Connecting the food and agriculture sector to nutrition interventions for improved health outcomes.

To achieve the Sustainable Development Goal of zero hunger, multi-sectoral strategies to improve nutrition are necessary. Building towards this goal, the food and agriculture sector must be considered when designing nutritional interventions. Nevertheless, most frameworks designed to guide nutritional interventions do not adequately capture opportunities for integrating nutrition interventions within the food and agriculture sector. This paper aims to highlight how deeply connected the food and agriculture sector is to underlying causes of malnutrition and identify opportunities to better integrate the food and agriculture sector and nutrition in low and middle income countries. In particular, this paper: (1) expands on the UNICEF conceptual framework for undernutrition to integrate the food and agriculture sector and nutrition outcomes, (2) identifies how nutritional outcomes and agriculture are linked in six important ways by defining evidence-based food and agriculture system components within these pathways: as a source of food, as a source of income, through food prices, women's empowerment, women's utilization of time, and women's health and nutritional status, and (3) shows that the food and agriculture sector facilitates interventions through production, processing and consumption, as well as through farmer practices and behavior. Current frameworks used to guide nutrition interventions are designed from a health sector paradigm, leaving agricultural aspects not sufficiently leveraged. This paper concludes by proposing intervention opportunities to rectify the missed opportunities generated by this approach. Program design should consider the ways that the food and agriculture sector is linked to other critical sectors to comprehensively address malnutrition. This framework is designed to help the user to begin to identify intervention sites that may be considered when planning and implementing multi-sectoral nutrition programs. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01262-3.

Effect of 12-month intervention with lipid-based nutrient supplements on physical activity of 18-month-old Malawian children: a randomised, controlled trial.

BACKGROUND/OBJECTIVES: This study measured the effects of dietary supplementation with lipid-based nutrient supplements (LNSs) on 18-month-old children's physical activity. SUBJECTS/METHODS: In a randomised, controlled, outcome-assessor blinded trial 1932 six-month-old children from Malawi received one of five interventions daily from 6-18 months of age: 10-g milk-LNS, 20-g milk-LNS, 20-g non-milk-LNS, 40-g milk-LNS or 40-g non-milk-LNS, or received no intervention in the same period (control). The control group received delayed intervention with corn-soy blend from 18-30 months. Physical activity was measured over 1 week by ActiGraph GT3X+ accelerometer at 18 months. Main outcome was mean vector magnitude accelerometer counts/15 s. Analyses were restricted to children with valid accelerometer data on at least 4 days with minimum 6 h of wearing time per day. RESULTS: Of the 1435 children recruited to this substudy, 1053 provided sufficient data for analysis. The mean (s.d.) vector magnitude accelerometer counts in the total sample were 307 (64). The difference (95% CI) in mean accelerometer counts, compared with the control group, was 8 (-6 to 21, P=0.258) in 10-g milk-LNS, 3 (-11 to 17, P=0.715) in 20-g milk-LNS, 5 (-8 to 19, P=0.445) in 20-g non-milk-LNS, 10 (-3 to 23, P=0.148) in 40-g milk-LNS and 2 (-12 to 16, P=0.760) in 40-g non-milk-LNS groups. CONCLUSIONS: Provision of 10-40 g doses of LNS daily for 12 months did not increase physical activity of Malawian toddlers.

Choosing between public and private health-care: a case study of malaria treatment in Brazil.

Individuals infected with malaria may be treated either in the public sector in in a private clinic. Private treatment is better, but expensive. Using micro-level data from a colonization project in Brazil, we estimate the factors that determine an individual's choice between the two sectors. Private treatment is (strongly) price sensitive and (weakly) wealth sensitive. Rural individuals are more likely to choose private treatment, but long distances to the treatment source deter private treatment. Individuals belonging to small, literate households are more likely to choose private treatment. Gender, age, and number of previous infections are unimportant. Policy implications are discussed.

Population change in the wake of agricultural improvement: lessons for Pakistan.

PIP: The research goal was to examine the extent to which modern agricultural technologies affected total fertility rates (TFR) between 1971 and 1981 at the district level in rural India. Total fertility rates were estimated and indicated declines of varying degrees for all districts. A description is provided of changes in agricultural practices and fertility between 1960-61 and 1979-80, followed by ordinary least squares analysis of fertility and technological change. A range of indirect and direct variables measured agricultural technology, agriculture, and income. Demographic variables were primary school attainment of females and rural tribal population. The results showed that agricultural yields, production technologies, and modern input between 1961 and 1980 varied across and within states. Regression results indicated that technology had a highly significant direct impact on fertility change. In a full model, higher yielding varieties technologies in 1980, the stock of gross irrigated area in 1961, and the rate of growth of irrigated areas over the entire period, did not influence changes in total fertility rates (TFRs). However, increases in "down side" variation in growth rates from the established growth trend did accelerate declines in TFRs. The growth rate in 1961 and 1960-80 did not influence changes in TFR. Slower declines in TFRs were associated with districts in which there were above average levels of farm mechanization in 1961 and 1960-80. The more successful the staple crop yield (wheat), the slower the demographic transition. Districts with large "down side" variations in growth rates of yields had significantly faster rates of change in TFR. Increases in the percentage concentration of gross cropped area in the top 3 crops led to faster declines in TFR. Districts that had increased real wages at above average rates and low "down side" variations in wage rates had faster declines in TFR. Changes in the percentage of rural labor out of total employment were significantly, negatively related to TFRs. Growth in crop derived income was positively related to declines in fertility. Demographic transitions were speeded up by above average levels of female education among 19-24 and 24-34 year olds in 1971, but increased educational levels in the 20-24 age group slowed down declines in TFR. Economic development should focus on increasing the education of rural women in order to promote faster demographic transition.^ieng

Malaria among gold miners in southern Pará, Brazil: estimates of determinants and individual costs.

As malaria grows more prevalent in the Amazon frontier despite increased expenditures by disease control authorities, national and regional tropical disease control strategies are being called into question. The current crisis involving traditional control/eradication methods has broadened the search for feasible and effective malaria control strategies--a search that necessarily includes an investigation of the roles of a series of individual and community-level socioeconomic characteristics in determining malaria prevalence rates, and the proper methods of estimating these links. In addition, social scientists and policy makers alike know very little about the economic costs associated with malarial infections. In this paper, I use survey data from several Brazilian gold mining areas to (a) test the general reliability of malaria-related questionnaire response data, and suggest categorization methods to minimize the statistical influence of exaggerated responses, (b) estimate three statistical models aimed at detecting the socioeconomic determinants of individual malaria prevalence rates, and (c) calculate estimates of the average cost of a single bout of malaria. The results support the general reliability of survey response data gathered in conjunction with malaria research. Once the effects of vector exposure were controlled for, individual socioeconomic characteristics were only weakly linked to malaria prevalence rates in these very special miners' communities. Moreover, the socioeconomic and exposure links that were significant did not depend on the measure of malaria adopted. Finally, individual costs associated with malarial infections were found to be a significant portion of miners' incomes.