6 indirect approaches to improving nutrition – part one

ID-100334531Malnutrition, in its various forms, is thought to affect over 2 billion people in the world and, as such, has far reaching consequences for societies, economies and livelihoods. Tackling poor nutrition is both complex and opportunistic in that there are links between nutrition and a whole other range of factors. In other words by tackling nutrition directly we may positively contribute to other developmental problems but there are also multiple ways to address undernutrition indirectly. While there is broad consensus on the need to take direct nutrition interventions such as promoting exclusive breastfeeding or biofortification of crops with micronutrients such as vitamin A or zinc, there is also an urgent need to tackle the underlying and inter-related determinants of malnutrition. The Lancet, for example, suggests that direct nutrition interventions, even if implemented at 90% coverage in high-burden countries would only reduce global stunting by 20%.

So-called nutrition-sensitive approaches are gaining popularity and the importance of including nutrition in a wide variety of sectors and policies is becoming better understood. Here we discuss some of the alternative routes through which malnutrition is impacted and thus could be reduced.

  1. Agriculture

The contribution of agriculture to meeting the nutritional needs of the population cannot be overstated, and the nutrition component of agricultural policies and investment plans needs to be strengthened. In Africa, agricultural development has been primarily focused on boosting production and developing markets with little attention given to nutrition. But agriculture is at the heart of addressing malnutrition. Its products provide us with the energy, protein, vitamins and minerals our bodies need. And in many developing countries the majority of people who are malnourished live in rural areas and depend on smallholder farming for their livelihoods. In fact, demographic and health survey (DHS) data shows that individuals living in rural areas are between 1.3 and 3.3 times more likely to be stunted than people in urban areas, which indicates that agriculture still has a long way to go in providing the global population with the right nutrition and adequate calories. It also indicates that by improving agricultural diversity and productivity in rural farming areas, malnutrition could be significantly reduced, although evidence on the impact agriculture can have on nutrition is currently limited in formal literature.

So how does agriculture need to change in order to better serve the world’s nutritional needs? The food system needs to provide access to enough nutritious foods, promote social norms that foster good nutrition practices and provide adequate income to purchase nutritious foods. Ensuring nutritious foods are affordable, accessible and available is essential and has typically been overlooked in the agricultural sector, rather being the domain of development and health. Home and school gardens, small livestock production, aquaculture and marketing policies which keep the prices of such foods at affordable levels are examples of food-based nutrition improvement initiatives. Some argue that the entire food chain needs to be put under a “nutrition lens” in order to identify areas for intervention such as “expanding and diversifying food production, improving food processing, preservation and preparation of foods, reducing losses and waste and assessing intervention impact on dietary consumption”.

The Soils, Food and Health and Communities (SFHC) project, used participatory research methods and awareness raising activities in Ekwendeni village in Northern Malawi to help smallholder famers select and test mixtures of diverse legume species for growing in combination with maize. Project results show that the intercropping of maize with legume mixes has led to improved nutrition for children in communities where the project is being implemented (over 9000 farmers have adopted this technology so far). [Read more…]

What we’ve been reading this week

This week’s summary on the news stories, reports and blogs that have grabbed our attention. We welcome your thoughts and comments on these articles.

Climate Change and Environment

Shock Waves: Managing the Impacts of Climate Change on Poverty, World Bank Group

Can farms be good for nature without being organic? The Guardian

Getting Green Climate Funding to the local level, iied

Want To Combat Climate Change? Give Up Red Lipstick, Drink Local, and Fly Direct (No Problem!), Forbes

Can UN climate talks catch up with the real world? Thomson Reuters Foundation

Renewables are changing the climate narrative from sacrifice to opportunity, The Guardian

Has capitalism captured conservation? Thrive

Food, Nutrition and Water Security

Helping communities in four West African countries improve their food security, Reliefweb [Read more…]

Don’t flush the nutrients down the toilet

By Katrin Glatzel

When you think of clean water and hygienic toilets, it’s not usually concerns about nutrition that come to mind first. Well, you might want to reconsider.

Poor sanitation, limited hygiene practices and unsafe water sources expose billions of people, particularly children and other vulnerable groups, to a wide range of preventable diseases and consequently high mortality rates in many countries. According to UNWater and the World Health Organisation, two and a half billion people do not have access to basic sanitation and 783 million people have no access to clean water.

Diseases and Diarrhoea lead to preventable child deaths


Credit: UN, Albert Gonzalez Farran

As a result, around four million people die from waterborne diseases every year; just over two million of these deaths are due to diarrhoea and one million of those are children under the age of five. Despite that these young children suffer from dehydration and infection, malnutrition is the root cause of more than one-third of all under-five child deaths globally.  Malnutrition results from not enough food or not enough nutrient-rich foods or both. The likelihood that a child will die from diarrhoea if he or she is severely underweight is almost ten times higher than a child of average weight for height and age. [Read more…]

Tracking progress and spending on nutrition

ID-100328810The Global Nutrition Report 2015: Actions and accountability to advance nutrition and sustainable development, has as a key theme the notion of tracking progress on tackling undernutrition as an important factor in holding donors, governments and other institutions to account. The data in the report itself plays a role in monitoring progress. At present, data allowing the monitoring of impact and reach of nutrition-specific interventions is limited. Lack of consensus on data, metrics and methods make monitoring difficult to undertake, analyse and compare, although improvements are being seen in actions to track nutrition.

Approaches to tackling undernutrition need to be multi-sectoral, which makes tracking both nutrition spending and progress towards targets difficult. As the Global Nutrition Report 2015 states, countries make progress when actions from multiple levels converge and reinforce each other in a virtuous circle. Nutrition-sensitive approaches, which seek to both reach a direct nutrition goal as well as address the factors underlying undernutrition, further complicate accurate measurement and monitoring.

Ickes et al (2015) calculated, based on data from the Organization for Economic Co-Operation and Development, estimates of nutrition aid received by countries with a high burden of undernutrition as well as investigated the relationship between this funding and nutrition measurements such as national stunting prevalence, stunting burden, and under-five mortality. In 2010, some US$379.4 million was given to nutrition specific projects and programmes and US$1.79 billion was committed to nutrition sensitive spending. The 25 highest burden countries accounted for 85% and 82% of this funding, respectively. The main areas of nutrition-sensitive spending were Reproductive Health Care (30.4%), Food Aid/Food Security Programs (14.1%), Emergency Food Aid (13.2%), and Basic Health Care (5.0%). The amount of nutrition sensitive and total nutrition Official Development Assistance was significantly correlated with stunting prevalence while the total number of stunted children in a country’s population was correlated with the amount of nutrition specific ODA. These results indicate not only the importance of nutrition-related funding in reducing stunting but also the importance of reliable estimates for nutrition spending for planning.

International funding for nutrition has, over the last five years, significantly increased. This rise has stimulated demand for greater accountability in the distribution of resources. As said, tracking nutrition expenditures is made difficult because nutrition spans several Ministries and involves multiple stakeholders. An Oxford Policy Management working paper by Picanyol et al (2015) entitled, Tracking Investments in Nutrition in Africa, reviews the experience of four countries (Tanzania, Madagascar, Ethiopia and Malawi) in tracking nutrition spending using different methods. Authors outline multiple ways in which nutrition spending can be tracked: through budgetary analysis, public expenditure reviews, National health accounts, the Clinton Health Access Initiative (CHAI) resource mapping tool, the OECD Development Assistance Committee (OECD/DAC) Credit Reporting System (CRS) online database. The report also introduces suggested desirable characteristics of tracking mechanisms, based on standard principles of good practice in public financial management and aid effectiveness (OECD, 2008; World Bank, 1998): [Read more…]

What we’ve been reading this week

This week’s summary on the news stories, reports and blogs that have grabbed our attention. We welcome your thoughts and comments on these articles.

Nutrition and Food Secuirty

What Works for Nutrition? Success stories from Vietnam, Uganda & Kenya, Results, Concern Worldwide and University of Westminster

Beans and Other Paragons of Dietary Virtue, CIAT Blog

24 TED Talks That Will Help Save the Food System, FoodTank

Good Governance Is the Only Real Way to Provide Food Security, World Politics Review

Can the G7 new alliance reduce hunger and poverty in Malawi? Concern Universal, ChristianAid, CISANET & CEPA

In Kenya, Improving Food Security and HIV Outcomes through Farming, Scientific American

Climate change 

Warming set to breach 1C threshold, BBC News

Rapid, Climate-Informed Development Needed to Keep Climate Change from Pushing More than 100 Million People into Poverty by 2030, World Bank

UN climate fund releases $183m to tackle global warming, The Guardian

The devil is in the detail, E3G

Leadership on Climate Change: COP21 & Beyond, SustainAbility

Linking Food Security and Climate Change: what role for the private sector? ecdpm [Read more…]

Making progress on nutrition

SUNA new report was launched last week in the Houses of Parliament which lays out progress made in tackling nutrition in several counties, as well as the challenges still ahead. “What works for nutrition? Stories of success from Vietnam, Uganda and Kenya”, a joint publication from RESULTS UK, Concern Worldwide and the University of Westminster, discusses these countries success in the context of global nutrition targets and concludes with key recommendations for government and civil society to build on this success and learn from their experiences.

Despite considerable progress in reducing hunger and the physical signs of malnutrition (the number of hungry people has been reduced by 200 million since 1990 and stunting in children under age five by 40%), malnutrition still places a heavy burden on survival and overall development. Some two billion people, for example, are estimated to suffer from micronutrient deficiencies (about 27% of the global population), which can have wide ranging long-term and irreversible consequences for their health and livelihoods. Undernutrition can reduce GDP and an individual’s earnings by as much as 10%. Progress in tackling malnutrition has also been uneven and inequitable: children in rural areas, for example, as twice as likely to be stunted as those in urban areas. But global initiatives are improving awareness of global malnutrition, and in 2012, the World Health Association (WHA) endorsed six targets on nutrition to be achieved by 2025.

  1. Achieve a 40% reduction in the number of children under-5 who are stunted;
  2. Achieve a 50% reduction of anaemia in women of reproductive age;
  3. Achieve a 30% reduction in low birth weight;
  4. Ensure that there is no increase in childhood overweight;
  5. Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%;
  6. Reduce and maintain childhood wasting to less than 5%.

Financing for nutrition has been growing recently, although evidence indicates donors need to quadruple their financial pledges and governments need to at least double the amount allocated to nutrition in order to meet the WHA target on stunting in 37 high burden countries. And nutrition is a good investment: every dollar invested in nutrition yields more than 16 in return. [Read more…]

What we’ve been reading this week

This week’s summary on the news stories, reports and blogs that have grabbed our attention. We welcome your thoughts and comments on these articles.

DFID’s Conceptual Framework on Agriculture, DFID

Insects should be part of a sustainable diet in future, says report, The Guardian

Big ideas and emerging innovations, The Chicago Council

Science on the Pulse: At the intersection of biodiversity, environmental and human health, Thrive

Green Climate Fund aims to fund first projects in November, Reuters

We Are the Solution: African Women Organize for Land and Seed Sovereignty, ReliefWeb

Adam Liaw: five scientific developments that will change the way we eat, The Guardian

Q&A: The Role of Agribusiness in Youth Unemployment, Technoserve

IITA Promotes a Solution that Puts Smallholders’ Food, Nutrition and Income in a Bag, IPS

Paris deal ‘departing station’ for climate action – UN’s Figueres, Thomson Reuters [Read more…]


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