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Background: Nutrition programs frequently approach wasting and stunting as 2 separate conditions with distinct causes and effects. Although several cross-sectional studies have identified an association between the 2 conditions, longitudinal studies are useful to quantify the risk of acute malnutrition based on the trajectory of linear growth.Objective: We analyzed data from a longitudinal study to explore associations between linear growth and relapse to acute malnutrition in high-risk children during the year after recovery from moderate acute malnutrition (MAM).Methods: This was a secondary data analysis from a cluster randomized trial involving 1487 Malawian children 6-62 mo old treated for MAM and enrolled upon recovery. Children were followed for 1 y, during which data were collected on anthropometric progress, symptoms of illness, and household food security. Multivariate fixed-effects logistic regression was used to identify associations between linear growth and relapse to acute malnutrition.Results: Children who have recovered from MAM proved to be a high-risk population, with nearly half experiencing a decrease in height-for-age z score (HAZ) for 12 mo. Children whose HAZ was declining were more likely to relapse to MAM or SAM than were those whose linear growth rate maintained or increased their HAZ (P < 0.001). Mean changes of +0.15, -0.03, -0.17, and -0.53 in HAZ were observed for those who sustained recovery, relapsed to MAM once, relapsed to MAM multiple times, and developed SAM, respectively.Conclusion: Our results add to the body of evidence suggesting that acute wasting is a harbinger of subsequent stunting. Children who experience poor linear growth after MAM are more likely to experience relapse. Given this bidirectional relation between wasting and stunting, supplementary feeding programs should consider both when designing protocols, aiming to optimize linear growth and achieve acute weight gain, as a means of reducing relapse. This trial was registered at clinicaltrials.gov as NCT02351687. [ABSTRACT FROM AUTHOR]

Many researchers use data from Household Consumption and Expenditure Surveys (HCES) to estimate individual food and nutrient intake when individual dietary data are not available. They assume that food is allocated within households according to members’ proportional energy requirements relative to an adult male (called an adult male equivalent, or AME). This study sought to validate AME-based estimates of individual consumption of calories, protein, iron, and animal source protein (ASP) across 10 age-sex categories, using data from Bangladesh and Ethiopia containing both household and individual-level consumption data. The study also assessed the accuracy of adjusting for meal partakers and physical activity levels (PAL), and compared energy-weighted AMEs to nutrient-specific AME predictions. Energy AME-based predictions of nutrient intake were generally accurate within ten percentage points of individually reported intakes, but were less accurate for infants 6–23 months and children in Bangladesh than for other demographic groups. AME predictions were more accurate: (1) in Ethiopia than in Bangladesh, (2) for predicting intake of the three nutrients rather than ASP, (3) for estimating nutrient intake rather than adequacy, (4) using energy-weighted AMEs rather than nutrient specific weights, and (5) using moderate PAL for youth and adults rather than high PAL. Adjusting for meal partakers did not consistently improve the AME-based predictions. Energy based AME estimates from household data can produce a useful proxy of average intake for certain population subgroups, however individually measured dietary assessment remains the best approach to identify groups at risk of nutrient inadequacy. [ABSTRACT FROM AUTHOR]

Abstract: Using panel data from Ethiopia covering 1994–1997, we estimate the impact of prime age adult mortality on household composition, household expenditures and dietary diversity. We employed propensity score matching with a difference-in-difference estimator to control for endogeneity of mortality to the outcomes of interest. Households losing a productive adult did not replenish the lost labor, regardless of economic status, sex or status of the deceased adult. With the exception of non-poor households, adult mortality resulted in increased dependency ratios, but did not adversely affect households’ expenditure patterns (total, food and non-food expenditures) regardless of the sex and position of the deceased and the economic status of the households. Although food expenditures were protected, a decline in dietary diversity, especially among the poorest households, reflected increased nutrition insecurity associated with adult mortality. [Copyright &y& Elsevier]

This article explores whether social capital—a measure of trust, reciprocity and social networks—is positively associated with household food security, independent of household-level socioeconomic factors. Interviews were conducted in 330 low-income households from Hartford, Connecticut. Social capital was measured using a 7-item Likert scale and was analyzed using household- and community-level scores. Household food security and hunger were measured using the US Household Food Security Module. χ2 tests were used to examine associations between social capital, food security and household demographic characteristics. Logistic regression was used to examine whether household- and community-level social capital decreases the odds of household hunger, and to estimate which household characteristics increase the likelihood of having social capital. Consistent with our hypotheses, social capital, at both the household and community levels, is significantly associated with household food security in these data. Community-level social capital is significantly associated with decreased odds of experiencing hunger (adjusted odds ratio (AOR)=0.47 [95% CI 0.28, 0.81], P<0.01), while controlling for household socioeconomic status. Results show that households with an elderly member are over two and a half times as likely to have high social capital (AOR=2.68 [1.22, 5.87], P<0.01) than are non-elderly households, after controlling for socioeconomic status. Having a household member who participates in a social or civic organization is also significantly associated with having higher levels of social capital. Social capital, particularly in terms of reciprocity among neighbors, contributes to household food security. Households may have similarly limited financial or food resources, but households with higher levels of social capital are less likely to experience hunger. [Copyright &y& Elsevier]

Public Nutrition is a field of professional study and practice that has existed for many years without being named as such. It encompasses the disciplines that deal with factors affecting the food consumption and nutritional outcomes of populations, and goes beyond the definition of Public Health Nutrition by including the study of public policy in areas outside of health and nutrition as traditionally defined, that nonetheless can have profound effects on nutrition. Career paths in Public Nutrition exist at a variety of professional levels, including practitioners and direct service providers; administrators and planners; policy makers; and researchers and educators. The professional preparation of those working in Public Nutrition typically combines education and experience in nutritional science, social science, and sometimes management and planning. The field of Public Nutrition is important in providing a critical link between advances in understanding biomedical determinants of nutrition and the application of such understanding in programs and policies. However, the study of Public Nutrition goes beyond this: it represents an agenda of research and practice in its own right. Public Nutrition includes the study of how specific policies, in varying contexts, affect food consumption and nutrition outcomes; it includes the study of determinants of program effectiveness in improving these outcomes. Specific training programs in Public Nutrition do exist; the elements of a curriculum in Public Nutrition include social science research skills (data collection, management, analysis and interpretation), an understanding of economic, social, political, and behavioral determinants of food consumption, health and nutrition; a grounding in nutritional science. Field experience is an essential part of the preparation of Public Nutrition professionals. [ABSTRACT FROM PUBLISHER]

Presents a paper adapted from a World Bank guidebook on monitoring and evaluation of nutrition programs in developing countries. Definition of monitoring and evaluation; Basic options for structuring monitoring and evaluation responsibilities. INSETS: Field insight: Neglecting the reasons for change.;Field insight: The benefits of constructing a....

Two‐hundred and forty households were interviewed through a survey assessing the impact on various aspects of household welfare of a large‐scale irrigation project in the Lukkos region of Morocco. Installation of milk centers to collect milk from producers for commercial purposes affected households’ economic and dietary patterns. It motivated households to procure genetically improved cattle and hence to increase their milk production. Caring for improved cattle had a positive effect on household income, but no additional effect of access to milk centers on income could be shown. This access negatively affected household consumption of dairy products and calcium intake, particularly during summer, when alternative sources of calcium were less available. A nutrition education program should address the importance of the consumption of dairy products to improve the quality of households’ diet. Expansion of rural markets will also benefit this quality through increase in the frequency of food purchase and the physical and economic access to food markets. [ABSTRACT FROM PUBLISHER]

Examines the economic and welfare implications of female headships in the Dominican Republic. Impact of female headships on household consumption patterns; Effects of female headship on expenditure and consumption patterns and on children's welfare; Exploration of the relationships between headship as defined by the survey and headship according to alternative definitions.

Presents implications of female household headship for food consumption and nutritional status in the Dominican Republic. Expenditure and consumption patterns of female- and male-headed households; Household dietary adequacy; Multivariate results on food expenditure and food and nutrient consumption; Nutritional status of children.

Presents several commentaries related to evidence-based nutrition practice. Insecurity of food in public hospital; Prevalence of obesity; Improvement in the quality of life through weight-loss surgery.

Lipid‐based nutritional supplements (LNS) and fortified blended flours (FBF) are widely used to increase the nutrient density of children's diets and improve their health, but their effectiveness could be modified by displacement of other foods. We reanalysed data from a cost‐effectiveness trial comparing impacts on anthropometry of three FBFs (Corn Soy Blend Plus [CSB+], Corn Soy Whey Blend [CSWB], SuperCereal Plus [SC+]) and one LNS (Ready‐to‐use Supplementary Food [RUSF]) among infants aged 7–23 months in Burkina Faso. Using dietary diversity data from a single 24‐h recall period (n = 1,591 children, observed once over 18‐month study period), we fit logistic regression models to estimate differences in intake of each food group making up the infant and young child minimum dietary diversity score and linear models to test for differences in dietary diversity score among children in each supplement arm. We tested for differences in breastfeeding time using the subsample for which breastfeeding was observed (n = 176). Children who consumed one of the three FBFs had lower odds of consuming household grains, roots and tubers compared with the LNS consumers (odds ratios [ORs] = 0.35–0.47; 95% confidence intervals [CIs]: 0.20–1.05). Consumption of other foods, dietary diversity and breastfeeding did not differ significantly at the 5% significance level. FBFs displaced the household's own cereals more than LNS, with no difference in the child's consumption of other more nutrient‐rich family foods. Given limited stomach capacity and feeding time, providing fortified cereals may help improve children's overall diet quality in settings where children would otherwise be fed nutrient‐poor root crops or cereal grains. [ABSTRACT FROM AUTHOR]

Corn Soy Blend (CSB) porridge is commonly prepared with oil for treatment of moderate acute malnutrition (MAM). A recent review recommended that 30 g of oil be used with 100 g of CSB to increase energy density and micronutrient absorption. This study assessed the effectiveness and cost-effectiveness of program changes aimed at achieving that target oil:CSB ratio in prepared porridge. Caregivers of children in MAM supplementary feeding programs were assigned to three groups: a control group received monthly rations of 1 L oil, 8 kg CSB in bulk, and social and behavior change communication (SBCC); intervention groups received 2.6 L oil, 8 kg CSB provided either in bulk (Group 1) or four 2-kg packages with printed messages (Group 2), and enhanced SBCC emphasizing the target oil:CSB ratio. Compared to the control, both intervention groups had higher mean added oil per 100 g CSB (18 g, p < 0.01, and 13 g, p= 0.04, higher in groups 1 and 2, respectively), and greater odds of meeting or exceeding the target ratio (28.4, p< 0.01, and 12.7, p= 0.02, in groups 1 and 2, respectively). Cost per caregiver reaching the target ratio was most favorable in Group 1 ($391 in Group 1, $527 in Group 2, and $1,666 in the control). Enhanced SBCC combined with increased oil ration resulted in increased use of oil in CSB porridge in a supplementary feeding program. Modified packaging did not improve effectiveness. However, both interventions were more cost-effective than standard programming. [ABSTRACT FROM AUTHOR]

Objective: The present paper aimed to demonstrate how 24 h dietary recall data can be used to generate a nutrition-relevant food list for household consumption and expenditure surveys (HCES) using contribution analysis and stepwise regression.Design: The analysis used data from the 2011/12 Bangladesh Integrated Household Survey (BIHS), which is nationally representative of rural Bangladesh. A total of 325 primary sampling units (PSU=village) were surveyed through a two-stage stratified sampling approach. The household food consumption module used for the analysis consisted of a 24 h open dietary recall in which the female member in charge of preparing and serving food was asked about foods and quantities consumed by the whole household.Setting: Rural Bangladesh.ParticipantsA total of 6500 households.Results: The original 24 h open dietary recall data in the BIHS were comprised of 288 individual foods that were grouped into ninety-four similar food groups. Contribution analysis and stepwise regression were based on nutrients of public health interest in Bangladesh (energy, protein, fat, Fe, Zn, vitamin A). These steps revealed that a list of fifty-nine food items captures approximately 90 % of the total intake and up to 90 % of the between-person variation for the key nutrients based on the diets of the population.Conclusions: The study illustrates how 24 h open dietary recall data can be used to generate a country-specific nutrition-relevant food list that could be integrated into an HCES consumption module to enable more accurate and comprehensive household-level food and nutrient analyses. [ABSTRACT FROM AUTHOR]

Highlights • Rural Ethiopian households exhibited significant intra-household nutrient inequities. • Conventional 'vulnerable groups' were not always most affected by inequity. • Inequities were greatest for 'invisible' nutrients (iron) • No factor consistently predicted detrimental inequity across groups and nutrients. • Programs must consider intra-household nutrient allocation for optimal targeting. Abstract Background Food assistance interventions directed at households may miss undernourished individuals if intra-household equity in nutrient allocation is assumed. A recent study from Ethiopia revealed that, while all age groups consumed calories in proportion to their fair share, iron and protein were inequitably allocated among household members. Further exploration of individual and household characteristics associated with these allocation patterns is necessary to gain a more complete understanding of existing disparities. Objective This paper sought to quantify energy, protein, and iron allocation inequity between four age and sex groups of household members (children and adults) commonly assumed to be disadvantaged versus preferentially treated in intra-household resource distribution. It then sought to identify individual and household factors that explained the inequity of intra-household nutrient allocation among these paired groups. Methods Data from a survey of 1185 households located in rural Oromiya and SNNPR regions of Ethiopia. A single quantitative 24-hour household-level dietary recall was collected from the primary food preparer who reported the proportion of household food distributed to each household member. Continuous ratios of relative calorie, protein, and iron adequacy for four pairs of age-sex groups (any child vs. any adult, any child vs. adult male, female child vs. male child, and adult female vs. adult male) in the household were computed and compared, along with a binary indicator of inequity. Logistic regressions and standard linear regression with Huber-White heteroscedasticity-adjusted standard errors were run to determine the predictors of household inequity for each pair-group and nutrient, on the full sample as well as on nutrient inadequate households. Results Common assumptions about inequitable distribution of nutrients within households were not consistently supported by this analysis. Significant intra-household nutrient inequities did exist in these rural Ethiopian households for certain nutrients, but household subgroups commonly presumed to be nutritionally vulnerable in the Ethiopian context were not always affected by detrimental inequity. Generally, household inequity favored children over adults or adult males, and female children over male children for protein consumption. Inequities were greatest against presumed vulnerable groups (adult women, children) for 'invisible' nutrients (iron) rather than calories or protein. There were relatively few households in which one of the interest groups (groups presumed vulnerable) experienced inequitable nutrient allocation and nutrient inadequacy. The number of households where inequity was present for a subgroup who also experienced nutrient inadequacy while the reference group (group presumed to be preferred) was nutrient adequate was negligible, suggesting that in very few of these household are there members who are "haves", benefiting nutritionally to the nutritional detriment of "have nots". The analysis of determinants did not reveal any single, consistent set of factors driving decisions across all pair groups and nutrients, but these factors were not substantially different for households that were and were not nutrient adequate. Household dependency ratio, higher relative male education, female household headship, and women's decision-making power provided mixed results for pairwise comparisons. Conclusions The variable pattern of nutrient inequities underscores the risk of overlooking intra-household nutrient allocation disparity or making assumptions about a particular intra-household food and nutrient distribution pattern in any context where programs are intended to benefit particular household members. [ABSTRACT FROM AUTHOR]

With the efficacy of antiretroviral therapy, people living with HIV (PLWH) are surviving longer and improving their health related quality of life (HRQol) has become an important long-term HIV treatment and management indicator. HRQol has been associated with various factors, including food insecurity (FI). The objective of this prospective study was to examine the association between FI and dietary diversity (HDDS) and HRQol among PLWH in Accra, Ghana. We recruited 152 PLWH from the HIV clinics of six district hospitals Accra, Ghana and utilized a prospective cohort study design with data collection at baseline, three and six months after recruitment for this study. Participants completed questionnaires measuring HRQol, FI and HDDS. Repeated measures ANOVA was used to analyze the associations between FI and HRQol as well as HDDS and HRQol separately and then together. Being food secure [0.035 (95% CI = 0.005, 0.065)] and having a high dietary diversity score [0.029 (95% CI = 0.004, 0.053)] were independently associated with an improvement in quality of life scores over time after adjusting for other covariates and each other. Interventions to improve dietary diversity and food security among PLWH have the potential to improve nutritional status as well as HRQol. [ABSTRACT FROM AUTHOR]

In spite of the important role nutrition plays in the management of HIV, access to nutrition services is inadequate, especially in resource limited settings. In addition, nutrition programs for people living with HIV (PLWH) have not been sufficiently evaluated for efficacy and this study was conducted to address this gap. This study aimed to evaluate the implementation of the nutrition assessment, counseling and support (NACS) program in Accra, Ghana, and to assess whether the level of implementation of NACS was associated with the body mass index (BMI) of PLWH. A cross-sectional study was conducted in six HIV clinics (3 NACS designated and 3 non-NACS). Study participants were 152 adult PLWH at least 6 months on antiretroviral therapy and not pregnant or breastfeeding. Using a NACS implementation scale developed for this study ranging from 0 to 8 (a higher score indicating better NACS implementation), median NACS implementation score was not different between NACS-designated, and non-NACS HIV clinics (5 vs 4, p = 0.14). Almost half (47%) of the respondents were overweight or obese. A higher score on the NACS implementation scale was not significantly associated with overweight or obesity (BMI >24.9 kg/m2) after adjusting for other covariates. It was concluded that, there was poor implementation of NACS in the NACS designated HIV clinics surveyed with no nutrition counseling offered nor food support available to those who might need it. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Improving the nutritional quality of U.S. food aid: recommendations for changes to products and programs," by P. Webb in a previous issue.

Background: The temporal relationship between length (linear) and weight (ponderal) growth in early life is important to support optimal nutrition program design. Studies based on measures of attained size have established that wasting often precedes stunting, but such studies do not capture responsiveness of growth to previous compared with current conditions. As a result, the temporality of linear and ponderal growth relationships remain unclear.Objectives: We used growth velocity indicators to assess the temporal bidirectional relationships between linear and ponderal growth in children.Methods: Using monthly anthropometric measurements from 5039 Burkinabè children enrolled at 6 months of age and followed until 28 months from August 2014 to December 2016, we employed multilevel mixed-effects models to investigate concurrent and lagged associations between linear and ponderal growth velocity, controlling for time trends, seasonality, and morbidity.Results: Faster ponderal growth is associated with faster concurrent and subsequent linear growth (0.21-0.72 increase in length velocity z-score per unit increase in weight velocity z-score), while faster linear growth is associated with slower future weight gain (0.009-0.02 decrease in weight velocity z-score per unit increase in length velocity z-score), especially among children 9-14 months. Ponderal growth slows around the same time as peaks in morbidity, followed roughly a month later by slower linear growth.Conclusions: Use of velocity measures to assess temporal dependencies between linear and ponderal growth demonstrate that the same growth-limiting conditions likely affect both length and weight velocity, that slow ponderal growth likely limits subsequent linear growth, and that linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid slowdowns in weight gain. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of seasonality on fruit and vegetable availability and prices across three outlet types (farmers' markets, roadside stands and conventional supermarkets).Design: Cross-sectional survey of geographically clustered supermarkets, farmers' markets and roadside stands. Enumerators recorded the availability and lowest price for eleven fruits and eighteen vegetables in each season of 2011.Setting: Price data were collected at retail outlets located in central and eastern North Carolina.Subjects: The sample consisted of thirty-three supermarkets, thirty-four farmers' markets and twenty-three roadside stands.Results: Outside the local harvest season, the availability of many fruits and vegetables was substantially lower at farmers' markets and roadside stands compared with supermarkets. Given sufficient availability, some items were significantly cheaper (P<0·05) at direct retail outlets in the peak season (e.g. cantaloupe cost 36·0 % less at roadside stands than supermarkets), while others were significantly more expensive (e.g. carrots cost 137·9 % more at farmers' markets than supermarkets). Although small samples limited statistical power in many non-peak comparisons, these results also showed some differences by item: two-thirds of fruits were cheaper at one or both direct outlets in the spring and autumn, whereas five of eighteen vegetables cost more at direct retail year-round.Conclusions: Commonly consumed fruits and vegetables were more widely available at supermarkets in central and eastern North Carolina than at direct retail outlets, in each season. Contingent on item availability, price competitiveness of the direct retail outlets varied by fruit and vegetable. For many items, the outlets compete on price in more than one season. [ABSTRACT FROM AUTHOR]

This study describes the effects of garden-based education on children’s vegetable consumption. As part of a pre—post panel study, 236 students complete the Garden Vegetable Frequency Questionnaire and 161 complete a taste test. Results indicate that school gardening may affect children’s vegetable consumption, including improved recognition of, attitudes toward, preferences for, and willingness to taste vegetables. Gardening also increases the variety of vegetables eaten. Future research should explore whether effects persist over time and if and how changes in children’s behavior affect the behavior of their caregivers. Implications of study findings for policy and practice are discussed. Suggestions for applying results to future health promotions are provided. [ABSTRACT FROM PUBLISHER]

Summary: Using Ethiopia rural household survey (ERHS) panel data set (1994–97), we evaluated the impact of prime age adult mortality on child survival and growth. We employed propensity score matching (PSM) with difference-in-difference (DID) estimators to control for endogeneity of adult mortality to child survival and growth. Bereavement (child living in a household with adult mortality) increased the probability of child mortality, with girls faring worse than boys. Bereaved boys and the poorest surviving bereaved children grew one third of a standard deviation slower than their matched non-bereaved counterparts in the same group. Preventing adult mortality is an important policy strategy to improve children’s health and longevity. [Copyright &y& Elsevier]

This paper hypothesizes that there is a common "core" to the household food insecurity experience that goes beyond insufficient food quantity and that transcends culture. The paper for the first time employs an exploratory approach to identify cross-cultural commonalities of the food insecurity experience as captured in 22 scales and related ethnographies derived from 15 different countries. The constant comparative method was used to code elements of the food insecurity experience expressed in the ethnographies and to regroup them into domains and subdomains. This typology was then applied to ascertain which experiential domains and subdomains were measured (or not) across all 22 studies. Survey data from 11 of the studies were then analyzed to assess similarities in the relative frequency with which culturally diverse households responded to questionnaire items related to these common domains/subdomains. The analysis confirmed that insufficient food quantity, inadequate food quality, and uncertainty and worry about food were a significant part of the food insecurity experience in all sampled cultures; concerns about social unacceptability emerged in all ethnographic accounts. Several subdomains were identified, such as concern over food safety and meal pattern disruption, with potentially important consequences for physical and psychological well-being. The comparative survey data showed that the relative frequency at which populations responded to domain-related questionnaire items was similar across all but a few cultures. Future food insecurity assessments should consider these core domains and subdomains as the starting point for measures that can generate rich information to inform food security policies and programs. [ABSTRACT FROM AUTHOR]

Background: Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed.Objectives: We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes.Methods: The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk.Results: Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different.Conclusions: Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897. [ABSTRACT FROM AUTHOR]

Objective: To examine participation in the Food Stamp Program, food pantries, and soup kitchens and to identify reasons food-insecure households choose not to participate. Design: Cross-sectional retrospective cohort study. Setting: In respondents' homes. Participants: 330 randomly selected low-income households (below 185% of poverty). Main Outcome Measures: Participation in any of 3 public or private food assistance programs and barriers to participation in each program. Analysis: Chi-square tests of association between program participation and sociodemographic characteristics. Logistic regression tested for associations between program participation and ethnicity and between food security status and household composition while controlling for potential confounding factors. Results: Controlling for socioeconomic status, Black households are less than half as likely to receive food stamps (odds ratio [OR] = 0.49; P < .02) as Hispanic households. Hispanic households are more likely than non-Hispanic households to say that they feel uncomfortable using food pantries (P < .01). Elderly households are less than half as likely to receive food stamps (OR = 0.44; P = .04) as nonelderly households and are more likely to say that they feel uncomfortable receiving food stamps (P = .05). Conclusions and Implications: Low-income households' perceptions of which programs are socially acceptable differ by race and age. Outreach for food stamps and private food assistance should accommodate these differences so that food-insecure households can benefit from all available food assistance. [ABSTRACT FROM AUTHOR]

Background: Multiple specialized nutritious food options are programmed for supplementation in humanitarian and development settings. However, comparative cost-effectiveness evidence is lacking, let alone incorporation of perspectives from uncompensated stakeholders. A Burkina Faso trial evaluated the cost-effectiveness of Corn Soy Blend Plus w/ oil (CSB+ w/oil, reference arm), Corn Soy Whey Blend w/oil (CSWB w/oil), Super Cereal Plus (SC+), and Ready-to-Use Supplementary Food (RUSF) in reducing stunting and wasting among children 6-23 months old. This paper presents cost-effectiveness findings from multiple stakeholders' perspectives, including caregivers and program volunteers.Methods: An activity-based costing with ingredients approach was used to summarize cost of the 18-month-long blanket supplementary feeding for each enrolled child (in 2018 USD). Time data were collected using self-reported and observational instruments. Cost-effectiveness relative to CSB+ w/oil assessed incremental cost per enrolled child against incremental outcomes: prevalence of stunting at 23 months of age and number of months of wasting. Two combined perspectives were compared: program (donor, implementer, and volunteer) versus program and caregiver (adding caregiver).Results: A total of 6112 children were enrolled. While similar effectiveness was found in three arms (CSWB w/oil was less effective), costs differed. Product cost and caregiver time to prepare study foods were major drivers of cross-arm cost differences from the respective combined perspective. The two major drivers were used to construct uncertainty ranges of cost per enrolled child from program and caregiver perspective: $317 ($279- $355) in CSB+ w/oil, $350 ($327- $373) in CSWB w/oil, $387 ($371- $403) in RUSF, and $434 ($365- $503) in SC+. Cost from program and caregiver perspective was a substantial increase from program perspective. CSB+ w/oil was most cost-effective in reducing stunting and wasting, and this main finding was robust to changing perspectives and all corresponding sensitivity analyses when uncompensated time was valued at minimum wage ($0.36/h). The break-even point for uncompensated time valuation is >$0.84/h, where RUSF became the most cost-effective from the program and caregiver perspective. Relative cost-effectiveness rankings among the other three arms depended on choice of perspectives, and were sensitive to values assigned to product cost, international freight cost, opportunity cost of time, and outcomes of a hypothetical control. Volunteer opportunity cost did not affect arm comparisons, but lack of compensation resulted in negative financial consequences for caregivers.Conclusions: Evaluating cost-effectiveness by incorporating uncompensated stakeholders provided crucial implementation insights around nutrition products and programming.Trial Registration: Trial registration number: NCT02071563. Name of registry: ClinicalTrials.gov URL of registry: https://clinicaltrials.gov/ct2/show/NCT02071563?type=Intr&cond=Malnutrition&cntry=BF&draw=2&rank=9 Date of registration: February 26, 2014. Date of enrollment of first participant: July 2014. [ABSTRACT FROM AUTHOR]

Background: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP).Methods: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child's illness, handwashing, and awareness of Nutrition and Health Days (NHDs).Results: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW's home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child's illness, handwashing, and awareness of NHDs.Conclusions: ASHAs' home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs' home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India. [ABSTRACT FROM AUTHOR]

Objective: To compare the impact on child diet and growth of a multisectoral community intervention v. nutrition education and livestock management training alone.Design: Longitudinal community-based randomized trial involving three groups of villages assigned to receive: (i) Full Package community development activities, delivered via women's groups; (ii) livestock training and nutrition education alone (Partial Package); or (iii) no intervention (Control). Household surveys, child growth monitoring, child and household diet quality measures (diet diversity (DD), animal-source food (ASF) consumption) were collected at five visits over 36 months. Mixed-effect linear regression and Poisson models used survey round, treatment group and group-by-round interaction to predict outcomes of interest, adjusted for household- and child-specific characteristics.Setting: Banke, Nepal.Participants: Households (n 974) with children aged 1-60 months (n 1333).Results: Children in Full Package households had better endline anthropometry (weight-for-age, weight-for-height, mid-upper-arm-circumference Z-scores), DD, and more consumption of ASF, after adjusting for household- and child-specific characteristics. By endline, compared with Partial Package or Control groups, Full Package households demonstrated preferential child feeding practices and had significantly more improvement in household wealth and hygiene habits.Conclusions: In this longitudinal study, a comprehensive multisectoral intervention was more successful in improving key growth indicators as well as diet quality in young children. Provision of training in livestock management and nutrition education alone had limited effect on these outcomes. Although more time-consuming and costly to administer, incorporating nutrition training with community social capital development was associated with better child growth and nutrition outcomes than isolated training programmes alone. [ABSTRACT FROM AUTHOR]

Objective: To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country.Design: Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order.Setting: Two urban and two rural communities in southern Malawi.Participants: Women (n 300) aged 18-45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years).Results: Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen's κw = 0·78-0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40-56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level.Conclusions: Digital PSEA require further testing in low-income settings to improve accuracy of estimations. [ABSTRACT FROM AUTHOR]

Objective: To investigate preferences for and ease-of-use perceptions of different aspects of printed and digitally displayed photographic portion-size estimation aids (PSEA) in a low-resource setting and to document accuracy of portion-size selections using PSEA with different visual characteristics.Design: A convergent mixed-methods design and stepwise approach were used to assess characteristics of interest in isolation. Participants served themselves food and water, which were weighed before and after consumption to measure leftovers and quantity consumed. Thirty minutes later, data collectors administered a meal recall using a PSEA and then a semi-structured interview.Setting: Blantyre and Chikwawa Districts in the southern region of Malawi.Participants: Ninety-six women, aged 18-45 years.Results: Preferences and ease-of-use perceptions favoured photographs rather than drawings of shapes, three and five portion-size options rather than three with four virtual portion-size options, a 45° rather than a 90° photograph angle, and simultaneous rather than sequential presentation of portion-size options. Approximately half to three-quarters of participants found the portion-size options represented appropriate amounts of foods or water consumed. Photographs with three portion sizes resulted in more accurate portion-size selections (closest to measured consumption) than other format and number of portion-size option combinations. A 45° angle and simultaneous presentation were more accurate than a 90° angle and sequential presentation of images.Conclusions: Results from testing PSEA visual characteristics separately can be used to generate optimal PSEA, which can improve participants' experiences during meal recalls. [ABSTRACT FROM AUTHOR]

Background: Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes.Objective: The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB).Methods: This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than -2), or PTB (born <37 weeks of gestation) (secondary outcomes).Results: The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05).Conclusions: Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049. [ABSTRACT FROM AUTHOR]

Background: Many organizations seek to alleviate poverty in the developing world, often focusing their interventions on women. The role, status, and education of women are fundamentally important facets of development. Thus, understanding the interaction of women's educational level and the response to interventions is important. Therefore, we examined the impact of educational level of household adults on responses to a livestock-based community intervention. Methods: Six pair-matched communities in 3 districts of Nepal (Chitwan/Nawalparasi/Nuwakot), were randomly assigned to receive community development activities via women's self-help groups at baseline or 1 year later. At 6 intervals over 48 months, a 125- item questionnaire addressing family demographics and child health/nutrition was completed in each household, plus child growth monitoring. Results were analyzed in relation to the highest education attained by any woman in the household, the child's mother, men, or any other adult in the household. Results: Outcomes (wealth, water/toilet availability, child diet diversity and growth) all significantly related to adult education. However, notable differences were found comparing the impact of men's and women's education. Percent change in wealth score was significant only in households where women had primary or secondary education (respectively, p = .0009 and p < .0001). Increased soap use related only to women's education (p < .0001). When adjusted for group assignment, baseline income, wealth, and animal scores, higher women's education was significantly associated with increased household wealth (p < .0001), better child height-for-age z scores (HAZ, p = .005), and improved child diet diversity (p = .01). Higher mother's education predicted better child HAZ (primary, p = .01, secondary, p = .03) and diet diversity (primary, p = .05, secondary, p < .0001). Higher men's education was significantly associated with household wealth (p = .02) and child diet diversity (p = .04), but not HAZ; higher education of any household member was associated only with household wealth (p < .0001). Moreover, households where the mother's education was better than the best-educated man also were significantly more likely to have children with better HAZ and dietary diversity (p = .03, p < .0001). Thus, the educational level of women and mothers had the broadest impact on child outcome variables. Conclusions: Household characteristics vary among participants in most community development projects. Of these, adult education likely mediates response to the inputs provided by the intervention. Particularly in interventions directed towards women, better education may enhance the ability of households to put interventions into practice, thus improving wealth, hygiene, and child diet and growth indices. [ABSTRACT FROM AUTHOR]

Background: In 2014, an intervention aimed at increasing the oil in corn soy blend (CSB) porridge prepared by caregivers of children with moderate acute malnutrition was implemented in Southern Malawi. This analysis describes the flow of key messages delivered through the Care Group model during this intervention.Methods: The intervention provided a supplementary food ration of CSB and oil and used a Care Group model in which healthcare workers were trained to deliver social and behavior change communication (SBCC) to care group volunteers who then delivered messages to caregivers of beneficiary children. Healthcare workers also delivered messages to caregivers directly. Interviews and focus groups were conducted with all three groups in order to determine the exchange of key messages about ingredient use, storage, and purpose, which were analyzed descriptively.Results: Analysis of SBCC flow and information exchange showed that 100% of caregivers reported learning about the amounts of oil and CSB to use while preparing porridge and over 90% of caregivers, healthcare workers, and care group volunteers reported talking about it. Focus groups confirmed an effective flow of communication among these three groups.Conclusion: This analysis evaluated the flow of key SBCC messages through multiple, overlapping lines of communication among healthcare workers, care group volunteers, and caregivers; the effective transmission of these SBCC messages through this model may contribute to the success of a supplementary feeding intervention program.Trial Registration: The study was registered at ClinicalTrials.gov ( NCT01873196 ). [ABSTRACT FROM AUTHOR]

Nutrition-sensitive agricultural interventions have the potential to improve child dietary quality in rural households, as evidenced by a growing body of work which concurrently measures agricultural and nutrition indicators. Our objective was to investigate whether children in rural farming communities of Nepal participating in a community-level, nutrition-sensitive development intervention had improved dietary quality compared with children living in non-participating matched rural communities. Six rural communities of Nepal where livelihoods were predominantly agricultural were selected to participate in the phased implementation of a community-level development intervention by Heifer International . Households and children in each community were surveyed at baseline, and follow-up surveys were implemented every six months for twenty-four months. Detailed data on food consumption for children older than 6 months of age were collected using a 24 h recall for 17 foods and food groups; parents responded for children. A difference-in-differences model with household fixed-effects and an analysis of covariance model were used to analyze the resulting panel data. Results indicated that the impacts of the intervention varied by agro-ecological region and by season. In the Hills region, which is poorer on average and more conducive to livestock production, children who had received the intervention for two years were 2.2 times as likely to have consumed food from an additional food group, 1.27 times as likely to have achieved minimum dietary diversity and 1.38 times as likely to have consumed animal source foods as children who received the intervention for only one year. In the Terai region, which is more conducive to crop production, there was no significant change in dietary quality attributable to the intervention. These results provide evidence that particularly vulnerable families can take advantage of community-level development activities. Given that the effects of community-level development activities were disparate across communities within the same country, we conclude that tailoring development activities for particular locations is necessary for success. [ABSTRACT FROM AUTHOR]

Background: Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children. Objective: To evaluate HC measurements in a population of rural Nepali children and relate these measurements to demographics, health and diet. Methods: An observational study of head growth was nested within a longitudinal evaluation of a livestock-based agricultural intervention in rural Nepal. Between 538 and 689 children (aged 6 months to 8 years) were measured (height, weight, HC) at each of six survey visits. A total of 3652 HC measurements were obtained. Results were converted toZ-scores (WHO Anthro). Results: Mean head circumferenceZ-scores (HCZ) diminished progressively over the first 4 years of life; a decline of 30% occurred between 3 and 4 years of age (−1.73 to −2.45,P < 0.0001). Overall, 56% of HCZ were <−2. Gender-adjusted HCZ (but not other measurements) were significantly lower for girls than boys [mean (SD) −2.31 (1.0)vs−1.99 (0.094),P < 0.0001]; girls more often had microcephaly (61%vs50%,P < 0.0001). For children <3 years of age, HCZ were better in those who had eaten two or more animal-source foods (ASFs) within the previous 24 h [−1.69 (.05)vs−2.08 (0.10),P = 0.001] than in those who had eaten none or only one; HCZ correlated with the number of ASFs consumed (P < 0.001). Regression analyses demonstrated that the main determinants of HCZ were age, weight-for-ageZ-scores (WAZ) and gender; 43% of the variance in HCZ in younger children was explained by WAZ and ASF consumption. Conclusion: HCs reflect brain size in young children; brain size is linked to cognitive function. Poor head growth represents another facet of the ‘silent emergency’ of child undernutrition. Routine HCZ assessments may contribute to better understanding of the links between poverty and cognitive development. [ABSTRACT FROM AUTHOR]

Deals with challenges in graduate education in integrated water resources management. Discussion on the implementation of integrated water resources management in the U.S.; Information on transboundary rivers and lack of access to safe water; Problems regarding water quality.

Resettled refugees have high rates of chronic disease, which may be partially due to persistent food insecurity. This study describes food experiences on arrival in the U.S. and current food security status and examines characteristics related to food insecurity in a well-established refugee community. Focus groups and a survey assessed food security status and personal characteristics of Cambodian women in Lowell, MA, USA. Multivariate logistic regression was used to examine relationships with food insecurity. Current rates of food insecurity are high. In multivariate models, food insecurity was positively associated with being depressed and being widowed, and negatively associated with higher income and acculturation. Early arrivers (1980s) had difficulty in the U.S. food system on arrival, while later arrivers (1990s-2000s) did not. Refugee agencies should consider strategically devoting resources to ensure successful early transition to the U.S. food environment and long-term food security of refugees. [ABSTRACT FROM AUTHOR]

An official goal of the Food Stamp Program (FSP) is to reduce household food insecurity, which the federal government measures using an 18-item survey module. This study combines features of "dose-response" and "participant/non-participant comparison" research designs to examine the impact of total income on individual food security items among 10,175 FSP participants and 144,372 non-participants using data from the 2001-2004 Current Population Surveys (CPS). We calculated the log odds of affirming 8 adult-specific items: worried food would run out, food bought didn't last, couldn't afford balanced meals, an adult cut or skipped meals, ate less, went hungry, lost weight, or did not eat for a whole day. FSP participants had higher odds of affirming each of the 8 items. As total income increased, the odds of affirming each of the 8 food security items decreased for FSP participants and non-participants. In addition, we measured "participant/non-participant difference" for a particular item as the log odds of affirmative response for participants at a particular total income level minus the log odds of affirmative response for non-participants at the same total income level. Across all income levels, the participant/non-participant difference was greatest for the least severe food security items, "worried food would run out" and "food bought didn't last" and smallest for the most severe, "did not eat for a whole day". [ABSTRACT FROM AUTHOR]

Introduction: While fruit and vegetables consumption has been linked to lower risk of chronic disease and obesity, there has not been any large-scale household study to demonstrate an association between fruit and vegetable consumption and healthy weight. Objective: This study analyzes the association between fruit and vegetable consumption and healthy family weight in Mexican families. Methods: The study estimated grams of fruit and vegetable consumption as a proportion of the total household food expenditure from 4,128 households in the Mexican Family Life Survey 2002. Households with pregnant women, underweight members or missing anthropometry measures were excluded from analysis. Remaining households were classified as either "healthy" or "not healthy" based on the presence or absence of an overweight/obese member. Result: Only 8.2% of the households were classified as having a "healthy weight", more so in the rural areas (9.2%) than the urban areas (7.0%) (p<0.05). The mean dietary intake from fruit and vegetable was 25.2±14.4%, and varied by region, p<.001. The conditional logistic regression odds ratio predicting household "healthy" weight status from intake from fruits and vegetables was 2.29, adjusted for socio-economic level, urban/rural area and adult equivalent (p<0.05). Conclusion: Fruit and vegetable consumption significantly predicts healthy family weight. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of prime age adult mortality (PAM) on child mortality and change annualized height-for-age Z-score (HAZ score) of children below eight years of age. The term "prime age" refers to adults between 15 to 54 years of age. Data: Four rounds of Ethiopia Rural Household Survey (ERHS) panel data set (1994-1997). Methods: This paper employed propensity score matching (PSM) with a difference in difference (DID) estimator to control for endogeneity of PAM to child survival and growth. Results: Bereavement (child living in a household with PAM) increased the probability of child mortality but did not significantly affect linear growth, conditional on survival. Bereavement increased the probability of death (but not growth) for both boys and girls, but girls fared worse than boys. Impact of bereavement on child survival but not linear growth was mediated through the relationship of the child to the household head. Becoming bereaved had a significant impact on the mortality probabilities of children only in the poorest tertile. Poorest surviving bereaved children grew half a standard deviation slower than their matched non-bereaved counterparts in the same economic group. The gender and position of the deceased did not affect the mortality and growth of bereaved children. Conclusion: Preventing PAM itself is an important policy strategy to improve children's health and longevity. [ABSTRACT FROM AUTHOR]

Objectives. We investigated Cambodian refugee women's past food experiences and the relationship between those experiences and current food beliefs, dietary practices, and weight status. Methods. Focus group participants (n=11) described past food experiences and current health-related food beliefs and behaviors. We randomly selected survey participants (n=133) from a comprehensive list of Cambodian households in Lowell, Massachusetts. We collected height, weight, 24-hour dietary recall, food beliefs, past food experience, and demographic information. We constructed a measure of past food deprivation from focus group and survey responses. We analyzed data with multivariate logistic and linear regression models. Results. Participants experienced severe past food deprivation and insecurity. Those with higher past food-deprivation scores were more likely to currently report eating meat with fat (odds ratio [OR]=1.14 for every point increase on the 9-to-27--point food-deprivation measure), and to be overweight or obese by Centers for Disease Control and Prevention (OR=1.28) and World Health Organization (OR=1.18) standards. Conclusions. Refugees who experienced extensive food deprivation or insecurity may be more likely to engage in unhealthful eating practices and to be overweight or obese than are those who experienced less-extreme food deprivation or insecurity. [ABSTRACT FROM AUTHOR]

Food insecurity is a daily reality for hundreds of millions of people around the world. Although its most extreme manifestations are often obvious, many other households facing constraints in their access to food are less identifiable. Operational agencies lack a method for differentiating households at varying degrees of food insecurity in order to target and evaluate their interventions. This chapter provides an overview of a set of papers associated with a research initiative that seeks to identify more precise, yet simple, measures of household food insecurity. The overview highlights three main conceptual developments associated with practical approaches to measuring constraints in access to food: 1) a shift from using measures of food availability and utilization to measuring "inadequate access"; 2) a shift from a focus on objective to subjective measures; and 3) a growing emphasis on fundamental measurement as opposed to reliance on distal, proxy measures. Further research is needed regarding 1) how well measures of household food insecurity designed for chronically food-insecure contexts capture the processes leading to, and experience of, acute food insecurity, 2) the impact of short-term shocks, such as major floods or earthquake, on household behaviors that determine responses to food security questions, 3) better measurement of the interaction between severity and frequency of household food insecurity behaviors, and 4) the determination of whether an individual's response to survey questions can be representative of the food insecurity experiences of all members of the household. [ABSTRACT FROM AUTHOR]

This paper compares a qualitative and a quantitative (Rasch) method of item assessment for developing the content of a food insecurity scale for Bangladesh. Data are derived from the Bangladesh Food Insecurity Measurement and Validation Study, in which researchers collected 2 rounds of ethnographic information and 3 rounds of conventional household survey data between 2001 and 2003. The qualitative method of scale development relied on content experts and respondents themselves to evaluate household food insecurity items generated through ethnographic research. The quantitative method applied the Rasch model to assess the fit of the same items using representative survey data. The Rasch model was then used to test for differential item functioning (DIF) across diverse demographic and geographic subgroups. The qualitative assessment flagged and discarded 10 items, leaving 13. The Rasch assessment of infit and outfit flagged 3 items, and the Rasch DIF test discarded another 10 items, leaving a total of 10 items in the Rasch-derived scale. The 2 scales contained 8 of the same items. The qualitatively and quantitatively derived scales were highly correlated (r = 0.96, P < 0.01), and the 2 methods located 90% of households in the same food insecurity tercile. This convergence lends added confidence to the use of either scale for identifying food-insecure households in different regions of Bangladesh. Multiple methods should continue to be applied in a systematic and transparent way to lend additional credence to the results when they converge and to pinpoint directions for further clarification where they do not. [ABSTRACT FROM AUTHOR]

Background There is a variety of specialized nutritious foods available for use in programs targeting undernutrition, but evidence supporting the choice of product is limited. Objectives We compared the cost-effectiveness of 4 specialized nutritious foods to prevent stunting and wasting in children aged 6–23 mo in Burkina Faso. Methods Four geographic regions were randomly assigned to 1 of 4 intervention arms: Corn-Soy Blend Plus (CSB+) programmed with separate fortified vegetable oil (the reference food), Corn-Soy-Whey Blend (CSWB; a new formulation) with oil, SuperCereal Plus (SC+), and ready-to-use supplementary food (RUSF). We compared the effects of each intervention arm on growth (length-for-age z score (LAZ), weight-for-length z score (WLZ), end-line stunting (LAZ < −2), and total monthly measurements of wasting (WLZ < −2). Rations were ∼500 kcal/d, distributed monthly. Children were enrolled in the blanket supplementary feeding program at age ∼6 mo and measured monthly for ∼18 mo. Average costs per child reached were linked with effectiveness to compare the cost-effectiveness of each arm with CSB+ with oil. Results In our sample of 6112 children (CSB+, n  = 1519; CSWB, n  = 1503; SC+, n  = 1564; RUSF, n  = 1526), none of the foods prevented declines in growth. Children in the SC+ and RUSF arms were not significantly different than those in the CSB+ with oil arm. Children in the CSWB with oil arm experienced higher end-line (measurement at age 22.9–23.9 mo) stunting (OR: 2.07; 95% CI: 1.46, 2.94) and more months of wasting (incidence rate ratio: 1.29; 95% CI: 1.09, 1.51). CSB+ with oil was the least-expensive ration in all costing scenarios ($113–131 2018 US dollars/enrolled child) and similar in effectiveness to SC+ and RUSF, and thus the most cost-effective product for the defined purposes. Conclusions CSB+ with oil was the most cost-effective ration in the prevention of wasting and stunting in this trial. This trial was registered at clinicaltrials.gov as NCT02071563. [ABSTRACT FROM AUTHOR]

Background A trial in Burkina Faso compared the cost-effectiveness of 4 specialized nutritious foods (SNFs) used to prevent stunting and wasting in children aged 6–23 mo. Objectives This article explores differences in SNF use that may have influenced effectiveness, specifically in relation to consumption by the recipient child and by any other person (i.e., sharing), other diversion from the recipient child, preparation, storage, and hygiene. Methods Subsamples from a geographically clustered, longitudinal trial with random assignment to Corn Soy Blend Plus with oil (CSB+ w/oil), Corn Soy Whey Blend with oil (CSWB w/oil), Super Cereal Plus (SC+), or ready-to-use supplementary food (RUSF) were selected for in-depth interviews, in-home observations, and focus group discussions. Results Sharing was common in all arms, with the highest reported in SC+ (73%) and highest observed in CSWB w/oil (36%). Some reported giving the ration away (highest in SC+ at 17%) or using it for other purposes (highest in CSWB w/oil at 17%). The recipient child was observed consuming the ration in 49% of households on average (38–60% by arm in CSB+ w/oil and RUSF, respectively). Qualitative reports of bitterness and spoilage emerged in the CSWB w/oil arm. Most observed households (excluding RUSF) did not prepare porridge daily as instructed (35–46% by arm). Household water samples showed either high-risk or unsafe contamination with Escherichia coli (72–78% by arm). Low percentages were observed handwashing (both child and server) before consuming the porridge. Conclusions The SNFs were not prepared or served as intended and diversion from the recipient was common. Storage conditions may have resulted in spoilage of the ration containing whey before reaching recipients. This article provides context about factors that may have influenced the effectiveness of these SNFs. Programming and household use of SNFs are as important as their nutrient composition. This trial was registered at clinicaltrials.gov as NCT02071563. [ABSTRACT FROM AUTHOR]