A ‘smart buy' for all? Unequal and unintended consequences of a messaging program for child education

Through a large-scale household-randomized trial, we document divergent and unintended effects of a SMS-nudge parenting intervention in Ghana. For parents with some exposure to formal schooling, the program supported parental education engagement, child school participation and social-emotional skills. Conversely, for parents with no schooling, the program backfired, exacerbating educational inequality. Messages also lowered parental selfefficacy, educational aspirations, and the perceived importance of regular school attendance among parents with no schooling. As light-touch, low-tech strategies integrate into education systems to combat the global learning crisis, these findings caution against potential unintended and distributional consequences, particularly in rural, low-literacy contexts

Household food insecurity and early childhood development: Longitudinal evidence from Ghana

The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years. Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves. Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy and short-term memory. When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009). No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development

Rural transformation and the double burden of malnutrition among rural youth in low and middle-income countries

Adolescence and early adulthood are periods of major biological, economic and social transitions for rural youth. They provide a critical window of opportunity for addressing chronic nutritional deficits from childhood, for “catch-up” growth, for providing a solid foundation for a healthy productive and reproductive life, and for arresting the intergenerational transmission of malnutrition. In this study we show that rural transformation processes are associated with improvements in rural youth nutrition – malnutrition and underweight – in nearly all regions, although the pace of change varies considerably across countries. Most low- and middle-income countries (LMICs) are faced with the double burden of malnutrition and overweight/obesity, and in some countries this double burden is increasing, with the prevalence of underweight and overweight/obesity rising concurrently. The effect of rural transformation processes on rural youth nutrition is mediated by its effects on the external and personal domains of the “food environment”. Transformation of agri-food systems are bringing about large changes in the diets of rural youth in LMICs, and particularly of the younger age groups, who appear to be witnessing rapid dietary transitions. The Young Lives dataset suggest that certain near-universal changes in patterns of dietary and nutrient intake patterns can be discerned in LMICs, although the pace of change varies. Dietary transitions are also driven by “globalisation influences” – especially dissemination of information through digital/social media and food industry advertising and marketing strategies – even in countries with low/slow rural transformation. Our results show that rural transformation processes can have both positive and negative effects on rural youth nutrition in LMICs. Despite the globalisation influences of international trade and agri-food systems, dietary changes in individual LMICs are still influenced by national policies and production patterns. Understanding the pathways to impact of rural transformation on rural youth nutrition is crucial for designing “nutrition-sensitive” rural transformation policies

IFAD RESEARCH SERIES 50 Rural Transformation and the Double Burden of Malnutrition Among Rural Youth in Developing Countries

Adolescence and early adulthood are periods of major biological, economic and social transitions for rural youth. They provide a critical window of opportunity for addressing chronic nutritional deficits from childhood, for “catch-up” growth, for providing a solid foundation for a healthy productive and reproductive life, and for arresting the intergenerational transmission of malnutrition. In this study we show that rural transformation processes are associated with improvements in rural youth nutrition – malnutrition and underweight – in nearly all regions, although the pace of change varies considerably across countries. Most low- and middle-income countries (LMICs) are faced with the double burden of malnutrition and overweight/obesity, and in some countries this double burden is increasing, with the prevalence of underweight and overweight/obesity rising concurrently. The effect of rural transformation processes on rural youth nutrition is mediated by its effects on the external and personal domains of the “food environment”. Transformation of agri-food systems are bringing about large changes in the diets of rural youth in LMICs, and particularly of the younger age groups, who appear to be witnessing rapid dietary transitions. The Young Lives dataset suggest that certain near-universal changes in patterns of dietary and nutrient intake patterns can be discerned in LMICs, although the pace of change varies. Dietary transitions are also driven by “globalisation influences” – especially dissemination of information through digital/social media and food industry advertising and marketing strategies – even in countries with low/slow rural transformation. Our results show that rural transformation processes can have both positive and negative effects on rural youth nutrition in LMICs. Despite the globalisation influences of international trade and agri-food systems, dietary changes in individual LMICs are still influenced by national policies and production patterns. Understanding the pathways to impact of rural transformation on rural youth nutrition is crucial for designing “nutrition-sensitive” rural transformation policies

Malnutrition, Hypertension Risk, and Correlates:An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15–19 Years Adolescent Boys and Girls

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

Trends and Factors Associated with the Nutritional Status of Adolescent Girls in Ghana:A Secondary Analysis of the 2003-2014 Ghana Demographic and Health Survey (GDHS) Data

Objective: We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Design: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Setting: Countrywide, covering rural and urban areas in Ghana. Participants: Non-pregnant adolescent girls aged 15–19 years. Results: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. Conclusions: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls

Learning in the Time of a Pandemic and Implications for Returning to School: Effects of COVID-19 in Ghana

The Covid-19 pandemic led to school closures all over the world, leaving children across diverse contexts without formal education for nearly a year. Remote-learning programs were designed and rapidly implemented to promote learning continuity throughout the crisis. There were inequalities in who was able to access remote-learning during school closures, though little systematic evidence documenting these gaps exists, particularly in sub-Saharan Africa. In this study, we surveyed 1,844 children in the Greater Accra Region of Ghana, as well as their caregivers and teachers, regarding their engagement in remote learning, literacy and math test scores, and household economic hardships. We document inequalities in access to and engagement in remote-learning activities during the ten months in 2020 in which schools were closed in Ghana. Specifically, children in private schools and children in higher-socioeconomic status households engaged in remote-learning at higher rates and received more support from their schools and caregivers. Further, controlling for demographic characteristics and pre-pandemic learning outcomes, we document gaps in children’s literacy and math test scores, with food insecure and low-SES children, as well as children enrolled in public schools before the pandemic, performing significantly worse than their peers (0.2-0.3 SD gap). Finally, children in households that experienced more economic hardships during the pandemic engaged in fewer remote learning activities and had lower literacy and numeracy assessment scores. The findings speak to the potential consequences of increased inequalities due to the pandemic as schools re-open in Ghana and around the world and provide insight into how schools may address these inequalities as children return to the classroom

A School Meals Program Implemented at Scale in Ghana Increases Height-for-Age during Midchildhood in Girls and in Children from Poor Households: A Cluster Randomized Trial

Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school-age children's anthropometry indicators

The impact of food assistance on food insecure populations during conflict: Evidence from a quasi-experiment in Mali

Mali, a vast landlocked country at the heart of West Africa in the Sahel region, is one of the least developed and most food insecure countries in the world. Mali suffered from a series of political, constitutional and military crises since January 2012, including the loss of government control of northern territories from April 2012 until January 2013. A range of humanitarian aid interventions were scaled up in response to these complex crises. In this study, we exploit data from a unique pre-crisis baseline to evaluate the impact of humanitarian aid on the food security of rural populations. We design a quasi-experimental study based on two survey rounds, five years apart, in the Mopti region in Northern Mali. Data was collected from 66 communities randomly selected from within food-insecure districts. Study outcomes include household expenditures and food consumption and a proxy for child nutritional status (height measurements). We estimate program impact by combining propensity score matching and difference-in-difference. Food assistance was found to increase household non-food and food expenditures and micro-nutrient availability. Disaggregating by degree of conflict exposure showed that the effects on children's height and caloric and micro-nutrient consumption were mostly concentrated in areas not in the immediate vicinity of the conflict, unlike the increase in food expenditures that were driven by households located in close proximity to armed groups. The effects were also concentrated on households receiving at least two forms of food assistance. In villages where armed groups were present, food assistance improved household zinc consumption and also appeared to support food expenditures. Food transfers are thus found to exert a protective effect among food insecure population in conflict context

Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data.

BACKGROUND: 'Home-grown' school feeding programmes are complex interventions with the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including smallholder farmers and women's groups. There is limited rigorous evidence, however, that this is the case in practice. This evaluation will examine explicitly, and from a holistic perspective, the simultaneous impact of a national school meals programme on micronutrient status, alongside outcomes in nutrition, education and agriculture domains. The 3-year study involves a cluster-randomised control trial designed around the scale-up of the national school feeding programme, including 116 primary schools in 58 districts in Ghana. The randomly assigned interventions are: 1) a school feeding programme group, including schools and communities where the standard government programme is implemented; 2) 'home-grown' school feeding, including schools and communities where the standard programme is implemented alongside an innovative pilot project aimed at enhancing nutrition and agriculture; and 3) a control group, including schools and households from communities where the intervention will be delayed by at least 3 years, preferably without informing schools and households. Primary outcomes include child health and nutritional status, school participation and learning, and smallholder farmer income. Intermediate outcomes along the agriculture and nutrition pathways will also be measured. The evaluation will follow a mixed-method approach, including child-, household-, school- and community-level surveys as well as focus group discussions with project stakeholders. The baseline survey was completed in August 2013 and the endline survey is planned for November 2015. RESULTS: The tests of balance show significant differences in the means of a number of outcome and control variables across the intervention groups. Important differences across groups include marketed surplus, livestock income, per capita food consumption and intake, school attendance, and anthropometric status in the 2-5 and 5-15 years age groups. In addition, approximately 19 % of children in the target age group received some form of free school meals at baseline. CONCLUSION: Designing and implementing the evaluation of complex interventions is in itself a complex undertaking, involving a multi-disciplinary research team working in close collaboration with programme- and policy-level stakeholders. Managing the complexity from an analytical and operational perspective is an important challenge. The analysis of the baseline data indicates that the random allocation process did not achieve statistically comparable treatment groups. Differences in outcomes and control variables across groups will be controlled for when estimating treatment effects. TRIAL REGISTRATION NUMBER: ISRCTN66918874 (registered on 5 March 2015)