Social and economic factors influencing intrahousehold food allocation and egg consumption of children in Kaduna State, Nigeria.

Adequate intake of high-quality nutritious foods during infancy and early childhood is critical to achieving optimal growth, cognitive and behavioural development, and economic productivity later in life. Integrating high-quality and nutrient-dense animal source foods (ASFs), a major source of protein and micronutrients, into children's diets is increasingly considered essential to reducing the global burden of malnutrition in low- and middle-income countries. While eggs are an ASF that shows promise for mitigating child undernutrition, interventions promoting egg consumption among children have had mixed results in improving egg intake and child growth outcomes. As part of an evaluation of a demand creation campaign promoting egg consumption, qualitative research was carried out in September 2019 to assess sociocultural and household factors affecting egg intake among young children living in Kaduna State, Nigeria, where a thriving egg industry and childhood stunting rates of 50% exist. Methods included freelisting exercises (11), key informant interviews (11), in-depth interviews (25) and FGDs (4). Results illuminated cultural rules that restrict egg consumption among children living in low-income households. These rules and norms reflect social and economic valuations that foster male dominance in household decision-making and guide food purchasing and intrahousehold food allocation that allow men to consume eggs more regularly. Study results highlight sociocultural considerations when selecting food interventions to address child malnutrition in low-income contexts. Interventions encouraging increased consumption of ASFs, and specifically eggs in young children, should be informed by formative research to understand sociocultural norms and beliefs guiding egg consumption.

A Systematic Review Investigating the Relation Between Animal-Source Food Consumption and Stunting in Children Aged 6-60 Months in Low and Middle-Income Countries.

Animal-source foods (ASFs) are a food group of interest for interventions aimed at reducing stunting and other inadequate growth measures in early childhood. The aim of this systematic review was to examine the relation between ASF consumption and stunting in children aged 6-60 mo in low- and middle-income countries (LMICs). The secondary aim was to examine the relation between ASF consumption and other indicators of growth and development (length/height, weight, head circumference, and anemia). A search of the peer-reviewed and grey literature published from January 1980 to June 2017 was conducted. Databases searched included CINAHL, Embase, Global Index Medicus, PubMed, and Web of Science. There were 14,783 records and 116 full text articles dual screened; 21 studies were included in the review and were dual evaluated for risk of bias (RoB). The relation between ASF and stunting (length- or height-for-age z-score←2) was examined in randomized-controlled trials [(RCTs), n = 3] and cross-sectional studies (n = 4) only; ASF reduced stunting in 1 RCT and was associated with reduced stunting in 1 cross-sectional study. We did not identify any longitudinal cohorts that examined this relation. The relation between ASF and secondary indicators length/height, weight, head circumference, and anemia were largely nonsignificant across study designs. The intervention/exposure, comparator, outcome measures, methods, and analyses were highly heterogeneous. Although we did not find a consistent relation between ASF consumption and our primary and secondary outcomes, this may have been a function of inconsistencies in study design. Foods in the whole diet, particularly combination dishes, are inherently difficult to assess. To quantitatively assess the relation between ASF and stunting and other indicators of growth and iron status in early childhood, future research should provide consistency in the definition and quantification of the exposure and outcomes allowing for interstudy quantitative comparisons.

Produce Rx Programs for Diet-Based Chronic Disease Prevention.

Background: To explore the ethical and policy implications of produce prescription (Rx) programs, PubMed, Embase, and Scopus databases were searched for peer-reviewed literature on existing Rx programs in February 2018. Methods: A review of the literature identified 19 articles published on produce Rx programs; all were included in the review. Inclusion criteria were interactions between a medical professional and patient in a health care setting where a prescription for the consumption of fruits and vegetables was provided. Programs were further classified by whether patients were recruited based on eligibility criteria such as low socioeconomic status, diet-related condition, and the type of referring physician. An ethical matrix was then used to evaluate well-being, autonomy, and fairness from the perspectives of adult and child patients, patient families, participating local farmers, physicians, and government assistance programs. Results: Patients with low income were subjects of 14 articles; 13 studies identified populations with diet-related health conditions such as diabetes or hypertension. Only 9 studies examined both health conditions and low socioeconomic status. An ethical analysis indicated that despite reducing financial burdens and increasing food choice, Rx programs might have unintended psychosocial consequences on participants with low income. Health care professionals benefit from employing a partnership model of care, building trust, and emotional intelligence. Participating farmers benefit from an enlarged customer base but might experience greater financial burdens. Some produce Rx programs could use existing government assistance programs (ie, Medicaid in medically underserved areas or the Supplemental Nutrition Assistance Program, or SNAP, in food deserts), although disbursement may be cost inefficient and disorganized without policy cohesion at all levels of government. Conclusions: Future research must test a variety of produce Rx program designs to ameliorate tradeoffs between well-being, fairness, and autonomy. As pilots grow in scale, produce Rx programs must acknowledge the critical roles and perspectives of health care professionals and local participating farmers. Programs must also determine whether Rx incentives will use the existing government assistance programs to identify patients with low income, with diet-related health conditions, or with both.