Promoting child health and nutrition in India

This article discusses the reasons for poor child nutrition in India. Inadequate advice to mothers in poor rural communities about breast milk supplements could allow progressive erosion of breast feeding practices in the face of aggressive promotion from baby food manufacturers. Health workers need better information about possible supplements produced from locally available foods if nutrition education programs are to succeed. The author warns of the detrimental effect on nutritonal status of the deemphasis of school health nutrition programs in India, and points to the need for a nutrition component as an integral part of rural employment/development programs.     

Indigenous peoples’ nutrition transition in a right to food perspective

In indigenous communities the nutrition transition characterized by a rapid westernization of diet and lifestyle is associated with rising prevalence of chronic disease. Field work and literature reviews from two different policy environments, Argentina (Jujuy) and Canada (Nunavut), identified factors that add to indigenous peoples’ disease risk. The analytical framework was the emerging human right to adequate food approach to policies and programmes. Indigenous peoples’ chronic disease risk tends to increase as a result of government policies that infringe on indigenous peoples’ livelihoods and territories, undermining their economic system, values and solidarity networks. Policies intended to increase food security, including food aid, may also fuel the nutrition transition. There is a need to explore further the connection between well-intended policies towards indigenous peoples and the development of chronic diseases, and to broaden the understanding of the role that different forms of discrimination play in the westernization of their lifestyles, values and food habits. Food policies that take due account of indigenous peoples’ human rights, including their right to enjoy their culture, may counteract the growth of chronic disease in these communities.     

Impact evaluation of child nutrition programmes

A review of current practices and recent developments regarding impact evaluation of nutrition programs for preschool children in developing countries is presented. Nutrition education, food suplementation, and nutrition rehabilitation, the 3 major components of intervention in child nutrition, generally focus on food consumption and are directed at individual cases. Impact evaluations are generally confronted with situations where different programs operate in a variety of cultural settings, where the effects of the interventions are small, and where methodological difficulties usually weaken the evaluations. Definitions of impact evaluation generally include reference to the measurement of program effects by "objective" and "systematic" means. The 1st refers to the use of reliable measuring instruments with standard routines; the 2nd to the comparison of different groups of recipients (and nonrecipients) in such a way that it reveals the impact of the intervention, irrespective of other factors that influence child nutrition. Impact evaluation has 2 major components the indicators selected to reflect program impact, and the design used for the comparison of different groups of recipients. Both the interventions and evaluations have to operate under restricting conditions, and different strategies to accomodate this situation are mentioned. It is argued that the contribution of evaluation is not so much in the nature of being a final arbiter, but rather in the nature of helping to seek the optimal combination of local conditions and type of assistance offered.     

Addressing food and nutrition security from a human rights-based perspective: A mixed-methods study of NGOs in post-Soviet Armenia and Georgia

Increasing numbers of non-governmental organizations (NGOs) declare a move from a needs- to a human rights-based approach (HRBA) in addressing food and nutrition security. Little work, however, has been done to reveal how HRBA to food is realized at a country level. Using a mixed methods approach, we demonstrate main challenges for NGOs’ adoption of HRBA in Armenia and Georgia. A combination of NGO operational and state level factors hamper rights-based food and nutrition work of NGOs. NGOs’ willingness and capacity to engage with HRBA to food and confront the state is influenced by the history of post-Soviet transition, views on the state versus market, and isolation from transnational actors propagating the right to adequate food.     

Improving the nutritional impact of extension services in rural Africa

Experience in nutrition interventions in Africa points to several design characteristics of field programs which could improve their effectiveness. Regular government extension services have the potential to reach large numbers of people, yet staff will require additional training to respond to the changing demands of field work. A new approach to obercome 2 implementation difficulties found in previous interventions has recently been formulated. The 1st difficulty addressed is that of reaching large enough numbers of people to affect the national prevalence of nutritional and other health problems. The 2nd is to present information that is directly relevant to the situation of people in different localities. The new approach to training rural extension workers has been developed by the Food and Agriculture Organization (FAO). The approach provides staff with information and managerial skills that are common to all extension work. The practical examples used to introduce these techniques illustrate nutritional problems that fieldworkers face and give a measure of confidence in finding solutions. The problems discussed include the adequacy of the techical information given during basic training; the need to understand the administrative aspects of a program or service, and the need to develop effective communication skills. It is intended that the fieldworker will be able to assess the situation in a locality and decide on appropriate action related to the nutritional problems identified. Subsequent action will always conform to the ministry's technical madate. The process of developing an understanding of the nutritional realities of a locality introduces a number of managerial techniques. These techniques for efficient management of field programs are explained and demonstrated during training, using examples that are nutritionally appropriate. In showing the step-by-step application of these techniques to nutritional activities, fieldworkers become familiar with nutritional terms. They also become confident in dealing with the nutritional implications of their work.     

Towards a food and nutrition policy in Tanzania

Fragments of a nutrition policy are seen throughout the different phases of Tanzania's modern history. Efforts of the pre-Independence period culminated in formation of a committee on nutrition which advocated improving food storage, food legislation and standardization, and nutrition education. After independence, an initial period of concentration on cash crops was followed by increased cooperation with the Ministry of Agriculture, and some nutritional surveys were undertaken. After the Arusha Declaration in 1967 a basic needs strategy giving greater stress to food production and adequate nutrition received emphasis, and a Food and Nutrition Centre was established with 4 departments: food science and technology; manpower development; medical nutrition; and planning and coordination. Emphasis on production is reflected in a target of reducing malnutrition by 30 to 50% in every region by 1981, and an interdisciplinary approach is being used to achieve this goal. The basic similarity in proposed activities during the various phases of Tanzania's history indicates that political will is necessary for carrying out the policies.     

Conceptual problems in nutrition education in Western Nigeria

A pilot survey of the factors affecting infant feeding practices in rural Western Nigeria highlights intercultural perceptual problems. Results show widespread use of imported, high cost carbohydrate foods and great resistance to the early introduction of local health protective items. It is commonly thought that "too much food" is bad for a child. Staff responsible for health education are held in a degree of disrepute not conducive to the acceptance of their educational efforts in the community. Recommendations include control of advertising; reviewed staff orientation and training; and an intensive campaign to reestablish breast feeding as the cultural norm. No data is presented on feeding of fluids (breast milk, additional milk, boiled water and glucose in water) and nonfluids (imported carbohydrate, local carbohydrate, local protein and fruits and vegetables) based on the mother's estimate of the age of a baby shown in a photograph. Approximate market prices of imported commodities commonly used for infant feeding in the study area are also included.     

A mechanisms-based explanation of nutrition policy (dis)integration processes in Uganda

Many African governments have recently invested in strengthened nutrition policy integration to address malnutrition; as a step towards realising the targets of the Sustainable Development Goal 2. Previous studies have identified various factors that enable or constrain how nutrition integration occurs across policy sectors. However, the explanatory value of these studies has remained relatively limited, as the causal processes through which independent variables affect policy outcomes remain unelucidated. This paper addresses this gap by applying a causal mechanisms approach to investigate the processes that explain observed patterns of nutrition policy (dis)integration in different ministries in Uganda. We employed a process-tracing research design to reconstruct the context-mechanism configurations that explain the observed patterns of nutrition integration in Uganda between 2000 and 2017. Data was collected from interviews with 34 respondents, various policy and programming documents, and a focus group discussion. Our analysis reveals that increased nutrition policy integration is explained by four causal mechanisms: (1) international policy promotion; (2) issue promotion by international actors; (3) issue promotion by domestic policy entrepreneurs; and (4) instrumental policy learning. Conversely, two mechanisms led to policy disintegration: (1) leadership contestation; and (2) turf wars. All mechanisms proved activated by configurations of contextual conditions that were time- and organisation-specific. This study showed how a mechanisms approach can provide a more refined understanding of policy successes and failures in nutrition governance. Whereas integration-fostering mechanisms cannot be automated, both government and international actors working to scale up investments in nutrition need to consider and invest in the contextual conditions that allow for sustained nutrition policy integration and, ultimately, a more effective delivery of nutrition services. These include developing leadership for nutrition at different governance levels, domestic ownership and integration-fostering capacity, and supporting policy-oriented learning.     

The nutrition transition and the human right to adequate food for adolescents in the Cape Town metropolitan area: Implications for nutrition policy

Changes in diet and nutrition, along with other lifestyle changes during the last decades, have affected the nutrition-related disease profile in many developing countries. This phenomenon, or process, is known as ‘The Nutrition Transition’. Several studies on adolescents in South Africa have shown that overweight and obesity are increasing, possibly due to this process. The aim of the present study was to extend our knowledge on the nutrition transition and the factors that influence adolescents’ choice of food in South Africa, and to develop policy recommendations that could facilitate the adolescents’ right to adequate food as laid down in the South African Constitutional Bill of Rights. The data were collected through focus groups with 25 female learners (grade 10, 14–16 years) from urban public schools in Cape Town and key informant interviews with 10 school staff members. The most important nutritional concerns that emerged from the analyses, included skipping breakfast and the consumption of unhealthy tuck shop food. In terms of the human right to adequate food, these findings reflected lack of availability and access to adequate food within the household, at schools, and in the community. In addition, the study showed that there were no or few opportunities for physical activity for adolescents during and after school hours. Social factors, including social norms and a need to conform to peer group pressure, appeared to affect the behaviour of learners considerably. Traditional foods appeared to have lost their importance, while learners preferred to consume fast foods and to adopt a more westernised diet connected to affluence and social acceptance. Traditional and more “Western” body perceptions co-existed among the study participants. The nutrition transition in South Africa is of a complex nature because of large differences that exist amongst different ethnic and socioeconomic groups. Policy decisions should be based on an understanding of these diverse factors. The media and the food industry should be encouraged to work with government in influencing adolescents to make healthy food choices. Cultural perceptions which may lead to unhealthy choices and lifestyle need to be addressed while at the same time respecting people’s cultural pride and human dignity. It is recommended that human rights principles are used purposively in the future in policy formulations, interventions, evaluation and monitoring.     

Survey on attitudes to nutrition planning

The results of a worldwide survey of nutrition planning professionals' attitudes towards nutrition policy are presented. The objective of the survey was to determine what those involved in nutrition planning perceive to be the causes of hunger and malnutrition, and their views on the effectiveness of the programs implemented to overcome these problems. In mid-1979, a questionnaire was compiled comprising 48 questions related to attitudes towards nutrition policy, voluntary questions about social class, political classification and professional behavior and a question on perceived major impediments to solving malnutrition in the world. The questionnaire was sent to 728 professionals 87 countries; 250 replies from 55 countries; 250 replies from 55 countries were received. 44% of respondents resided in the US, 16% in Latin America and the Caribbean, 14% in the Far East, 12% in Africa and the Middle East and 13% in Europe, Canada and Australasia. Self-classification of political beliefs is the most clear cut correlate in predicting attitudes towards food and nutrition policy. There appear to be 2 clear schools of scientific/political behavior in the sample: one holds a more moderate, but generally liberal, set of views regarding the failure of modern technology in resolving world hunger and nutrition problems; a 2nd more liberal group believes political causes to be at the root of hunger. There is no single profession that can be typified as a breeding ground for nutrition planners. While the European trained and/or native group tends to be more to the left in their attitudes than their counterparts in the US, both groups are decidedly liberal and believe that social structural changes are needed to solve the problems of hunger and malnutrition in the world.     

Agricultural inputs and nutrition in South Asia

There are a number of potential pathways leading from agricultural input decisions to nutrition outcomes of farm households. These have special resonance in less developed areas of South Asia given widespread undernutrition problems, market failures and restricted access to land and other key assets and inputs, as well as ongoing debates around the implications that the green revolution has held for nutritional outcomes. A number of initiatives, including the Leveraging Agriculture for Nutrition in South Asia (LANSA) project have been undertaking research that addresses these linkages. The objectives of this paper are to systematically review the recent evidence on linkages between agricultural inputs and diet and nutrition outcomes of farm households in South Asia, place relevant LANSA research within the context of this review, and draw implications for policy, practice and the future research agenda. We focus on land and livestock assets and the set of productivity enhancing inputs in the form of irrigation, seed and agrochemicals. We report on a systematic review of recent evidence based on observational data on the links between these agricultural inputs and assets and diet and nutrition outcomes of farm households in India, Pakistan, Bangladesh, Afghanistan and Nepal. We find that the literature has slowly but steadily grown since previous reviews conducted in the early 2010s, but that there is still a long way to go. Review results suggest that while there is no indication that land ownership or size by themselves have clear associations with farm household dietary or nutrition outcomes, land productivity is more clearly associated with improved outcomes. Yet the literature linking specific inputs such as improved seeds or irrigation with nutrition remains very thin. The literature appears strongest for the case of links between livestock keeping and dietary and nutrition outcomes. This is particularly the case with animals reared for milk, with the evidence indicating milch animal ownership improves household milk intakes and thereby influences the growth of children. Priorities for future research include the formulation and testing of more specific hypotheses relating to input-nutrition linkages and more strenuous efforts to improve causal identification in this literature.     

Women’s agricultural work and nutrition in South Asia: From pathways to a cross-disciplinary,grounded analytical framework

In this systematic review, we aim to examine the impact of women’s work in agriculture on maternal and child nutrition in South Asia. Building on previous reviews supported under the Leveraging Agriculture for Nutrition in South Asia (LANSA) consortium, and recent published literature, we include findings from new LANSA research. While mapping literature onto the gender-nutrition pathways linking agriculture to nutrition (Kadiyala et al., 2014), we also point to conceptual and methodological directions for further exploration emerging from our work. Key amongst these are a focus on seasonality, poverty, and gender relations, moving beyond both an exclusive focus on women as a unified and homogenous group, and agriculture as an unchanging and common set of activities and production processes. Our analysis suggests the need for a more contextualised approach, and for a richer cross-disciplinary framework for effectively addressing the ways in which women’s work mediates agriculture’s role in improving child and maternal nutrition in South Asia.     

Food security and nutrition challenges in Tajikistan: Opportunities for a systems approach

Despite progress in poverty reduction achieved over the last two decades, Tajikistan’s food security situation remains challenging. Recent studies and analyses have highlighted progress as well as areas that require increased attention from the Government of the Republic of Tajikistan and international development partners. The paper argues that a systems approach that takes into consideration policy interventions by different sectors is required to more effectively improve access and affordability of healthy diets, contributing to a better food security and nutrition situation of the population.     

Rejoinder: nutrition planning is alive and well,thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political political systems could be made responsive to the problems, significant advances have been achieved. Many of the successes of nutrition planning and theimportance of multisectoral work are outlined. Malnutrition is a problem that escapes all the standard programs, and cannot be tackled through the health and agriculture sectors alone. There has been much critical thinking by many concerned people various countries. To suggest that nutrition planners moved blindly is to ignore much of the literature. A number of cautions--some of them very early--make it clear that practitioners were not oblivious to the bureaucratic constraints and political realities Professor Field now identifies. It would be cruelly wrong to suggest that no progress has been made. Nutrition planning may have borne fruit of a different sort than some of its early advocates envisioned, but there is no question that it bore fruit. The issue is whether nutrition planning has influenced the way people think about nutrition and the way they analyze problems. And about this there can be no doubt.     

National nutrition planning: lessons of experience

National nutrition planning has failed to fulfill its initial promise because of inadequate consideration of political and administrative obstacles to applying the methodology. The political and operational contexts within which multisectoral nutrition planning has occurred are reviewed in order to draw insights and lessons from the experience of the last 10 years. Considered are the political process, macro and micro planning, the multisectoral approach, integration with agricultural and health planning, nutrition interventions, community participation, cost benefit analyses, and information systems evaluation, management and organization. Emphasis on the multisectoral causation of malnutrition has contributed substantially to nutrition programming and remains indispensable for improving nutrition, but requires more thoughtful response to practical implementation problems. Integrating nutrition concerns more effectively into health and agriculture systems offers a more promising approach than efforts to attack malnutrition by encouraging multisectoral nutrition coordinating agencies and national plans.     

Faltering fisheries and ascendant aquaculture: Implications for food and nutrition security in Bangladesh

Bangladesh has made considerable progress against human development indicators in recent years, but malnutrition resulting from poor dietary diversity and low micronutrient intakes remains entrenched. Fish is central to the Bangladeshi diet and small fish species are an important micronutrient source. Although fish consumption per capita has increased in recent years as a result of rapid expansion of aquaculture, it is likely that consumption of fish from capture fisheries (including small indigenous species particularly rich in micronutrients), has declined. This paper evaluates data on fish consumption collected in Bangladesh by the International Food Policy Research Institute in 1996/7 and 2006/7 to assess changing patterns of fish consumption and their implications for food and nutrition security. This analysis indicates that growth of aquaculture has been positive, mitigating a sharp reduction in the quantity of fish consumed from capture fisheries and smoothing out seasonal variability in consumption. However, increased availability of fish from aquaculture may not have fully compensated for the loss of fish from capture fisheries in terms of dietary diversity, micronutrient intakes and food and nutrition security, particularly for the poorest consumers. A range of approaches are recommended to sustain and enhance the contributions capture fisheries and aquaculture make to food and nutrition security in Bangladesh     

Nutrition policies and programmes: a decade of redirection

This article assesses the effectiveness of nutrition programs and policies since the World Food Conference, 10 years ago. The authors perceive several distinct approaches. Just before the World Food Conference, nutrition programs had passed through an era of enchantment with technological solutions (single-cell protein, oilseed protein isolates). Supply was regarded as the problem; protein inadequacy as the crisis. None of the technological fixes had much of an impact on the malnutrition problem. This contributed to a willingness to entertain a much broader approach to nutrition. The new paradigm manifested itself 1st as a movement toward integrated nutrition planning. The national planning process was assumed to be the appropriate vehicle for applying this methodology. However, integrated nutrition planning threatened, conflicted with or at least brought pressure for change in the administrative and political reality of governmental organizations. Moreover, the nutrition community's capacity to respond to the demands flowing from the new paradigm was limited. The difficulties encountered in trying to achieve full integration led to a reexamination of working within traditional sectors but addressing the problem in several key sectors simultaneously, such as health and agriculture. The past decade also saw a move toward analyzing and improving the design and implementation of various kinds of nutrition interventions. The emphasis was on understanding and dealing with the administrative, economic and political realities of such efforts. Incorporation of consumption and nutrition considerations in the analysis and formulation of food policies in some countries is 1 of the important achievements of the past decade. This overwhelmingly economic approach focuses on pricing policies and market effects, recognizing that poverty and purchasing power are central to the malnutrition problem. Analysis of macrofood policy has filled an important void, giving a more concrete and inclusive view of food security. Nutrition progress during the next decade will require the development community to confront a changed environment and several key challenges, namely the surge of conservative politics in the early 1980s, and the severe economic problems most countries face. There is a need to be realistic about the tenacity of the problem and the multiple barriers to implementation of nutrition policies. The challenges face both national governments and development agencies. There is agreement that, during the decade since the World Food Conference, the field of nutrition has gone through a metamorphosis and that there has been progress. However, the development community still faces an unfinished nutrition agenda.     

Capacity development in food and nutrition in central and Eastern Europe: A decade of achievements

This article summarizes the activities performed by the Network for Capacity Development in Nutrition in Central and Eastern Europe and Balkan countries (NCDNCEE) in the past decade. The article gives a retrospective of the achievements and challenges in building capacity in nutrition research.Recognizing the lack of capacity and incoherent nutritional situation in CEE/BC, the United Nations University (UNU), Food & Nutrition Programme and the UN Standing Committee on Nutrition (SCN) encouraged the formation of NCDNCEE in 2005, which became CAPNUTRA in 2012.The network’s aim was to initiate and support tailor-made activities for capacity development in food & nutrition in research and training in CEE/BC. To identify the challenges and needs of nutrition research in the region, the network performed inventories on existence of food composition databases, food systems elements, dietary surveys, micronutrient recommendations, application of dietary assessment methods and grey literature. Further on, the network focused on the development of food composition databases and concomitant data management software, the Diet Assess & Plan platform for food consumption collection, dietary intake assessment and nutrition planning. These and other elements form the Balkan Food Platform, which underpins harmonized nutrition research in CEE/BC. Among key actions promoted by the platform are EFSA-supported dietary surveys conducted in four Balkan countries, on children and adults, in which food consumption data are collected and analysed in a harmonized way. Cooperation with FAO and active participation in international research projects enhanced the exchange of information and knowledge and brought international recognition to the CAPNUTRA network.     

The soft underbelly of applied knowledge: Conceptual and operational problems in nutrition planning

Nutrition planning features a ‘rational choice’ bias that often characterises applied knowledge. John O. Field questions this bias by exploring the softer side of success in nutrition planning efforts. He contrasts the scope of nutrition planning as understood by the international community of experts and by administrators in low income countries. He examines the politics of planning and programme implementation. Consideration of nutrition planning in an ideological and historical perspective reveals both the ambivalence of nutrition planners as agents of change and the tenuous, untested nature of nutrition planning as an approach to ameliorating malnutrition.     

Trade Union Influence on Human Resource Management Practices

This paper examines the influence of unions on 37 human resource management practices, ranging from hiring policies to promotion practices. The logistic regression results show that unionization is positively associated with a more formal approach to human resource management. There is, however, a shift from performance-based payment systems and performance appraisal (P.A.) functions in unionized settings. The results also indicate that union firms are more selective of new hires by adopting a formal probationary period for new employees. Last, the estimates suggest that the impact of unions on training programs varies with the nature of the programs.