Background
In the past decade, numerous exercises have been undertaken to document knowledge of the effects of agricultural development projects on human nutrition.
Objective
The present paper ...reviews 10 papers published since 2000 to synthesize current evidence of agriculture-to-nutrition linkages.
Results
Although there are differences in focus, methods used, and standards of evidence across the set of papers considered, three common findings emerge. First, the empirical evidence for plausible and significant impacts of agricultural interventions on defined nutrition outcomes remains disappointingly scarce. Second, absence of evidence should not be equated with evidence of no impact. Weaknesses in study design and survey methods are all too common, leading to weak results and limited generalizability. Third, the broad domains of “agriculture' on the one hand, and “nutritional status' on the other, must be unpackaged in future analyses if statistically significant findings and relevant policy or program conclusions are to be drawn.
Conclusions
Expectations of the potential for nutrition impact of different kinds of investment in agriculture must be set rationally, based on well-defined mechanisms and pathways. Planned and ongoing initiatives aimed at generating such evidence must hold themselves to high standards of both research and communication of findings to appropriate policy audiences globally.
This paper explores trends in poverty and nutrition during economic transformation and especially the impacts linked to government support for agriculture during the process. Analysis of multiyear ...data for 29 developing countries confirms that structural transformation raises total income and that poverty falls faster with strong support for agriculture. In turn, poverty reduction supports improved nutrition, especially in rural areas. However, transformation brings problems through health risks associated with rising obesity in rural as well as urban areas. Thus, the transition process must be managed better, through targeted support for smallholder agriculture and health interventions, if the negative consequences of obesity and chronic disease are to be mitigated.
Summary Maternal undernutrition contributes to 800 000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie ...nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches—ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets—they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.
South Asia continues to carry the greatest share and number of wasted children worldwide. Understanding the determinants of wasting is important as policymakers renew efforts to tackle this ...persistent public health and development problem. Using data from national surveys in Bangladesh, India, the Maldives, Nepal, Pakistan and Afghanistan, this analysis explores factors associated with wasting among children aged 0 to 59 months (n = 252,797). We conducted multivariate mixed logistic regression and backwards stepwise methods to identify parsimonious models for each country separately (all p values <0.05). Younger children (0 to 5 months), and those whose mothers had a low body mass index (<18.5 kg/m2) had greater odds of being wasted in all countries. Later birth order, being male, maternal illiteracy, short maternal stature, lack of improved water source, and household poverty were also associated with wasting in various countries, but not systematically in all. Seasonality was also not consistently associated with wasting in the final models. These findings suggest that pre-conception (adolescence), pregnancy and early postpartum, represent windows of opportunity for tackling child wasting, not only stunting. Our analysis suggests that the underlying determinants of wasting and stunting in South Asia are similar, but not universal across geographies. Cost-effective interventions to prevent both stunting and wasting, and to treat severe wasting, need to be scaled up urgently. Separating these two manifestations of child undernutrition in conceptual and programmatic terms may unnecessarily impair progress to reach the Sustainable Development Goals targets aimed at addressing both child stunting and wasting.
•The importance of the fisheries sector in global food systems is often overlooked.•Nutrition-sensitive fisheries policies are needed to contribute to healthy diets.•Policy focus on aquaculture ...productivity and economic gains inhibits healthy diets.•Complementarity of capture fisheries and aquaculture improves nutrition and health.
The Sustainable Development Goals (SDGs) agenda makes achieving food security and ending malnutrition a global priority. Within this framework, the importance of fisheries in local and global food systems and its contribution to nutrition and health, particularly for the poor are overlooked and undervalued. This paper reviews current fish production and consumption from capture fisheries and aquaculture, highlights opportunities for enhancing healthy diets and outlines key multi-sectoral policy solutions. Mirroring the call for a diversification of agricultural research and investment beyond a few staple grains, it is anticipated that productivity gains for a few farmed aquatic species will not suffice. Capture fisheries and aquaculture have a complementary role to play in increasing fish availability and access, and must be promoted in ways that support measurable nutrition and health gains. This paper argues that the lack of a nutrition-sensitive policy focus on capture fisheries and aquaculture represents an untapped opportunity that must be realised for ensuring sustainable healthy diets for all.
‘Hidden hunger’ is a term used to describe human deficiencies of key vitamins and minerals, also known as micronutrients. While global in scale, the prevalence of micronutrient deficiencies is ...particularly high in South Asia despite recent successes in economic growth, agricultural output and health care. The present paper reviews the most recent evidence on patterns and trends of hidden hunger across the region, with a focus on the most significant deficiencies – iodine, Fe, vitamin A and Zn – and interprets these in terms of health and economic consequences. The challenge for South Asian policy makers is to invest in actions that can cost-effectively resolve chronic nutrient gaps facing millions of households. Appropriate solutions are available today, so governments should build on evidence-based successes that combine targeted health system delivery of quality services with carefully designed multisector actions that help promote healthier diets, reduce poverty and ensure social protection simultaneously.
Household food insecurity remains a major policy challenge in low-income countries. Identifying accurate measures that are relatively easy to collect has long been an important priority for ...governments seeking to better understand and fund solutions for communities in remote settings. Conventional approaches based on surveys can be time-consuming and costly, while data derived from satellite imagery represent proxies focused on biological processes (such as rainfall and crop growth) lack granularity in terms of human behaviors. As a result, there has recently been interest in tapping into the large digital footprint offered by mobile phone usage. This paper explores empirical relationships between data relating to mobile phones (ownership and spending on service use), and food insecurity in rural Nepal. The work explores models for estimating community-level food insecurity through aggregated mobile phone variables in a proof-of-concept approach. In addition, sensitivity analyses were performed by considering the performance of the models under different settings. The results suggest that mobile phone variables on ownership and expenditure can be used to estimate food insecurity with reasonable accuracy. This suggests that such an approach can be used in and beyond Nepal as an option for collecting timely food insecurity information, either alone or in combination with conventional approaches.
The promotion of livestock production is widely believed to support enhanced diet quality and child nutrition, but the empirical evidence for this causal linkage remains narrow and ambiguous. This ...study examines whether adoption of improved dairy cow breeds is linked to farm-level outcomes that translate into household-level benefits including improved child nutrition outcomes in Uganda. Using nationwide data from Uganda's National Panel Survey, propensity score matching is used to create an unbiased counterfactual, based on observed characteristics, to assess the net impacts of improved dairy cow adoption. All estimates were tested for robustness and sensitivity to variations in observable and unobservable confounders. Results based on the matched samples showed that households adopting improved dairy cows significantly increased milk yield-by over 200% on average. This resulted in higher milk sales and milk intakes, demonstrating the potential of this agricultural technology to both integrate households into modern value chains and increase households' access to animal source foods. Use of improved dairy cows increased household food expenditures by about 16%. Although undernutrition was widely prevalent in the study sample and in matched households, the adoption of improved dairy cows was associated with lower child stunting in adopter household. In scale terms, results also showed that holding larger farms tends to support adoption, but that this also stimulates the household's ability to achieve gains from adoption, which can translate into enhanced nutrition.
In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the ...implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low‐ and middle‐income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near‐term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid‐upper‐arm circumference combined with weight‐for‐age Z score might effectively identify children at most risk of near‐term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.
This special feature calls for forward thinking around paths of convergence for agriculture, health, and wealth. Such convergence aims for a richer integration of smallholder farmers into national ...and global agricultural and food systems, health systems, value chains, and markets. The articles identify analytical innovation, where disciplines intersect, and cross-sectoral action where single, linear, and siloed approaches have traditionally dominated. The issues addressed are framed by three main themes: (i) lessons related to agricultural and food market growth since the 1960s; (ii) experiences related to the integration of smallholder agriculture into national and global business agendas; and (iii) insights into convergence-building institutional design and policy, including a review of complexity science methods that can inform such processes. In this introductory article, we first discuss the perspectives generated for more impactful policy and action when these three themes converge. We then push thematic boundaries to elaborate a roadmap for a broader, solution-oriented, and transdisciplinary approach to science, policies, and actions. As the global urban population crosses the 50% mark, both smallholder and nonsmallholder agriculture are keys in forging rural–urban links, where both farm and nonfarm activities contribute to sustainable nutrition security. The roadmaps would harness the power of business to reduce hunger and poverty for millions of families, contribute to a better alignment between human biology and modern lifestyles, and stem the spread of noncommunicable chronic diseases.
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