Search

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]

Background Linear growth faltering is determined primarily by attained heights in infancy, but available data consist mainly of cross-sectional heights at each age. Objectives This study used longitudinal data to test whether faltering occurs episodically in a few months of very low growth, which could potentially be prevented by timely intervention, or is a chronic condition with slower growth in every month of infancy and early childhood. Methods Using anthropometric data collected monthly between August 2014 and December 2016, we investigated individual growth curves of 5039 children ages 6–27 mo in Burkina Faso (108,580 observations). We evaluated growth-curve smoothness by level of attained length at ∼27 mo by analyzing variation in changes in monthly growth rates and using 2-stage regressions: 1) regressing each child's length on their age and extracting R 2 to represent curve smoothness, initial length, and average velocity by age; and 2) regressing extracted parameters on individual-level attained length. Results Short children started smaller and remained on their initial trajectories, continuously growing slower than taller children. Growth between 9 and 11 mo was the most influential on attained length; for each 1-cm/mo increase in growth velocity during this period, attained length increased by 6.71 cm (95% CI: 6.59, 6.83 cm). Furthermore, a 0.01 increase in R 2 from individual regression of length on age was associated with a 3.10-cm higher attained length (95% CI: 2.80, 3.41 cm), and having 2 consecutive months of slow growth (<15th centile relative to the sample) was associated with 1.7-cm lower attained length (95% CI: −1.80, −1.59 cm), with larger effects in younger children, suggesting that smoother growth patterns were also associated with higher attained length. Conclusions Children who experience extreme growth faltering are likely less resilient to systematic growth-limiting conditions as well as episodic insults to their growth. This trial was registered at clinicaltrials.gov as NCT02071563. [ABSTRACT FROM AUTHOR]

Background Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed. Objectives We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement. Methods In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ∼12 wk to 2691 children with MAM aged 6–59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined. Results Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil [0.83 (95% CI: 0.64–1.08) for CSWB w/oil, 1.01 (95% CI: 0.78–1.3) for SC + A, 1.05 (95% CI: 0.82–1.34) for RUSF]. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49–0.99) but not CSWB w/oil or SC + A [1.08 (95% CI: 0.73–1.6) and 0.96 (95% CI: 0.67–1.4), respectively] when compared to CSB+ w/oil. Costs per enrollee [US dollars (USD)/child] ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges. Conclusions The 4 supplements performed similarly across recovery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment. This trial was registered at clinicaltrials.gov as NCT03146897. [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]

Background Environmental enteric dysfunction (EED) may influence growth during and recovery from moderate acute malnutrition (MAM), however, biomarkers to assess these relations have yet to be identified. Objectives The objectives of this study were to: 1) develop a score for EED based on host fecal mRNA transcripts, 2) compare biomarkers of EED with each other, and 3) examine associations between the EED biomarkers and recovery from MAM and growth outcomes. Methods In a cohort of 520 Sierra Leonean MAM children, biomarkers of EED included the lactulose: mannitol (L: M) test, 15 host fecal mRNA transcripts, and host fecal proteins [α-1-antitrypsin (AAT), myeloperoxidase (MPO), neopterin (NEO)]. Anthropometry data were also collected and z scores were computed for length-for-age (LAZ) and weight-for-length (WLZ). Recovery from MAM was defined as midupper arm circumference ≥12.5 cm. Factor analysis was used to identify EED scores using the mRNA transcripts, and mixed effects regression was conducted to test for associations. Results The 15 host fecal mRNA transcripts were clustered into 3 scores: gut inflammation (GI) score, gut structure (GS) score, and gut defense (GD) score. We found agreement between certain inflammation markers (GI score and MPO), and permeability markers (GS score and AAT; AAT and the L: M excretion ratio). Antimicrobial gut defense (GD score) was inversely associated with percent lactulose excreted, a measure of intestinal permeability. LAZ (β: –0.08; 95% CI: –0.14, –0.02) and WLZ (β: –0.03; 95% CI: –0.06, –0.01) were negatively associated with GI score. A high GD score (β: 0.36; 95% CI: 0.08, 0.64) and low AAT (β: –1.35; 95% CI: –2.35, –0.36) were associated with recovery from MAM. Conclusions Scores derived from host fecal mRNA transcript variably correlated with the L: M test and host fecal proteins. Markers of intestinal inflammation, permeability, and defense were associated with growth outcomes and recovery from MAM. [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: 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 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]

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]

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 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]

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.

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.

In rural Bangladesh, a community-based weaning intervention used volunteers to teach complementary feeding to families of 62 breast-fed infants aged 6-12 mo. Over 5 mo, treatment children gained on average 0.46 SD (≈460 g) more in weight-for-age (WAZ) than the 55 control subjects, and were ≈0.5 kg heavier at the final measure. The differences were statistically significant (P < 0.001). The percent median weight-for-age (WAPM) of treatment children held steady at 76% of the National Center for Health Statistics' reference, whereas the WAPM of control subjects dropped from 78% to 72%. The increase in percentage points of severe malnutrition (below - 3 WAZ) was only 5% in the treatment group compared with 26% in the control subjects. Treatment children consumed a significantly greater percent of their energy and protein requirements from complementary foods than did control subjects. The affordable complementary foods consisted mainly of cereal porridge with oil and brown sugar. These findings suggest that educational interventions teaching families to feed hygienic, simple, cheap, energy-enriched complementary foods to breast-fed infants after 5-6 mo can improve child growth, even under impoverished conditions. [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]

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]

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]

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]