Suitability of Alternative Protein Foods for Agroecological Approaches to Address Nutrition in Low- and Middle-Income Countries

Agroecology has been proposed as a holistic approach to transform food systems that meet global food requirements with favorable environmental and social impacts. Agroecology relies on science, practices, and social movements that emphasize ecological principles, local knowledge, culture, and traditions to increase the sustainability and equity of the food system. Agroecological practices have demonstrated positive outcomes on food security and nutrition in low- and middle-income countries (LMICs). Agroecology principles can be applied across the food system and could facilitate the integration of certain alternative protein (AP) foods to address multiple issues. In this perspective, agroecological principles were analyzed to compare the suitability of different AP sources: unprocessed/minimally processed legumes, plant-based meats, edible insects, macroalgae (seaweed), fungal biomass, and cultivated meat. Considerations were identified for the feasibility of AP adoption in LMICs within an agroecological framework to provide nutrient-rich and sustainable diets while addressing other principles such as fairness and economic diversity. From this analysis, legumes, simplified plant-based meat analogs such as texturized plant proteins with minimal additives, edible insects, and macroalgae (location dependent) would make excellent nutritional contributions alongside animal-sourced food within LMICs within an agroecological framework. In contrast, highly processed plant-based meats, fungal biomass, and cultivated meat do not align well with agroecological principles for large-scale human consumption within LMICs. Furthermore, the production facilities to make these foods require robust capital investment and there may be issues related to who owns the intellectual property of these technologies. The NOVA classification system categorizes food based on the degree of processing. Our assessment suggests that foods with lower NOVA classification of unprocessed and minimally processed best fit the agroecological principles related to nutrition, agroecosystem, and societal demands for sustainable food systems.

Women's empowerment, production choices, and crop diversity in Burkina Faso, India, Malawi, and Tanzania: a secondary analysis of cross-sectional data

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.

A Mixed Methods Exploration of the Role of Participation in a Nutrition-Sensitive Agroecology Intervention in Rural Tanzania

Background

Participation is key to the successful implementation of nutrition-related interventions, but it has been relatively overlooked.

Objective

We sought to describe participation intensity among smallholder farmers in a randomized nutrition-sensitive agroecology study in rural Tanzania. We explored the association between baseline characteristics and overall participation intensity (quantitatively at the individual level and qualitatively at the group level), the association of participation intensity with 2 process indicators, and the association between participation intensity and key study outcomes.

Methods

Data came from 7 rounds of surveys with 295 women and 267 men across 29 months and 2 rounds of semi-structured interviews with the 20 "mentor farmers" who delivered the intervention. Participation intensity was based on the number of months of attendance at village-level project meetings or household visits (range: 0-29). Multivariable models of participation were built.

Results

Women and men participated for 17.5 ± 7.2 and 13.6 ± 8.3 months, respectively. Participation intensity followed 1 latent trajectory: initially low, with a sharp increase after month 7, and plateaued after the first year. At baseline, higher participation intensity was associated with older age, higher education, level of women's empowerment, being in the middle quintile of wealth, and qualitatively, village residence. Higher participation intensity was associated with 2 process indicators - better recall of topics discussed during meetings and greater knowledge about key agroecological methods. High participation intensity was positively associated with increased use of sustainable agricultural practices among all participants, and among women, with husband's involvement in household tasks and child's dietary diversity score.

Conclusions

Participation intensity covaried with key study outcomes, suggesting the value of increased attention to implementation in nutrition-related programs for providing insights into drivers of impact. We hope that investigations of participation, including participation intensity, will become more widespread so that intervention impacts, or lack thereof, can be better understood.

Does Crop Diversity Influence Household Food Security and Women's Individual Dietary Diversity? A Cross-Sectional Study of Malawian Farmers in a Participatory Agroecology and Nutrition Project

BACKGROUND

Agroecological methods have the potential to impact nutrition and food security, however, to date there is limited research evaluating this approach.

OBJECTIVE

A 5-year participatory research project with farming households in north and central Malawi was designed to train farmers on agroecological practices, alongside raising awareness on nutrition and gender equity. This cross-sectional study aimed to explore the relationships between crop diversity, food security at the household level, and individual diversity for women, within the context of an agroecology, nutrition education, and farmer mentoring program.

METHODS

Participating farmers were trained in and experimented with different farming methods. These farmers subsequently trained other farmers on these short-term agroecological practices and provided mentorship using community-based educational methods designed to address both household food security and nutrition. In year 4 of the intervention, a cross-sectional survey assessed farm practices, food security, and individual dietary diversity of 851 participating households.

RESULTS

Households with lower crop diversity were significantly less likely to be food secure (odds ratios [OR] = 0.829, P < .001). Women in households with higher crop diversity were more likely to have higher individual dietary diversity (OR = 1.120, P < .01), eat vitamin A rich foods (OR = 1.176, P < .01), and legumes, nuts, and seeds (OR = 1.141, P < .01).

CONCLUSIONS

These findings suggest that within a participatory agroecological training combined with community-based nutrition education with a focus on social equity, crop diversity is associated with less household food insecurity and poorer diet quality for rural farming households. Crop diversity may improve dietary diversity by making nutritious foods more available.

Farm size affects the use of agroecological practices on organic farms in the United States

Organic agriculture outperforms conventional agriculture across several sustainability metrics due, in part, to more widespread use of agroecological practices. However, increased entry of large-scale farms into the organic sector has prompted concerns about 'conventionalization' through input substitution, agroecosystem simplification and other changes. We examined this shift in organic agriculture by estimating the use of agroecological practices across farm size and comparing indicators of conventionalization. Results from our national survey of 542 organic fruit and vegetable farmers show that fewer agroecological practices were used on large farms, which also exhibited the greatest degree of conventionalization. Intercropping, insectary plantings and border plantings were at least 1.4 times more likely to be used on small (0.4-39 cropland ha) compared with large (≥405 cropland ha) farms, whereas reduced tillage was less likely and riparian buffers were more likely on small compared with medium (40-404 cropland ha) farms. Because decisions about management practices can drive environmental sustainability outcomes, policy should support small and medium farms that already use agroecological practices while encouraging increased use of agroecological practices on larger farms.

Interplays between changing biophysical and social dynamics under climate change: Implications for limits to sustainable adaptation in food systems

Climate change scenarios have significant implications for the livelihoods and food security of particular groups in society and will necessitate a range of adaptation actions. While there is a significant literature on the social as well as biophysical factors and limits to adaptation, less is known about the interactions between these, and what such interactions mean for the prospects of achieving sustainable and resilient food systems. This paper is an attempt at addressing this gap by examining changing biophysical and social factors, with specific consideration of vulnerable groups, across four case studies (Ghana, Malawi, Norway and Spain). In each case, future climate change scenarios and associated biophysical limits are mapped onto four key social factors that drive vulnerability and mediate adaptation, namely, scale, history, power and politics, and social differentiation. We then consider what the interaction between biophysical limits and socio-political dynamics means for the options for and limits to future adaptation, and how climate may interact with, and reshape, socio-political elements. We find that biophysical limits and socio-political factors do not operate in isolation, but interact, with dynamic relationships determining the 'space' or set of options for sustainable adaptation. By connecting the perspectives of biophysical and social factors, the study illuminates the risks of unanticipated outcomes that result from the disregard of local contexts in the implementation of adaptation measures. We conclude that a framework focusing on the space for sustainable adaptation conditioned by biophysical and social factors, and their interactions, can help provide evidence on what does and does not constitute sustainable adaptation, and help to counter unhelpful narratives of climate change as a sole or dominant cause of challenges in food systems.

Understanding human vulnerability to climate change: A global perspective on index validation for adaptation planning

Climate change is a severe global threat. Research on climate change and vulnerability to natural hazards has made significant progress over the last decades. Most of the research has been devoted to improving the quality of climate information and hazard data, including exposure to specific phenomena, such as flooding or sea-level rise. Less attention has been given to the assessment of vulnerability and embedded social, economic and historical conditions that foster vulnerability of societies. A number of global vulnerability assessments based on indicators have been developed over the past years. Yet an essential question remains how to validate those assessments at the global scale. This paper examines different options to validate global vulnerability assessments in terms of their internal and external validity, focusing on two global vulnerability indicator systems used in the WorldRiskIndex and the INFORM index. The paper reviews these global index systems as best practices and at the same time presents new analysis and global results that show linkages between the level of vulnerability and disaster outcomes. Both the review and new analysis support each other and help to communicate the validity and the uncertainty of vulnerability assessments. Next to statistical validation methods, we discuss the importance of the appropriate link between indicators, data and the indicandum. We found that mortality per hazard event from floods, drought and storms is 15 times higher for countries ranked as highly vulnerable compared to those classified as low vulnerable. These findings highlight the different starting points of countries in their move towards climate resilient development. Priority should be given not just to those regions that are likely to face more severe climate hazards in the future but also to those confronted with high vulnerability already.

Food Sovereignty and Rights-Based Approaches Strengthen Food Security and Nutrition Across the Globe: A Systematic Review

This systematic review assembles evidence for rights-based approaches–the right to food and food sovereignty–for achieving food security and adequate nutrition (FSN). We evaluated peer-reviewed and gray literature produced between 1992 and 2018 that documents empirical relationships between the right to food or food sovereignty and FSN. We classified studies by literature type, study region, policy approach (food sovereignty or right to food) and impact (positive, negative, neutral, and reverse-positive) on FSN. To operationalize the concepts of food sovereignty and the right to food and connect them to the tangible interventions and practices observed in each reviewed study, we also classified studies according to 11 action types theorized to have an impact on FSN; these included “Addressing inequities in land access and confronting the process of land concentration” and “Promoting gender equity,” among others. We found strong evidence from across the globe indicating that food sovereignty and the right to food positively influence FSN outcomes. A small number of documented cases suggest that narrow rights-based policies or interventions are insufficient to overcome larger structural barriers to realizing FSN, such as inequitable land policy or discrimination based on race, gender or class.

Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania

In Tanzania, suboptimal complementary feeding practices contribute to high stunting rates. Fathers influence complementary feeding practices, and effective strategies are needed to engage them. The objectives of this research were to examine the acceptability and feasibility of (1) tailored complementary feeding recommendations and (2) engaging fathers in complementary feeding. We conducted trials of improved practices with 50 mothers and 40 fathers with children 6-18 months. At visit 1, mothers reported current feeding practices and fathers participated in focus group discussions. At visit 2, mothers and fathers received individual, tailored counselling and chose new practices to try. After 2 weeks, at visit 3, parents were interviewed individually about their experiences. Interview transcripts were analysed thematically. The most frequent feeding issues at visit 1 were the need to thicken porridge, increase dietary diversity, replace sugary snacks and drinks and feed responsively. After counselling, most mothers agreed to try practices to improve diets and fathers agreed to provide informational and instrumental support for complementary feeding, but few agreed to try feeding the child. At follow-up, mothers reported improved child feeding and confirmed fathers' reports of increased involvement. Most fathers purchased or provided funds for recommended foods; some helped with domestic tasks or fed children. Many participants reported improved spousal communication and cooperation. Families were able to practice recommendations to feed family foods, but high food costs and seasonal unavailability were challenges. It was feasible and acceptable to engage fathers in complementary feeding, but additional strategies are needed to address economic and environmental barriers.

Assessing Transitions to Sustainable Agricultural and Food Systems: A Tool for Agroecology Performance Evaluation (TAPE)

There is increasing interest in agroecology as a way to move toward more sustainable agriculture and food systems. However, the evidence of agroecology's contribution to sustainability remains fragmented because of heterogeneous methods and data, differing scales and timeframes, and knowledge gaps. Facing these challenges, 70 representatives of agroecology-related organizations worldwide participated in the development of the Tool for Agroecology Performance Evaluation (TAPE), to produce and consolidate evidence on the multidimensional performances of agroecological systems. TAPE is composed of: Step 0, the preliminary step that includes a description of the main socio-economic and demographic characteristics of the agricultural and food systems and an analysis of the enabling environment in terms of relevant policy, market, technology, socio-cultural and/or historical drivers; Step 1, the Characterization of Agroecological Transitions (CAET), based on the 10 Elements of Agroecology adopted by FAO and its member countries, using descriptive scales to establish scores and assessing the degree of transition, with information from the farm/household and community/territory scale; Step 2, the Core Criteria of Performance listing the key dimensions considered relevant to address the Sustainable Development Goals (SDGs): Environment &amp; climate change; Health &amp; nutrition; Society &amp; culture; Economy and Governance. Finally Step 3, a participatory validation of the results obtained from the previous steps with the producers and relevant stakeholders. TAPE can be used (i) to assess the extent of agroecological transition among agricultural producers in a community or a territory, (ii) to monitor and evaluate projects by characterizing the initial and subsequent steps in an agroecological transition, and/or (iii) to evaluate widely diverse agricultural systems against agroecological elements and how they contribute to the achievement of the SDGs. Its application can support the transition of all forms of agricultural systems toward more sustainable practices and the formulation of adequate policies to enable this transformation. Preliminary results from pilot applications show that TAPE can perform in a variety of geographic regions and agroecosystems and that it allows assessment of performances of various criteria that move beyond classic indicators to begin to build a global evidence base for agroecology and support transformation to sustainable agricultural production and food systems.

Agroecology and household production diversity and dietary diversity: Evidence from a five-year agroecological intervention in rural Malawi

Following a decade of declining food insecurity, the global undernourished population has increased successively in the last three years. This increasing trend highlights the challenge of meeting the zero hunger and nutrition targets of Sustainable Development Goal (SDG) 2. Malawi is one of the most food insecure countries in Africa, with a significant proportion of its population being undernourished. Amid evidence of the counter-productive effects of input-intensive agriculture in this context, including the narrowing of the food basket and unequal access to subsidized inputs, some scholars have argued that alternative diversified agricultural approaches, combined with attention to underlying inequalities, maybe more promising in addressing undernutrition. Agroecology is one such approach which promotes biodiversity and pays attention to socio-political inequalities. That notwithstanding, there is limited research on the potential role of agroecology in improving household food outcomes. Drawing theoretical insights from political ecology and using Difference-in-Difference and mediation techniques, we examine the impact of agroecology on household production diversity and dietary diversity using data from a five-year agroecological intervention in Malawi (n = 514 agroecology-practicing farming households and 400 non-agroecology households). Findings from the Difference-in-Difference analysis show a positive treatment effect of agroecology on both production diversity (β = 0.289, p < 0.01) and dietary diversity (β = 0.390, p < 0.01). Results from the mediation analysis indicate that generally, production diversity is directly associated with dietary diversity (β = 0.18, p < 0.01), although the relationship is stronger for households practicing agroecology (β = 0.19, p < 0.01) compared to non-agroecology households (β = 0.14, p < 0.01). These findings provide evidence of the potential for agroecology to improve nutrition in smallholder farming contexts and contribute to achieving SDGs 2. Malawi is currently grappling with widespread micronutrient deficiencies. Given that smallholder farmers typically draw a significant proportion of their diet from what they produce, farming approaches like agroecology, which emphasizes the cultivation of diverse crops, may be promising for improving household nutrition.

First Nations Food Environments: Exploring the Role of Place, Income, and Social Connection

BACKGROUND

In Canada, few studies have examined how place shapes Indigenous food environments, particularly among Indigenous people living in southern regions of Ontario.

OBJECTIVE

This paper examines and compares circumstances of food insecurity that impact food access and dietary quality between reserve-based and urban-based Indigenous peoples in southwestern Ontario.

METHODS

This study used a community-based survey containing a culturally adapted food-frequency questionnaire and cross-sectional study design to measure food insecurity, food access, and dietary quality among Indigenous respondents living in urban (n = 130) and reserve-based (n = 99) contexts in southwestern Ontario.

RESULTS

Rates of food insecurity are high in both geographies (55% and 35% among urban- and reserve-based respondents, respectively). Urban-based participants were 6 times more likely than those living on-reserve to report 3 different measures of food insecurity. Urban respondents reported income to be a significant barrier to food access, while for reserve-based respondents, time was the most pressing barrier. Compared with recommendations from Canada's Food Guide, our data revealed overwhelming trends of insufficient consumption in 3 food categories among all respondents. Close to half (54% and 52%) of the urban- and reserve-based samples reported that they eat traditional foods at least once a week, and respondents from both groups (76% of urban- and 52% of reserve-based respondents) expressed interest in consuming traditional foods more often.

CONCLUSIONS

Indigenous Food Sovereignty and community-led research are key pathways to acknowledge and remedy Indigenous food insecurity. Policies, social movements, and research agendas that aim to improve Indigenous food security must be governed and defined by Indigenous people themselves. Indigenous food environments constitute political, social, and cultural dimensions that are infinitely place based.

Role of Women's Empowerment in Child Nutrition Outcomes: A Systematic Review

Women's empowerment has gained attention as critical for child nutrition during the first 1000 days of life. However, the ways in which various women's empowerment measures are applied and the evidence for how they are differentially related to child nutrition is unclear. In this systematic review, therefore, we 1) systematically parse the many ways in which women's empowerment has been quantitatively measured in the context of child nutrition through the use of a theoretically driven application of dimensions and domains of empowerment; 2) summarize evidence for each of the various pathways between women's empowerment and child nutrition, based on dimensions and domains of empowerment; and 3) offer suggestions for future research to better articulate the relationship between women's empowerment and child nutrition. A search of evidence yielded 62 quantitative studies that used 200 unique indicators of women's empowerment, tested in 1316 associations with various child nutrition outcomes. Despite the large number of unique indicators, indicators for time resource allocation and reproductive decisions and indicators for men's engagement in child care and nutrition, all pertinent to child nutrition, were missing. Overall, the findings indicated an inconclusive relationship between women's empowerment and child nutrition: 379 out of 461 (82% weighted) and 217 out of 258 (84% weighted) associations found with stunting and wasting outcomes, respectively, were not significant. The current lack of evidence is likely not due to the absence of an underlying relationship between women's empowerment and child nutrition, but rather limitations in study design. Future research should carefully select women's empowerment indicators in context-specific ways, aggregate them meaningfully, and use a longitudinal study design to conduct pathway and lifecycle analysis in appropriate populations to clarify the relationship between women's empowerment and child nutrition.

Production Diversity Is Not Associated with Women's Dietary Diversity After Controlling for Wealth and Participation in an Agriculture Intervention in Tanzania (P10-031-19)

Objectives

Farm production diversity has long thought to be a primary driver of dietary diversity. Few studies have explored the drivers of dietary diversity among women, who are often vulnerable to sub-optimal diets. We therefore investigated how production diversity affects women's dietary diversity in smallholder farming communities in rural Tanzania. Specifically, we hypothesized that women in households with greater farm production diversity would have higher dietary diversity.

Methods

Female farmers (n = 462) were surveyed on agricultural practices in 2018 and their diet in the subsequent harvest season as a part of the Singida Nutrition and Agroecology Project (SNAP-Tz). SNAP-Tz is a cluster randomized effectiveness trial of a participatory agroecology and nutrition intervention. We estimated the impact of production diversity (crop species richness, range: 1–10) on women's dietary diversity (Minimum Dietary Diversity for Women, range: 1–10) using linear regression analysis with Stata15, controlling for geographic clustering and other known covariates of women's dietary diversity.

Results

Farm production diversity was positively associated with women's dietary diversity after controlling for household size, age, and women's occupation (b = 0.15, P < 0.01). However, this association was not significant (b = 0.068, P = 0.18) after additionally controlling for household wealth and participation in the intervention.

Conclusions

Contrary to our hypothesis, women living in households with higher production diversity did not have more diverse diets when controlling for other covariates of dietary diversity, i.e., household wealth and participation in the participatory agroecology intervention. Modifiable determinants of women's dietary diversity are an important area for future exploration. Comparing and contrasting the role of production diversity here to that in other settings will be fruitful.

Funding Sources

This study is funded by the McKnight Foundation. Sera L. Young was supported by the National Institutes of Health (K01 MH098902).

A Participatory Investigation of Dietary Diversity Amplifies Knowledge Coproduction and Participant Involvement in an Agroecological Intervention in Rural Tanzania (OR25-08-19)

Objectives

Nutrition-sensitive interventions often fail because they lack contextual awareness. Participatory dissemination (PD), the formal sharing of research data with participants, can improve impact by fostering coproduction of knowledge and increasing participant involvement in the project. Here, we demonstrate how PD revealed previously unidentified challenges and solutions to dietary diversity, and strengthened a nutrition-sensitive project in Tanzania.

Methods

Singida Nutrition and Agroecology Project (SNAP-Tz) is a participatory intervention in sustainable agriculture, nutrition, and gender equity. Study staff shared simple graphs of village-level findings, including those about children's diet and nutrition status in May-Jun 2017. Farmers (n = ∼175) from the 10 intervention villages reflected on and interpreted the data in groups of 2–12 (n = 26 groups). Discussions were recorded, transcribed in Swahili, and then translated to English. Thematic analyses and deductive coding were performed using Dedoose.

Results

Three main barriers to dietary diversity surfaced: 1. resource limitation was the main barrier identified (n = 42 mentions; 16 groups). Female-only groups disclosed that 2. gender inequity limits women's control of household resources and priority to food (n = 22; 13). This exacerbates resource limitation, especially when coupled with some men's alcohol consumption. 3. Cultural beliefs discourage the consumption of eggs (n = 7; 6).

Two solutions were to: 1. encourage gender equity by including women in financial decisions and involving men in childcare (n = 6, 5 by males; 4), and 2. invest in livestock to become self-reliant for eggs, milk, and meat. Those with livestock noted the desire to use their production more for their families and not only for sale (n = 7; 5).

Conclusions

PD opened up a space for peer-mentorship as participants shared previously unconsidered solutions. Mentor farmers amplified efforts for gender equity and began addressing cultural beliefs with these interpretations. Further, findings suggested avenues for quantitative exploration with survey data. This exercise strengthened the contextual understanding and participant involvement in the project, ensuring the intervention's success.

Funding Sources

McKnight Foundation and Atkinson Center for Sustainable Futures of Cornell University funded this study.

Production Diversity, Men's Help with Household Tasks, & Lower Women's Depression Mediate Impact of an Agriculture Intervention on Child's Dietary Diversity in Tanzania (FS01-06-19)

Objectives

Production diversity and women's empowerment are two ways by which nutrition-sensitive agriculture interventions are thought to improve children's diet, but, few empirical studies have tested these pathways. We therefore investigated the impact of the Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876) on child's dietary diversity, as well as the mediating role of production diversity and women's empowerment on that relationship.

Methods

SNAP-Tz is a randomized trial of a participatory agroecology and nutrition intervention on which mentor farmers lead their fellow farmers with children < 1 y.o. at baseline (n = 587) in learning and experimentation on agroecology, nutrition, and gender equity. We estimated the intention-to-treat impact of SNAP-Tz on Child's Dietary Diversity Score (CDDS) [0–7] using difference-in-difference analysis between 2016 and 2018. Average Causal Mediation Effect (ACME5) were estimated for production diversity (Crop Nutritional Functional Richness; 0–7) and 4 measures of women's empowerment: Abbreviated Women's Empowerment in Agriculture Index (AWEAI, 0–1), women's ability to allocate income (WEAI questions; 0–1), men's help with household chores (with 7 activities; 0–7), and women's depression (Center for Epidemiologic Studies Depression Scale; 0–60). All analyses were done on Stata14 and controlled for geographic clustering and social desirability bias.

Results

SNAP-Tz significantly improved child's dietary diversity (β = 0.53, P < 0.01). Increased production diversity, greater male involvement in household chores, and lower women's depression mediated 11% (ACME: .06; 95%CI: .01-.11), 6% (ACME: .04; 95CI: .00-.08), and 7% (ACME: .03; 95%CI: .00-.07) of SNAP-Tz's impact on child's dietary diversity, respectively. Mediation of AWEAI and income allocation decision making, on the other hand, were not significant.

Conclusions

SNAP-Tz improved child's dietary diversity through increasing agricultural production diversity, men's involvement in household chores, and women's mental health. By engaging men in household tasks and prioritizing women's mental health, we can optimize the impact of nutrition-sensitive agriculture projects.

Funding Sources

SNAP-Tz is funded by the McKnight Foundation. SLY was supported by the NIH (K01MH098902).

Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers

BACKGROUND

Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival.

OBJECTIVE

We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding.

METHODS

We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically.

RESULTS

Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores.

CONCLUSION

Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.

Agroecology and healthy food systems in semi-humid tropical Africa: Participatory research with vulnerable farming households in Malawi

This paper assesses the relationship between agroecology, food security, and human health. Specifically, we ask if agroecology can lead to improved food security and human health among vulnerable smallholder farmers in semi-humid tropical Africa. The empirical evidence comes from a cross-sectional household survey (n=1000) in two districts in Malawi, a small country in semi-humid, tropical Africa. The survey consisted of 571 agroecology-adoption and 429 non-agroecology-adoption households. Ordered logistics regression and average treatment effects models were used to determine the effect of agroecology adoption on self-reported health. Our results show that agroecology-adoption households (OR=1.37, p=0.05) were more likely to report optimal health status, and the average treatment effect shows that adopters were 12% more likely to be in optimal health. Furthermore, being moderately food insecure (OR=0.59, p=0.05) and severely food insecure (OR=0.89, p=0.10) were associated with less likelihood of reporting optimal health status. The paper concludes that with the adoption of agroecology in the semi-humid tropics, it is possible for households to diversify their crops and diets, a condition that has strong implications for improved food security, good nutrition and human health.

The determinants of dietary diversity and nutrition: ethnonutrition knowledge of local people in the East Usambara Mountains, Tanzania

BACKGROUND

Diet and nutrition-related behaviours are embedded in cultural and environmental contexts: adoption of new knowledge depends on how easily it can be integrated into existing knowledge systems. As dietary diversity promotion becomes an increasingly common component of nutrition education, understanding local nutrition knowledge systems and local concepts about dietary diversity is essential to formulate efficient messages.

METHODS

This paper draws on in-depth qualitative ethnographic research conducted in small-scale agricultural communities in Tanzania. Data were collected using interviews, focus group discussions and participant observation in the East Usambara Mountains, an area that is home primarily to the Shambaa and Bondei ethnic groups, but has a long history of ethnic diversity and ethnic intermixing.

RESULTS

The data showed a high degree of consensus among participants who reported that dietary diversity is important because it maintains and enhances appetite across days, months and seasons. Local people reported that sufficient cash resources, agrobiodiversity, heterogeneity within the landscape, and livelihood diversity all supported their ability to consume a varied diet and achieve good nutritional status. Other variables affecting diet and dietary diversity included seasonality, household size, and gender.

CONCLUSIONS

The results suggest that dietary diversity was perceived as something all people, both rich and poor, could achieve. There was significant overlap between local and scientific understandings of dietary diversity, suggesting that novel information on the importance of dietary diversity promoted through education will likely be easily integrated into the existing knowledge systems.

A social-ecological perspective on harmonizing food security and biodiversity conservation

The major challenges of improving food security and biodiversity conservation are intricately linked. To date, the intersection of food security and biodiversity conservation has been viewed primarily through an agricultural "production lens"-for example, via the land sparing/sharing framework, or the concept of sustainable intensification. However, a productionist perspective has been criticized for being too narrow, and failing to consider other relevant factors, including policy, equity, and diversity. We propose an approach that conceptualizes rural landscapes as social-ecological systems embedded within intersecting multi-scalar processes. Based on such a framing, empirical research can be more clearly set in the context of system properties that may influence food security, biodiversity conservation, or both. We illustrate our approach through a description of contrasting agricultural systems within Brazil's Cerrado region. We emphasize the need for new empirical research involving systematic comparisons of social-ecological system properties in landscapes threatened by food insecurity and ecosystem degradation.

Integrated agriculture programs to address malnutrition in northern Malawi

BACKGROUND

In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi.

METHODS

A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions.

RESULTS

Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms.

CONCLUSIONS

Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women's roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

Agroecology and sustainable food systems: Participatory research to improve food security among HIV-affected households in northern Malawi

This article shares results from a long-term participatory agroecological research project in northern Malawi. Drawing upon a political ecology of health conceptual framework, the paper explores whether and how participatory agroecological farming can improve food security and nutrition among HIV-affected households. In-depth interviews were conducted with 27 farmers in HIV-affected households in the area near Ekwendeni Trading Centre in northern Malawi. The results show that participatory agroecological farming has a strong potential to meet the food, dietary, labour and income needs of HIV-affected households, whilst helping them to manage natural resources sustainably. As well, the findings reveal that place-based politics, especially gendered power imbalances, are imperative for understanding the human impacts of the HIV/AIDS epidemic. Overall, the study adds valuable insights into the literature on the human-environment dimensions of health. It demonstrates that the onset of disease can radically transform the social relations governing access to and control over resources (e.g., land, labour, and capital), and that these altered social relations in turn affect sustainable disease management. The conclusion highlights how the promotion of sustainable agroecology could help to partly address the socio-ecological challenges associated with HIV/AIDS.

Comparison of Phytochemicals and Antioxidant Capacity in Three Bean Varieties Grown in Central Malawi

The aims of the current work were: (1) to study the influence of variety and geographical production area on the total phenolic content, total anthocyanin content, total flavonoid content, total carotenoid content and antioxidant activity in bean varieties (Dimeta, Napirira and Nanyati) from different growing areas in central Malawi, and (2) to evaluate the possibility of establishing a classification based on the geographical areas of the growing regions. A total of 47 bean samples were collected from Makowe, Mphathi, Chuma-Chitsala and Khulungira Zone. These four locations were segregated based on altitude, latitude and longitude. Principal component and hierarchical cluster analysis were used to distinguish and classify among these samples. Significant differences (P < 0.05) in total phenolic content (2.92-4.97 mg/g), total anthocyanin content (14.52-152.31 μg/g), total flavonoid content (2.01-6.38 mg/g) and oxygen radical absorbance capacity (16.75-24.51 μmol/g) were found among the different sampled villages, showing a significant effect of the producing region on these parameters. The beans in Makowe had lower polyphenols than in other locations. Results of principal component analysis indicate that phytochemicals and antioxidant capacity could serve as parameters to establish a bean classification according to the geographical area of production.

Intergenerational participatory discussion groups foster knowledge exchange to improve child nutrition and food security in northern Malawi

This article assesses the effectiveness of a participatory, intergenerational, dialogue approach in addressing gender and generational conflicts related to both child nutrition and agriculture. Analysis of 46 interviews and 3 focus groups with smallholder farmers in rural agrarian communities with high rates of child malnutrition in northern Malawi suggested that participatory discussion can lead to positive change, including increasing child feeding frequency and dietary diversity. An intergenerational, transformative, and holistic approach to nutrition education which integrates agricultural and gender issues can effectively address sensitive conflicts within households and communities that affect child nutrition, and come up with local solutions.

Breastfeeding and Mixed Feeding Practices in Malawi: Timing, Reasons, Decision Makers, and Child Health Consequences

Background

In order to effectively promote exclusive breastfeeding, it is important to first understand who makes child-care and child-feeding decisions, and why those decisions are made; as in most parts of the world, exclusive breastfeeding until 6 months of age is uncommon in Malawi.

Objective

To characterize early infant foods in rural northern Malawi, who the decision-makers are, their motivation, and the consequences for child growth, in order to design a more effective program for improved child health and nutrition.

Methods

In a rural area of northern Malawi, 160 caregivers of children 6 to 48 months of age were asked to recall the child's age at introduction of 19 common early infant foods, who decided to introduce the food, and why. The heights and weights of the 160 children were measured.

Results

Sixty-five percent of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months. Mzuwula and dawale (two herbal infusions), water, and porridge were common early foods. Grandmothers introduced mzuwula to protect the children from illness; other foods were usually introduced by mothers or grandmothers in response to perceived hunger. The early introduction of porridge and dawale, but not mzuwula, was associated with worse anthropometric status. Mzuwula, which is not associated with poor growth, is usually made with boiled water and given in small amounts. Conversely, porridge, which is associated with poor child growth, is potentially contaminated and is served in larger amounts, which would displace breastmilk.

Conclusions

Promoters of exclusive breastfeeding should target their messages to appropriate decision makers and consider targeting foods that are most harmful to child growth.

Reliability of infrared tympanic thermometry in the detection of rectal fever in children

STUDY OBJECTIVE

Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard.

DESIGN

Prospective observational study.

SETTING

Urban teaching hospital ED with annual census of 60,000.

PARTICIPANTS

Consecutive children 6 months to 6 years old who had rectal temperatures measured.

INTERVENTIONS

Triage nurses recorded rectal temperatures and bilateral ITT temperatures. Temperatures were correlated by Pearson correlation coefficients and compared using paired t tests with significance set at P < .01. Children were categorized by degree of fever using rectal temperature (afebrile, less than 100.4 degrees F; low fever, 100.4 to 102.9 degrees F; and high fever, more than 102.9 degrees F), and the accuracy of ITT in detecting fever and high fever was determined.

RESULTS

Three hundred seventy patients were enrolled in the study. The mean age was 18.4 +/- 11.3 months; boys comprised 56% of patients. The mean temperatures were rectal, 101.0 +/- 2.0 degrees F; right tympanic membrane, 100.4 +/- 1.9 degrees F; and left tympanic membrane, 100.3 +/- 1.9 degrees F. The tympanic membrane temperatures were significantly lower than rectal readings (P << .001 for both right and left versus rectal). Rectal temperatures showed good correlation with both right and left tympanic membrane temperatures (r = .83 and .85, respectively). ITT was 76% sensitive and 92% specific in detecting fever of 100.4 degrees F or more (positive predictive value, 0.92; negative predictive value, 0.76). In the detection of high fever, ITT was only 57% sensitive but 98% specific (positive predictive value, 0.90; negative predictive value, 0.90). Rectal and TM temperatures differed by at least 0.5 degree F in 70% of the patients, 1.0 degree F in 41%, 2.0 degrees F in 12%, and 3.0 degrees F in 3%.

CONCLUSION

Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.

Meanings adult daughters attach to a parent's death

The purpose of this qualitative study was to explore how meanings adult daughters attached to their parent's death influenced the duration of their grief. The sample consisted of 67 adult daughters, ages 35 to 69 years, who had lost a parent 1 to 3 years earlier. Respondents were asked to explore their perceptions about their parent's death, their lifelong parent-daughter relationship, and any lifestyle changes that occurred after a parent's death. Categories were identified from the interview questions, and themes within each category were developed from the interview data. Results indicated that how respondents experienced a parent's death--including their guilt, regrets, or anticipatory grief, shifts in other family relationships, and changes in lifestyle--influenced the duration of their grief. The findings suggest that the subjective experience of grief may be an important area for further research as well as for assessment and intervention.

Infrared tympanic thermometry in the evaluation of pediatric acute otitis media

OBJECTIVE

The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM.

METHODS

520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria.

RESULTS

Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 +/- 1.8 degrees F) than the uninfected ears (U = 100.3 +/- 1.8 degrees F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I - U = 0.2 +/- 0.9 degrees F) was similar to the difference between right and left ears in those without AOM (R - L = 0.1 +/- 0.8 degrees F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I - RefT = -0.8 +/- 1.2 degrees F in AOM; ITT - RefT = -0.8 +/- 1.2 degrees F in non-AOM; p = 0.94). This study had >99% power to detect a 1.0 degrees F difference for all groups compared.

CONCLUSIONS

Infrared tympanic temperature are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.