Gina Kennedy

Agricultural research for nutrition outcomes – rethinking the agenda

Agriculture and food are assumed to be critical determinants of stunting and micronutrient deficiency. However, agriculture research for development has not translated as expected into better nutrition outcomes. We argue that to do so, agriculture research needs to be fundamentally changed, from the current emphasis on supply-side production and productivity goals to understanding consumption and addressing factors that can improve diet quality. Some of the research will be to improve the efficiency of supply for more nutritious foods. Other research will need to focus on factors that promote diet quality rather than focus on food security goals through stocks of staple cereals. Because of its importance in low-income, high-burden countries, agriculture can also contribute more effectively to multisectoral nutrition-sensitive development strategies and programs. Critical roles for agricultural research in multisectoral actions will be better metrics, indicators and research studies for diet quality and better evaluation methods – both randomized trials for specific interventions and contribution analysis through theories of change for more complex multisectoral system interventions to prevent stunting and micronutrient deficiencies. To achieve improvements in nutrition outcomes at scale, researchers must engage in new partnerships. In food systems, these partnerships must include more disciplines from agriculture and food science through economics and social science to business and delivery science. Food system researchers will also need to engage more with value chain actors and policy makers. Current efforts to improve nutrition outcomes at scale are severely hampered by data and evidence gaps that prevent better decisions and faster learning.

Expanding the view on the production and dietary diversity link: Scale, function, and change over time.

Sibhatu et al. (1) elegantly show how access to markets influences the relationship between production and consumption diversity at the household level. This confirms similar findings from other recent studies (2) but lacks discussion of three major points: (i) landscape diversity and local markets, (ii) multifunctionality of diversity, and (iii) remote settings.

Dietary species richness as a measure of food biodiversity and nutritional quality of diets

Significance Current research linking biodiversity and human diets has used metrics without justification from a nutritional point of view. Diet species richness, or a count of the number of different species consumed per day, assesses both nutritional adequacy and food biodiversity of diets for women and children in rural areas. The positive association of food species richness with dietary quality was observed in both the wet and the dry season. Food biodiversity contributes to diet quality in vulnerable populations in areas with high biodiversity. Reporting the number of species consumed during dietary assessment provides a unique opportunity to cut across two critical dimensions of sustainable development—human and environmental health—and complements existing indicators for healthy and sustainable diets. Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which <30% were consumed in more than one country. Nine species were consumed in all countries and provided, on average, 61% of total energy intake and a significant contribution of micronutrients in the wet season. Compared with Simpson’s index of diversity and functional diversity, species richness (SR) showed stronger associations and better diagnostic properties with micronutrient adequacy. For every additional species consumed, dietary nutrient adequacy increased by 0.03 (P < 0.001). Diets with higher nutrient adequacy were mostly obtained when both SR and DDS were maximal. Adding SR to the minimum cutoff for minimum diet diversity improved the ability to detect diets with higher micronutrient adequacy in women but not in children. Dietary SR is recommended as the most appropriate measure of food biodiversity in diets.

Development of a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity in Women of Reproductive Age

Abstract Background: Dietary diversity is a key element of diet quality, but diets of women of reproductive age (WRA; aged 15–49 y) in resource-poor settings are often deficient in a range of micronutrients. Previous work showed associations between simple food-group diversity indicators (FGIs) and micronutrient adequacy among WRA. For operational and advocacy purposes, however, there is strong demand for a dichotomous indicator reflecting an acceptable level of dietary diversity. Objective: The aim of the study was to develop a dichotomous indicator of dietary diversity in WRA. Methods: We performed a secondary analysis of 9 data sets containing quantitative dietary data from WRA in resource-poor settings (total n = 4166). From the raw dietary data, we calculated an individual “mean probability of adequacy” (MPA) across 11 micronutrients. Several candidate FGIs were constructed. Indicator performance in predicting an MPA >0.60 was assessed within each data set by using receiver-operating characteristic analysis and sensitivity and specificity analysis at various FGI cutoffs. The analysis was performed separately for nonpregnant and nonlactating (NPNL) women and for lactating women. Results: We identified 2 “best candidate” dichotomous indicators on the basis of 9- or 10-point food-group scores (FGI-9 and FGI-10) with a cutoff of ≥5 food groups. Both were significantly correlated to MPA in each site (P < 0.001). Areas under the curve were moderate, ranging from 0.62 to 0.82 among NPNL women and from 0.56 to 0.90 among lactating women. Comparisons of results slightly favored FGI-10 for all women. Conclusions: When resource-intensive dietary methods are not feasible, a simple dichotomous indicator based on a cutoff of ≥5 of 10 defined food groups reflects “minimum dietary diversity for women of reproductive age.” According to the conclusions of a consensus meeting of experts, this indicator is well suited for population-level assessment, advocacy, and possibly also for tracking of change in dietary diversity across time.

Integrated systems research in nutrition-sensitive landscapes: A theoretical methodological framework

South Asia and sub-Saharan Africa are two regions of the world with the highest concentration of nutritionally vulnerable populations that depend to a large extent on agriculture as an important source of livelihood (Gillespie et al., 2015). The vast majority of farmers in these regions have small landholdings due to land fragmentation (Jayne et al., 2014; Valbuena et al., 2015) and are often constrained in their access to resources and agricultural inputs (Herrero et al., 2010), especially women (e.g., Cole et al., 2015). As a consequence, productivity levels are low, and because income sources are also limited, dependence on surrounding landscapes and ecosystem services is high in terms of safeguarding supplies of clean water, human and animal foods, construction materials and fuel wood. People shape their physical landscapes (Ellis, 2015), influenced by cultures, values and livelihood opportunities (Horlings, 2015). People’s utilization of their physical landscapes is shaped by various conditions such as soil properties, topography, climate and flooding patterns. People’s dependence on their physical landscapes is strong and expected to increase due to climate change, resulting in gradual but persistent changes including adjustments in frequency, timing and severity of anomalies such as droughts and floods (Naylor et al., 2007; Gornall et al., 2010).

Complementary feeding practices of children aged 6-23 months in rural area, Southern-Benin: challenges and opportunities

Aims: This study aims to provide in-depth knowledge of current infant feeding practices in order to create an evidence base and develop well-targeted strategies to reduce the prevalence of child malnutrition. Study Design: This study is designed by using a descriptive cross-sectional survey. Place and Duration of Study: This study was carried out in two rural districts, Bopa and Original Research Article Mitchodigni et al.; IJTDH, 24(2): 1-12, 2017; Article no.IJTDH.33877 2 Houeyogbe, in Southern Benin from October to December 2013. Methodology: A total of 1225 mother-infant pairs, aged 6-23 months were randomly selected in seventeen villages through exhaustive sampling. Socio-demographic data of participants were obtained through semi-structured interviews. Complementary feeding practices were assessed using recommended Infant and Young Child Feeding (IYCF) indicators. Statistical analysis were performed with SPSS version 20. Statistical significance was set at P<0.05. Results: Overall, 20% had timely initiation of complementary feeding, whereas 61% and 17% had early and delayed initiation of complementary feeding, respectively. The mean age of introducing solid foods was 4.9 ± 2.3 months. Prevalence of MDD, MMF and MAD was 60%, 71% and 46% respectively. There is no specific complementary foods (CFs) for Benin children. Cereal porridges and extracts from family diets were two categories of complementary foods identified. Complementary food (CF) is characterized by unenriched porridges, mashed family diets and low consumption of fruits and eggs. Most of the children (70%) were fed vegetables consumed individually or mixed with other leaves. The most popular vegetables consumed by the children were Corchorus olitorius (48%), Hibiscus esculentus (22%), Solanum macrocarpon (18%). Conclusion: Untimely initiation of complementary feeding was predominant. Complementary feeding practices in this area of Benin were suboptimal. The valorization of local biodiversity and traditional recipes was an opportunity to improve quality of child’s diet. Reinforcing the capacity building of stakeholders focused on child feeding may be a crucial step for child well-being.

Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6–23 months in Southern Benin

Poor complementary feeding practices have detrimental effects on child growth, development and survival. This cross-sectional study in rural areas of southern Benin examined some determinants of complementary feeding practices using socioeconomic and dietary data collected among 1225 primary caregivers. Determinants of complementary feeding practices in the study areas are multidimensional and include many interacting factors such as socio-economic aspects, farming practices, household demographics, cultural practices and geography. Child age, diversity of food groups produced, income allocated to feeding, commune of residence, ethnicity, caregivers’ occupation, marital status and household size were identified as the main factors affecting complementary feeding practices. Food group diversification in farm-systems and overall social behavior and support as well as women’s empowerment are necessary to improve children’s diets. Reducing women’s workload through improved working conditions appears crucial to decrease time burdens and allow more time for child care. Multisectoral interventions should be embraced to improve complementary feeding practices in Benin.