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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.

Alive and Thrive, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI), Background The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. Objective This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Methods We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. Results In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). Conclusions The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.

Nutrition, Diets, and Health (NDH), Objectives: A two-arm cluster randomized trial was designed to compare 2 approaches of behavior change communication for improved nutrition and women’s empowerment practices. Both intervention arms received monthly training sessions using village saving and loans associations (VSLA) as main delivery platform, while in one arm, influential men’s groups (called EBENE) were also trained to promote improved nutrition and women’s empowerment practices. Methods: Data were collected after one year of implementation in June and August 2023 through phone surveys in a composite sample of women pre-identified before the intervention including members of VSLA, women interested in VSLA and women of the general population. Mixed-effects regression models using fixed effects for treatment exposure and random effects at cluster level, were used to assess differential effects of the interventions on program participation, and knowledge and practices related to diets and women’s empowerment. Adjusted models estimated the effects of insecurity and of the EBENE intervention in the context of insecurity, adjusting for baseline characteristics associated to insecurity prior to its onset, to account for its non-random nature. Results: Unadjusted analyses found participation rates of 44% and 38% for training on nutrition and gender respectively, with no significant differences between intervention groups. The EBENE intervention was found to increase the likelihood that women felt encouraged by men to improve dietary practices and that women and children consumed poultry and eggs. Adjusted analyses suggested that though insecurity had a negative effect on program participation and diet diversity, the EBENE intervention had a protective effect on diet diversity in areas with higher insecurity. The EBENE intervention was found to have protective effects on women’s mobility, group membership and participation in decisions related to poultry production. Conclusions: In the context of increasing

Poverty, Gender, and Inclusion (PGI), 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.

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.