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Non-PR, IFPRI1; DCA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Diet-related risks cause 20% of global deaths (~11 million) per year (Afshin et al., 2019). Increased urbanization in low- and middle-income countries accompanied by a nutrition transition, involving increased consumption of unhealthy, processed foods and reductions in physical activity, has exacerbated diet-related risks, leading to increases in rates of overweight and obesity (Popkin et al., 2020). Diets in urban settings are also affected by the reduced time for food preparation, convenience and affordability of unhealthy foods. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to tackle these problems. FRANI was previously validated against observed weighed records, the gold standard for diet assessment, and shown to be as accurate as a trained dietician undertaking a standard, multi-pass 24-hr recall (Folson et al., 2023). FRANI was developed to also provide gamified nudges and personalized feedback designed to promote healthy food choices. The objectives of this study were to measure the acceptability, adherence, and likeability of FRANI, as well as its effects on the food choices of female youth in Accra, Ghana.

EgyptSSP, Nutrition, Diets, and Health (NDH); Development Strategies and Governance (DSG); AFR; Poverty, Gender, and Inclusion (PGI); LAC; DGO, The regional section of the 2024 Global Food Policy Report examines the evolving problem of malnutrition—including undernutrition, micronutrient deficiencies, and overweight and obesity—in low- and middle-income countries across the world’s major regions. Policy interventions are highlighted that address the particular challenges and opportunities in each region, with recommendations that aim to transform food systems to make healthier, more diverse, and more sustainable diets available, affordable, accessible, and desirable for everyone, including the most vulnerable.

Non-PR, IFPRI1; DCA; G Cross-cutting gender theme, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; Poverty, Gender, and Inclusion (PGI), Enhanced women's empower ment has been linked to im provements in various areas of women's lives, such as in creased access to resources, decision-making power, and a manageable workload. It can also have posi tive effects on child health out comes, including nutritional sta tus and early childhood develop ment. However, there can also be trade-offs for women, such as their own nutritional outcomes. While the relationship between women's empowerment and child health outcomes has been extensively studied, there is limited research on the relationship between women's empowerment and their own mental health, particularly in low- and middle-income countries (LMIC). One aspect of mental health, maternal depressive symptoms is prevalent in these countries and can have a negative impact on both the moth ers and their children. In Malawi, Stewart et al. (2010) find that 30 percent of mothers of young children, attending a child health clinic grapple with depressive epi sodes. In this study, we explore the relationship between women's empowerment, as measured by the pro-WEAI, and maternal depressive symptoms, as measured by the 20 symptom Self-Reported Ques tionnaire (SRQ-20). The Pro-WEAI is particularly useful because it allows us to explore the relationship of various components of women’s empowerment with maternal depressive symptoms.

Non-PR, IFPRI1; 2 Promoting Healthy Diets and Nutrition for all; Capacity Strengthening; DCA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Recent estimates suggest that diet related risk factors cause 11 million deaths every year, more than any other factor included in the Global Burden of Disease analyses. These risks have been exacerbated by trends associated with the “nutrition transition,” including increased consumption of unhealthy, processed foods and reductions in physical activity, leading to increases in rates of overweight and obesity. Up-to-date dietary intake data are essential for the development of evidence-based nutrition actions. However, dietary data collection and analysis is complex and expensive. Dietary assessment surveys commonly use the multi pass 24-hour recall (24HR) method that has been validated for use in adults self-reporting their intake and/or that of their young children, and in adolescents. The costs of undertaking a 24HR are of the order of $500 per recall.

PR, IFPRI3; DCA; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; ISI; CRP4, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Bolstering farm-level crop diversity is one strategy to strengthen food system resilience and achieve global food security. Women who live in rural areas play an essential role in food production; therefore, we aimed to assess the associations between women's empowerment and crop diversity. Methods: In this secondary analysis of cross-sectional data, we used data from four cluster-randomised controlled trials done in Burkina Faso, India, Malawi, and Tanzania. We assessed women's empowerment using indicators from the Women's Empowerment in Agriculture Index. Farm-level crop diversity measures were the number of food crops grown, number of food groups grown, and if nutrient-dense crops were grown. We used a two-stage modelling approach. First, we analysed covariate-adjusted country-specific associations between women's empowerment and crop diversity indicators using multivariable generalised linear models. Second, we pooled country-specific associations using random-effects models. Findings: The final analytic sample included 1735 women from Burkina Faso, 4450 women from India, 547 women from Malawi, and 574 women from Tanzania. Across all countries, compared with households in which women provided input into fewer productive decisions, households of women with greater input into productive decisions produced more food crops (mean difference 0·36 [95% CI 0·16–0·55]), a higher number of food groups (mean difference 0·16 [0·06–0·25]), and more nutrient-dense crops (percentage point difference 3 [95% CI 3–4]). Across all countries, each additional community group a woman actively participated in was associated with cultivating a higher number of food crops (mean difference 0·20 [0·04–0·35]) and a higher number of food groups (mean difference 0·11 [0·03–0·18]), but not more nutrient-dense crops. In pooled associations from Burkina Faso and India, asset ownership was associated with cultivating a higher number of food crops (mean difference 0·08 [0·04–0·12]) an

PR, IFPRI3; ISI; CRP4; Capacity Strengthening; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors an

PR, IFPRI3; ISI; DCA; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all; CRP4, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2−4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15−49 years with an index child aged 2−4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04−0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03−0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.

PR, IFPRI3; ISI; IFPRIOA; CRP4; DCA; SELEVER; 2 Promoting Healthy Diets and Nutrition for all; 3 Building Inclusive and Efficient Markets, Trade Systems, and Food Industry; Cross-cutting gender theme; Women’s Empowerment in Agriculture Index, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Understanding the types of food systems interventions that foster women's empowerment and the types of women that are able to benefit from different interventions is important for development policy. SELEVER was a gender- and nutrition-sensitive poultry production intervention implemented in western Burkina Faso from 2017 to 2020 that aimed to empower women. We evaluated SELEVER using a mixed-methods cluster-randomized controlled trial, which included survey data from 1763 households at baseline and endline and a sub-sample for two interim lean season surveys. We used the multidimensional project-level Women's Empowerment in Agriculture Index (pro-WEAI), which consists of 12 binary indicators, underlying count versions of 10 of these, an aggregate empowerment score (continuous) and a binary aggregate empowerment indicator, all for women and men. Women's and men's scores were compared to assess gender parity. We also assessed impacts on health and nutrition agency using the pro-WEAI health and nutrition module. We estimated program impact using analysis of covariance (ANCOVA) models and examined whether there were differential impacts by flock size or among those who participated in program activities (treatment on the treated). Program impacts on empowerment and gender parity were null, despite the program's multipronged and gender-sensitive approach. Meanwhile, results of the in-depth gender-focused qualitative work conducted near the project mid-point found there was greater awareness in the community of women's time burden and their economic contributions, but it did not seem that awareness led to increased empowerment of women. We reflect on possible explanations for the null findings. One notable explanation may be the lack of a productive asset transfer, which have previously been shown to be essential, but not sufficient, for the empowerment of women in agricultural development programs. We consider these findings in light of current debates on asset transfer

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; G Cross-cutting gender theme; ISI; IFPRIOA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Development programs often rely on women’s participation. However, there is little evidence of whether development programs that engage women’s unpaid labor – particularly in care work – add to their time burdens. We tested this hypothesis on a nutrition-sensitive agriculture program delivered through community-based preschools in Malawi. The mixed-methods study was conducted over one year using data from 1,168 female caregivers from a cluster-randomized control trial. A longitudinal binomial logistic regression model was used to estimate the proportion of time spent caregiving in a 24-hour period (expressed as minutes) at baseline and then separately for each treatment group at 6-months and 1-year post-randomization. In addition, two rounds of 38 qualitative in-depth interviews (n = 76) were conducted with women, men and adolescent girls to explore their perceptions of program activities, time use and gender attitudes. We found that the program quantitatively increased daily caregiving time for participating women by approximately 30 min. However, this effect occurred only during the lean season when preschool scale-up investments increased. Qualitatively, program-related tasks were not considered burdensome. Moreover, participants saw contributions as important investments in their children’s development. These findings add to limited evidence of the impacts of nutrition-sensitive agricultural programs and early childhood interventions on women’s time use. Measuring women’s participation through mixed-method evaluations can aid interpretation to avoid harm and to better understand the tradeoffs of women’s time.

PR, IFPRI3; ISI; DCA; CRP2; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 5 Strengthening Institutions and Governance, PIM; Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy, CGIAR Research Program on Policies, Institutions, and Markets (PIM); CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities, and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally-disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda.

Non-PR, IFPRI1; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good; DCA, PHND, This Food Atlas provides a photograph series of 68 meals commonly consumed by adolescent girls in Accra, Ghana. It consists of pictures of four portion sizes per meal, including weights. The main aim of this Food Atlas is to enable accurate portion-size estimation; during food consumption surveys, these images can be shown to respondents to aid them in describing the quantity of food consumed. The Food Atlas can also to aid in estimating, quantifying, educating, and counseling on appropriate portions of food in order to help improve dietary intake. The meals were chosen using data collected during a previous study conducted at the Department of Nutrition, NMIMR, “Dietary Patterns and Cardio-metabolic Risk in Urban Dwelling Adolescents” (IRB Study Number 001/17-18), aimed at understanding the eating patterns, physical activity levels and their association with measures of adiposity, blood pressure, and fasting blood sugar among adolescents between ages 10 and 17. All recipes were compiled with the aid of a professional caterer who had experience cooking for adolescents in a school setting.

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; G Cross-cutting gender theme; CRP4; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Objective: Though there is a wide array of evidence that women's empowerment is associated with more positive health and nutritional outcomes for women and children, evidence around the relationship with mental health or subjective well-being remains relatively limited. The objective of this paper is to explore this relationship in longitudinal data from rural Burkina Faso. Methods: We analyze the association between empowerment measured using the project-level Women's Empowerment in Agriculture Index (pro-WEAI), and two additional outcomes of interest: stress (measured using the SRQ-20) and maternal depression (measured using the Edinburgh scale for post-partum depression). The analysis employs both cross-sectional specifications and panel specifications conditional on individual fixed effects.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Investments in social assistance programmes (SAPs) have accelerated alongside interest in using SAPs to improve health and nutrition outcomes. However, evidence of how design features within and across programme types influence the effectiveness of SAPs for improving diet and nutrition outcomes among women and children is limited. To address this, we reviewed evaluations of cash, in-kind and voucher programmes conducted between 2010 and 2020 among women and children, and examined associations between design features (targeting, including household and individual transfers, fortified foods and behaviour change communication) and positive impacts on diet (diet diversity, micronutrient intake) and nutrition (anthropometric indicators, haemoglobin, anaemia) outcomes. Our review has several key findings. First, SAPs improve dietary diversity and intake of micronutrient-rich foods among women and children, as well as improve several nutrition outcomes. Second, SAPs were more likely to impact diet and nutrition outcomes among women compared with children (23/45 [51%] vs. 52/144 [36%] of outcomes measured). Third, in-kind (all but one of which included fortified foods) compared with cash transfer programmes were more likely to significantly increase women's body mass index and children's weight-for-height/length Z-score, and both women's and children's haemoglobin and anaemia. However, there is limited evidence on the effectiveness of SAPs for improving micronutrient status and preventing increased prevalence of overweight and obesity for all populations and for improving diet and nutrition outcomes among men, adolescents and the elderly. Further research in these areas is urgently needed to optimize impact of SAPs on diet and nutrition outcomes as countries increase investments in SAPs.

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; CRP4; IFPRIOA; Nudging for Good, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good; IFPRIOA, PHND, Background: There is a gap in data on dietary intake of adolescents in low- and middle-income countries. Traditional methods for dietary assessment are resource intensive and lack accuracy with regards to portion size estimation. Technology assisted dietary assessment tools have been proposed but few have been validated for feasibility of use in LMICs. Objectives: We assess the relative validity of FRANI (Food Recognition Assistance and Nudging Insights), a mobile Artificial Intelligence (AI) application for dietary assessment in adolescent females (n = 36) aged 12–18y in Vietnam, against weighed records (WR) standard, and compared FRANI performance to a multi-pass 24-hour recall (24HR).

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND, Unhealthy diets are a critical global concern while dietary measure methods are time consuming and expensive. There is limited evidence that phone-based interventions can improve nutrition data collection and dietary quality, especially for adolescents in developing countries. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to address these problems. FRANI can recognize foods in images, track food consumption, display statistics and use gamified nudges to give positive feedback on healthy food choice. This study protocol describes the design of new pilot studies aimed at measuring the feasibility (acceptability, adherence, and usability) of FRANI and its effects on the quality of food choice of adolescents in Ghana and Vietnam. In each country, 36 adolescents (12–18 years) will be randomly allocated into two groups: The intervention group with the full version of FRANI and the control group with the functionality limited to image recognition and dietary assessment. Participants in both groups will have their food choices tracked for four weeks. The control groups will then switch to the full version of FRANI and both groups will be tracked for a further 2 weeks to assess acceptability, adherence, and usability. Analysis of outcomes will be by intent to treat and differences in outcomes between intervention and control group will use Poisson and odds ratio regression models, accounting for repeated measures at individual levels. If deemed feasible, acceptable and usable, FRANI will address gaps in the literature and advance the nutrition field by potentially improving the quality of food choices of adolescent girls in developing countries. This pilot study will also provide insights on the design of a large randomized controlled trial. The functioning and dissemination of FRANI can be an important step towards highly scalable nutrition data collection and healthier food choices for a popu

Non-PR, IFPRI1; CRP4; 3 Building Inclusive and Efficient Markets, Trade Systems, and Food Industry; DCA; Women’s Empowerment in Agriculture Index; G Cross-cutting gender theme, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Understanding the types of food systems interventions that foster women’s empowerment and the types of women that are able to benefit from different interventions is important for development policy. SELEVER was a gender- and nutrition-sensitive poultry production intervention implemented in western Burkina Faso from 2017 to 2020 that aimed to empower women. We evaluated SELEVER using a mixed-methods cluster-randomized controlled trial, which included survey data from 1763 households at baseline and endline and a sub-sample for two interim lean season surveys. We used the multidimensional project-level Women’s Empowerment in Agriculture Index (pro-WEAI), which consists of 12 binary indicators, underlying count versions of 10 of these, an aggregate empowerment score (continuous) and a binary aggregate empowerment indicator, all for women and men. Women’s and men’s scores were compared to assess gender parity. We also assessed impacts on health and nutrition agency using the pro-WEAI health and nutrition module. We estimated program impact using analysis of covariance (ANCOVA) models and examined whether there were differential impacts by flock size or among those who participated in program activities. Program impacts on empowerment and gender parity were null, despite the program’s careful approach to developing a gender-sensitive intervention. Meanwhile, results of the in-depth gender-focused qualitative work conducted near the project mid-point found there was greater awareness in the community of women’s time burden and their economic contributions, but it did not seem that awareness led to increased empowerment of women. We reflect on possible explanations for the null findings. One notable explanation may be the lack of a productive asset transfer, which have previously been shown to be essential, but not sufficient, for the empowerment of women in agricultural development programs. We consider these findings in light of current debates on asset transfers. Unfo

PR, DCA; IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; Capacity Strengthening; CRP4; ISI, A4NH; PHND, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Bangladesh struggles with undernutrition in women and young children. Nutrition-sensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of multisectoral programmes. This study estimates the economic costs of the Targeting and Re-aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women's income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro-costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5-year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture-nutrition intervention implemented through a microcredit platform. Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.

PR, IFPRI3; CRP2; ISI; DCA, PHND; PIM, CGIAR Research Program on Policies, Institutions, and Markets (PIM), A critical, yet underexplored, dimension of food systems is how consumer food preferences and beliefs interact with the food environment. We present a consumer-centered approach to identifying options for improving diets. The Value Chains for Nutrition (VCN) mixed-methods multi-disciplinary analytical approach was applied in rural Ghana. Data from in-depth consumer interviews, structured vendor interviews, and (secondary) household consumption surveys were analyzed to assess consumer diet patterns, related norms and preferences, and supply and demand characteristics of a set of empirically defined high-potential nutritious foods. Mapping results onto a supply–demand typology, we identify promising interventions to support increased availability, access, and affordability of these foods. Consumption data suggested that diets among Ghanaians were deficient in key micronutrients and calories. Fresh nutritious fruits and vegetables tended to be grown for home consumption rather than sale due to transportation challenges and seasonality of demand, especially near rural markets. Seasonal availability (fruits and vegetables) and affordability (animal foods) severely limited consumption of many nutritious foods. A set of supply, demand, and value chain interventions to enhance availability and affordability of nutritious foods are presented. Critical to success is to consider the set of interventions along each value chain required for impact.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; DCA; SELEVER; IFPRIOA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: SELEVER is a nutrition- and gender-sensitive poultry value chain project designed and implemented by international NGO Tanager which consists of poultry market facilitation and behavior change activities aiming at increasing poultry production and improving diets without free inputs transfer. Objectives: The study aimed at assessing the impact of SELEVER on diets of women and children during the lean season. Methods: Within a cluster-randomized controlled trial, 45 communes were assigned to one of three arms, including 1) SELEVER interventions; 2) SELEVER with an intensive hygiene and sanitation component (SELEVER + WASH); and 3) a control group without intervention. Two rounds of survey were conducted 2 years apart during the lean season. Primary dietary outcomes were the probability of adequacy (PA) of iron, zinc and vitamin A intakes, mean PA (MPA) of 11 micronutrients and individual dietary diversity score collected through quantitative 24-hour recall in longitudinal samples of women and index children (2–4 years old) in 1,054 households; and minimum acceptable diet in the repeated cross-sectional sample of their younger sibling aged 6–23 months. Impacts were assessed by intention-to-treat analysis of covariance. Results: Relative to control, SELEVER interventions (groups 1 + 2) increased the PA of iron intakes in women by 1.8 pp (P = 0.030). We found no further impact on primary outcomes, although eggs consumption increased in index children (+0.73 pp, P = 0.010; +0.69 kcal/d, P = 0.036). Across the three groups, we observed negative effects of SELEVER on the PA of zinc intakes in women relative to SELEVER + WASH (-4.1 pp, P = 0.038), and on a variety of secondary dietary outcomes relative to both other groups. The study was registered on the ISCRCTN registry (ISRCTN16686478). Conclusions: information-only-based value-chain interventions may not have meaningful positive effects on diets of women and children in the lean season in settings with large

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Low-quality diets contribute to the burden of malnutrition and increase the risk of children not achieving their developmental potential. Nutrition-sensitive agriculture programs address the underlying determinants of malnutrition, though their contributions to improving diets do not factor into current nutrition impact modeling tools. Objective: To synthesize the evidence on the effectiveness of nutrition-sensitive agriculture programs in improving dietary diversity in young children (6-23.9 months and 6-60 months). Methods: A literature search was conducted for published trials through existing systematic reviews and individual database search of the ISI Web of Science. All dietary diversity measures in the studies selected to be in the analysis were extracted. Estimation of main pooled effects were conducted on outcomes of minimum diet diversity (MDD) and diet diversity score (DDS) using random-effects meta-regression models. We report pooled effect sizes as standardized mean differences (SMDs) or odds ratios (ORs). Results: Nutrition-sensitive agricultural interventions have a significant positive impact on the diet diversity scores of children aged 6-23.9 months (SMD = 0.22, 95% confidence interval (CI) = 0.09-0.36) and on the odds of reaching minimum diet diversity (OR = 1.45, 95% CI = 1.20, 1.76). Similar impacts are found when analyses are expanded to include studies for children aged 6-60 months (DDS SMD = 0.22, 95% CI = 0.12-0.32) (MDD OR = 1.64, 95% CI: = 1.38-1.94). Conclusion: Nutrition-sensitive agriculture interventions consistently have a positive impact on child dietary diversity. Incorporating this evidence in nutrition modeling tools can contribute to decision-making on the relative benefits of nutrition-sensitive interventions as compared with other maternal, newborn, child health and nutrition (MNCHN) interventions.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; DCA; Capacity Strengthening, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This paper reports on the effects of a training-based intervention seeking to increase household engagement in poultry production in Burkina Faso, analyzing data from a large-scale cluster randomized trial in which 1798 households in 60 communes were observed over a period of three years. The intervention SELEVER — entailing a short series of trainings for households as well as capacity building for local animal health and credit services — had little effect on household poultry production and no effect on profits. There is some evidence of an increase in the utilization of poultry inputs and an associated reduction in poultry mortality, primarily for larger poultry producers; however, there is no evidence of any treatment effects for the smallest producers.

PR, IFPRI3; ISI; DCA; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; Capacity Strengthening; SELEVER; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2−4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15−49 years with an index child aged 2−4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04−0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03−0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Simple proxy indicators are needed to assess and monitor micronutrient intake adequacy of vulnerable populations. Standard dichotomous indicators exist for nonpregnant women of reproductive age and 6–23-mo-old children in low-income countries, but not for 24–59-mo-old children or pregnant or breastfeeding women. Objectives: This study aimed to evaluate the performance of 2 standard food group scores (FGSs) and related dichotomous indicators to predict micronutrient adequacy of the diet of rural Burkinabe 24–59-mo-old children and women of reproductive age by physiological status. Methods: A 24-h recall survey was conducted at dry season among 1066 pairs of children and caregivers. Micronutrient adequacy was evaluated by the mean probability of adequacy (MPA) of intake over 11 micronutrients. Proxy indicators were FGS-10 [10 food groups based on the FAO/FHI360 minimum dietary diversity for women (MDD-W) guidelines] and related MDD-W (FGS-10 ≥5); and FGS-7 [7 groups based on the WHO infant and young child (IYC) feeding MDD guidelines] and related MDD-IYC (FGS-7 ≥4). Results: FGS-10 and FGS-7 were similar across children and women (∼3 groups). FGS-10 performed better than FGS-7 to predict MPA in children (Spearman rank correlation = 0.59 compared with 0.50) and women of all 3 physiological statuses (Spearman rank correlation = 0.53–0.55 compared with 0.42–0.52). MDD-W and MDD-IYC performed well in predicting MPA >0.75 in children and MPA >0.6 in nonpregnant nonbreastfeeding (NPNB) women, but a 4-group cutoff for FGS-10 allowed a better balance between sensitivity, specificity, and proportion of correct classification. MPA levels for pregnant and breastfeeding women were too low to assess best cutoff points. Conclusions: MDD-IYC or an adapted MDD-W (FGS-10 ≥4 instead of FGS-10 ≥5) can be extended to 24–59-mo-old children and NPNB women in similar-diet settings. The inadequacy of micronutrient intakes in pregnant and breastfeeding women warrants urgent action

Non-PR, IFPRI1; CRP4; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This Food Atlas provides a photograph series of the 360 meals most commonly eaten by adolescent girls in Thai Nguyen, Viet Nam. It was developed using calibrated portion sizes and standardized methods and consists of pictures, recipes, and portion sizes per meal, including weights. The purpose of this Food Atlas is to improve the accuracy of portion-size estimation during food consumption surveys. The images can be shown to respondents to help them accurately describe the amount of food consumed. The meals were selected using previous food consumption surveys aimed at understanding the eating patterns of urban girls between ages 15 and 17, as well as from traditional cookbooks and national food composition tables. A rapid school survey of 290 teenage girls was also used in Thai Nguyen to refine the final list of 360 meals. When recipes were not available from existing sources for particular meals, the cooking team collected the ingredients and developed recipes based on food composition tables developed by Viet Nam’s National Institute of Nutrition (NIN). Some recipes were also collected from street vendors when other sources did not provide sufficient information. When many recipes were available for a particular meal, the project team prepared and photographed the three most common recipes, prioritizing the preparations used by street vendors. For dishes with varying ingredients, the distribution of ingredient variations from past surveys was tabulated, and the most common ingredient variations were prepared, weighed, and photographed.

Non-PR, IFPRI1; DCA; CRP4; 3 Building Inclusive and Efficient Markets, Trade Systems, and Food Industry; 4 Transforming Agricultural and Rural Economies; CRP2; GSSP, PHND; A4NH; PIM, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH); CGIAR Research Program on Policies, Institutions, and Markets (PIM), Social protection programs such as cash or food transfers support current poverty and inequality reduction goals, while at the same time enhance future productivity through human capital investments. Yet, the quantification of their overall productivity and equity benefits is challenging. We address this question utilizing a new methodology that quantifies productivity gains from learning as well as an approach for assessing social protection benefits. We do so by combining data on distributional benefits stemming from current poverty reduction in conjunction with future human capital gains in the context of a large-scale national school feeding program in Ghana. We develop a straightforward approach to map effect sizes from randomized controlled studies into broader economic analyses. In addition, we include the often recognized, but seldom quantified, distributional impacts of multi-sectoral investments. Our methodology is relevant to a broad range of social protection programs that have multidimensional benefits spanning both human capital improvements and equity gains.

Non-PR, IFPRI1; CRP2; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies, PHND; A4NH; PIM, CGIAR Research Program on Policies, Institutions, and Markets (PIM); CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Enhancing women’s participation in agricultural production, including livestock production, has the potential to generate a range of benefits for rural households in the developing world. These benefits include enhanced economic welfare, investment in children’s health and nutrition, and empowerment for women. However, attitudes and norms may shape the ability of women to engage in a broader range of productive activities if those activities are not viewed as traditionally female domains. The attitudes of women themselves and their husbands may be particularly salient: if women do not view livestock production as an appropriate activity to pursue based on their perception of community norms, they may not be responsive to economic incentives designed to encourage their involvement. Similarly, if husbands do not view ownership and control over assets or the sale of agriculture as appropriate roles for their wives, it may be very challenging for women to maintain or increase their role in household agricultural production.

Non-PR, IFPRI1; CRP2; CRP4; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies; Capacity Strengthening, PHND; A4NH; PIM, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH); CGIAR Research Program on Policies, Institutions, and Markets (PIM), In complex nutrition-sensitive interventions, separately identifying the effect of each programmatic component on the outcomes of interest can be challenging. This paper examines the relationship between participation in different elements of the nutrition-sensitive intervention SELEVER, implemented in rural Burkina Faso with the objective of increasing poultry production and enhancing related nutritional outcomes, and women’s poultry production. We use structural equation modeling to estimate the direct effect of each component of program participation. Our findings suggest that respondents’ directly reported participation in SELEVER intervention activities mediates less than half of the observed intervention effects on poultry owned by women as well as women’s revenue and profits from poultry production. Accordingly, other indirect channels for program effects also seem to be important.

Non-PR, IFPRI2; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Investments in social assistance programs (SAPs) in low- and middle-income countries (LMICs) are increasing. As investments increase, the objectives of these programs are expanding from focusing on reducing poverty to addressing other social issues such as improving diets and nutrition. At the same time, there is increasing interest in addressing all forms of malnutrition within the framework of food systems. Given the intersections between SAPs and food systems, we reviewed the effectiveness of SAPs (agriculture asset transfers, cash transfers, in-kind transfers, vouchers, public works and school meals programs) for reducing all forms of malnutrition across the lifecycle within a food systems framework. As several programs included multiple treatment arms, each representing a unique program design, we used study arm as the unit of analysis and assessed the proportion of study arms with positive or negative program impacts on diet and nutrition outcomes among men, women and children. The majority of the studies included in this review were from evaluations of agriculture asset, cash and in-kind transfer programs. There was clear evidence of positive impacts on women’s and children’s diet-related outcomes. Very few studies assessed program impact on women’s nutritional status outcomes. However, there was some evidence of impacts on increasing body mass index and hemoglobin concentration (Hb) with in-kind transfer programs. Among children, several study arms across the agriculture asset, cash and in-kind transfer programs found positive impacts on increasing height-for-age Z-score (33%-45% of study arms) and weight-for-height Z-score (33%-50% of study arms) and decreasing the prevalence of wasting (43%-60% of study arms). Cash and in-kind transfer programs also found positive effects on reducing stunting prevalence in 33% and 45% of study arms, respectively. Lastly, a few study arms assessed program impact on increasing Hb with some evidence of positive impacts in in

Non-PR, IFPRI1; DCA; CRP4, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Governments and international development partners investing over $40 USD billion a year in school meals have shown interest in linking these programs with agriculture sector development, through what has become known as “Home-Grown” school feeding (HGSF). Nevertheless, evidence on the effectiveness of HGSF and agriculture is limited. This article reports on the findings of a three-year cluster randomized trial implemented in 58 districts of Ghana including a panel of 1,668 households. Communities were randomly assigned to 1) standard school meals; 2) HGSF or 3) control with no intervention. Post-intervention, the caterer-level analysis highlighted major challenges related to delayed program disbursements, resulting in a mismatch between budgeted and actual caterer outlay on food purchases per pupil equivalent to approximately 50% of the budgeted per child per day allocation. For caterers, by far the largest procurement channel was through traders, though there is evidence that HGSF may have increased the share of value purchased directly from smallholders. We find no strong evidence that the school feeding program or HGSF affected smallholders market structure, farm, non-farm and household income. When interpreting these null results, it is important to consider the findings of two parallel studies that showed positive effects of this national program on school children’s learning, cognition, and nutrition outcomes. The national program can still be considered as an effective social protection strategy with multiple objectives, even if the agriculture objectives remain aspirational.

Non-PR, IFPRI1; CRP2; DCA, PHND; PIM, CGIAR Research Program on Policies, Institutions, and Markets (PIM), We assess the impact of conflict exposure on households’ food security in rural areas of Mopti, Mali over the period 2012-17. Our main data source is a unique panel dataset of 1,617 households for which the baseline round was collected before the conflict broke out. We estimate the impact of conflict with a weighted difference-in-differences approach. We find that exposure to high level of conflict-related fatalities within a radius of 50km leads to a reduction of daily calorie intake per adult equivalent of 311 kcal (0.39 SD) and a reduction of dietary diversity score by one food group (0.56 SD). The presence of armed groups leads to lower dietary diversity (by 1.2 food group) but has no independent effect on calories. The negative impact of conflict on dietary diversity is concentrated on households with higher scores at baseline. We also estimate whether receiving food assistance mitigates the impact of conflict. We find that school-feeding protects households facing intense conflict by supporting calorie intake.

Non-PR, IFPRI2; CRP2; GSSP; 2 Promoting Healthy Diets and Nutrition for all; 4 Transforming Agricultural and Rural Economies, DSGD; PHND; PIM, CGIAR Research Program on Policies, Institutions, and Markets (PIM), This publication presents an in-depth analysis of the food system in Ghana with the dual purpose of providing an overview of the current situation, and identifying opportunities for leveraging the role of small and medium-sized enterprises for nutrition-sensitive food systems. The data collected and the results of the analysis enhance the understanding of some of the challenges that, in the Ghanaian context, contribute to determining diet-related issues; more importantly, the analysis identifies opportunities and entry points for improving diets by overcoming some of the challenges faced by small and medium-sized enterprises. The information provided could be of support not only for further analyses, but also for planning interventions and designing policies to improve nutrition in Ghana and in other contexts.

Non-PR, IFPRI1; DCA; CRP4; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), Background: Low quality diets are a public health problem affecting individuals of all ages worldwide. Nudging for Good (NFG) is a new research project aimed at developing, validating, and examining the feasibility of using artificial intelligence (AI)-based technology to improve adolescent girls' diets in urban Ghana and Vietnam. Objectives: Provide evidence to support the design of a new mobile phone intervention including: a) identifying the demand for mobile app to improve diets in adolescent girls; b) defining the intervention objectives and activities to be delivered via a mobile app; and c) assessing the potential for nudging functionality to be incorporated in the mobile app. Methods: This study used mixed methods including both literature and nutrition-related app reviews, as well as focus group discussions. A literature review was conducted using PubMed and Google Scholar databases, and intervention studies using technology to improve nutrition outcomes of adolescents were included. Nine focus group discussions (five in Ghana and four in Vietnam) were undertaken with 61 girls to gauge smartphone and internet access and use and to obtain feedback on the prototype of a mobile app. Results: Nine studies met the selection criteria for the literature review, including seven randomized control trials (RCTs) and two systematic reviews. The evidence from the literature on how technology-based nutrition interventions should be conducted and what should be the best outcomes of success was mixed. Most of the 22 apps reviewed required manual entry of dietary information, and recommended diets based on motivation to change body weight. In the focus groups discussions, the adolescents suggested modifications on the prototype of the mobile app we presented, and indicated possibility to regularly take pictures of foods and beverages during meal time. Conclusion: We did not find an app available in either the Ghana or Vietnam markets that could improve dietary quality of a

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI4; G Cross-cutting gender theme, PHND, Vulnerable groups have been most affected by disruption to food systems, such as lockdowns, through loss of employment and incomes. Social protection has a key role to play in times of health and economic shocks. KEY MESSAGES - Poverty, poor health, and malnutrition not only result from pandemic stresses, but they also contribute to pandemic-related risks that impact wellbeing and worsen existing inequities. - Vulnerable groups have been most affected by disruptions to food systems, such as lockdowns, through loss of employment and incomes. - The urban poor, especially informal workers and women, have likely borne the brunt of health and employment impacts. Refugees and internally displaced persons have also been disproportionately affected. - Men, women, and children experience different risks and stresses. Women have been more likely to experience increased domestic violence and food insecurity, reduced autonomy, and loss of income. - Social protection is critical for supporting vulnerable groups, and has expanded to an unprecedented degree. But many people were still left without coverage, and programs were rarely gender sensitive.

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

Non-PR, IFPRI1; CRP4; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all; SELEVER, MTID; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Poultry rearing is widespread in rural Burkina Faso, and contributes to both the food security and cash income of smallholders farmers. The landlocked status of the country, coupled with increasing demand for poultry in urban areas implies an opportunity for significant, pro-poor growth through this sector. We use data from a survey of 1800 poultry producers to characterize smallholder poultry producers and their practices. We find that 88% of households in program areas raised poultry. While access to vaccination services and veterinary medicines at the village level is high, uptake of these services is limited, especially among smaller producers. Fewer women than men own poultry, but most women report that they control the proceeds from sales of their own birds, indicating the potential for development of the poultry sector to generate relatively equitable gains in terms of gender. Access to credit appears to increase women’s poultry ownership, but remains limited, as does women’s access to poultry output markets.

Non-PR, IFPRI1; DCA; CRP4; 3 Building Inclusive and Efficient Markets, Trade Systems, and Food Industry; 4 Transforming Agricultural and Rural Economies; 5 Strengthening Institutions and Governance; G Cross-cutting gender theme; Capacity Strengthening; SELEVER, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), This article reports on a cluster-randomized controlled trial conducted in 120 villages in rural Burkina Faso evaluating a multifaceted intervention (SELEVER) that seeks to increase poultry production by delivering training in conjunction with the strengthening of village-level institutions providing veterinary and credit services to poultry farmers. The intervention is evaluated in a sample of 1,080 households surveyed following two years of program implementation. Households exposed to the intervention significantly increase their use of poultry inputs (veterinary services, enhanced feeds, and deworming), and report more poultry sold and higher revenue; however, there is no evidence of an increase in profits. This evidence is consistent with the hypothesis that the return to inputs in the poultry market may not be sufficient to counterbalance the market costs of these inputs.

Non-PR, IFPRI1; SELEVER; CRP4; GAAP; 2 Promoting Healthy Diets and Nutrition for all; G Cross-cutting gender theme; DCA; Capacity Strengthening, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), The SELEVER study is a five-year impact evaluation designed to address key knowledge gaps on the impact of a poultry value chain intervention on the diets, health, and nutritional status of women and children in Burkina Faso. This report uses qualitative methods to examine gendered participation in poultry value chains, the gendered opportunities and barriers experienced in poultry value chains, and the SELEVER program’s impact on these factors. A previous report (Eissler et al., 2020) based on the same fieldwork covered questions relating to local understandings of empowerment and dynamics of household food production and allocation. Six villages across five provinces were purposively selected for this study. Data were collected using multiple qualitative methods. In each village, we conducted four sex-disaggregated focus group discussions and semi-structured individual interviews with a man and a woman from two different households. Sex-disaggregated seasonal calendars were created for half of the villages. Interviews were also conducted with project service providers in each community, including group leaders (n=13), voluntary vaccinators (n=10), and poultry traders (n=6). A mix of inductive and deductive coding guided the thematic analysis of the data. The results indicate that while women in the study areas do engage in agricultural labor and various income-generating activities, they must prioritize their domestic responsibilities. Men are primarily responsible for providing staple food ingredients (e.g. grains or meat) for household consumption and earning the primary income, which often requires them to engage in seasonal migration. Men are increasingly aware of women’s time and unpaid labor burdens, and have started sharing in these tasks, a shift in which participants attribute to SELEVER. Additionally, we find that SELEVER has increased women’s capacity and opportunity to engage in poultry value chain activities while reducing barriers to their participat

Non-PR, IFPRI1; DCA; CRP4; GAAP; 2 Promoting Healthy Diets and Nutrition for all; G Cross-cutting gender theme; SELEVER; UNFSS, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), The SELEVER study is a five-year impact evaluation designed to address key knowledge gaps on the impact of a poultry value chain intervention on the diets, health, and nutritional status of women and children in Burkina Faso. This report qualitatively examines the SELEVER program’s impact on women’s empowerment and intra-household gender dynamics in relation to food production and allocation, as well as control and use over poultry resources in the study areas. Six villages across five provinces were purposively selected for this study. Data were collected using multiple qualitative methods. In each village, we conducted four sex-disaggregated focus group discussions, and semi-structured individual interviews were held with a man and a woman from two different households. Sex-disaggregated seasonal calendars were created for half of the villages. Interviews were also conducted with project service providers in each community, including group leaders (n=13), voluntary vaccinators (n=10), and poultry traders (n=6). A mix of inductive and deductive thematic coding guided the analysis of the data. Men and women participants described an empowered woman in terms of her confidence, how she spent her time, financial capacity, and freedom of movement. SELEVER beneficiaries illuminated how gender norms were shifting related to household activities and women’s empowerment, such that young boys are now washing dishes and women earn additional incomes from raising her own poultry. Yet results suggest that women’s empowerment may threaten men and their masculinity, an important tension of which SELEVER and other projects should be cognizant. Participants perceived that while SELEVER has increased women’s access to the necessary resources and capacity to raise quality poultry, and their incomes, women still lack full latitude to make decisions around when to sell or kill their bird. Instead they must rely on their husbands’ permission. Beneficiaries are more aware of the benefits

PR, IFPRI3; ISI; MaSSP; CRP4; DCA; UNFSS, PHND; A4NH; DSGD, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Governments and development partners looking to accelerate progress in addressing malnutrition have been examining how to use interventions in value-chains to improve diets. However, the links between interventions in value chains and diets involve a range of direct and indirect effects that are not yet well understood. We apply a mixed-method multisectoral diagnostic to examine potential interventions in food systems to improve diets of smallholder farmers in Malawi. We examine entry points for interventions involving public and private-sectors, and explore the methodological requirements for undertaking this type of multisectoral analysis. We find that although food consumption is dominated by maize, a range of nutritious foods are also being consumed; including leafy greens, fruits, chicken, dried fish, dried beans and peas, and groundnuts. Yet important deficits in nutrient intake remain prevalent in low-income households due to inadequate quantity of consumption. While increasing consumption through own-production is one potentially important channel to increase quantity of nutritious foods available (particularly fruits and leafy green vegetables), markets also play a potentially important role. Nutritious foods are available on markets year-round, although strong seasonality impacts the availability and price of perishable products. For beans, peas and groundnuts, supply appears to be available throughout the year, with price fluctuations relatively controlled due to storage capacity and imports. The capacity of markets to supply safe and nutritious food is limited by a number of issues, including poor hygiene; lack of infrastructure for storage and selling; limited information on nutrition, and weak coordination among sellers and producers. Other bottlenecks include: on-farm constraints for expanded production, consumers with limited purchasing capacity, intense competition among sellers and few services for sellers to increase volume of product sold during

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; CRP4; 5 Strengthening Institutions and Governance; G Cross-cutting gender theme; Capacity Strengthening, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; DCA; CRP4; ISI; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Young children in Malawi consume low-quality diets lacking micronutrients critical for their development. Objective: To evaluate the impact of an agriculture and nutrition behavior change communication (BCC) intervention implemented through community-based childcare centers on the nutrient adequacy of diets of children living in food-insecure settings in Malawi.

Objective: We examined the trends-over-time and the factors associated with malnutrition among adolescent girls in Ghana.Design: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n=983), 2008 (n=955) and 2014 (n=857).We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.Setting: Countrywide, covering rural and urban areas in Ghana.Subjects: Non-pregnant adolescents girls aged 15-19 years.Results: Compared with 2003, thinness declined marginally [PR 0.88 95% C.I (0.45, 1.73)] in 2008 and in 2014 [PR 0.71 95% C.I (0.38, 1.56)].Stunting declined marginally by 19% in 2008 [PR 0.81 95% C.I (0.59, 1.12)], flattening out in 2014 [PR 0.81 95% C.I (0.57, 1.17)].We found an increasing trend of overweight/obesity with the PR peaking in 2014 [PR 1.39 95% C.I (1.02, 1.88)] compared to 2003.The anaemia prevalence remained severe without a clear trend.A low level of education of the adolescent girl was positively associated with stunting.Increasing age was positively associated with stunting but inversely associated with thinness and anaemia.Girls who ever bore a child were more likely to be anaemic compared to those who never did.A lower level of household wealth and a unit increase in household size were negatively associated with overweight/obesity.Urban dwelling girls were less likely to be stunted.Conclusion: The stagnant burden of undernutrition and rising overnutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

PR, IFPRI3; ISI; DCA; CRP4, PHND; A4NH, 11 pages, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school‐aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6–9 years; n = 323) and adolescents (10–17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro‐ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro‐ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro‐ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro‐ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.

Non-PR, IFPRI1; Voice for Change Partnership; CRP4, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), An analysis of learning outcomes from the evaluation of a national school feeding program in Ghana reveals that disadvantaged students benefited most from free school meals. Overall, students with access to school meals had higher academic and cognitive test scores on average compared with students without access to the program, but the program led to much greater gains for certain disadvantaged groups including girls, students from poor households, and students from the Northern regions of Ghana. This evidence suggests that providing free school meals is an effective way to increase opportunities for disadvantaged youth by leveling the playing field through improved educational achievement. However, key structural changes could maximize potential learning impacts resulting from the program. Improvements in program implementation through monitoring the quality and quantity of food served are needed to overcome program implementation challenges identified by the evaluation. Beyond the feeding program itself, investments to improve the quality of education are expected to further improve learning outcomes, especially when school meals incentivize increased school attendance.