How important is improving food availability for reducing child malnutrition in developing countries?

Do increases in the food supply per person in a country, i.e., national food availability, contribute substantially to reductions in malnutrition among its children? This paper sets out to answer this controversial question using panel data from 63 developing countries over 1970–1996. This paper gives evidence in support of a statistically significant and strong positive impact of national food availability on child nutrition, finding that increased food supplies have resulted in significant reductions in malnutrition since the 1970s despite population increases over the period. However, per‐capita food supplies have a declining marginal impact: their effect is quite strong for countries with very low food availability (e.g., most countries in sub‐Saharan Africa and South Asia), but weak or non‐existent for those with high levels (e.g., most countries in the Near East and North Africa). Further, non‐food factors, such as women's education and status and the quality of health environments, are also important determinants of children's nutritional status. Depending on the state of food availability in any particular geographic area and relative costs, these factors may merit greater priority in policies to reduce malnutrition.     

Food value chain transformations in developing countries: Selected hypotheses on nutritional implications

We examine how the transformation of food value chains (FVCs) influence the triple malnutrition burden (undernourishment, micronutrient deficiencies and over-nutrition) in developing countries. We propose a FVC typology (modern, traditional, modern-to-traditional, and traditional-to-modern) that takes into account the participants, the target market, and the products offered. Next, we propose selected hypotheses on the relationship between each FVC category and elements of the triple malnutrition burden. The primary finding is that the transformation of FVCs creates challenges and opportunities for nutrition in developing countries. For example, Modern FVCs may increase over-nutrition problems and alleviate micronutrient deficiencies for urban people with relatively high incomes. However, they have little nutritional impacts among rural residents and urban poor people, who primarily depend on traditional FVCs to access adequate quantities of calories and micronutrients. In addition, modern food manufacturers are leveraging traditional distribution networks (modern-to-traditional FVCs), substantially increasing access to low-priced processed/packaged foods in rural areas and low-income urban neighbors with mixed impacts on the triple burden of malnutrition. Further research should focus on the influence of FVC transformation on reduction of micronutrient deficiencies, on modeling demand substitution effects across food categories and the attendant policy implications for malnutrition.     

Dynamics of Child Malnutrition in Rural and Small‐Town Ethiopia

Improving the status of malnourished children, and preventing children from becoming malnourished, lies at the heart of several of the Sustainable Development Goals. While many cross‐sectional studies examine correlates of stunting, they largely cannot identify drivers of change in stunting. We use two waves of panel data from Ethiopia and incrementally larger sets of fixed effects to control for time‐variant observable characteristics and time‐invariant unobservable characteristics. After controlling for these potential confounders, our analysis reveals that many factors that are associated with stunting in the cross‐section do not impact stunting dynamics. We also estimate individual fixed‐effects regressions, separately, according to baseline stunting status. We find evidence suggesting that while improved societal conditions drive many children out of a stunted state, certain exogenous factors may lead previously healthy children to become stunted. Overall, policymakers and practitioners would be wise to consult research utilising both cross‐sectional and panel data analyses in order to more effectively target already stunted children as well as vulnerable children who may be at risk of becoming stunted.     

Social Marketing of a Fortified Staple Food at Scale: Generating Demand for Fortified Rice in Brazil

ABSTRACT

This paper describes the social marketing strategy implemented by PATH and GAIN to create a sustainable market for rice fortification in Brazil and develop a replicable model relevant to other geographies. It draws on market research on consumer attitudes and practices, as well as key demand and consumer metrics before and after execution of the social marketing campaign in Brazil. This marketing endeavor succeeded in establishing the viability of introducing fortified rice in a country through a purely market-based approach. Whereas social marketing is vital to the introduction and scale-up of fortified staple foods through commercial markets, it is not sufficient to achieve meaningful scale and sustainability. Engagement from the public and social sectors, clear governance, and other factors are critical to substantial and long-term impact. Lessons from this first attempt to introduce a fortified staple food through a market-based approach are relevant to similar initiatives elsewhere.     

Millennium Development Goal shortfalls in Zimbabwe: Analysing the impact of access to water and sanitation on early childhood morbidity

ABSTRACT

An Africana feminist framework is presented that considers the ways in which inequality resulting from a historical legacy of political conflict and other dimensions intersect to impact upon the accomplishment of Millennium Development Goals with regards to environmental sustainability and child malnutrition in Zimbabwe. Demographic and Health Surveys are analysed from 1988 to 2011 to examine whether differential access to water and sanitation is predicted by ethnic differences in Zimbabwe, and is predictive of chronic malnutrition. Safe water and sanitation are in short supply, and logistic regression analyses provide evidence that residents in Shona and Ndebele-dominated provinces generally have better access to these resources. Uneven distribution of these development resources has a deleterious impact on early childhood nutrition. This work elicits results that give rise to child health-related policy recommendations that may inform post-2015 discussions of Sustainable Development Goals, namely that within-country ethnic differences must be taken into account.     

Economic burden of hospital malnutrition and the cost–benefit of supplemental parenteral nutrition in critically ill patients in Latin America

Abstract

Aim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost–benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost–benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America.

Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost–benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN.

Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion–$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone.

Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown.

Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost–benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.     

Stunting and academic achievement among Vietnamese children: new evidence from the young lives survey

Most of the empirical literature on the relationship between the health condition and skill development of school children are based on a static relationship between health and skill development. This article contributes to the literature by examining the dynamic relationship between stunting and school achievement using data from the first three waves of the Young Lives Survey in Vietnam. Using both structural equation and hybrid estimators, empirical results show that past school performance is the most significant predictor of the academic performance. Stunting has a significant negative effect on school performance, and its effect in the long run is as twice as much its effect in the short run. The empirical evidence also shows that the age of the child, mothers’ literacy, access to electricity and household consumption significantly affect school performance.     

Food system strategies for preventing micronutrient malnutrition

Micronutrients are defined as substances in foods that are essential for human health and are required in small amounts. They include all of the known vitamins and essential trace minerals. Micronutrient malnutrition affects ⅓–½ of the global population. It causes untold human suffering and levies huge costs on society in terms of unrealized human potential and lost economic productivity. The goal of this paper is to identify deficiencies in the food system that lead to micronutrient malnutrition and explore and evaluate strategies for its prevention. We examine the impact of agricultural practices on micronutrients in the food supply, including cropping systems, soil fertility and animal agriculture. We then discuss the potential of biofortification – i.e. increasing the concentration of micronutrients in staple food crops through conventional plant breeding or genetic engineering– as a means to reduce micronutrient deficiency. In addition, we discuss the impact of food losses and food waste on micronutrients in the food supply, and we explore successful strategies to preserve micronutrients from farm to plate, including food fortification. Our review of the literature sheds light on the advantages and limitations of alternative interventions to reduce micronutrient deficiencies along the supply chain. We end with recommendations for actions that will reduce the prevalence of micronutrient malnutrition.     

Sources of food price volatility and child malnutrition in Niger and Malawi

In recent times, considerable attention has been paid to the nutritional impact of the sharp hikes in the international food prices which took place in 2007–8 and 2010–11. While understandable, this growing focus has perhaps obscured the impact of other variables affecting malnutrition in Sub-Saharan Africa, i.e. the long-term impact of agricultural policies on food supply and prices, large and persistent seasonal variations in food prices, and the impact of famines which still affect parts of the continent. This paper focuses on the relative impact of these factors on child malnutrition (measured by the number of child admissions to feeding centres) in Malawi and Niger, two countries which closely represent the situation of other small, landlocked, subsistence agricultural economies facing severe food security problems. Our analysis shows that in these countries the drivers of changes in domestic staple prices and child malnutrition are related not only – or not primarily – to variations of international food prices but also to the impact of agricultural policies on food production and prices, in a persistent food price seasonality, and in recurrent and poorly managed famines. These factors can exert a strong upward pressure on food prices and child malnutrition even during years of falling international prices.