Assessing nutritional status and nutrition-related knowledge,attitudes and practices of Albanian schoolchildren to support school food and nutrition policies and programmes

In Albania, many children exhibit poor nutritional status, have unhealthy diets and inadequate physical activity. Yet, comprehensive studies on the nutritional status, food and nutrition knowledge, attitudes and practices (KAP) are largely non-existent for Albanian school-age children.To fill these important gaps, a nationwide survey was conducted in Albania in 2017–2018 to assess the nutritional status and the nutrition-related KAP of Albanian school-aged children.The study consisted of a nationally representative sample of 7578 Albanian schoolchildren from all regions of the country. In addition, 6810 parent questionnaires were collected, along with interviews with the directors of all involved schools, 311 teachers and 53 key informants representing local authorities in all districts of Albania. Data collection consisted of anthropometric measurements of children and structured questionnaires administered to children, their parents, teachers, school directors, and key informants.The survey is unique in both the scope of the respondents involved, and in the breadth of content area covered, and as such, makes an important contribution not only to Albania, but also to the field of research in food, health and nutrition for school-age children.This paper presents the preliminary findings from the KAP survey that will help influence policies for actionable advancement on the commitments and priorities of Albania to improve food security and nutrition. In particular, the study findings will support the development of a national school food and nutrition programme in Albania embedded into the local food system and the design of food and nutrition educational materials and campaigns to promote healthy diets and practices among both school-age children and the Albanian population.     

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 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.     

Sustainable food systems for healthy diets in Europe and Central Asia: Introduction to the special issue

This Special Issue highlights various good practices and food policy discussion in relation to the transformation of current food systems toward their social, environmental and economical sustainability. The papers describe policies, programmes and initiatives in developing and advanced economies of Europe and Central Asia that refer to the core elements of food systems, such as food supply, food environments, and consumers. The shared opinions, analyses, studies and approaches, experiences and insights contribute to a better understanding of regional specificities and support the efforts to guide the complex food systems’ transformation for their improved capacity to deliver healthy diets.     

Aid,collective action and benefits to smallholders: Evaluating the World Food Program's purchase for progress pilot

Agricultural commodity markets in developing countries often operate in a constrained environment of prohibitive transaction costs. Consequently, smallholder farmers are only partly integrated into these markets, a situation that keeps them in a lower level of development equilibrium (poverty trap). Although cooperative institutional alternatives such as Farmers’ Organizations (FOs) may reduce transaction costs and revitalize agricultural production and commercialization, they rarely have been successful in fully delivering on these promises. Against this backdrop, the World Food Programmed (WFP) has recently implemented a multi-year and multi-country pilot to increase smallholder participation in commodity markets. The projects involved investing in physical and human capacities of Farmer Organizations (FOs) to aggregate commodities and add value, as well as locally purchasing food aid from the same. The combination of interventions was expected to increase the relative price of agricultural products, particularly staple crops. In this study, using Ethiopian panel survey data, we estimated the causal income and investment effects of the Ethiopian P4P intervention among smallholders. Using an entropy balancing (EB) model and semi-parametric difference-in-difference (DID) model, we show that the P4P intervention has increased per capita consumption by smallholders. Our additional analysis confirms that this effect is heterogeneous owing to elite capture within Farmer Organizations. We also find evidence of increased food consumption scores, increased investments in child schooling, and increased asset holding among program-participating smallholders relative to comparison farmers. Policy implications are discussed.     

Advancing the evidence base for public policies impacting on dietary behaviour,physical activity and sedentary behaviour in Europe: The Policy Evaluation Network promoting a multidisciplinary approach

Non-communicable diseases (NCDs) are the leading cause of global mortality. As the social and economic costs of NCDs have escalated, action is needed to tackle important causes of many NCD’s: low physical activity levels and unhealthy dietary behaviours. As these behaviours are driven by upstream factors, successful policy interventions are required that encourage healthy dietary behaviours, improve physical activity levels and reduce sedentary behaviours of entire populations. However, to date, no systematic research on the implementation and evaluation of policy interventions related to these health behaviours has been conducted across Europe. Consequently, no information on the merit, gaps, worth or utility of cross-European policy interventions is available, and no guidance or recommendations on how to enhance this knowledge across European countries exists. As part of the Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL), 28 research institutes from seven European countries and New Zealand have combined their expertise to form the Policy Evaluation Network (PEN). PEN’s aim is to advance tools to identify, evaluate, implement and benchmark policies designed to directly or indirectly target dietary behaviours, physical activity, and sedentary behaviour in Europe, as well as to understand how these policies increase or decrease health inequalities. Using well-defined evaluation principles and methods, PEN will examine the content, implementation and impact of policies addressing dietary behaviour, physical activity levels and sedentary behaviour across Europe. It will realise the first steps in a bespoke health policy monitoring and surveillance system for Europe, and refine our knowledge of appropriate research designs and methods for the quantification of policy impact. It will contribute to our understanding of how to achieve successful transnational policy implementation and monitoring of these policies in different cultural, demographic or socioeconomic settings. PEN will consider equity and diversity aspects to ensure that policy actions are inclusive and culturally sensitive. Finally, based on three policy cases, PEN will illustrate how best to evaluate the implementation and impact of such policies in order to yield healthy diets and activity patterns that result in healthier lives for all European citizens.