The role of food and nutrition system approaches in tackling hidden hunger

One of the World`s greatest challenges is to secure sufficient and healthy food for all, and to do so in an environmentally sustainable manner. This review explores the interrelationships of food, health, and environment, and their role in addressing chronic micronutrient deficiencies, also known as "hidden hunger", affecting over two billion people worldwide. While the complexity and underlying determinants of undernutrition have been well-understood for decades, the scaling of food and nutrition system approaches that combine sustainable agriculture aimed at improved diet diversity and livelihoods have been limited in their development and implementation. However, an integrated system approach to reduce hidden hunger could potentially serve as a sustainable opportunity

Linking Social Protection Schemes: The Joint Effects of a Public Works and a Health Insurance Programme in Ethiopia

In developing countries and in particular in sub-Saharan Africa, social protection schemes tend to operate in silos. However, schemes targeting the same geographical areas may have synergies that have not yet been examined, and which are worth scrutinising. This paper contributes to this knowledge gap by examining the joint impacts of two social protection programmes in Ethiopia, that is, the Productive Safety Net Programme and a Community Based Health Insurance Scheme. Based on three rounds of individual level panel data and several rounds of qualitative interviews, we find that individuals covered by both programmes, as opposed to neither or only one of the two programmes, provide greater labour supply, have larger livestock holdings, and have a lower amount of outstanding loans. Furthermore, joint participation is associated with greater use of modern health care facilities as compared to participating only in the safety net programme. These results show that bundling of interventions enhances protection against multiple risks and that linking social protection schemes yields more than the sum of their individual effects

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

State legitimacy and famines in Sub-Saharan Africa

Political Economy of famines mainly focuses on political regimes to understand the role of institutions. In this paper, we investigate a broader concept, state legitimacy, and its role on one specific development outcome, famine management. State legitimacy refers to the political history of a country, meaning the embedding of state and society. Using a database of Sub-Saharan countries observed from 1980 to 2005, we use three empirical strategies: logit on famine occurrence, negative binomial regression and Arellano-Bond dynamic model on the number of years of famines. They all lead to the same results: there is room for a political economy of famine based on an analysis of state. State legitimacy prevents famines, controlling for shocks countries might go through, and controlling for the quality of government. The main contributions of this paper are first to consider the role of state legitimacy in the political economy of famines and second to apply the concept in an empirical analysis, using for the first time a state legitimacy variable

To Be or Not to Be a Member of a Primary Co-operative in Brazil: Any Difference in Household Decision-Making and Gender Equality?

The paper investigates the effect of co-operative membership on people's capability to participate in household decision-making and on domestic gender relations. Our hypothesis is that the democratisation process activated in genuine co-operatives, authentic member-owned forms of business, may then be transferred to the household. We tested this in the "Coppalj" co-operative in Brazil, where we collected primary data. Both the techniques employed, regression and propensity score matching, support our hypotheses in a number of life domains. Though results vary slightly according to the domain and the outcome indicator, they show that members of the co-operative have a statistically significant higher capability to participate in decision-making and to share their decisions with partners than non-members (the control group). We then triangulated these quantitative outcomes with qualitative ones: the latter confirm an improvement in gender relations between co-operators and their partners, highlighting the fundamental role of Coppalj in fostering gender equality. © 2014 Oxford Department of International Development