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Background: In Indonesia, food security and dietary patterns varied by regions. This might lead to differences in problem nutrients (PN) and should be considered in developing local-specific food-based recommendations (FBRs) for stunting prevention., Objectives: This study aims to identify PNs in diet of under-five children in selected 37 stunting priority districts in Indonesia and assess whether the number of PNs was associated with district food security status., Methods: Linear programming analysis (LP) using Optifood was done using single 24-hour dietary recall data Ministry of Health 2016 Food Consumption Survey. PN was defined as nutrient which did not meet 100% Recommended Nutrient Intake (RNI) based on Indonesian-RNI in the 2-best-diets scenario. District's food security status was determined using Food Security Vulnerability Atlas 2018., Results: The top three PNs amongst under-five childrenwere iron, folate, vitamin B12 (6-11mo); folate, calcium, zinc (12-23mo); folate, calcium, vitamin C (24-35mo); and calcium, folate, vitamin C (36-59mo). There were no significant differences in number of PNs based on food security status. After integrating the nutrient-dense foods into FBRs, the number of districts with dietary inadequacy decreased for the top-3 problem nutrients in each age group, with the exception of iron for infants., Conclusions: Our findings showed that problem nutrients and dietary inadequacy were prevalent in diet of under-five children, even in food-secure areas. Promoting locally available nutrient-dense foods through FBRs (nutrition-specific intervention) and ensuring availability and access to these foods (nutrition-sensitive intervention) are recommended. Additional intervention(s), particularly for iron in infants, are required., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fahmida et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight., Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia., Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents' knowledge about stunting prevention through the app and standard interventions., Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ≥80% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001)., Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth., (© Kadek Ayu Erika, Nur Fadilah, Aulia Insani Latif, Nurhikmawaty Hasbiah, Aidah Juliaty, Harun Achmad, Anugrayani Bustamin. Originally published in JMIR Human Factors (https://humanfactors.jmir.org).)

Child undernutrition remains a widespread public health problem in the Global South, especially in Africa. Childhood stunting-meaning linear growth retardation-is a comprehensive and commonly used indicator of chronic child undernutrition and is mostly the result of insufficient nutrient intake, among other factors. Previous research showed that the consumption of animal-sourced foods (ASF), including meat, dairy, eggs, and fish, is associated with lower rates of child stunting, but reliable evidence for Africa is scant. In Africa, average ASF consumption is low. We use representative panel data from five African countries-Ethiopia, Malawi, Nigeria, Tanzania, and Uganda-with over 32,000 observations from children aged 0 to 5 y to show that ASF consumption increases mean child height-for-age Z-scores (HAZ) by 0.30 ( P < 0.01) and reduces the likelihood of stunting by 6.8 percentage points ( P < 0.01), after controlling for confounding factors. The child nutritional benefits of diets containing ASF are larger than those of purely plant-based diets. Nutritious plant-based foods, such as fruits, vegetables, and legumes, can provide most of the nutrients required and also have positive effects on HAZ, but they are sometimes not available and accessible in sufficient quantities all year round, especially in rural areas. Given the large environmental footprints of livestock farming, initiatives to make food systems more sustainable often call for a strong reduction in ASF consumption. While ASF consumption should be reduced where consumption quantities are high, our results suggest that poor households' access to ASF in Africa should be further improved to help reduce child undernutrition., Competing Interests: Competing interests statement:The authors declare no competing interest.

Aim: This study aimed to explore the strategies and important components that can be implemented to build adolescent awareness about stunting prevention., Methods: This study used descriptive qualitative design. The data were collected through focus group discussions (FGDs) and semi-structured interviews. Purposive sampling method was employed to select the participants. The FGDs involved adolescents (n = 6) and high school counselling teachers (n = 5), while the semi-structured interviews were conducted with experts frequently involved in overcoming stunting problems in Indonesia (n = 7). The interview results were transcribed in verbatim transcription and analysed by using thematic analysis., Results: Five themes were identified from the results: 1) Adolescent identity development with three sub-themes: online identity exploration, rebellious stage, and peer influence; 2) Creative and visually appealing website with six sub-themes: interesting appearance, short time span, serial content, story pattern, scenario using adolescent idol's name, and attractive website menu; 3) Nutritional needs for adolescents with three sub-themes: iron and calcium intake, less sugar consumption, and nutritional status; 4) Engaging content for adolescents with seven sub-themes: stunting, reproductive health, anaemia, diet, wellness, early marriage, and physical activity; and 5) Effective communication strategy with two sub-themes: consistency of activities and communicative., Implications: In designing adolescent stunting prevention interventions, multidisciplinary programs utilizing engaging digital health modules and grassroots partnerships should be developed and tested. These programs aim to enhance knowledge retention among youth through appealing online content and interactive community activities. Rigorous evaluation of biopsychosocial approaches can establish integrated best practices across individual, social and policy dimensions for reducing stunting., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nurhaeni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Vitamin A is related to concentrations of insulin-like growth factor type 1, a protein produced in response to growth hormone, and to increased mobilization of body iron stores. Thus, vitamin A aids in increased hematopoiesis and may be useful in preventing stunting and anemia. This study aimed to identify the association between vitamin A supplementation from the National Vitamin A Supplementation Program instituted in Brazil and stunting and anemia in socially vulnerable Brazilian children., Methods: This is a Cross-sectional population-based study. Children aged 6-59 months old, living in favelas of a capital city in the Northeast of Brazil, were included. Sociodemographic variables were collected. Vitamin A supplementation was also evaluated using the child's vaccination card information. Anthropometric and capillary hemoglobin evaluations were performed to identify the presence of stunting and anemia, respectively. The association analysis was performed using Poisson regression with robust variance estimation., Results: 598 children participated in this study; 11.3% and 55.6% had stunting and anemia, respectively. As for vitamin A supplementation, 59.5% had taken at least one dose of the supplement,and 3.5% were on the complete supplementation scheme. In the adjusted association analysis, vitamin A supplementation decreased the likelihood of children having stunting and anemia by 8% (RP:0.86; 95% IC 0.86-0.98; p = 0.014) and 31% (RP:0.69; 95% IC 0.53-0.89; p = 0.004), respectively. Children who were fully supplemented were 58% (RP:0.42; 95% IC 0.24-0.77; p = 0.008) less likely to have anemia., Conclusion: Thus, vitamin A supplementation is a protective tool against stunting and anemia in children living in a situation of social vulnerability., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The research aims to understand the challenges and opportunities in policy and programme convergence to accelerate interventions for reducing stunting at the district, subdistrict and the 10 focused villages., Design: Data were collected through qualitative methods (in-depth interviews and document reviews), and then analysed using thematic processes with NVivo V.11 software, by QSR International The process included coding, categorising and linking to the eight implementation outcome variables (as determined themes), namely acceptability, adoption, appropriateness, feasibility, compliance, implementation cost, coverage and sustainability. The variables of convergence action policies were implemented differently by stakeholders at different layers of governance., Setting: Pidie district, Aceh province, Indonesia., Participants: 106 respondents from provincial to village levels were selected and interviewed, including leaders and policymakers (n=10); and convergence action implementers from the province to the villages (n=96)., Results: Stunting reduction policies were generally acceptable to local leaders and policymakers as a policy imperative. Implementation costs were considered sufficient by stakeholders, although focusing only on nutrition-specific interventions. However, in terms of adoption, feasibility, compliance, nutrition-sensitive intervention coverage and sustainability aspects were insufficiently implemented in all the focused villages due to inadequate collaboration between health and non-health sectors and limited experts., Conclusions: This study offers key recommendations for policy and practice changes and considerations. The utilisation of methods and findings from this study in other areas in Indonesia or other low- and middle-income countries is important to explore more about the applicability, benefits and weaknesses of this study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background : Providing early nutritional support through Ying Yang Bao (YYB) can assist children in achieving their full developmental potential. We aimed to examine the lasting impact of YYB and how growth affects neurodevelopment in preschool children. Methods : 1104 children aged 1 year were divided into a YYB control group (YYB-CG) and a YYB intervention group (YYB-IG). Information on basic characteristics, anthropometric measurements, dietary status, YYB consumption, and neurodevelopment for these children was taken annually from 2018 to 2022 until they reached 5 years old. Confounders were well balanced using propensity score matching (PSM), and then 474 pairs of children were included in subsequent analyses. The comparison between groups was performed using t -tests or chi-square analyses. Linear regressions were used to examine the independent associations between children's dimensions (Z-score for weight relative to age [WAZ], Z-score for height relative to age [HAZ], Z-score for body mass index by age [BAZ], and conditional measures of height- and weight-based growth) and neurodevelopment. Results : Children in the YYB-IG had higher scores in the mental index (MI), the developmental quotient (DQ), height, and BAZ ( p < 0.05) and had a lower risk of stunting. Accelerated weight gain from ages 1 to 5 (β (95% confidence interval [CI]): 0.26 (0.08-0.45)) and increased height gain during this period (β (95% CI): 0.68 (0.14-1.23)) were associated with greater MI. A higher WAZ was linked to increased MI at 1 year (β (95% CI): 0.89 (0.09-1.68)), 2 years (β (95% CI): 0.99 (0.20-1.78)), 3 years (β (95% CI): 0.92 (0.15-1.69)), 4 years (β (95% CI): 0.88 (0.09-1.68)), and 5 years of age (β (95% CI): 1.01 (0.28-1.74)). An increased HAZ corresponded with a higher MI score at ages 1 year (β (95% CI): 1.47 (0.75-2.20)), 2 years (β (95% CI): 1.25 (0.49-2.02)), 3 years (β (95% CI): 1.11 (0.31-1.90)), 4 years (β (95% CI): 0.93 (0.12-1.74)), and 5 years old (β (95% CI): 1.17 (0.43-1.90)); higher DQ levels were also recorded at 1 year (β (95% CI): 0.82 (0.10-1.55)) and 5 years of age (β (95% CI): 0.79 (0.06-1.51)). Conclusions : YYB can improve specific areas of neurodevelopment and growth in preschool children. Additionally, children's linear growth is positively linked to neurodevelopment in those of preschool age.

Stunting is one of the consequences of chronic malnutrition whose prevalence continues to increase in Indonesia. This study used an observational analytical approach to develop a model of mother behaviour in stunting prevention in children. The population consisted of 215 mothers who had children aged 0-24 months. The variables included assessment of behavioural beliefs, behaviour outcomes, attitudes, demographics, perceived control, and intentions. The SEM - smartPLS4 was used for the analysis. The validity test results indicate that the values for Cronbach's alpha and Composite Reliability (C.R) are above 0.7, and the value for Average Variance Extracted (AVE) is above 0.50, indicating that all indicators are valid and reliable. The results revealed that a mother's behaviour in stunting prevention is directly influenced by her intention, whereas mother's intentions are influenced by attitudes, demography, and perceived control. We conclude that a mother who has high intentions to prevent stunting will be able to practice it because of having a positive attitude and a good perceived control. Behavioural intentions have been identified as the mediating variable of the transformation of behavioural attitudes into treatment, which is consistent with the TPB theory and other research on physician behaviour. In other words, intent can serve not only as an internal driving process of attitude, but also as a condition of preparation for behaviour., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Childhood stunting remains a global health issue with significant consequences for the growth, long-term health, and development of childre, Poor nutrition is a well-established contributor to childhood stunting. This study aims to investigate the potential of utilizing biscuits as a nutritional intervention to improve the child's stunting condition. This systematic review was consisted of a literature search in several databases: Scopus, Web of Science, mScience Direct, PubMed, and Springer, following the PRISMA methodology. Our search yielded a total of 836 records, while 11 studies were finally included after the screening. The studies revealed critical findings regarding the utilization of biscuits as a carrier in providing essential nutrients. Nevertheless, more well-designed and standardized studies are required to establish clear guidelines for the formulation and implementation of biscuitbased interventions. Policymakers and health practitioners should consider incorporating fortified biscuits into strategies aimed at reducing stunting, especially in regions with a high prevalence of stunting., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

In the implementation of stunting prevention, the lack of cooperation between stunting cadres, no direct communication media and no one who facilitates the cooperation of stunting cadres to carry out data collection tasks as indicators of stunting achievement and for stunting prevention. This can result in repeated data collection, unequal data, and irrelevant data accuracy. Stunting cadres, who are community health workers selected and trained to monitor and prevent stunting at the village level, play a crucial role in these efforts. If stunting cadres collaborate, the performance of both will be more effective and efficient. This study aims to find out the factors related to the collaboration of stunting cadres in stunting prevention efforts. A quantitative research method with a cross-sectional study design was employed. The research sample consisted of 63 stunting cadres. Data analysis was conducted using univariate and bivariate analysis. The results showed that variables such as trust (p-value 0.032), communication (p-value 0.021), agreement (p-value 0.002) and added public value (p-value 0.001) were significantly related to the collaboration of stunting cadres. The conclusion of this study is that stunting cadre collaboration is important in stunting prevention efforts and has an impact on optimizing stunting prevention programs., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Stunting in toddlers (0-2 years) remains a significant public health problem in Indonesia. Adequate breastfeeding is essential for stunting prevention, yet many mothers struggle with insufficient milk production. Moringa oleifera, known locally as moringa, has traditionally been used to increase breast milk production. Moringa plants have the potential to overcome various kinds of malnutrition or malnutrition problems in toddlers, pregnant women and breastfeeding mothers. This study aims is to examines the effect of consuming Moringa leaf-based vegetable soup on milk production in breastfeeding mothers with stunted toddlers at Leggung Health Centre. A quasi-experimental design was employed with 40 breastfeeding mothers of stunted toddlers (0-2 years) - 20 in the treatment group (given Moringa soup) and 20 in the control group (no treatment). Pretest results showed that only 57% of mother in the treatment group had adequate milk production, which increased to 76% after consuming Moringa leaf vegetable soup. The Mann-Witney U test revealed a significant difference (p = 0.000). These findings suggest that Moringa leaf soup can enhance breast milk production in breastfeeding mothers and may indirectly support stunting prevention efforts., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

The current child feeding practice is still suboptimal. There are several factors that affect child feeding practices. This review aimed to synthesize the available evidence on factors related to child feeding practices based on social-cognitive theory construct. The study was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist and used five databases, including Scopus, ScienceDirect, Web of Science, PubMed and ProQuest. There were no restrictions in the year of publication. Based on the search strategy, 1179 articles were extracted resulting in 23 articles that were suitable for inclusion in the study. Factors related to child feeding practices included knowledge, self-efficacy and social support. Social support from health workers plays an important role in increasing maternal self-efficacy in feeding practices. Education interventions for mothers and husbands or other family members need to be carried out to increase knowledge, self-efficacy and social support in feeding practices., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Stunting is a significant public health issue in Indonesia, characterized by a very high prevalence. The Indonesian government places utmost importance on prevention. Preventive measures and timely identification are crucial, particularly by trained personnel. The research aims to uncover patterns in the enhancement of cadre ability to mitigate the prevalence of stunting. A review was conducted using data from content analysis, which focuses on results from several studies published in health journals listed on Scopus. The search is conducted using Scopus, with the terms "cadre," "stunting," and "Indonesia" within 2018 to 2023. The research shows that increasing the capacity of cadres can be done by increasing knowledge, attitudes, motivation, skills, perceptions of effectiveness, self-efficacy, with training intervention methods, short courses and collaborative interventions with all parties for the entire community through cadres as the front line in reducing stunting as well., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Stunting is a chronic malnutrition problem caused by a lack of nutrients over a long period. This leads to problems later in life, resulting in difficulty in achieving optimal physical and cognitive development. This study analyzes policies, interventions, and addresses of child stunting in Asian, African, and American countries through a systematic review. The design used is a systematic review, articles are collected using electronic databases such as ScienceDirect, SpringerLink, ProQuest, PubMed, and SAGE from 2019-2023 using the keywords policy, management, and stunting. As the results of the literature review to reduce stunting rates, stunting policies and programs focus on food security, decentralization of the health system, availability of health services and access to health services, maternal education, access to water, hygiene, sanitation, maternal nutrition, and poverty alleviation- appropriate policy implementation results of holistic and comprehensive policy formulation. Stunting prevention requires cross-program and cross-sector collaboration and is carried out comprehensively., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

The "SusCatinTing" application is a digital health intervention designed to enhance the knowledge, attitudes, and practices (KAP) of brides-to-be regarding stunting prevention during the critical first 1000 days of life. This study aimed to evaluate the effectiveness of this application in improving stunting prevention efforts among brides-to-be in Bengkulu Province, Indonesia. The application provides educational content on healthy pregnancy, maternal nutrition, and stunting prevention strategies, incorporating both text and audio explanations to ensure accessibility for illiterate and visually impaired users. A quantitative research design was employed, utilizing a single-group pretest-posttest approach involving 50 pairs of brides-to-be with internet-connected Android smartphones. Data collection was conducted through structured questionnaires administered by trained enumerators, focusing on KAP related to stunting prevention. The results indicated a significant improvement in KAP scores post-intervention (knowledge score increase: 42.59, p < 0.001). The application's unique features, including interactive quizzes and a certification process for marriage registration at the Office of Religious Affairs, contributed to its effectiveness. The study concludes that the "SusCatinTing" application is a promising tool for enhancing health education and promoting preventive behaviors among brides-to-be. Further research is recommended to explore the long-term impact of such digital interventions on stunting rates and maternal-child health outcomes., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Objective: Behaviour Change Communication (BCC) intervention programmes often lack documentation of successful processes. This manuscript aims to describe the development of Program Impact Pathway (PIP) using Theory of Change (ToC) approach for a mHealth BCC intervention titled 'Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI)' aimed at reducing stunting in infants at 18 months of age., Design: The PIP was developed using ToC to design the intervention and plan its implementation. Literature review and data from previous pilots helped to identify health service gaps that needed to be addressed by the PIP of this intervention., Setting: M-SAKHI was implemented in 244 villages under governance of forty primary health centres of Nagpur and Bhandara districts of eastern Maharashtra in central India., Participants: The study investigators and the public health stakeholders participated in developing the PIP. M-SAKHI evaluation study recruited 2501 pregnant women who were followed up through delivery until their infants were 18 months old., Results: The PIP was developed, and it identified the following pathways for the final impact: (1) improving maternal and infant nutrition, (2) early recognition of maternal and infant danger signs, (3) improving access and utilisation to healthcare services, (4) improving hygiene, sanitation and immunisation practices, and (5) improving implementation and service delivery of community health workers through their training, monitoring and supervision in real time., Conclusion: This paper will illustrate the significance of development of PIP for M-SAKHI. It can aid other community-based programmes to design their PIP for nutrition-based BCC interventions.

Background: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey., Methods: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight., Results: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38-0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25-0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28-0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29-0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22-0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26-0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months., Conclusion: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children., (© 2024. The Author(s).)

Background: Small-quantity lipid-based nutrient supplements (SQ-LNS), which has been widely tested to reduce child stunting, has largely modest effects to date, but the mechanisms underlying these modest effects are unclear. Child stunting is a longstanding indicator of chronic undernutrition and it remains a prevalent public health problem. The infant gut microbiome may be a key contributor to stunting; and mother and infant fucosyltransferase (FUT) phenotypes are important determinants of infant microbiome composition., Methods: We investigated whether mother-infant FUT status (n = 792) and infant gut microbiome composition (n = 354 fecal specimens from 172 infants) modified the impact of an infant and young child feeding (IYCF) intervention, that included SQ-LNS, on stunting at age 18 months in secondary analysis of a randomized trial in rural Zimbabwe., Findings: We found that the impact of the IYCF intervention on stunting was modified by: (i) mother-infant FUT2+/FUT3- phenotype (difference-in-differences -32.6% [95% CI: -55.3%, -9.9%]); (ii) changes in species composition that reflected microbiome maturation (difference-in-differences -68.1% [95% CI: -99.0%, -28.5%); and (iii) greater relative abundance of B. longum (differences-in-differences 49.1% [95% CI: 26.6%, 73.6%]). The dominant strains of B. longum when the intervention started were most similar to the proficient milk oligosaccharide utilizer subspecies infantis, which decreased with infant age and differed by mother-infant FUT2+/FUT3- phenotypes., Interpretation: These findings indicate that a persistently "younger" microbiome at initiation of the intervention reduced its benefits on stunting in areas with a high prevalence of growth restriction., Funding: Bill and Melinda Gates Foundation, UK DFID/Aid, Wellcome Trust, Swiss Agency for Development and Cooperation, US National Institutes of Health, UNICEF, and Nutricia Research Foundation., Competing Interests: Declaration of interests AJP was supported by Wellcome Trust grant 108065/Z/15/Z. ARM was supported by Bill & Melinda Gates Foundation grant OPP1021542 and OPP1143707, with a subcontract to the University of British Columbia 20R25498 EKG was supported by The Nutricia Research Foundation grant 2021-52. T.J.E. was paid a scientific consulting fee in relation to the analysis of the data presented here by the Zvitambo Institute for Maternal and Child Health Research. RCR declares remittance from Abbott Nutrition Health Institute and Nutricia for public conference talks outside of the submitted work in the past 36 months. All other authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Stunting, attributed to insufficient nutrition during the critical first 1000 days of life, remains a pressing public health issue in North Sumatera, Indonesia. This study investigates the influence of pre-marital education on prospective couples' knowledge and nutritional status as a stunting prevention strategy. Employing a quantitative, cross-sectional design, the study involved 1000 prospective couples across 10 districts. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling (SEM). The findings demonstrate that pre-marital education significantly enhances knowledge of nutrition, family planning, and stunting prevention, leading to improved nutritional status. However, increased knowledge of stunting was inversely related to nutritional status. The study concludes that comprehensive pre-marital education is vital for effective stunting prevention. It recommends a thorough revision of pre-marital educational content, emphasizing a tailored and integrative approach to health and nutrition, to address specific regional challenges and enhance overall program efficacy., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Objective: Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia., Design: A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey., Setting and Participants: At the national level, Indonesia encompassed 43 284 toddlers., Interventions: Non-intervention study., Primary and Secondary Outcomes: The study's eight independent factors were the mother's age, education, marital status, employment, wealth, antenatal care (ANC), children's age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam., Results: Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0-11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105)., Conclusion: The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

At present, the world is off-track to meet the World Health Assembly global nutrition targets for 2025. Reducing the prevalence of stunting and low birthweight (LBW) in children, and anaemia in women, and increasing breastfeeding rates are among the prioritized global nutrition targets for all countries. Governments and development partners need evidence-based data to understand the true costs and consequences of policy decisions and investments. Yet there is an evidence gap on the health, human capital, and economic costs of inaction on preventing undernutrition for most countries. The Cost of Inaction tool and expanded Cost of Not Breastfeeding tool provide country-specific data to help address the gaps. Every year undernutrition leads to 1.3 million cases of preventable child and maternal deaths globally. In children, stunting results in the largest economic burden yearly at US$548 billion (0.7% of global gross national income [GNI]), followed by US$507 billion for suboptimal breastfeeding (0.6% of GNI), US$344 billion (0.3% of GNI) for LBW and US$161 billion (0.2% of GNI) for anaemia in children. Anaemia in women of reproductive age (WRA) costs US$113 billion (0.1% of GNI) globally in current income losses. Accounting for overlap in stunting, suboptimal breastfeeding and LBW, the analysis estimates that preventable undernutrition cumulatively costs the world at least US$761 billion per year, or US$2.1 billion per day. The variation in the regional and country-level estimates reflects the contextual drivers of undernutrition. In the lead-up to the renewed World Health Assembly targets and Sustainable Development Goals for 2030, the data generated from these tools are powerful information for advocates, governments and development partners to inform policy decisions and investments into high-impact low-cost nutrition interventions. The costs of inaction on undernutrition continue to be substantial, and serious coordinated action on the global nutrition targets is needed to yield the significant positive human capital and economic benefits from investing in nutrition., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Considerable evidence supports the effectiveness of nutritional supplementation with or without nutrition education in preventing stunting in developing countries, but evidence from Afghanistan is scarce., Objectives: This project aimed to assess the effectiveness of specialized nutritious food (SNF), social and behavior change communication (SBCC) intervention to prevent stunting among children under 2 y during the first 1000 d of life in Badakhshan, Afghanistan., Methods: We used a community-based quasi-experimental pre-post study design with a control group. Pregnant and lactating women received a monthly ration of 7.5 kg of super cereal (250 g/d) during pregnancy and the first 6 mo of breastfeeding. Children aged 6-23 mo received 30 sachets of medium-quantity lipid-based nutrient supplement (50 g/sachet/d) monthly. We compared pre- and postintervention assessments of the intervention and control groups to isolate the effect of the intervention on key study outcomes at the endline by difference-in-differences (DID) estimates., Results: A total of 2928 and 3205 households were surveyed at baseline and endline. DID estimates adjusted for child, maternal, and household characteristics indicated a significant reduction in stunting (DID: -5% (95% confidence interval [CI]: -9.9, -0.2) and underweight (DID: -4.6% (95% CI: -8.6, -0.5) among children <2 y of age. However, DID estimates for wasting among children in the intervention and control groups were not significantly different (DID: -1.7 (95% CI: -5.1, 1.6). Furthermore, exposure to the SBCC messages was associated with improvements in the early initiation of breastfeeding (DID: 19.6% (95% CI: 15.6, 23.6), exclusive breastfeeding under 6 mo (DID: 11.0% (95% CI: 2.3, 19.7), minimum meal frequency (DID: 23% (95% CI: 17.7, 28.2), and minimum acceptable diet (DID: 13% (95% CI: 9.8, 16.3)., Conclusions: The provision of SNF in combination with SBCC during the first 1000 d of life was associated with reduction in stunting and underweight and improvements in infant and young child feeding practices among children under 2 y of age. This trial was registered at clinicaltrials.gov as NCT04581993., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Weight faltering (WF) has been associated with stunting and with long-term adverse consequences for health and development. Nutritional care for managing WF may consist of giving nutritional advice (NA) and/or provision of oral nutrition supplements (ONSs). In this study, we aimed to evaluate practical management options in the community for infants with WF aged 6-12 months. This nonrandomized clinical trial was conducted in the community of Makassar, South Sulawesi, from March 2022 to March 2023. A total of 1013 infants were enrolled for screening. Anthropometric measures were performed in 913 infants, of which 170 showed WF below the 15th percentile of the WHO weight increment table without stunting. Infants with a weight increment below P5th were assigned to receive NA plus ONS, while infants between P5th and below P15th were assigned to receive only NA. At the second and third months, ONSs were administered to WF infants who were below P15th. One month after the intervention, 87/105 infants in the NA-plus-ONS group (82.8%) and 52/65 infants in the NA-only group (80%) were no longer WF. After 3 months, infants in the NA-plus-ONS group achieved greater weight gain than infants in the NA group (264.1 g vs. 137.4 g, p < 0.001) as well as greater length gain (2.35 cm vs. 2.14 cm, p < 0.001). WF management should be started at below P15th to achieve a better result. Infants with greater nutritional deficits should be assigned to receive the combination of NA plus ONSs to achieve a higher rate of resolution of growth.

Background: Childhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development., Methods: The main objective of the study was to assess whether home-installed growth charts as well as small-quantity lipid-based nutrient supplements (SQ-LNS) can reduce growth faltering among infants. All caregivers of infants between 2 and 10 months of age at baseline, and at least 6 months old at the beginning of the interventions, in 282 randomly selected enumeration areas in Choma, Mansa and Lusaka districts in Zambia were invited to participate in the study. Cluster randomisation was stratified by district. A software-generated random number draw was used to assign clusters to one of four arms: (1) no intervention (control); (2) home installation of a wall chart that contained a growth monitoring tool along with key messages on infant and young child feeding and nutrition (growth charts only); (3) 30 sachets of SQ-LNS delivered each month (SQ-LNS only) or (4) growth charts+SQ LNS. The primary outcomes were children's height-for-age z-score (HAZ) and stunting (HAZ <-2) after 18 months of intervention. Secondary outcomes were haemoglobin (Hb), anaemia (Hb<110.0 g/L), weight-for-height, weight-for-age z-score (WAZ), underweight (WAZ<-2) and child development measured by the Global Scales of Early Development (GSED). Outcomes were analysed intention to treat using adjusted linear and logistic regression models and compared each of the three interventions to the control group. Assessors and analysts were blinded to the treatment-blinding of participating families was not possible., Results: A total of 2291 caregiver-child dyads across the 282 study clusters were included in the study. 70 clusters (557 dyads) were assigned to the control group, 70 clusters (643 dyads) to growth charts only, 71 clusters (525 dyads) to SQ-LNS and 71 clusters (566 dyads) to SQ-LNS and growth charts. SQ-LNS improved HAZ by 0.21 SD (95% CI 0.06 to 0.36) and reduced the odds of stunting by 37% (adjusted OR, aOR 0.63, 95% CI (0.46 to 0.87)). No HAZ or stunting impacts were found in the growth charts only or growth charts+SQ LNS arms. SQ-LNS only improved WAZ (mean difference, MD 0.17, 95% CI (0.05 to 0.28). No impacts on WAZ were seen for growth charts and the combined intervention. Child development was higher in the growth charts only (MD 0.18, 95% CI (0.01 to 0.35)) and SQ-LNS only arms (MD 0.28, 95% CI (0.09 to 0.46). SQ-LNS improved average haemoglobin levels (MD 2.9 g/L (0.2, 5.5). The combined intervention did not have an impact on WAZ, Hb or GSED but reduced the odds of anaemia (aOR 0.72, 95% CI (0.53 to 0.97)). No adverse events were reported., Interpretation: SQ-LNS appears to be effective in reducing growth faltering as well as improving anaemia and child development. Growth charts also show the potential to reduce anaemia and improve child development but do not seem as effective in addressing growth faltering. Further research is needed to better understand reduced effectiveness when both interventions are combined., Trial Registration Number: NCT051204272., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study examines how significant is the changes in child stunting in Sub-Saharan African countries (SSA). Then, it investigates factors that contributed to the reduction in child stunting in those countries. For each country, we distinguish the contribution of compositional effects and structural effect., Methods: This paper uses data from Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2000 and 2020. The z-test to compare two independent proportions was used to assess changes in child stunting and explanatory variables over the period. Recentred influence function (RIF) decomposition method was used to decompose changes in stunting over the year in each country, and to determine the contribution of each variable to the changes., Results: The prevalence of child stunting declines significantly in 11 countries over the year. The decline varies from 6.8% in Cameroun to 19% in Mali. The average year of education of the child's mother and father, and the proportion of households with access to an improved drinking water source have contributed to the reduction in child stunting. This result was found in all the countries. Improvements in living standards, child vaccination, antenatal care attendance, delivery to health care centres, maternal education, improved drinking water sources, and improved sanitation make the largest contribution to the composition component, hence reducing child stunting., Conclusions: This study sheds light on what has contributed to the achieved improvement in child nutritional status and suggests how to possibly accelerate the reduction in undernutrition in countries that lag., (© 2024. The Author(s).)

Introduction: Monitoring, Evaluation and Learning (MEL) is an integral part of research, programme and policy development and implementation. However, MEL methods used to monitor and evaluate interdisciplinary research projects are often informal and under-reported. This article describes the MEL protocol of the UKRI GCRF Action Against Stunting Hub (AASH)., Methods and Analysis: The AASH conducts interdisciplinary research into childhood stunting in India, Indonesia and Senegal across 23 distinct work packages. Project-specific MEL framework and methods will be implemented. A logframe will be developed to monitor and evaluate the research activities across the field sites including the number of participants recruited, questionnaires, measurements and procedures completed. MEL dashboards using Tableau and Glasscubes will be used to track and report progress, milestones and outcomes of the project. Dashboard outputs will be reported as numbers and percentages, with additional graphs/charts for easy visualisation. A 'learning' framework will be developed to outline appropriate pipelines for the dissemination of the research findings. This includes a theory of change explicating the overarching ambitions of the project in influencing policy, practice and research, and strategic engagement of relevant stakeholders to evaluate knowledge, attitudes and best practices for impactful engagement and dissemination of the research findings., Ethics and Dissemination: Ethical approval was granted by the Ethics Committee of the London School of Hygiene & Tropical Medicine (17915/RR/17513); National Institute of Nutrition (ICMR)-Ministry of Health and Family Welfare, Government of India (CR/04/I/2021); Health Research Ethics Committee, University of Indonesia and Cipto Mangunkusumo Hospital (KET-887/UN2.F1/ETIK/PPM.00.02/2019); and the National Ethics Committee for Health Research (CNERS), Senegal (Protocole SEN19/78). Findings from this work will be published in peer-reviewed journals, presented in conferences and disseminated to policy makers and research communities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.

Background: Animal source foods are rich in multiple nutrients. Regular egg consumption may improve infant growth in low- and middle-income countries., Objectives: To assess the impact of daily egg consumption on linear growth among 6-12-mo olds in rural Bangladesh., Methods: We conducted a 2 × 4 factorial cluster-randomized controlled trial allocating clusters (n = 566) to treatment for enteric pathogens or placebo and a daily egg, protein supplement, isocaloric supplement, or control. All arms received nutrition education. Here, we compare the effect of the egg intervention versus control on linear growth, a prespecified aim of the trial. Infants were enrolled at 3 mo. We measured length and weight at 6 and 12 mo and visited households weekly to distribute eggs and monitor compliance. We used linear regression models to compare 12-mo mean length, weight, and z-scores for length-for-age (LAZ), weight-for-length, and weight-for-age (WAZ), and log-binomial or robust Poisson regression to compare prevalence of stunting, wasting, and underweight between arms. We used generalized estimating equations to account for clustering and adjusted models for baseline measures of outcomes., Results: We enrolled 3051 infants (n = 283 clusters) across arms, with complete 6 and 12 mo anthropometry data from 1228 infants (n = 142 clusters) in the egg arm and 1109 infants (n = 141 clusters) in the control. At baseline, 18.5%, 6.0%, and 16.4% were stunted, wasted, and underweight, respectively. The intervention did not have a statistically significant effect on mean LAZ (β: 0.05, 95% confidence interval [CI]: -0.01, 0.10) or stunting prevalence (β: 0.98, 95% CI: 0.89, 1.13) at 12 mo. Mean weight (β: 0.07 kg, 95% CI: 0.02, 0.11) and WAZ (β: 0.06, 95% CI: 0.02, 0.11) were significantly higher in the egg compared with control arms., Conclusions: Provision of a daily egg for 6 mo to infants in rural Bangladesh improved ponderal but not linear growth., Trial Registration Number: NCT03683667, https://clinicaltrials.gov/ct2/show/NCT03683667., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0-5 months. In children aged 6-59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers at the subnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non-reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non-reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non-reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non-reduced districts were more likely to report the optimal implementation of multi-sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non-reduced districts more often reported challenges in their relationships with national-level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid-level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross-sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF) to children 18-23 months of age, pregnant and lactating women in the lowest tier of Rwanda's social support system. Data were collected in 2017, 2018 and 2021 through interviews with caregivers; anthropometric measurements and a capillary blood sample were obtained from children. The primary statistical analysis compared the nutritional status of children before and after the introduction of FBF. We enroled 724 children during each survey. The prevalence of stunting declined from 47% to 35% between 2017 and 2021; in 2018, the prevalence of stunting was 43%. Children had a 42% reduction in the odds of being stunted (adjusted odds ratio [AOR]: 0.58, 95% confidence interval [CI]: 0.47-0.74, p < 0.001) from 2017 to 2021 even after adjusting for inherent, distal, proximal, and intermediate covariates. The reduction in stunting observed within the first year of the programme was not statistically significant (AOR: 0.83, 95% CI: 0.67-1.03, p < 0.091). We observed meaningful reductions in the prevalence of stunting among children which coincided with the introduction of Government-led initiative to reduce malnutrition. The Rwandan Government has committed to improving the living conditions of vulnerable households and has made strong investments in reducing malnutrition. The impact of these investments can be seen in the overall trend towards improved nutritional status highlighted in this evaluation., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Child undernutrition disproportionally affects children in low- and middle-income countries. In Ethiopia, both wasting and stunting are serious public health concerns, with high human and economic costs. Understanding the dynamics in ponderal and linear growth faltering is critical to inform the design of innovative interventions that can prevent both wasting and stunting in poor and complex settings. Using two longitudinal studies conducted in 2017 and 2019 in four highland regions of Ethiopia, we evaluated the dynamics and drivers of child growth faltering in children 6-23 months of age (N = 5003). Child wasting prevalence peaked during the first 6 months of life, whereas stunting increased significantly after 6 months of age. Male sex, child illnesses (i.e., diarrhoea or fever) and low consumption of fruits and vegetables were associated with higher odds of acute undernutrition (P < 0.05). The consumption of animal source foods (ASF) was associated with increases (β: 95% CI) in weight-for-length Z-score (WLZ; 0.12: 0.0002; 0.242), whereas fruit or vegetables consumption was associated with increases in midupper arm circumference (MUAC; 0.11 cm: 0.003; 0.209). Only consumption of ASF was the statistically significant predictor of future linear growth (0.14: 0.029; 0.251). Distinct trends in WLZ and MUAC were observed by child sex and age. Improving diet quality through improved nutrition knowledge and increased access and affordability of ASFs, along with effective infection prevention/control measures could prevent both child wasting and stunting concurrently., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Despite the global decrease over the last two decades, stunting, also called 'chronic malnutrition', remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.

Introduction: As a topic of inquiry in its own right, data management for interdisciplinary research projects is in its infancy. Key issues include the inability of researchers to effectively query diverse data outputs and to identify potentially important synergies between discipline-specific data. Equally problematic, few semantic ontologies exist to better support data organisation and discovery. Finally, while interdisciplinary research is widely regarded as beneficial to unpacking complex problems, non-researchers such as policy-makers and planners often struggle to use and interrogate the related datasets. To address these issues, the following article details the design and development of the UKRI GCRF Action Against Stunting Hub (AASH)'s All-Hub Data Repository (AHDR)., Methods and Analysis: The AHDR is a single application, single authentication web-based platform comprising a data warehouse to store data from across the AASH's three study countries and to support data querying. Four novel components of the AHDR are described in the following article: (1) a unique data discovery tool; (2) a metadata catalogue that provides researchers with an interface to explore the AASH's data outputs and engage with a new semantic ontology related to child stunting; (3) an interdisciplinary aid to support a directed approach to identifying synergies and interactions between AASH data and (4) a decision support tool that will support non-researchers in engaging with the wider evidence-based outputs of the AASH., Ethics and Dissemination: Ethical approval for this study was granted by institutional ethics committees in the UK, India, Indonesia and Senegal. Results will be disseminated via publications in peer-reviewed journals; presentations at international conferences and community-level public engagement events; key stakeholder meetings; and in public repositories with appropriate Creative Commons licences allowing for the widest possible use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction:  A stoma will cause nutrients loss which could result in impaired growth. Impaired growth can negatively impact long-term development. This study aims to evaluate: (1) the effect of stomas on growth comparing small bowel stoma versus colostomy and (2) if early closure (within 6 weeks), proximal small bowel stoma (within 50 cm of Treitz), major small bowel resection (≥ 30 cm), or adequate sodium supplementation (urinary level ≤ 30 mmol/L) influences growth., Methods:  Young children (≤ 3 years) treated with stomas between 1998 and 2018 were retrospectively identified. Growth was measured with weight-for-age Z-scores. Malnourishment was defined using the World Health Organization's definition. Comparison between changes in Z-scores at creation, closure, and a year following closure was done by Friedman's test with post hoc Wilcoxon's signed rank test or Wilcoxon's rank-sum test when necessary., Results:  In the presence of a stoma in 172 children, 61% showed growth decline. Severe malnourishment was seen at the time of stoma closure in 51% of the patients treated by small bowel stoma and 16% of those treated by colostomy. Within a year following stoma closure, 67% showed a positive growth trend. Having a proximal small bowel stoma and undergoing major small bowel resection led to significantly lower Z-scores at closure. Adequate sodium supplementation and early closure did not lead to significant changes in Z-scores., Conclusion:  Stomas have a negative impact on growth in the majority of children. This impact might be decreased by preventing small bowel stomas when possible, specifically proximal stomas, and limiting small bowel resection. Since stoma closure is essential in reversing the negative effect on growth, we opt that early closure might result in an early shift to catch-up growth., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences., (© 2024. The Author(s).)

Objective: This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019., Study Design: Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study., Methods: Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries., Results: Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%)., Conclusions: Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The government of Serdang Bedagai Regency initiated a supplementation program to reduce the high prevalence of stunting in the area by delivering extra supplementation, which were nutritious biscuits from national government and fish-based supplement produced from local resources. A 6-month study from April 2022 to September 2022 was conducted to monitor and evaluate the government program that involved 219 under-5-year-old children with height-for-age Z-score (HAZ-score) below - 2. We observed the stunting prevalence reduction by 37.00%, where 81 children recovered from stunting (HAZ-score ≥ - 2). Furthermore, the mean HAZ-score and WHZ-score (Weight-for-Height Z-score) were monitored to significantly improve by 0.97 ± 1.45 (P-value = 1.74e -14 ) and 1.00 ± 2.18 (P-value  = and 2.40e -8 ), subsequently. The most significant improvement in HAZ-score was monitored among children receiving fish-based supplements with 1.04 ± 1.44 improvement (P-value = 6.59e -17 ). Then, a significant WHZ-score improvement was reported from children consuming fish-based supplements and a combination of fish-based supplements with nutritious biscuits (P-value = 2.32e -8 and 5.48e -5 ) by 1.04 ± 2.29 and 0.83 ± 1.84, respectively. The results of the observation become evidence that the program could effectively reduce the prevalence of stunting in children below five years old, especially among children who received locally produced fish-based supplements., (© 2024. The Author(s).)

Undernutrition is a major public health problem in developing countries. Around 40·2 % of children are stunted in Pakistan. This longitudinal study aimed to assess the effectiveness of locally produced ready-to-use supplementary foods in the prevention of stunting by detecting change in of children in intervention v . control arm against the 2006 WHO growth reference. A community-based non-randomised cluster-controlled trial was conducted from January 2018 to December 2020 in the district of Kurram, Khyber Pakhtunkhwa, Pakistan. A total of 80 clusters (each cluster comprising ≈ 250-300 households) were defined in the catchment population of twelve health facilities. Children aged 6-18 months were recruited n 1680. The intervention included a daily ration of 50 g - locally produced ready-to-use-supplementary food (Wawa-Mum). The main outcome of this study was a change in length for age z-score (LAZ) v . WHO growth standards. Comparison between the interventions was by t test and ANOVA. Cox proportional hazard models were used to assess the association between stunting occurrence and the utilisation of locally produced supplement. Out of the total 1680, fifty-one out of the total 1680, 51·1 out of the total 1680 and 51·1 % ( n 859) were male. Mean age 13·9 months (sd + 859) were male. Mean age 13·9 months (sd + -4·4). At baseline, 36·9 % ( n 618) were stunted. In the intervention group, mean LAZ score significantly increased from -1·13(2·2 sd) at baseline to -0·93(1·8 sd) at 6-month follow-up ( P value 0·01) compared with the control group. The incidence rate of stunting in the intervention arm was 1·3 v . 3·4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (Hazard Ratio (HR) 1·7, 95 % CI 1·46, 2·05, P value < 0·001) v . the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below 2 years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan.

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing 'cultural protocols' to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which 'crystallize' their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful., (© 2024. The Author(s).)

Child stunting due to linear growth faltering remains a pervasive issue in low- and middle-income countries. Two schools of thought have existed pertaining to the role of domestic livestock ownership (DLO) in child linear growth. On one hand, it is argued that DLO leads to greater income and financial security, resulting in better child-raising conditions, including greater animal-source food (ASF) consumption, having protective effects towards child stunting. On the other hand, researchers argue that DLO contributes to faecal contamination and transmission of zoonotic enteric infections from animals to children, thus having destructive effects on child growth. Reviews of this association have revealed ambiguous findings. In this perspective, we argue that measuring the association between exposures to domesticated animals and child stunting is difficult and the ambiguous associations revealed are a result of confounding and differences in the management of DLO. We also argue that the increasingly prominent area of research of environmental enteric dysfunction, a sub-clinical condition of the small intestine thought to be due to frequent faecal pathogen exposure and associated with stunting, will be a useful tool to measure the potential destructive effects of DLO on child growth. We present our argument and identify challenges and considerations and directions for future research., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Stunting, a persistent nutritional issue arising from prolonged inadequate nutrient intake, poses substantial risks such as heightened morbidity, mortality, and compromised cognitive, psychomotor, and verbal development. In Indonesia, addressing stunting in children under two necessitates urgent community empowerment, given its multifaceted nature. The aim of this study was to assess the effects of an intervention targeting mothers of toddlers, called RT kawal baduta (ERKADUTA) model, a local community-based assistance for babies under two years old. A quasi-experiment using pre-test and post-test with a control group design was conducted. Employing a quantitative analytic approach with 112 respondents, the effectiveness of ERKADUTA model to improve the knowledge, attitude, and practice of stunting prevention among mothers with child under two years old was assessed. ERKADUTA program was run for three months. The Wilcoxon test was used to determine score changes before and after program in both groups, while the Mann-Whitney test was used to analyze the score differences of knowledge, attitude and practice between intervention and control groups. Our data indicated that there were changes in knowledge, attitudes, and practices in preventing stunting in both the intervention and control groups. There are significant differences in knowledge ( p <0.001, effect size=-0.855), attitude ( p <0.001, effect size=-0.864), and practice score ( p <0.001, effect size=-0.924) between the intervention and control groups after the intervention. This study highlights that the ERKADUTA model emerged as a potent catalyst in improving stunting prevention behaviors among mothers with toddlers and this model holds promise for addressing the complexities of stunting in Indonesia., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2024 by the authors.)

Objective: This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda., Methods: A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms., Results: The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001)., Conclusion: Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs., Trial Registration: Clinicaltrials.gov, NCT05584969., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Komakech et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: In 2020, an estimated 150 million children under the age of 5 years were stunted. Stunting results from early-life adversity and it is associated with significant physical and cognitive deficit, lifelong socioeconomic disadvantage and reduced life expectancy. There is a need to understand the causes of stunting and its effects in order to develop strategies to avoid it and to mitigate the consequences once stunting has occurred. Epigenetics is an important mechanism through which early-life factors are thought to influence biological function, with long-term consequences. We describe a series of epigenetic studies designed to understand how early-life adversity results in stunting and to inform the development of practical tools such as predictive markers and therapeutic targets. This work is part of the UKRI GCRF Action Against Stunting Hub., Methods and Analysis: The project-in India, Indonesia and Senegal-comprises an observational study of mothers, fathers, and offspring (n=500) spanning the first 1000 days of life, and an intervention study in each country. Epigenetic status (DNA methylation) is determined in saliva from babies collected within 1 month of birth and again at 18 months of age, and from mothers and fathers around the time of birth. Epigenome-wide analysis is carried out using the Illumina EPIC array, augmented by high-definition sequencing approaches. Statistical analysis is carried out at the level of candidate genes/regions, higher dimensional epigenetic states and epigenome-wide association. Data analysis focuses on the determinants of stunting, the effectiveness of interventions, population comparisons and the link between epigenetics and other thematic areas, which include anthropometry, microbiome, gut health, parasitology, cognition, nutrition, food hygiene and water sanitation, food systems and the home environment., Ethics and Dissemination: This study has been approved by the relevant Ethics Committees in Indonesia, India and Senegal, and the UK. Research data will be published and posted in public repositories., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Child stunting has a complex aetiology, especially in the first 1000 days of life. Nutrition interventions alone have not produced expected impacts in reducing/preventing child stunting, indicating the importance of understanding the complex interplay between environmental, physiological and psychological factors influencing child nutritional status. This study will investigate maternal and child nutrition, health and well-being status and associated factors through the assessment of: (1) anthropometry, (2) biomarkers of nutrition and health status, (3) dietary intakes, (4) fetal growth and development, (5) infant morbidity, (6) infant and young child feeding (IYCF) and (7) perinatal maternal stress, depression and social support., Methods: This study will be conducted in a prospective pregnancy cohort in India, Indonesia and Senegal. Pregnant women will be recruited in the second (Indonesia, Senegal) and third (India) trimester of pregnancy, and the mother and infant dyads followed until the infant is 24 months of age. During pregnancy, anthropometric measures will be taken, venous blood samples will be collected for biochemical assessment of nutrition and health status, dietary intakes will be assessed using a 4-pass-24-hour dietary recall method (MP24HR), fetal ultrasound for assessment of fetal growth. After birth, anthropometry measurements will be taken, venous blood samples will be collected, MP24HR will be conducted, infant morbidity and IYCF practices will be assessed and a sample of breastmilk will be collected for nutrient composition analyses. Perinatal maternal stress, depression, social support and hair cortisol levels (stress) will be measured. The results from this study will be integrated in an interdisciplinary analysis to examine factors influencing infant growth and inform global efforts in reducing child stunting., Ethics and Dissemination: Ethical approval was granted by the Ethics Committee of the London School of Hygiene and Tropical Medicine (17915/RR/17513); National Institute of Nutrition (ICMR)-Ministry of Health and Family Welfare, Government of India (CR/04/I/2021); Health Research Ethics Committee, University of Indonesia and Cipto Mangunkusumo Hospital (KET-887/UN2.F1/ETIK/PPM.00.02/2019); and the Comité National d'Ethique pour la Recherche en Santé, Senegal (Protocole SEN19/78); the Royal Veterinary College (URN SR2020-0197) and the International Livestock Research Institute Institutional Research Ethics Committee (ILRI-IREC2020-33). Results will be published in peer-reviewed journals and disseminated to policy-makers and participating communities., Competing Interests: Competing interests: none., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Environmental hygiene and food safety are important determinants of child stunting. This research aims to explore the relationship between child stunting and household hygiene practices and behaviours, including the availability of water, sanitation and hygiene (WASH) facilities; the use of safe food and good quality drinking water (especially when used for complementary feeding); hygienic practices in food transport, storage and preparation and the control of cross-contamination from animals, their produce and waste., Methods and Analysis: This study is part of a wider observational study which aims to investigate the interdisciplinary factors contributing to child stunting using a 'whole child' paradigm. The observational study recruits women during pregnancy in Hyderabad, India, Lombok, Indonesia and Kaffrine, Senegal, and dyads (ie, 500 mother-infant pairs per country) are followed longitudinally up to 24 months after birth. Within the interdisciplinary niche, the study here has developed tools to investigate the potential exposure pathways to environmental pathogen contamination of foods and water. Holistic WASH and food safety data collection tools have been developed to explore exposure pathways at the household level, including: (1) survey questionnaires; (2) spot-checks; (3) biological sampling of drinking water, food and domestic surfaces and (4) direct observation. An integrated analytical approach will be used to triangulate the evidence in order to examine the relationships between child stunting, WASH and food safety behaviours., Ethics and Dissemination: Ethical approval of the study was granted by the ethics committee of the LSHTM, RVC, ILRI, ICMR, IIPHG, SEAMEO-RECFON, University of Cheikh Anta Diop. Findings of the study will be disseminated through publication in peer-reviewed journals, relevant international conferences, public engagement events, and policy-maker and stakeholder events., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Stunting is a significant and growing global problem that is resisting scientific attempts to understand it in terms of direct nutrition-related determinants. In recent years, research included more complex, indirect and multifactorial determinants and expanded to include multisectoral and lifestyle-related approaches. The United Kingdom Research Initiative Global Challenges Research Fund's (UKRI GCRF) Action Against Stunting Hub starts on the premise that dominant factors of stunting may vary between contexts and life phases of the child. Thus, the construction of a typology of clustered factors will be more useful to design effective programmes to alleviate it.The Shared Values theme seeks to build a bottom-up holistic picture of interlinked cultural contextual factors that might contribute to child stunting locally, by first eliciting shared values of the groups closest to the problem and then enquiring about details of their relevant daily activities and practices, to reveal links between the two. We define shared values as what groups consider 'valuable, worthwhile and meaningful' to them., Methods and Analysis: We will recruit 12-25 local stakeholder groups in each site (in India, Indonesia and Senegal) involved in children's food and early learning environments, such as mothers, fathers, grandmothers, teachers, market vendors and health workers. The WeValue InSitu process will be used to assist them to collectively elicit, negotiate and self-articulate their own shared values through exploration of shared tacit knowledge. Focus group discussions held immediately subsequently will ask about daily activities relevant to the children's environment. These contain many examples of cultural contextual factors potentially influencing stunting locally, and intrinsically linked to shared values articulated in the previous session., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Inadequate access to affordable, safe, desirable and convenient nutrient-dense food is one of the underlying causes of child stunting. While targeted nutrition-sensitive interventions (eg, backyard 'nutri-gardens') may increase dietary diversity within farming households, such interventions have limited scalability across the wider food system where markets remain underdeveloped. This research aims to develop and assess market-based interventions for key nutrient-dense foods to help improve the diets of women and children in the first 1000 days of life., Methods: Data collection uses four parallel approaches in each of the three study countries (India, Indonesia and Senegal). (1) A novel food environment tool will be developed to characterise the accessibility and affordability of nutrient-dense foods in the study countries. The tool will be validated through pretesting using cognitive interviewing and piloting in purposively sampled households, 10 (cognitive interviewing) and 30 (piloting) households in each country; (2) stakeholder interviews (eg, with producers, intermediaries and retailers) will be conducted to map out nutrition-sensitive entry points of key value chains (eg, animal-sourced foods), before hotspots of potential food safety hazards will be identified from food samples collected along the chains; (3) the Optifood and Agrifood tools will be used to identify foods that can address food system nutrient gaps and engage key stakeholders to prioritise market interventions to improve nutrition outcomes. Optifood and Agrifood parameters will be informed by publicly available data, plus interviews and focus groups with value chain stakeholders; (4) informed by the previous three approaches and a campaign of participatory 'group model building', a novel system dynamics model will evaluate the impact of alternative market-based solutions on the availability and affordability of nutrient-dense foods over time., Ethics and Dissemination: The study has received ethical approval in the United Kingdom, Senegal, Indonesia and India. Dissemination comprises peer-reviewed journals, international disciplinary conferences and multistakeholder dissemination workshops., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)