cherry Law
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- (Honorary) College of Medicine & Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Bhavani Shankar
- Centre for Development, Environment and Policy, SOAS University of London, London, WC1H 0XG, UK
| | - Cécile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kerry A. Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Alan D. Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laura Cornelsen
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- (Honorary) College of Medicine & Health, University of Exeter, Exeter, EX1 2LU, UK
| |
Collapse
|
33
|
Sparling TM, White H, Kadiyala S. PROTOCOL: Evidence and gap map protocol: Understanding pathways between agriculture and nutrition: An evidence and gap map of tools, metrics and methods developed and applied in the last 10 years. Campbell Syst Rev 2019; 15:e1035. [PMID: 33395472 PMCID: PMC8356529 DOI: 10.1002/cl2.1035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
34
|
Yates J, Deeney M, White H, Joy E, Kalamatianou S, Kadiyala S. PROTOCOL: Plastics in the food system: Human health, economic and environmental impacts. A scoping review. Campbell Syst Rev 2019; 15:e1033. [PMID: 37131475 PMCID: PMC8356532 DOI: 10.1002/cl2.1033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Joe Yates
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Megan Deeney
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | | | - Edward Joy
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Sofia Kalamatianou
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| |
Collapse
|
35
|
Haghparast-Bidgoli H, Skordis J, Harris-Fry H, Krishnan S, O'Hearn M, Kumar A, Pradhan R, Mishra NK, Upadhyay A, Pradhan S, Ojha AK, Cunningham S, Rath S, Palmer T, Koniz-Booher P, Kadiyala S. Protocol for the cost-consequence and equity impact analyses of a cluster randomised controlled trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child dietary diversity and nutritional status in rural Odisha, India (UPAVAN trial). Trials 2019; 20:287. [PMID: 31133067 PMCID: PMC6537168 DOI: 10.1186/s13063-019-3388-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach. Methods The economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted. Discussion Evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes. Trial registration ISRCTN65922679. Registered on 21 December 2016 Electronic supplementary material The online version of this article (10.1186/s13063-019-3388-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Jolene Skordis
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Sneha Krishnan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Meghan O'Hearn
- Tufts University, Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Abhinav Kumar
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Avinash Upadhyay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Amit Kumar Ojha
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Sarah Cunningham
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115,, USA
| | - Shibanand Rath
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Tom Palmer
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research and Training Institute, Inc., 1616 Fort Myer Drive 16th Floor, Arlington, VA, 22209, USA
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| |
Collapse
|
36
|
Abstract
BACKGROUND Rapid economic growth, urbanization, and globalization have resulted in dietary transformation in India. Triple burden of malnutrition remains a significant concern, with high prevalence of undernutrition, widespread micronutrient deficiencies, and rising obesity. OBJECTIVE This article reviews the dietary transition in India by analyzing trends in food consumption across time and space. METHODS Household consumption survey data from 1993 to 2012 are analyzed to examine both national- and state-level trends to investigate how diets have changed and vary across the country. Typical Indian diets are characterized using k-mean cluster analysis and associated with socioeconomic and geographical aspects. RESULTS The article finds that on average Indian household diets have diversified slowly but steadily since the 90s. Indians diets have shifted away from cereals to higher consumption of milk. However, progress on micronutrient-rich food groups such as fruits, vegetables, meat, and egg has been worryingly slow. Even by 2012, about a fifth of rural Indian households did not consume fruits or milk, while more than half of both urban and rural households did not consume any meat, fish, or eggs. Five predominant dietary types are identified. Sections of the Indian households do consume reasonably balanced diets, but large percentages consume cereal-focused, dairy-focused, or processed food heavy diets with high processed food content. CONCLUSIONS Diets in India have not transformed sufficiently to overcome major gaps in intakes of micronutrient-rich foods. Large regional heterogeneities in diets call for regionally differentiated strategies to improve diets.
Collapse
Affiliation(s)
- Mehroosh Tak
- 1 School of Oriental and African Studies (SOAS), University of London, London, UK.,2 Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
| | - Bhavani Shankar
- 1 School of Oriental and African Studies (SOAS), University of London, London, UK.,2 Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
| | - Suneetha Kadiyala
- 2 Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK.,3 The London School of Hygiene & Tropical Medicine (LSHTM), University of London, London, UK
| |
Collapse
|
37
|
Waage J, Cornelsen L, Dangour AD, Green R, Häsler B, Hull E, Johnston D, Kadiyala S, Lock K, Shankar B, Smith RD, Walls HL. Integrating Agriculture and Health Research for Development: LCIRAH as an Interdisciplinary Programme to Address a Global Challenge. Glob Chall 2019; 3:1700104. [PMID: 31565369 PMCID: PMC6450449 DOI: 10.1002/gch2.201700104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/16/2018] [Indexed: 06/10/2023]
Abstract
The multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in "Agri-Health," and built an international research community with a particular focus on strengthening research capacity in low- and middle-income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals.
Collapse
Affiliation(s)
- Jeff Waage
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Laura Cornelsen
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Alan D. Dangour
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Rosemary Green
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Barbara Häsler
- Royal Veterinary College4 Royal College StreetLondonNW1 0TUUK
| | - Elizabeth Hull
- School of Oriental and African StudiesThornhaugh StreetLondonWC1H 0XGUK
| | - Deborah Johnston
- School of Oriental and African StudiesThornhaugh StreetLondonWC1H 0XGUK
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Karen Lock
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Bhavani Shankar
- School of Oriental and African StudiesThornhaugh StreetLondonWC1H 0XGUK
| | - Richard D. Smith
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Helen L. Walls
- London School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| |
Collapse
|
38
|
Lamanna C, Hachhethu K, Chesterman S, Singhal G, Mwongela B, Ng'endo M, Passeri S, Farhikhtah A, Kadiyala S, Bauer JM, Rosenstock TS. Strengths and limitations of computer assisted telephone interviews (CATI) for nutrition data collection in rural Kenya. PLoS One 2019; 14:e0210050. [PMID: 30699207 PMCID: PMC6353544 DOI: 10.1371/journal.pone.0210050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/17/2018] [Indexed: 11/29/2022] Open
Abstract
Despite progress in fighting undernutrition, Africa has the highest rates of undernutrition globally, exacerbated by drought and conflict. Mobile phones are emerging as a tool for rapid, cost effective data collection at scale in Africa, as mobile phone subscriptions and phone ownership increase at the highest rates globally. To assess the feasibility and biases of collecting nutrition data via computer assisted telephone interviews (CATI) to mobile phones, we measured Minimum Dietary Diversity for Women (MDD-W) and Minimum Acceptable Diet for Infants and Young Children (MAD) using a one-week test-retest study on 1,821 households in Kenya. Accuracy and bias were assessed by comparing individual scores and population prevalence of undernutrition collected via CATI with data collected via traditional face-to-face (F2F) surveys. We were able to reach 75% (n = 1366) of study participants via CATI. Women’s reported nutrition scores did not change with mode for MDD-W, but children’s nutrition scores were significantly higher when measured via CATI for both the dietary diversity (mean increase of 0.45 food groups, 95% confidence interval 0.34–0.56) and meal frequency (mean increase of 0.75 meals per day, 95% confidence interval 0.53–0.96) components of MAD. This resulted in a 17% higher inferred prevalence of adequate diets for infants and young children via CATI. Women without mobile-phone access were younger and had fewer assets than women with access, but only marginally lower dietary diversity, resulting in a small non-coverage bias of 1–7% due to exclusion of participants without mobile phones. Thus, collecting nutrition data from rural women in Africa with mobile phones may result in 0% (no change) to as much as 25% higher nutrition estimates than collecting that information in face-to-face interviews.
Collapse
Affiliation(s)
| | - Kusum Hachhethu
- Vulnerability, Analysis, and Mapping Unit, United Nations World Food Programme, Rome, Italy.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | - Sabrina Chesterman
- World Agroforestry Centre, Nairobi, Kenya.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gaurav Singhal
- Vulnerability, Analysis, and Mapping Unit, United Nations World Food Programme, Rome, Italy
| | - Beatrice Mwongela
- Kenya Country Office, United Nations World Food Programme, Nairobi, Kenya
| | | | - Silvia Passeri
- Vulnerability, Analysis, and Mapping Unit, United Nations World Food Programme, Rome, Italy.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jean-Martin Bauer
- Vulnerability, Analysis, and Mapping Unit, United Nations World Food Programme, Rome, Italy.,United Nations World Food Programme, Brazzaville, Republic of the Congo
| | - Todd S Rosenstock
- CGIAR Research Program on Climate Change, Agriculture, and Food Security, Kinshasa, Democratic Republic of the Congo.,World Agroforestry Centre, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
39
|
Cunningham K, Ferguson E, Ruel M, Uauy R, Kadiyala S, Menon P, Ploubidis G. Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal. Matern Child Nutr 2018; 15:e12638. [PMID: 30047247 DOI: 10.1111/mcn.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
Abstract
In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes.
Collapse
Affiliation(s)
| | - Elaine Ferguson
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Ruel
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA
| | - Ricardo Uauy
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Food Nutrition and Food Technology, Santiago, Chile
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA.,Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - George Ploubidis
- Department of Quantitative Social Science, Centre for Longitudinal Studies; Institute of Education, London, UK
| |
Collapse
|
40
|
Kadiyala S, Prost A, Harris-Fry H, O’Hearn M, Pradhan R, Pradhan S, Mishra NK, Rath S, Nair N, Rath S, Tripathy P, Krishnan S, Koniz-Booher P, Danton H, Elbourne D, Sturgess J, Beaumont E, Haghparast-Bidgoli H, Skordis-Worrall J, Mohanty S, Upadhay A, Allen E. Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial. Trials 2018; 19:176. [PMID: 29523173 PMCID: PMC5845188 DOI: 10.1186/s13063-018-2521-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. 'Nutrition-sensitive' agriculture programs could tackle the underlying causes of undernutrition. METHODS/DESIGN This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women's groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women's groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women's groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6-23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0-23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children's weight-for-height z-score < -2 standard deviations (SD). The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (< 10 km or ≥ 10 km), and low (< 30%), medium (30-70%), or high (> 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. DISCUSSION This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. TRIAL REGISTRATION ISRCTN , ISRCTN65922679 . Registered on 21 December 2016.
Collapse
Affiliation(s)
- Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Audrey Prost
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Meghan O’Hearn
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Suchitra Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Nirmala Nair
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Shibanand Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | | | - Sneha Krishnan
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Heather Danton
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Sturgess
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emma Beaumont
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Jolene Skordis-Worrall
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Satyanarayan Mohanty
- Development Corner Consulting Pvt. Ltd. (DCOR), 131(P), Punjabi Chhak, Satyanagar, Near Hotel Sungreen, Bhubaneshwar, 751007 India
| | - Avinash Upadhay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
41
|
Avula R, Oddo VM, Kadiyala S, Menon P. Scaling-up interventions to improve infant and young child feeding in India: What will it take? Matern Child Nutr 2017; 13 Suppl 2. [PMID: 29032618 PMCID: PMC6866129 DOI: 10.1111/mcn.12414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/17/2016] [Accepted: 11/02/2016] [Indexed: 01/22/2023]
Abstract
We assessed India's readiness to deliver infant and young child feeding (IYCF) interventions by examining elements related to policy, implementation, financing, and evidence. We based our analysis on review of (a) nutrition policy guidance and program platforms, (b) published literature on interventions to improve IYCF in India, and (c) IYCF program models implemented between 2007 and 2012. We find that Indian policies are well aligned with global technical guidance on counselling interventions. However, guidelines for complementary food supplements (CFS) need to be reexamined. Two national programs with the operational infrastructure to deliver IYCF interventions offer great potential for scale, but more operational guidance, capacity, and monitoring are needed to actively support delivery of IYCF counselling at scale by available frontline workers. Many IYCF implementation efforts to date have experimented with approaches to improve breastfeeding and initiation of complementary feeding but not with improving diet diversity or the quality of food supplements. Financing is currently inadequate to deliver CFS at scale, and governance issues affect the quality and reach of CFS. Available evidence from Indian studies supports the use of counselling strategies to improve breastfeeding practices and initiation of complementary feeding, but limited evidence exists on improving full spectrum of IYCF practices and the impact and operational aspects of CFS in India. We conclude that India is well positioned to support the full spectrum of IYCF using existing policies and delivery platforms, but capacity, financing, and evidence gaps on critical areas of programming can limit impact at scale.
Collapse
Affiliation(s)
- Rasmi Avula
- International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Vanessa M Oddo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Purnima Menon
- International Food Policy Research Institute (IFPRI), New Delhi, India
| |
Collapse
|
42
|
Kadiyala S, Young RG, Thiede MA, Bruder SP. Culture Expanded Canine Mesenchymal Stem Cells Possess Osteochondrogenic Potential in Vivo and in Vitro. Cell Transplant 2017; 6:125-34. [PMID: 9142444 DOI: 10.1177/096368979700600206] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mesenchymal Stem Cells (MSCs) possessing the capacity to differentiate into various cell types such as osteoblasts, chondrocytes, myoblasts, and adipocytes have been previously isolated from the marrow and periosteum of human, murine, lapine, and avian species. This study documents the existence of similar multipotential stem cells in canine marrow. The cells were isolated from marrow aspirates using a modification of techniques previously established for human MSCs (hMSCs), and found to possess similar growth and morphological characteristics, as well as osteochondrogenic potential in vivo and in vitro. On the basis of these results, the multipotential cells that were isolated and culture expanded are considered to be canine MSCs (cMSCs). The occurrence of cMSCs in the marrow was determined to be one per 2.5 × 104 nucleated cells. After enrichment of the cMSCs by centrifugation on a Per-coll cushion, the cells were cultivated in selected lots of serum. Like the hMSCs, cMSCs grew as colonies in primary culture and on replating, grew as a monolayer culture with very uniform spindle morphology. The population doubling time for these cMSCs was approximately 2 days. The morphology and the growth kinetics of the cMSCs were retained following repeated passaging. The osteogenic phenotype could be induced in the cMSC cultures by the addition of a synthetic glucocorticoid, dexamethasone. In these osteogenic cultures, alkaline phosphatase activity was elevated up to 10-fold, and mineralized matrix production was evident. When cMSCs were loaded onto porous ceramics and implanted in autologous canine or athymic murine hosts, copious amounts of bone and cartilage were formed in the pores of the implants. The MSC-mediated osteogenesis obtained by the implantation of the various MSC-loaded matrix combinations is the first evidence of osteogenesis in a canine model by implantation of culture expanded autologous stem cells. The identification and isolation of cMSCs now makes it feasible to pursue preclinical models of bone and cartilage regeneration in canine hosts.
Collapse
Affiliation(s)
- S Kadiyala
- Osiris Therapeutics, Inc., Baltimore, MD 21231, USA
| | | | | | | |
Collapse
|
43
|
Kennedy A, Kadiyala S, Daniel R, Poole N, Olney D. Homestead Food Production and Child Anemia in Burkina Faso: The Mediating Roles of Mother's Knowledge and Production of Micronutrient‐Rich Fruits and Vegetables. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.786.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Kennedy
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | | | - Rhian Daniel
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Nigel Poole
- SOAS University of LondonLondonUnited Kingdom
| | - Deanna Olney
- International Food Policy Research InstituteWashington, DC
| |
Collapse
|
44
|
Maluccio JA, Wu F, Rokon RB, Rawat R, Kadiyala S. Assessing the Impact of Food Assistance on Stigma Among People Living with HIV in Uganda Using the HIV/AIDS Stigma Instrument-PLWA (HASI-P). AIDS Behav 2017; 21:766-782. [PMID: 27372803 DOI: 10.1007/s10461-016-1476-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV-related stigma among persons living with HIV/AIDS (PLHIV) is prevalent throughout sub-Saharan Africa. There is limited evidence, however, on which interventions are effective in reducing it. We used data from a prospective impact evaluation of a 12-month food assistance intervention among 904 antiretroviral therapy (ART)- naïve PLHIV in Uganda to examine the program impact on stigma. Stigma was measured using the comprehensive HASI-P scale, which demonstrated good internal consistency (Cronbach's alpha = 0.87) and was correlated with several related constructs including physical and mental health-related quality of life, disclosure, and physical health symptoms in the sample. Using quasi-experimental difference-in-difference matching methods to better infer causality, we tested whether the intervention improved the overall stigma scale and its subscales. The food assistance intervention had a significant effect on reported internalized (but not external) stigma of approximately 0.2 SD (p < 0.01). The HASI-P stigma scale is a useful tool for measuring and tracking stigma. Food assistance interventions, embedded in an HIV care program, can reduce internalized stigma.
Collapse
Affiliation(s)
- John A Maluccio
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA.
| | - Fan Wu
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA
| | - Redwan B Rokon
- Department of Economics, Middlebury College, 14 Old Chapel Road, Middlebury, VT, 05753, USA
| | - Rahul Rawat
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
45
|
Kim SS, Avula R, Ved R, Kohli N, Singh K, van den Bold M, Kadiyala S, Menon P. Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study. BMC Public Health 2017; 17:161. [PMID: 28153041 PMCID: PMC5290617 DOI: 10.1186/s12889-017-4088-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 01/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs – Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery. Methods Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers. Results Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities. Conclusions Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4088-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sunny S Kim
- International Food Policy Research Institute, 2033 K Street, Washington, D.C., 20006, NW, USA.
| | - Rasmi Avula
- International Food Policy Research Institute, NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi, 110012, India
| | - Rajani Ved
- National Health Systems Resource Center, National Institute of Health and Family Welfare campus, Baba Gangnath Marg, Munrika, New Delhi, India
| | - Neha Kohli
- International Food Policy Research Institute, NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi, 110012, India
| | - Kavita Singh
- International Food Policy Research Institute, NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi, 110012, India
| | - Mara van den Bold
- International Food Policy Research Institute, 2033 K Street, Washington, D.C., 20006, NW, USA
| | - Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, 133b LSHTM Keppel Street, WC1E 7HT, London, England
| | - Purnima Menon
- International Food Policy Research Institute, NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi, 110012, India
| |
Collapse
|
46
|
Abstract
Background Because agriculture is the livelihood base for the majority of people affected by AIDS in sub-Saharan Africa, the interactions between AIDS and agriculture, and their implications for policy and programming, are of fundamental importance. Objective This paper summarizes evidence from three RENEWAL (Regional Network on AIDS, Livelihoods, and Food Security) research studies and one policy review on the interactions between AIDS and agriculture in Zambia and their implications for future policy and programming. Methods The unit of analysis adopted for each study varies, spanning the individual, household, cluster, and community levels, drawing attention to the wider socioeconomic landscape within which households operate. Results This paper identifies the ways in which livelihood activities, within the prevailing norms of gender, sexuality, and perceptions of risk in rural Zambia, can influence susceptibility to HIV, and how the nature and severity of the subsequent impacts of AIDS are modified by the specific characteristics and initial conditions of households, clusters, and communities. Conclusions The findings demonstrate the importance of studying the risks, vulnerabilities, and impacts of the AIDS epidemic in the context of multiple resource flows and relationships between and within households—and in the context of other drivers of vulnerability, some of which interact with HIV and AIDS. The paper addresses several factors that enable or hinder access to formal support programs, and concludes by highlighting the particular importance of engaging communities proactively in the response to HIV and AIDS, to ensure relevance, sustainability, and scale.
Collapse
Affiliation(s)
- Elizabeth Byron
- Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kadiyala S, Morgan EH, Cyriac S, Margolies A, Roopnaraine T. Adapting Agriculture Platforms for Nutrition: A Case Study of a Participatory, Video-Based Agricultural Extension Platform in India. PLoS One 2016; 11:e0164002. [PMID: 27736897 PMCID: PMC5063370 DOI: 10.1371/journal.pone.0164002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 08/01/2016] [Indexed: 12/11/2022] Open
Abstract
Successful integration of nutrition interventions into large-scale development programmes from nutrition-relevant sectors, such as agriculture, can address critical underlying determinants of undernutrition and enhance the coverage and effectiveness of on-going nutrition-specific activities. However, evidence on how this can be done is limited. This study examines the feasibility of delivering maternal, infant, and young child nutrition behaviour change communication through an innovative agricultural extension programme serving nutritionally vulnerable groups in rural India. The existing agriculture programme involves participatory production of low-cost videos promoting best practices and broad dissemination through village-level women’s self-help groups. For the nutrition intervention, 10 videos promoting specific maternal, infant, and young child nutrition practices were produced and disseminated in 30 villages. A range of methods was used to collect data, including in-depth interviews with project staff, frontline health workers, and self-help group members and their families; structured observations of mediated video dissemination sessions; nutrition knowledge tests with project staff and self-help group members; and a social network questionnaire to assess diffusion of promoted nutrition messages. We found the nutrition intervention to be well-received by rural communities and viewed as complementary to existing frontline health services. However, compared to agriculture, nutrition content required more time, creativity, and technical support to develop and deliver. Experimentation with promoted nutrition behaviours was high, but sharing of information from the videos with non-viewers was limited. Key lessons learned include the benefits of and need for collaboration with existing health services; continued technical support for implementing partners; engagement with local cultural norms and beliefs; empowerment of women’s group members to champion nutrition; and enhancement of message diffusion mechanisms to reach pregnant women and mothers of young children at scale. Understanding the experience of developing and delivering this intervention will benefit the design of new nutrition interventions which seek to leverage agriculture platforms.
Collapse
Affiliation(s)
- Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, United Kingdom
- * E-mail:
| | - Emily H. Morgan
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, United Kingdom
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Shruthi Cyriac
- St. Johns Research Institute, Bengaluru, Karnataka, India
| | - Amy Margolies
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | |
Collapse
|
48
|
Walls HL, Kadiyala S, Smith RD. Research and policy for addressing malnutrition in all its forms. Obesity (Silver Spring) 2016; 24:2032. [PMID: 27589239 DOI: 10.1002/oby.21636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/26/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Helen L Walls
- London School of Hygiene and Tropical Medicine, Leverhulme Centre for Integrative Research on Agriculture and Health, UK.
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Leverhulme Centre for Integrative Research on Agriculture and Health, UK
| | - Richard D Smith
- London School of Hygiene and Tropical Medicine, Leverhulme Centre for Integrative Research on Agriculture and Health, UK
| |
Collapse
|
49
|
Thow AM, Kadiyala S, Khandelwal S, Menon P, Downs S, Reddy KS. Toward Food Policy for the Dual Burden of Malnutrition: An Exploratory Policy Space Analysis in India. Food Nutr Bull 2016; 37:261-274. [PMID: 27312356 DOI: 10.1177/0379572116653863] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is global consensus that a strong policy response is essential for addressing the dual burden of malnutrition. However, policy makers in low- and middle-income countries may perceive a conflict between food supply policies to combat persistent undernutrition and more recent recommendations for policies addressing rising rates of diet-related noncommunicable diseases (NCDs). OBJECTIVE This article explores the potential to use policy space analysis to identify food supply policy opportunities for addressing both undernutrition and diet-related NCDs and to support improved policy coherence. METHODS We conducted an exploratory policy space analysis to identify opportunities and constraints for integrated nutrition policy with respect to the food supply in India, where a dual burden of malnutrition has been well documented. We conducted a review of food supply policies and 27 key informant interviews (16 with stakeholders active in India's national nutrition policy space, and 11 with policy makers and experts in food supply policy). RESULTS The analysis suggests several opportunities for an integrated food supply policy agenda, including targeting common foods of concern (such as highly processed foods) and foods that present common benefits (such as fruits and vegetables), and scaling up existing small-scale policy initiatives that support the availability of nutrient-rich foods. Challenges include policy inertia and competing priorities within the economic sector. CONCLUSION This scoping study indicates that the policy space analysis framework used here can help to identify specific, contextually appropriate policy options and strategies for strengthening public health nutrition policy within sectors responsible for food supply policy.
Collapse
Affiliation(s)
- Anne Marie Thow
- 1 Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Suneetha Kadiyala
- 2 Leverhulme Centre for Integrated Research on Agriculture and Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Purnima Menon
- 4 International Food Policy Research Institute, New Delhi, New Delhi, India
| | - Shauna Downs
- 5 Earth Institute, Columbia University, New York, NY, USA
| | - K Srinath Reddy
- 3 Public Health Foundation of India, New Delhi, New Delhi, India
| |
Collapse
|
50
|
McCoy SI, Njau PF, Czaicki NL, Kadiyala S, Jewell NP, Dow WH, Padian NS. Rationale and design of a randomized study of short-term food and cash assistance to improve adherence to antiretroviral therapy among food insecure HIV-infected adults in Tanzania. BMC Infect Dis 2015; 15:490. [PMID: 26520572 PMCID: PMC4628274 DOI: 10.1186/s12879-015-1186-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023] Open
Abstract
Background Food insecurity is an important barrier to retention in care and adherence to antiretroviral therapy (ART) among people living with HIV infection (PLHIV). However, there is a lack of rigorous evidence about how to improve food security and HIV-related clinical outcomes. To address this gap, this randomized trial will evaluate three delivery models for short-term food and nutrition support for food insecure PLHIV in Shinyanga, Tanzania: nutrition assessment and counseling (NAC) alone, NAC plus food assistance, and NAC plus cash transfers. Methods/Design At three HIV care and treatment sites, 788 participants will be randomized into one of three study arms in a 3:3:1 ratio, stratified by site: NAC plus food assistance, NAC plus cash transfer, and NAC only. Eligible participants are: 1) at least 18 years of age; 2) living with HIV infection; 3) initiated ART in the past 90 days; and 4) food insecure, as measured with the Household Hunger Scale. PLHIV who are severely malnourished (body mass index (BMI) < 16 kg/m2) will be excluded. Participants randomized to receive food or cash transfers are eligible to receive assistance for up to six months, conditional on attending regularly scheduled visits with their HIV care provider. Participants will be followed for 12 months: the initial 6-month intervention period and then for another 6 months post-intervention. The primary outcome is ART adherence measured with the medication possession ratio. Secondary outcomes include 1) retention in care; 2) nutritional indicators including changes in food security, BMI, and weight gain; 3) viral suppression and self-reported ART adherence; and 4) participation in the labor force. Discussion This rigorously designed trial will inform policy decisions regarding supportive strategies for food insecure PLHIV in the early stages of treatment. The study will measure outcomes immediately after the period of support ends as well as 6 months later, providing information on the duration of the interventions’ effect. The comparison of food to cash transfers will better inform policies favoring cash assistance or will provide rationale for the continued investment in food and nutrition interventions for PLHIV. Trial registration ClinicalTrials.gov: NCT01957917.
Collapse
Affiliation(s)
- Sandra I McCoy
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Prosper F Njau
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
| | - Nancy L Czaicki
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Room 305, 36 Gordon Square London WC1H 0PD, London, UK.
| | - Nicholas P Jewell
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - William H Dow
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Nancy S Padian
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| |
Collapse
|