BackgroundEdible residues from Hindu offerings (lungsuran) may enter mixed waste streams despite retaining nutritional value. Although food rescue research has focused on household leftovers and supply-chain loss, less is known about how culturally governed norms and changing ritual economies shape post-ritual handling of edible offerings.ObjectiveTo examine how socio-religious norms, authority structures, and changing ritual economies shape lungsuran handling in urban Bali and identify culturally legitimate pathways for nutrition-sensitive recovery.MethodsWe conducted a qualitative study in Denpasar, Indonesia, from September to November 2025 using 20 in-depth interviews with key informants, 4 focus group discussions involving 40 participants, and structured observations across 8 household and temple ritual settings. Data were transcribed, coded, and analyzed thematically.ResultsParticipants described lungsuran as edible and blessed, yet discard occurred in both household and temple settings, especially after large or frequent ceremonies. Post-ritual handling was shaped by four interrelated mechanisms: ritual-temporal suitability, authority and ownership, social permission and hierarchy, and marketization with devotional abundance. Reuse was more likely when decision rights were clear, social permission was explicit, and sorting occurred within an acceptable safety window. In pooled temple settings, ownership ambiguity, reluctance to be seen taking food, and reliance on purchased offerings increased discard. Across settings, time, labor, containers, storage, and transport affected recovery.ConclusionsLungsuran is not ordinary leftover food but a culturally governed edible flow. Nutrition-sensitive recovery is more likely when it aligns with ritual timing, clarifies authority, reduces social hesitation, and integrates food safety into community governance.
Dietary vitamin A inadequacy remains a serious public health problem, especially among young children. Food and condiment fortification programs and policies are in place in many countries to address this issue, but degradation of the vitamin A added via fortification can reduce the quantity of vitamin A reaching consumers. We modeled the impacts of vitamin A degradation on program effectiveness and cost-effectiveness in fortified wheat flour, sugar, and (hypothetical) bouillon cubes in Nigeria. We used secondary data to estimate the prevalence of vitamin A inadequacy among young children (6-59 months), and the programs' modeled contributions to reducing vitamin A inadequacy at selected levels of vitamin A degradation. The Lives Saved Tool was used to estimate child-lives saved. Program costs were estimated using activity-based models. Vitamin A degradation had a large negative impact on program effectiveness. Over the 0% to 80% vitamin A degradation range, accounting for other existing programs, fortification of sugar (7.5 mg/kg), wheat flour (2 mg/kg), and bouillon cubes (96 mg/kg) would reduce inadequacies among children by 2.9 to 0.7 percentage points, 3.9 to 0.7 percentage points, and 20.6 to 9.6 percentage points, respectively. Over the same vitamin A degradation range, average annual child-lives saved ranged from 3984 to 769 (sugar), 3036 to 739 (wheat flour), and 15 301 to 7153 (bouillon cubes); estimated cost/child-life saved ranged from US$ 550 to US$ 2848 (sugar), US$ 1039 to US$ 4271 (wheat flour), and US$ 944 to US$ 2018 (bouillon cubes). Vitamin A fortificant selection, technological innovations in vitamin A fortificants, and/or changes in premix and fortified food handling and storage could reduce degradation; these options could increase program costs, but merit consideration.
BackgroundAnimal-source foods (ASFs) are critical for addressing child undernutrition, yet consumption remains low in Ethiopia. Prevailing evidence often aggregates ASFs, potentially obscuring the unique socioeconomic and demographic determinants of specific, nutrient-rich foods like dairy, eggs, and meat.ObjectiveThis secondary analysis aimed to compare the determinants of dairy, egg, and meat/poultry consumption among children aged 6 to 23 months in Harar City, Eastern Ethiopia, using existing cross-sectional data.MethodsThis secondary analysis utilized data from an institution-based cross-sectional study conducted among 542 mother-child pairs from July to August 2024. The original data were collected electronically via structured questionnaires. For this analysis, consumption of each ASF (dairy, eggs, meat/poultry) in the preceding 24 h was the primary outcome. Separate multivariable logistic regression models identified adjusted factors associated with each food type. The very low prevalence of meat/poultry consumption (4.5%) limits statistical power for detecting associations.ResultsConsumption prevalence was 28.6% for dairy, 15.0% for eggs, and 4.5% for meat/poultry. Household wealth exhibited a strong, positive gradient for all ASFs, most pronounced for eggs (richest vs poorest: Adjusted Odds Ratio [AOR] = 3.50; 95% Confidence Interval [CI]: 1.33, 9.24). Maternal primary education was significantly associated with higher odds of dairy (AOR = 1.93; 95% CI: 1.17, 3.19) and egg consumption (AOR = 2.52; 95% CI: 1.26, 5.05) but not meat. Large family size (≥7 members) was a major constraint, reducing the odds of egg consumption by 70% (AOR = 0.30; 95% CI: 0.13, 0.74).ConclusionsThe socioeconomic and demographic determinants of ASF consumption are not uniform but are distinctly patterned by food type. Nutrition-sensitive interventions must therefore be equally specific, combining economic strategies to improve affordability with targeted education-particularly for dairy and eggs-while addressing intrahousehold food allocation in larger families.
BackgroundThe Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) is widely used to assess food insecurity (FI) in Brazil and has demonstrated strong internal and external validity. However, evidence regarding its measurement invariance across different population groups remains limited.ObjectiveThis study aimed to evaluate the invariance of the 8-item EBIA by sex, race, and education of household members, using data from the 2013 Brazilian National Household Sample Survey (n = 116 543).MethodsThe sample was split into 3 independent subsamples, and multigroup confirmatory factor analysis and the alignment method were employed to test for measurement invariance across groups. Households were classified according to the composition of residents based on each variable.ResultsFindings indicated that the EBIA exhibits configural and scalar invariance across all 3 groupings. Although the alignment method identified a few localized violations, over 80% of parameters were invariant, suggesting approximate invariance.ConclusionsWe conclude that EBIA demonstrates broad measurement invariance across sex, race, and education, supporting valid comparisons of FI scores among these subpopulations. These findings reinforce the psychometric robustness of EBIA as a tool for monitoring FI in diverse sociodemographic contexts.
BackgroundStunting is a pervasive issue in low- and middle-income countries, particularly affecting rural and Indigenous populations. Little reported data is available on the growth of clinical populations of children with stunting, including those with more severe stunting.ObjectiveThis study examines growth trajectories of children under 5 years of age from a long-standing clinical care program to address childhood stunting that provides monthly at-home growth monitoring, family food rations, nutrition counseling, micronutrient supplementation, and childhood illness management.HypothesisWe hypothesized that children with stunting are a clinically heterogeneous group, where some experience ongoing growth failure and others catch-up growth.MethodsWe utilized data from 2827 children and 38 864 height measurements. We applied superimposition by translation and rotation modeling to characterize growth patterns.ResultsMedian age at first measurement was 9 months (IQR: 3, 16) and median length of growth monitoring was 17 months (IQR: 8, 30). Median height-for-age Z-score at first measurement was -2.51 (IQR: -3.23, -1.68). There was variability in growth dynamics, with some children showing potential catch-up growth, particularly those with the lowest initial height-for-age metrics. In regression analysis, factors significantly associated with growth improvement over time included greater initial severity of stunting, male sex, and geographical region.ConclusionsThese findings underscore the heterogeneity of growth responses among stunted children and the need for individualized intervention strategies. They emphasize the necessity for ongoing investigations of both tailored clinical interventions and novel factors associated with growth variability and catch-up growth.
ObjectiveThis study aimed to characterize the factors influencing dietary diversity scores (DDS) of infants whose caregivers were classified as doers (those who fed a more diverse diet) and non-doers (those who fed a less diverse diet).MethodsThis study was conducted using a multiphase study design and guided by a biocultural framework. Phase 1. Interviews with community leaders (n = 13) and direct 6-h household observations (n = 10) were used to formatively explore factors influencing diet. Phase 2. A dietary assessment (n = 81) was used to determine dietary diversity of indexed infants. Phase 3. A biocultural survey and direct 3-h. observations were conducted among indexed infants (6-9 months) (n = 80) to understand the biocultural factors influencing infant DDS. Phase 4. Interviews (n = 34) were conducted among indexed caregivers to understand why and how biocultural factors shape infant DDS. Dietary data were analyzed, and biocultural survey variables were subjected to a forward stepwise linear regression. Textual data were analyzed to identify salient biocultural factors.ResultsFindings revealed that infants had an average DDS of 2. Having water access in the household, owning land for homestead food production, and feeding infants the same foods caregivers consume were positively associated with DDS. Conversely, adhering to food proscriptions was negatively associated with DDS. Most caregivers were food insecure and employed both food and non-food-based coping strategies to feed their infants.ConclusionDecreasing adherence to food rules, promoting homestead food production, and promoting non-food-based coping strategies may improve infant DDS in Guinea.
Background In response to high rates of undernutrition, Uganda began rolling out the multisectoral Uganda Nutrition Action Plan (UNAP) in 2011, followed by Phase II (UNAP II) in 2020. Uganda has since progressed toward several nutrition targets; however, limitations in nutrition coordination and financing call for continued strengthening of the UNAP II.Objectives Given that monitoring of the UNAP II does not consistently capture district-level outcomes and relies upon quantitative nutrition indicators, this study aims to qualitatively assess nutrition stakeholder and community perspectives at the district level.Methods From June to August in 2022, under an umbrella study utilizing community-based participatory research methods to train youth from Lira District in research, in partnership with the University of Southern California (USC) and community organization Children's Chance International-Uganda, these youth helped carry out an explanatory qualitative assessment consisting of 10 key informant interviews. Responses were compiled, transcribed, and analyzed using the Atlas TI software to code responses for thematic insights.Results Participants highlighted several challenges with the UNAP II implementation at the local level. Mechanisms intended to promote multisectoral collaboration, such as district nutrition coordination committees, have been on hiatus due to limited funding; local governments experience funding disbursement delays and a lack of nutrition prioritization; and nutrition surveillance is limited by tools, training, and human resources.Conclusions Obtaining community perspectives revealed several gaps in local UNAP II implementation and demonstrates the importance of creating mechanisms for communities to continuously provide feedback for national policies like the UNAP II.
This Nevin S. Scrimshaw Prize Lecture presented in Paris on August 28, 2025, chronicles the scientific journey from Dr. Scrimshaw's vision of “Nutrition for All” to the emerging paradigm of “Precision Nutrition for Everyone,” with a focus on Asian metabolic health. The central research question—“Why don't Western nutrition guidelines work optimally for Asian people?”—arose from clinical observations of Korean patients showing suboptimal metabolic outcomes despite adherence to conventional dietary recommendations. By 2024, nearly 1 in 3 Korean adults had metabolic disease, with particularly alarming trends among Millennials and Generation Z developing risk factors at earlier ages and lower BMIs than Western populations. Through 3 distinct research phases spanning 2017-2029, this work demonstrates that population specific precision nutrition requires integration of genomics, metabolomics, and culturally relevant dietary interventions. Phase I (2017-2020) identified obesity-inflammation biomarkers including NK cell activity and lipid mediators (lysoPE/lysoPC) in metabolically unhealthy obese individuals. Phase II (2019-2024) developed predictive models combining Genetic Risk Score and Oxidative Stress Score, achieving 75.1% accuracy for obesity prediction. Korean-specific genetic variants ( TMEM182 rs141764639, NPC1L1 rs217434, LP-PLA2 Val279Phe) were identified as strong metabolic disease predictors absent from Western genome-wide studies. Phase III (2024-2029) translated omics findings into actionable dietary recommendations, establishing a fiber threshold of ≥17.28 g/day for maintaining healthy metabolic profiles and demonstrating metabolic benefits of legume-based rice substitution through randomized controlled trials. This journey underscores that precision nutrition must democratize health equity by recognizing genetic diversity as signal rather than noise, ensuring that molecular discoveries translate into accessible public health interventions for all populations.
BackgroundChildhood anemia is a major global health issue, disproportionately affecting indigenous communities like the Orang Asli in Peninsular Malaysia. Despite its high prevalence, it remains under-researched and overshadowed by other public health priorities.ObjectivesThis study aims to quantify the burden of anemia and identify its determinants among these vulnerable children.MethodsA cross-sectional study was conducted in 4 rural districts in Peninsular Malaysia, involving 503 Orang Asli children aged ≤ 5 years. The children were purposively sampled from the mobile clinics. Anthropometry was measured and anemia was assessed using point-of-care photometry. Data on sociodemographic, childcare practices, home environment, and food insecurity were collected via structured interviews with parents or caregivers. Multivariate logistic regression was used to determine the factors associated with anemia.ResultsThe prevalence of anemia was 86.1% (95% CI: 82.8, 89.0); with 19.5% (95% CI: 16.1, 23.2) classified as mild, 52.1% (95% CI:47.6, 56.5) moderate, and 14.5% (95% CI: 11.6, 17.9) severe. Factors associated with anemia were early initiation of complimentary feeding (aOR: 2.7, 95% CI: 1.0, 7.0) and recent fever or upper respiratory infections (aOR: 2.6, 95% CI: 1.3, 5.3). Geographic variations were observed, with children from Jerantut (aOR: 0.2, 95% CI: 0.1, 0.4) and Lipis (aOR: 0.3, 95% CI: 0.1, 0.9) showing lower odds of anemia.ConclusionsAnemia prevalence among Orang Asli children is alarmingly high. Targeted interventions should improve feeding practice and enhance health management. Identifying district-specific lower risk characteristics can guide broader strategies to tackle childhood anemia among the indigenous Orang Asli children.
BackgroundObesity is a global public health crisis exacerbated by ultra-processed and nutrient-poor foods. Despite policy interventions, progress remains uneven due to socioeconomic, political, and industry barriers.ObjectiveThis review examines global food policies on obesity prevention, highlights implementation gaps, and suggests pathways for more equitable, coordinated action.MethodsA narrative review was conducted using literature from PubMed and Scopus (2017-2025), including peer-reviewed studies, policy documents, and international agency reports. Key search terms included "global food policies," "obesity prevention," "ultra-processed foods," "nutrition labeling," and "sugar taxes." Inclusion criteria encompassed studies on policy strategies for obesity prevention and healthier food environments.ResultsThe review categorized food policy interventions into key thematic areas: fiscal policies, nutrition labeling, marketing restrictions, regulation of ultra-processed foods (UPFs), out-of-home/food-service policies (eg, menu and nutrient labeling, portion-size and sodium limits, healthy defaults, procurement standards), school food policies, and international coordination. Evidence shows that front-of-package labeling and sugar-sweetened beverage levies are effective in some regions. Healthy food subsidies and purchase incentives yield mixed but promising results, especially among low-income groups. However, socioeconomic disparities, industry resistance, weak regulations, and poor multisector and public-private partnerships (PPPs) governance limit their scalability and sustainability.ConclusionsCurrent global food policy efforts are insufficient to curb the escalating obesity epidemic. Transformative, multisectoral, and equity-focused policy frameworks augmented by digital tools for monitoring, enforcement, and targeted health promotion are critical to accelerate progress and reduce inequities. Priority should be given to regulating UPFs, standardizing labels, tightening marketing controls, and integrating obesity prevention into health policies.
BackgroundIndonesia still experiences a high stunting burden. This has both short- and long-term impacts, including higher morbidity and mortality, impaired future growth, increased chronic disease risk, and reduced productivity later in life.ObjectiveThis paper aims to assess the main risk factors associated with stunting in Indonesia and to develop a predictive model to identify stunting risk in children.MethodsData from the 2018 Indonesian Basic Health Research database were analyzed for children aged under 5 years (n = 13 106) and their mothers. Bivariate analysis was used to select variables significantly associated with stunting risk. A decision tree model was then applied to predict the risk of stunting by age group, and the data were plotted into a receiver operating characteristic (ROC) curve.ResultsThe stunting rate reached 25.8%. Based on the decision tree, age, sex, birth weight, birth length, mother's highest level of education, handwashing habits, and exclusive breastfeeding were found to impact stunting risk. The prediction model demonstrated an accuracy of 73.8% for assessing the risk of stunting. The ROC curve showed an area under the curve of 63.7%, with a sensitivity of 60.1% and specificity of 59.8%.ConclusionsThis prediction model is accurate for assessing the risk of stunting. The decision tree-based prediction model performs reasonably well in differentiating between stunted and non-stunted children across different age groups, as indicated by the ROC curve.
BackgroundIn many low-income settings, pregnant and lactating women (PLW) often have poor dietary diversity, poor nutritional status, and perpetuation of a cycle of malnutrition.ObjectiveThis study aimed to assess the association of Social and Behavioral Change Communication (SBCC) combined with an egg production intervention on the feeding practices of PLW in the Bishoftu and East Shoa Zone, Ethiopia.MethodA 4-round repeated cross-sectional survey was conducted, including 459, 494, 425, and 547 PLW in the first, second, third, and fourth rounds, respectively. The Market-based Innovation for Nutrition in Ethiopia (MINE) project implemented the egg hub model to increase egg production, and a comprehensive SBCC package was used to promote egg consumption. Dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD-W) tool, with intake measured through a 24-h recall method. Dietary diversity among PLW was evaluated by comparing data from the first survey round to subsequent rounds. Multivariable logistic regression identified the independent association of the MINE intervention with MDD-W, controlling for confounders.ResultThe proportion of PLW meeting MDD-W increased from 29.9% in the first survey round to 71.3% in the second, 56.7% in the third, and 66.8% in the fourth rounds. Maternal knowledge improved from 52.7% to 78.2%, and favorable attitudes toward feeding recommendations rose from 76.3% to 87.2%.ConclusionThe findings suggest the combined intervention was associated with significant improvements in the dietary diversity, knowledge, and attitudes of PLW, suggesting that it should be scaled up across Ethiopia to evaluate its broader effectiveness.
BackgroundLow- and middle-income countries (LMICs) developing dietary guidelines often face challenges in translating nutrient requirements into practical, culturally acceptable recommendations due to limited data and technical resources. To address this gap, the Food and Agriculture Organization (FAO) developed FAO DietSolve, a user-friendly tool designed to support such efforts through a systematic and evidence-based approach.ObjectiveTo present an overview of the FAO DietSolve methodology, demonstrating its application through a hypothetical example, and highlighting its utility in supporting the development of dietary guidelines in LMICs.MethodsFAO DietSolve uses a mathematical optimization approach using Microsoft Excel's Solver add-in. It combines food groups that meet both nutritional constraints (energy and nutrient requirements) and acceptability constraints (minimum/maximum limits for each food group), while optimizing an objective function. The tool also allows for integration of additional sustainability criteria such as cost, cultural acceptability, and environmental impact into developed dietary patterns. Food groupings are based on representative foods and food consumption data. Objective functions can vary, such as minimizing deviation from observed dietary patterns.ResultsThe tool has been utilized by 8 LMICs in developing their national dietary guidelines. The optimized dietary patterns generated have supported the creation of food selection guides tailored to different population groups and informed food graphics.ConclusionsFAO DietSolve provides LMICs with a practical, data-driven method for developing comprehensive, sustainable, and culturally appropriate dietary patterns. It enables countries to address multiple dimensions of diets and food systems, in line with FAO's new food systems-based dietary guidelines methodology.
BackgroundDespite a growing interest in household-level agriculture-nutrition linkage, evidence remains thin in countries like Tajikistan, one of the poorest former socialist countries where food crop production decisions by individual farm households had been significantly regulated by the government until recently.ObjectivesWe narrow this knowledge gap by examining the linkages between households' food production practice as well as their productivity performances and dietary diversity scores (DDS) of both the household and individual women in Tajikistan.MethodsWe use a panel sample of households and individual women of reproductive ages in the Khatlon province of Tajikistan, the poorest province and a major agricultural region of the country. Difference-in-difference propensity score regressions and panel fixed-effects instrumental variable regressions are applied.ResultsHigher overall diversity in food groups (FGs) produced by households, as well as greater overall production per land and per household member at the household level, leads to higher DDS both for the household and for individual women, particularly in areas with poor food market access. FG-specific analyses suggest that for vegetables, fruits, legumes/nuts/seeds, dairy products, and eggs, significant one-on-one linkage exists between own production and consumption for these FGs.ConclusionsResults underscore the importance of supporting household-level agricultural diversification and agricultural productivity growth in Tajikistan to improve dietary diversity, especially in remote areas.
Bridging the gap between research and policy continues to be a major challenge in Ethiopia, particularly in the nutrition sector, where evidence is often fragmented, inconsistently collected, and underutilized. Traditional research-to-policy approaches are frequently misaligned with policymaking needs due to differences in timelines, priorities, and communication practices. While these challenges are not unique to Ethiopia-and indeed, numerous global efforts have attempted to address them with varying degrees of success-examples from other settings offer useful insights for strengthening the interface between evidence and action. In the Ethiopian context, the National Information Platform for Nutrition (NiPN) represents an important shift toward a more responsive, demand-driven model that seeks to improve the relevance and uptake of evidence. Unlike conventional approaches that begin with research questions and proceed directly to data collection, Ethiopia's NiPN starts with policy question formulation, aligning evidence generation with real-time decision-making priorities. This approach emphasizes embedding research in institutional processes and tailoring outputs to policy needs. The paper explores how NiPN addresses structural barriers to nutrition governance-such as limited institutional capacity, fragmented coordination, and weak knowledge translation. It engages multiple sectors in mapping evidence, analyzing data, and supporting dialogue to inform actionable recommendations. Using examples like the Seqota Declaration and the School Feeding Program, the paper demonstrates how NiPN has improved policy relevance, intervention targeting, and national ownership. The Ethiopian case offers transferable insights for other countries seeking to institutionalize evidence-informed policymaking in complex, multisectoral domains.
IntroductionUndernutrition continues to be a significant public health concern, particularly among children under 5 years.ObjectivesThis study evaluated the efficacy of an additional nutritional intervention in improving growth parameters, dietary diversity and hemoglobin levels in children aged 6 to 59 months with moderate acute malnutrition (MAM) during the 2023 economic crisis in Sri Lanka.MethodsThis was a randomized-controlled trial, and children with MAM were randomly allocated to either the intervention group, receiving additional food transfers and nutrition education, or the control group, receiving standard care. The outcomes were improvement in growth parameters, dietary diversity, and hemoglobin levels. Regression analysis was used to adjust for potential confounding variables. A total of 510 children were enrolled and followed for 6 months. The intervention group showed a significant proportion of children improving to normal weight-for-height Z-scores than the control group in addition to the improvement in dietary diversity. However, the 2 groups had no significant difference in stunting and underweight.ConclusionsThe nutritional intervention improved weight for height z-scores and dietary diversity in this cohort of children with MAM. The study highlights the importance of targeted nutrient-adequate food security interventions in undernourished children during crises to support their nutrition rehabilitation effectively.
BackgroundIran has developed a comprehensive action plan aimed at reducing premature mortality as a result of noncommunicable diseases (NCDs) by 25% by 2025.ObjectiveThis study aimed to describe and assess current policies and actions that public sectors in Iran are taking to create healthy food environments for prevention and management of obesity, NCDs, and their related inequalities.MethodsThe Healthy Food Environment Policy Index was the principal tool used, and interaction with key stakeholders was the main approach. Available evidence of policy implementation was collated for 47 good practice indicators across 13 policy and infrastructure support domains through searches on institutional websites and verified by government stakeholders. The final evidence report was rated by a national expert panel based on the level of implementation compared to international best practices.ResultsOverall, 89 relevant documents were identified, classified, and analyzed, comprising 5 constitutional laws or general policies, 20 parliamentary mandates, 5 national documents, 22 national regulations, and 37 national programs which were categorized into policy (n = 62) and infrastructure (n = 42) components. Notably, the highest level of evidence was observed in Leadership5 (14 documents), Provision1 (13 documents), and Provision2 (8 documents). No indicator was rated as "high" implementation, while nearly two-thirds of the indicators were rated as low or very low.ConclusionsDespite the Iranian government's broad landscape in supporting policies that help create healthier food environments. The findings also show the need to reform all of their policies and supportive infrastructure in order to achieve significant results.
Adequate amounts of fruit and vegetables (F&V) are an important part of a healthy diet, yet intake is suboptimal in most population groups worldwide. To better understand the evidence of strategies aiming to improve F&V intake, we conducted a scoping review of interventions assessing the impact on F&V intake, including those aiming to improve F&V intake explicitly and those targeting diet, health, lifestyle, or food environment generally. Among all eligible interventions reviewed, most of which were implemented in high-income countries, about half reported a significant positive impact on fruit and/or vegetable intake. Interventions that used a multicomponent strategy (61%) and those that focused on F&V specifically (72%) were most likely to find a significant increase in fruit and/or vegetable intake. Detailed summaries are provided in 2 accompanying articles. In the present article, we put these findings into perspective. Specifically, we considered the evidence for 4 target countries of the Fruit and Vegetables for Sustainable Healthy Diets Initiative: Benin, the Philippines, Sri Lanka, and Tanzania. When considering available evidence at the national level, there is a paucity of information from intervention trials despite evidence of inadequate F&V intakes in each of these countries. When considering available evidence at the global level, and especially for low-and-middle income countries, there is a critical need to strengthen the evidence across various intervention strategies, particularly related to targeting, timing, intensity, duration, frequency, and other key characteristics, to better understand how to enhance their impact on F&V intake in various population groups and contexts.
Background: Campaign-based vitamin A supplementation (VAS) programs are under pressure to reduce costs and increase coverage. Objectives: This study examined coverage, costs, cost-effectiveness, and cost burdens of a campaign-based VAS event (JVA+) in the Yako and Kombissiri health districts of central Burkina Faso. Methods: Data were collected from groups of JVA+ event implementers and caregivers. Post-event coverage surveys measured coverage; spatially scaled primary data provided estimates of costs. Costs of caregiver participation were measured. Data were provided by all actors involved in the design and implementation of the JVA+ event. Results: Overall, 88% of the target age group was covered. Overall coverage did not differ across health districts but was lower in urban areas. Children 6 to 11 months of age had lower coverage, especially in urban areas. The VAS event cost ∼137k USD. Average cost per child reached was 1.34 USD, ranging from 1.19 USD (Yako) to 1.62 USD (Kombissiri). National costs, with international support, covered VA capsules and community health worker salaries. Community stakeholders incurred administrative and transportation/communication costs; regional and district-level stakeholders made small contributions. Caregivers in rural areas contributed significant amounts of time (∼20% of total program costs in some areas). Conclusions: The vast majority of Burkinabe children suffer from vitamin A inadequacy. JVA+ events can be generally effective in distributing twice-annual VAS, but are expensive and heavily reliant on international assistance, and are unsustainable. Young children were consistently under-reached, especially in urban areas. Costs to caregivers were high in rural areas. Evidence-based, area-specific changes in program design could increase coverage and efficiency.
BackgroundKenya has shown progress in social, economic, and health indicators over the past two decades. Yet, malnutrition remains a critical public health issue. Effective Multisectoral Nutrition Governance (MNG) is an enabling determinant of nutrition ensures that nutrition policies are well-coordinated, adequately funded, and effectively implemented, leading to better nutrition outcomes.ObjectiveOur study assessed the status, evolution, and factors associated with MNG in Kenya using a cross-sectional design at two distinct time points (2012 and 2023). The two distinct time points provided valuable comparative perspectives allowing for the assessment of progress and trends in MNG allowing further analysis.MethodsThe study targeted 96 government and nongovernmental staff from eligible ministries at the national level. It used a structured closed-ended questionnaire adapted from a validated Nutrition Governance Index.ResultsOur findings reveal an improvement in MNG status, from 58.4% in 2012 to 71.1% in 2023 (P < .01). The six MNG domains demonstrated varying performance levels, with mean scores ranging from 3.1 to 4.0 (out of 5). Despite the performance variation, the domains contributed equally to the MNG status. A positive relationship was found between the MNG score and respondent affiliation with the Ministry of Health and the level of prioritization of nutrition in a ministry (P < .05).ConclusionsFurther efforts are needed to strengthen specific MNG domains, particularly nutrition financing, transparency, accountability, and capacity, to ensure progress in tackling malnutrition in Kenya. These findings can inform efforts to enhance MNG strategies to improve nutrition outcomes sustainably in Kenya.
