Farm production diversity and women's dietary diversity: Evidence from central Tunisia.

In the context of studies on the effects of agricultural production diversity, there are debates in the scientific community as to the level of diversification appropriate for improving dietary diversity. In Tunisia, agriculture is a strategic sector for the economy and a critical pillar of its food sovereignty. Using instrumental variable methods to account for endogeneity, we have estimated the association between agricultural production diversity and women's dietary diversity among smallholder farming households in the Sidi Bouzid governorate (central Tunisia). Although we found a low level of agricultural production diversity and a fairly diversified diet among women, we observed a systematic weak positive association between five different indicators of agricultural production diversity and women's dietary diversity. We observed a stronger positive association between women's dietary diversity and women being more educated and households being wealthier. Neither diversity of food supplies in food markets nor market distance were associated with women's dietary diversity, whereas we observed a higher level of consumption of some products (dairy) when they were produced on the farm.

Identification and frequency of consumption of wild edible plants over a year in central Tunisia: a mixed-methods approach.

OBJECTIVE: To identify wild plants used as food and assess their frequency of consumption over a year in a region of Tunisia where agriculture is undergoing a major transformation from smallholder farming to an intensive high-input agricultural system. DESIGN: Qualitative ethnobotanical study followed by a survey of women's frequency of consumption of wild plants conducted using FFQ at quarterly intervals. SETTING: Sidi Bouzid governorate of central Tunisia. PARTICIPANTS: Mixed-gender group of key informants (n 14) and focus group participants (n 43). Survey sample of women aged 20-49 years, representative at governorate level (n 584). RESULTS: Ethnobotanical study: thirty folk species of wild edible plants corresponding to thirty-five taxa were identified by key informants, while twenty folk species (twenty-five taxa) were described by focus groups as commonly eaten. Population-based survey: 98 % of women had consumed a wild plant over the year, with a median frequency of 2 d/month. Wild and semi-domesticated fennel (Foeniculum vulgare Mill. and Anethum graveolens) was the most frequently consumed folk species. Women in the upper tertile of wild plant consumption frequency were more likely to be in their 30s, to live in an urban area, to have non-monetary access to foods from their extended family and to belong to wealthier households. CONCLUSIONS: In this population, wild edible plants, predominantly leafy vegetables, are appreciated but consumed infrequently. Their favourable perception, however, offers an opportunity for promoting their consumption which could play a role in providing healthy diets and mitigating the obesity epidemic that is affecting the Tunisian population.

A "Fork-to-Farm" Multi-Scale Approach to Promote Sustainable Food Systems for Nutrition and Health: A Perspective for the Mediterranean Region.

Mediterranean countries are undergoing dietary and nutritional changes that affect their inhabitants' health, while facing massive environmental challenges. The increasing demand of water in agriculture, the capacity to maintain local food production, and the growing dependence on food imports are interconnected issues that must be addressed to ensure food security and nutrition in the Mediterranean region. Here, we present the conceptual framework and methodologies developed by the MEDINA-Study Group for rethinking food systems toward sustainable consumption and production modes. Based on its multidisciplinary expertise, the MEDINA-Study Group designed a "fork-to-farm" multi-scale approach, stemming from current dietary habits and examining how some options to nutritionally improve these habits might affect the food systems. This approach was developed for research activities in the South of France and Tunisia, two areas with very different diet-agriculture-environment nexus. The conceptual framework is based on the analysis of elements of the food systems (from consumption to production) at different levels (individual, household, regional and national levels). The methods include: (i) modeling options of dietary changes at different scales, in order to nutritionally optimize food consumption-production without increasing the environmental impact, (ii) translating the best-choice changes into possible policy actions, (iii) testing the acceptability and feasibility of these actions with several stakeholders, and (iv) producing guidelines for sustainable food choices and production. The MEDINA-Study Group identified additional issues that could be included in a future framework to help designing ambitious agricultural, food and health policies in the Mediterranean region.

The adult male equivalent concept and its application to Household Consumption and Expenditures Surveys (HCES).

BACKGROUND: Knowledge of the amount and quality of food consumed by a population is essential in determining the adequacy of the food availability and supply. Since its founding the Food and Agriculture Organization (FAO) has developed methods for determining food availability and consumption that may be useful to other investigators. OBJECTIVE: Based on FAO's 60 years of experience in conducting Household Consumption and Expenditures Surveys (HCES), to explain and demonstrate the advantages and use of the Adult Male Equivalent (AME) and Equivalent Nutrition Unit (ENU) concepts. METHODS: The important factors related to the AME and ENU, such as energy requirements, size and composition of the food consumer unit, and attendance at meals, are explained through the examples of two hypothetical families: a family consisting of a father, a mother, a 12-year old daughter, and a 3-year old son plus an adult guest; and a family consisting of a single mother, a 10-year old son, and two daughters, 6 and 4 years of age. The reader is guided through the steps in calculating the AME and ENU. RESULTS: The various scenarios of the composition, size, and attendance at meals of the consumer unit show that the calculated food energy adequacy can range from +2% to -29%. CONCLUSIONS: Care and attention must be given to correctly attributing the consumers of the food intake measured or estimated. In addition, use of these concepts allows for a valid comparison of food consumption units of various sizes and compositions.

Using Household Consumption and Expenditures Survey (HCES) data to assess dietary intake in relation to the nutrition transition: a case study from Cape Verde.

BACKGROUND: Few surveys of food and nutrient intakes are conducted at the individual level in low- and middle-income countries, whereas Household Consumption and Expenditures Surveys (HCES) are regularly carried out to monitor economic conditions. Because of the paucity of individual-level data, there is interest in using HCES to aid in the design of food and nutrition policies. OBJECTIVE: Data from the 2001/02 HCES from Cape Verde were used to assess household dietary intakes in the context of the country's nutrition transition. METHODS: The survey included weighed measurements of household food intake and measurements of the weight and height of all household members. Households were classified as "underweight" if they had at least one underweight member, "overweight" if they had at least one overweight member, and "dual burden" if they had at least one underweight and one overweight member. RESULTS: The proportion of households classified as underweight, overweight, and dual burden was 18%, 41%, and 14%, respectively. Household food and nutrient intakes were higher in the overweight households (particularly protein, vitamin A, and calcium) and lower in the underweight households, while there was no clear pattern of intakes in the dual burden group. Overweight households consumed more animal food groups than other households. Intakes of fruits and vegetables were low in all groups. CONCLUSIONS: The HCES data for Cape Verde were useful for assessing the extent of the nutrition transition and characterizing dietary intakes by anthropometric classification. Analysis of nutrient and food intakes showed that ensuring sufficient energy availability is no longer the most important issue for Cape Verde, but that ensuring dietary quality is equally crucial, in particular increasing access to fruits and vegetables.

Proceedings of the workshop on food-consumption surveys in developing countries: future challenges.

The workshop "Food-consumption surveys in developing countries: Future challenges," held in Chiang Rai, Thailand, January 25--26, 2003, brought together 30 nutritionists and food safety experts from 10 Southeast Asian countries as well as from countries outside the region. It provided a forum for sharing information and experiences relating to food-consumption survey methodology. It enabled detailed discussions of the gathering of food-consumption data in developing countries for purposes of nutrition assessment, exposure assessment, and studies of diet-disease relationships. The workshop participants emphasized the need to obtain the support of policy and decision makers to establish a mechanism for conducting regular coordinated food-consumption surveys to meet these needs. The participants emphasized the importance of identifying all relevant stakeholders and involving them in the planning and conduct of these surveys. A number of technical issues related to food-con.sumption surveys were discussed, including food-intake methodologies. It was felt that surveys on individuals are preferred, and a combination of 24-hour recall and food-frequency questionnaire would most likely provide the required data. The workshop emphasized the need to develop, maintain, and update databases at the national and regional levels for nutrients and non-nutrients as well as contaminants and food additives. To ensure that surveys are conducted regularly and professionally, the importance of having qualified and trained personnel was emphasized. Several issues related to reports of food-consumption data were discussed, including timely reporting, effective dissemination, and appropriate usage. The participants unanimously recommended the organization of further technical meetings or workshops to follow up on recommended activities and enable continuing regional collaboration on food-consumption surveys.

[Breastfeeding in Africa: will positive trends be challenged by the AIDS epidemic?]. / L'allaitement maternel en Afrique: lévolution favorable sera-t-elle remise en question par l'épidémie de sida?

In Africa, more than 95% of infants are currently breastfed, but feeding practices are often inadequate: feeding water, and other liquids, to breastfed infants is a widespread practice. Consequently, the rate of exclusive breast-feeding is low, particularly in West Africa. The rate of bottle-feeding is high in some countries (exceeding 30% in Tunisia, Nigeria, Namibia and Sudan). Nevertheless prolonged breastfeeding is common, and the median duration of breastfeeding ranges between 16 and 28 months. Urbanization and mothers' education are the major factors that tend to shorten breastfeeding. Nevertheless recent trends show an increase in early initiation and in duration of breastfeeding as a result of promotion efforts deployed by WHO and Unicef, local governments, and non-governmental organizations. The importance of breastmilk as a food resource of African countries is generally not recognized. In 31 countries where data on prevalence of breastfeeding are available, consumption of breastmilk by children under three years is estimated at 3.5 million tons per year. The AIDS epidemic could threaten breastfeeding because the virus can be transmitted through breastmilk, as demonstrated by numerous studies. A study suggests that feeding breastmilk and other liquids to infants could be the feeding mode associated with the highest rate of transmission. To prevent mother-to-child transmission of HIV, WHO recommends replacement feeding if it is feasible and safe. Otherwise, mothers are encouraged to practice exclusive breastfeeding for the first months of life followed by early and rapid weaning. The feasibility of replacement feeding with breastmilk substitutes, however, is very uncertain. In a study where free substitutes were given to HIV-positive mothers, the mortality of the formula-fed infants was the same as that of the breastfed infants. HIV-positive mothers may find it difficult to cope with the constraints of replacement feeding, in terms of cost, workload and time, and with the additional health care needs of non-breastfed infants. Exclusive breastfeeding for a few months could carry a lower risk of death than replacement feeding. But success in promoting exclusive breastfeeding has been limited in Africa, and new promotion methods are needed. Infants of all mothers, whether HIV-positive or not, will benefit from improving the rate of exclusive breastfeeding. The major problem is to ensure that early and rapid weaning, between 4 and 6 months, does not have a negative impact on the child's health. Early weaning is known to increase susceptibility to infections and can cause malnutrition. The feasibility and safety of this recommendation will have to be monitored carefully. A strong determination of African governments to promote exclusive breastfeeding among all mothers and to protect prolonged breastfeeding among non-infected mothers will limit the mother-to-child transmission of HIV while preserving the benefits of breastfeeding.