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Background: The response to the global call for more data on children’s and adolescents’ diets and nutrition is limited by the lack of straightforward practical indicators to track their diet quality. On the basis of a food group score compiled from 10 food groups (FGS-10), the minimum dietary diversity for women, calculated as FGS-10 ≥ 5, is a validated proxy population indicator for better micronutrient intake adequacy for adult women in low- and middle-income countries (LMICs). Objectives: This study aims to validate FGS-10 and its related cutoffs against micronutrient intake adequacy in 4–15-y-old children/adolescents in LMICs. Methods: We conducted a secondary data analysis of 9 datasets of repeated 24-h recalls or weighed records including 11,524 children/adolescents aged 4–15 y, collected in 7 countries (Burkina Faso, Ghana, Ecuador, India, Malawi, Uganda, and Zambia) between 2007 and 2022. For each dataset and the pooled sample (meta-analysis), we assessed the association between FGS-10 and the mean probability of adequacy (MPA) of intake over 8 micronutrients (MPA-8), and the performance of several FGS-10 cutoffs in predicting acceptable (≥0.60) and good (≥0.80) levels of MPA-8. Robustness analyses used the 7 datasets with data on 11 micronutrients (MPA-11). Results: FGS-10 ranged from 3.0 to 4.8 across datasets, and the proportion of children/adolescents with acceptable MPA-8 ranged from 8.4% to 74%. Positive and significant associations between FGS-10 and MPA-8 were found in all datasets and the pooled sample. The optimal cutoff varied across datasets from FGS-10 ≥ 4 to FGS-10 ≥ 6. In the pooled sample, FGS-10 ≥ 5 had the highest performances in predicting acceptable and good levels of MPA-8. FGS-10 ≥ 5 was also the best proxy indicator for MPA-11 ≥ 0.80. Conclusions: The continuous FGS-10 and dichotomous FGS-10 ≥ 5 may be extended to 4–15-y-old children/adolescents in LMICs. In this population, FGS-10 ≥ 5 can be used as a proxy population indicator for good micronutrient adequacy of diets.

Abstract This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children

Background: Adolescent nutrition has faced a policy neglect, partly owing to the gaps in dietary intake data for this age group. The Food Recognition Assistance and Nudging Insights (FRANI) is a smartphone application validated for dietary assessment and to influence users toward healthy food choices. Objectives: This study aimed to assess the feasibility (adherence, acceptability, and usability) of FRANI and its effects on food choices and diet quality in female adolescents in Vietnam. Methods: Adolescents (N = 36) were randomly selected from a public school and allocated into 2 groups. The control group received smartphones with a version of FRANI limited to dietary assessment, whereas the intervention received smartphones with gamified FRANI. After the first 4 wk, both groups used gamified FRANI for further 2 wk. The primary outcome was the feasibility of using FRANI as measured by adherence (the proportion of completed food records), acceptability and usability (the proportion of participants who considered FRANI acceptable and usable according to answers of a Likert questionnaire). Secondary outcomes included the percentage of meals recorded, the Minimum Dietary Diversity for Women (MDDW) and the Eat-Lancet Diet Score (ELDS). Dietary diversity is important for dietary quality, and sustainable healthy diets are important to reduce carbon emissions. Poisson regression models were used to estimate the effect of gamified FRANI on the MDDW and ELDS. Results: Adherence to the application was 82% and the percentage of meals recorded was 97%. Acceptability and usability were 97%. MDDW in the intervention group was 1.07 points (95% CI: 0.98, 1.18; P = 0.13) greater than that in the control (constant = 4.68); however, the difference was not statistically significant. Moreover, ELDS in the intervention was 1.09 (95% CI: 1.01, 1.18; P = 0.03) points greater than in the control (constant = 3.67). Conclusions: FRANI was feasible and may be effective to influence users toward healthy food choices. Research is needed for FRANI in different contexts and at scale.The trial was registered at the International Standard Randomized Controlled Trial Number as ISRCTN 10681553.

Abstract 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.

Abstract 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.

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 population at risk of malnutrition.The study protocol and the methods and materials were approved by the Institutional Review Board (IRB) of the IFPRI on April 29th, 2020 (registration number #00007490), the Thai Nguyen National Hospital on April 14th, 2020 (protocol code 274/ĐĐĐ-BVTWTN) and the University of Ghana on August 10th, 2020 (Federalwide Assurance FWA 00001824; NMIMR-IRB CPN 078–19/20). The study protocol was registered in the International Standard Randomized Controlled Trial Number (ISRCTN 10681553; https://doi.org/10.1186/ISRCTN10681553) on November 12, 2021.

Abstract 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.

This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster‐randomized controlled trial implemented in rural Malawi (2022–2025). We fit an evidence‐based theoretical model using structural equation modelling examining four caregiver factors: (1) diet diversity (sum of food groups consumed in the past 24 h), (2) empowerment (assessed using the project‐level Women's Empowerment in Agriculture Index), (3) mental health (assessed using the Self‐Reported Questionnaire, SRQ‐20), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm‐referenced aggregate Z‐score). The model controlled for child, caregiver, and household socioeconomic characteristics. Results showed that caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.091 [95% CI 0.027, 0.153]) and lower SRQ‐20 scores −0.058 (−0.111, −0.006). Empowerment was directly associated with higher child development scores (0.071 [0.007, 0.133]), higher stimulation score (0.074 [0.013, 0.140]), higher dietary diversity (0.085 [0.016, 0.145]), and lower SRQ‐20 scores (−0.068 [−0.137, −0.002]). Further, higher empowerment was indirectly associated with improved child development through enhancement of caregiver dietary diversity, with an indirect effect of 0.008 (0.002, 0.018). These findings highlight the important role that caregiver diet and empowerment play in directly influencing child development and other aspects of caregiver well‐being. Interventions aimed at enhancing child development should consider these factors as potential targets to improve outcomes for children and caregivers. Key messages: Caregiver diet and empowerment were associated with child development in children <2 years of age in rural Malawi.Caregiver diet was associated with improved caregiver mental health.Caregiver empowerment was directly associated with improved caregiver diet, mental health, and stimulation practices.Caregiver empowerment was indirectly associated with child development via improved caregiver diet.Interventions aimed at enhancing child development can focus on caregiver diet and empowerment as potential targets to improve outcomes for both children and their caregivers. [ABSTRACT FROM AUTHOR]

School feeding programs can support children's nutrition, health, and education in emergencies. This study assessed the feasibility, trade‐offs, cost efficiency, and perceived benefits of school feeding modalities operating in urban Yemen. It draws on primary data from a qualitative evaluation with 21 school feeding implementers and 88 beneficiaries conducted in Feb–Mar 2023, and secondary data from a desk review of published and program literature on school feeding operations. Results showed that school feeding provided students with on average 18%, 40%, and 66% of daily energy, protein, and micronutrient requirements, respectively. Models including fortified snacks were 3–11 times more cost‐efficient in terms of nutrient delivery. The most prominent strength of the models examined were the perceived benefits on child, family, and financial outcomes. Among the main weaknesses was the poor nutritional quality of the meal, which in turn emerged as a primary opportunity to improve school feeding through hybrid models providing a combination of fortified snacks and healthy meals. Other weaknesses such as poor water, sanitation, and hygiene infrastructure, and desired improvements such as the school kitchen and canteen, require considerable investments. Hybrid models are cost‐efficient, acceptable, and feasible in Yemen and can serve the diet and nutrition needs of school‐aged children. [ABSTRACT FROM AUTHOR]

School meal programs are popular social programs. They are provided to 61 percent of primary students in high-income countries but to a smaller share of students in less wealthy countries. There is a body of evidence documenting their contribution to education, health and nutrition, and social protection. But in each domain, program objectives have evolved: schooling is recognized to be more about learning than grades obtained; nutrition goals include healthy diets that reduce risks of non-communicable diseases and are more environmentally responsible; social protection programs aim to respond to acute crises and address chronic poverty. In addition to assisting in these sectors, school meal programs are tasked with creating food systems that assist smallholder farmers, an endeavor that has yet to be extensively studied. This review examines the latest evidence on these evolving dimensions of school meal programs. Findings suggest that while there is a strong evidence base for school meals, there are also specific gaps in the evidence of effectiveness and a particular lack of clarity around costs. The country-led School Meals Coalition, developed in response to COVID pandemic-related school closures, has brought new momentum to national programs and new urgency for reliable evidence on effectiveness and costs. [ABSTRACT FROM AUTHOR]

BackgroundAdolescents’ 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. ObjectiveThis 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. MethodsA total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. ResultsAdolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability. ConclusionsA phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale.

Abstract Background The SELEVER study is designed to evaluate the impact of an integrated agriculture–nutrition package of interventions (including poultry value chain development, women’s empowerment activities, and a behavior change communications strategy to promote improved diets and feeding, care, and hygiene practices) on the diets, health, and nutritional status of women and children in Burkina Faso. This paper presents the rationale and study design. Methods The impact evaluation involves a cluster randomized controlled trial design that will be implemented in 120 rural communities/villages within 60 communes supported by SELEVER in the Boucle de Mouhoun, Centre-Ouest, and Haut-Bassins regions of Burkina Faso. Communities will be randomly assigned to one of three treatment arms, including: (1) SELEVER intervention group; (2) SELEVER with an intensive WASH component; and (3) control group without intervention. Primary outcomes include the mean probability of adequacy of diets for women and children (aged 2–4 years at baseline), infant and young child feeding practices of caregivers of children aged 0–2 years, and household poultry production and sales. Intermediate outcomes along the agriculture and nutrition pathways will also be measured, including child nutrition status and development. The evaluation will follow a mixed-methods approach, including a panel of child-, household-, community-, and market-level surveys, and data collection points during post-harvest and lean seasons, as well as one year after implementation completion to examine sustainability. Discussion To our knowledge, this study is the first to rigorously examine from a food systems perspective, the simultaneous impact of scaling-up nutrition-specific and nutrition-sensitive interventions through a livestock value-chain and community-intervention platform, across nutrition, health, and agriculture domains. The findings of this evaluation will provide evidence to support the design of market-based nutrition-sensitive interventions. Trial registration ISRCTN registry, ISRCTN16686478 . Registered on 2 December 2016.

Abstract Background The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial. Methods Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children’s Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children’s ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders. Discussion Assessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes. Trial registration ISRCTN registry, ID: ISRCTN96497560 . Registered on 21 September 2016.

Background: Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program. Methods: We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status. Discussion: This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes. Trial registration: ISRCTN ISRCTN53055824. Registered on 7 March 2022. [ABSTRACT FROM AUTHOR]

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. Key messages: Few experimental studies have examined the potential nutritional benefits and health risks of livestock‐related interventions in low‐and middle‐income settings.We conducted a 3‐year cluster randomised trial of nutrition‐ and gender‐sensitive poultry intervention in Burkina Faso.Despite low participation in the intervention activities, caregiver's knowledge of water, sanitation and hygiene‐livestock risks was higher in the intervention groups than in the control group.No effects were found on hygiene and hygiene‐livestock‐related practices (except for practices involving separation between livestock and children) nor on child morbidity symptoms and anthropometry indicators. [ABSTRACT FROM AUTHOR]

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. Key messages: Nutrition‐sensitive agriculture programmes can improve rural undernutrition but lack information on costs.We use a standardised approach to estimate the total incremental costs of an integrated nutrition intervention in Bangladesh to improve maternal and child undernutrition.Costs per household compare favourably with similar interventions.This study provides evidence on the costs of integration to support the design and implementation of multisectoral nutrition programmes.Our results illustrate the value of standardising costing to facilitate comparisons with other multisectoral nutrition interventions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. Key Points/Highlights: Social assistance programmes (SAPs) can be used to improve diets of women and children.Effectiveness of SAPs may differ by programme type and outcome assessed. For example, in‐kind transfers (with fortified foods) compared with cash transfer programmes were more likely to significantly increase children's weight‐for‐length/height Z‐score (WLZ/WHZ), and women's and children's haemoglobin concentration (Hb) and decrease anaemia prevalence.If programmes aim to reduce stunting and anaemia or increase WLZ/WHZ, mid‐upper arm circumference or Hb, they should consider targeting women and/or young children, including both household and individual transfers, fortified foods/supplement and/or behaviour change communication.Evidence of the effectiveness of SAPs for improving micronutrient status and preventing an increase in overweight and obesity is scarce as is evidence for the effectiveness of SAPs for improving diet and nutrition outcomes among men, adolescents and the elderly in low‐ and middle‐income countries.To better understand which programme design features are most important for achieving impacts, randomized evaluation designs and consistency in programme and evaluation design across several programmes in different contexts are needed. [ABSTRACT FROM AUTHOR]

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. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users'medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app's feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent's feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. [ABSTRACT FROM AUTHOR]

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. Participants: Non-pregnant adolescent girls aged 15–19 years. Results: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 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 was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. Conclusions: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls. [ABSTRACT FROM AUTHOR]

This article reports on a cluster-randomised controlled trial conducted in rural Burkina Faso evaluating a multifaceted intervention, SELEVER, that seeks to increase poultry production by delivering training and strengthening of village-level institutions providing veterinary and credit services. 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 may not be sufficient to counterbalance the market costs of these inputs. [ABSTRACT FROM AUTHOR]

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 an 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. [ABSTRACT FROM AUTHOR]

Background: Community-based preschool meals can provide an effective platform for implementing integrated agriculture and nutrition programs. However, there is little evidence on the costs and cost-efficiency of implementing these types of multisectoral interventions.Objectives: Assess the economic costs and cost-efficiency of implementing an effective integrated nutrition-sensitive intervention through a preschool platform in Malawi, including community-level contributions.Methods: The Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) framework and methods were applied to assess financial and economic costs of the intervention. A mixed-methods approach was used to measure and allocate costs for program activities and inputs using financial expenditure data combined with micro-costing. All costs were allocated to input and expenditure categories using the SEEMS-Nutrition framework. To facilitate comparisons with existing school meals programs, activities were also mapped against a standardized school feeding supply chain framework.Results: The total annualized cost of the program was US$197 377, inclusive of both financial and economic costs. The annual economic cost of the program ranged from US$160 per preschool child to US$41 per beneficiary. The principal drivers of cost by program activity were training (46%), school meals provision (19%), monitoring and evaluation (12%), and establishing and running community groups (6.5%). Notably, community contributions accounted for 25% and were driven by food donations and volunteer labor.Conclusions: Cost per beneficiary estimates of implementing an integrated agriculture-nutrition intervention through an early childhood development platform compare favorably with similar interventions. Further research is needed that applies a standardized economic evaluation framework to such multisectoral interventions. [ABSTRACT FROM AUTHOR]

Background: Nutrition-sensitive programs can accelerate progress in addressing malnutrition. However, evidence gaps exist related to their effectiveness and how to optimize program design and implementation.Objective: We present the process the International Food Policy Research Institute and the World Food Programme (WFP) used to develop nutrition-sensitive program guidance and plans for improving program effectiveness and contributing to the evidence base through rigorous evaluations.Methods: A 5-step process, using principles of design thinking (a systematic, iterative analytical approach to problem solving), was used to develop, test, and refine WFP's nutrition-sensitive guidance. The guidance focuses on improving nutrition outcomes for nutritionally vulnerable groups across the life cycle: women and children in the first 1000 days, preschoolers, schoolchildren, and adolescents.Results: Through iterative consultations, we created WFP's nutrition-sensitive guidance that includes harmonized theories of change across WFP's programs; 7 opportunities to enhance the programs' nutrition-sensitivity; and mapping of these opportunities to WFP programs and key evidence gaps. This guidance has been rolled out to WFP's offices worldwide to support improved nutrition outcomes. Finally, several evaluation designs have been proposed to fill identified evidence gaps.Conclusions: By leveraging our implementation-research partnership, we expect that WFP's programs will be more effective and cost effective for improving nutrition. This can be assessed through coupling newly designed nutrition-sensitive programs with rigorous evaluations. Evaluation results will be used to refine WFP's nutrition-sensitive guidance and improve their programs globally. This guidance, and creation process, could be useful for others interested in designing nutrition-sensitive programs and increasing program effectiveness for nutrition. [ABSTRACT FROM AUTHOR]