Effect of chestnut tannins and short chain fatty acids as anti-microbials and as feeding supplements in broilers rearing and meat quality

Chestnut tannins (CT) and saturated short medium chain fatty acids (SMCFA) are valid alternatives to contrast the growth of pathogens in poultry rearing, representing a valid alternative to antibiotics. However, the effect of their blends has never been tested. Two blends of CT extract and Sn1-monoglycerides of SMCFA (SN1) were tested in vitro against the proliferation of Clostridium perfringens, Salmonella typhymurium, Escherichia coli, Campylobacter jejuni. The tested concentrations were: 3.0 g/kg of CT; 3.0 g/kg of SN1; 2.0 g/kg of CT and 1.0 g/kg of SN1; 1.0 g/kg of CT and 2.0 g/kg of SN1. Furthermore, their effect on broiler performances and meat quality was evaluated in vivo: one-hundred Ross 308 male birds were fed a basal diet with no supplement (control group) or supplemented with CT or SN1 or their blends at the same concentration used in the in vitro trial. The in vitro assay confirmed the effectiveness of the CT and SN1 mixtures in reducing the growth of the tested bacteria while the in vivo trial showed that broiler performances, animal welfare and meat quality were not negatively affected by the blends, which could be a promising alternative in replacing antibiotics in poultry production

Options for the livestock sector in developing and emerging economies to 2030 and beyond

This paper focuses on emerging and developing nations. It argues that making use of the great diversity of livestock systems along with “enablers for transformation” creates opportunities to translate today’s rapid growth in demand for livestock-derived foods into rapid progress in sustainable and equitable development. We recognize that while most stakeholders in livestock development have the same end in mind – the evolution of a sustainable, responsible and efficient livestock sector – the great diversity of livestock species and production systems will necessitate very different starting points and trajectories. This diversity should be approached not as a problem to be solved but as a requirement for meeting societies’ protein and other needs

The potential of provitamin A-biofortified maize and sweet potato, and bambara groundnut for improving the nutritional status of rural communities in KwaZulu-Natal, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.The double burden of malnutrition, under- and over-nutrition, is a serious health problem and a leading contributor to the global disease burden. Undernutrition presents as wasting, stunting, underweight and micronutrient deficiencies, such as vitamin A, iron and zinc, while over-nutrition presents as overweight, obesity and several non-communicable diseases. Children under the age of five years and pregnant women are the most affected by malnutrition, especially in rural areas. In developing countries, such as South Africa (SA), the major contributing factors to all forms of malnutrition are poverty, food and nutrition insecurity as well as the shift from traditional diets to more westernised diets. There have been several strategies employed in SA to alleviate malnutrition, especially vitamin A deficiency (VAD), yet it still remains a problem. Provitamin A (PVA)-biofortified crops could be used as a complementary strategy to address VAD; however, there are challenges of poor consumer acceptability. The poor acceptability of PVA-biofortified foods could be improved by combining them with other commonly consumed plant food items and animal food sources such as chicken to produce provitamin A-rich traditional dishes. However, animal food products can be unaffordable to many economically disadvantaged households, thus legumes could be used as an alternative and cheaper protein source. Bambara groundnut is an underutilised indigenous legume that is found in sub-Saharan Africa (SSA). It is a good source of protein and when consumed together with cooked starch-based products, it forms a complementary protein. Therefore, combining PVA-biofortified maize with bambara groundnut could contribute to improving the nutritional status of vulnerable population groups in SSA, including SA. Cream-fleshed sweet potato (CFSP) (Ipomoea batata L.) is a commonly consumed crop in SA and would be ideal for PVA-biofortification to produce orange-fleshed sweet potato (OFSP). Unlike PVA-biofortified maize that showed poor consumer acceptability, OFSP has been found acceptable to consumers. The OFSP has a high PVA carotenoid concentration, therefore it could be used as a food-based approach to address VAD among the economically disadvantaged population groups who are usually at risk of VAD, particularly rural communities. Research conducted on the nutritional composition and consumer acceptability of composite dishes made with PVA-biofortified maize and OFSP is limited, especially in SA. Furthermore, there is paucity of literature on the nutritional composition and consumer acceptance of bambara groundnut combined with cooked PVA-biofortified maize. Thus, this study investigated the potential of PVA-biofortified maize and sweet potato, and bambara groundnut for improving the nutritional status of rural communities in KwaZulu-Natal (KZN), SA. In order to formulate an effective food-based approach to address malnutrition, the nutritional status and dietary patterns of the target population group/s (communities) needed to be determined. Thus, the first study objective was to assess the nutritional status, using selected anthropometric indices and dietary intake methods, of four rural communities in KZN, who had been selected for investigating the proposed food-based nutrition approach. Purposive sampling generated a sample of 50 households each in four rural areas of KZN: Swayimane, Tugela Ferry and Umbumbulu and 21 households at Fountain Hill Estate. Anthropometric [height, weight, mid-upper arm circumference (MUAC), and waist circumference] and dietary intake data (repeated 24-hour recall and food frequency) were collected. The Food Finder 3 software of the Medical Research Council (MRC), SA, was used to analyse dietary intake data, and the Statistical Package for Social Sciences (SPSS, version 25) was used to analyse the other data sets. The Estimated Average Requirement (EAR) cut-point method was used to assess the prevalence of inadequate nutrient intake. The results of the study indicated that 17.9 % (n=7), 30.8% (n=12) and 15.5% (n=6) of the children under five years were underweight, stunted and overweight, respectively. According to the MUAC measurements, 20.5% (n=8) and 5.1% (n=2) of the children under five years had severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively. The Fisher’s Exact test showed that a significant proportion (37.5%; n=3) of those with a MUAC below 11.5 cm had a weight-for-height (WFH) Z-score below -3 standard deviation (SD) of the WHO child growth standards median, indicating severe malnutrition (p=0.046). The majority of the adult participants were either overweight (23.6%; n=76) or obese (29.5%; n=95), with a higher prevalence of overweight and obesity among females than males. According to the Binomial test, a significant number (67.0%; n=213) of adult participants had waist circumference measurements below 88 cm and 102 cm for females and males, respectively (p<0.05). The Chi-square test indicated that there was a significant relationship between gender and waist circumference (p<0.05). A significant proportion of adult males (92.9%; n=105) had a normal waist circumference and were not at risk of obesity-related diseases, whilst a significant proportion (p<0.05) of adult females (47.3%; n=97) were at risk of obesity-related diseases, such as diabetes, high cholesterol and hypertension. Adult participants that were underweight or had a normal body mass index (BMI) were not at risk of co-morbidities and obesity, whilst participants who were classified as obese class I, II and III had a high risk of co-morbidities (p<0.05). Although not statistically significantly different, there was a higher prevalence of over-nutrition than undernutrition at all four research sites for females aged 16-35 years old. There was a significant relationship between BMI and the risk of having a clinically undesirable waist circumference (p<0.05). There was frequent consumption of food items high in carbohydrates (mainly the cereal grain foods), and low intake of micronutrients and fibre by most age groups. The food frequency results indicated that onion, phutu, brown bread, tomato, rice, apple, eggs and chicken were the most commonly consumed food items. Results of analysis by the EAR-cut point method indicated that, among most of the age groups, there was a high prevalence of inadequate intake of several nutrients, including dietary fibre, vitamins, including vitamin A and minerals, including zinc and iron. The second study objective was to determine the effect of replacing white maize and CFSP with PVA-biofortified maize and OFSP, respectively, on the nutritional composition of traditional and indigenous dishes of KZN, SA. The phutu combinations were selected based on a survey conducted in four selected rural study sites in KZN to determine popular dishes in which maize was combined with other food items. Popular indigenous knowledge systems (IKS)-based recipes were collected to determine methods of preparing and processing white maize and CFSP into food products. Phutu (traditional crumbly porridge) was selected as the cooked maize meal dish, curried cabbage as a vegetarian dish and curried chicken as a meat dish. Curried bambara groundnut was selected as an alternative animal protein source. Grains of one PVA-biofortified maize variety and one white variety (control) was cooked into phutu. Both varieties of phutu were served with either curried cabbage, chicken or bambara groundnut. Two types of boiled sweet potato were used in the study; OFSP and CFSP (control). Composite dishes were prepared by combining either PVA-biofortified phutu or white phutu with other food items, separately, i.e. curried cabbage, curried chicken and curried bambara groundnut and the nutritional composition of the dishes were analysed. Generally, the proximate composition of the PVA-biofortified phutu composite dishes were not significantly different from those of white phutu composite dishes (controls) (p>0.05). However, the PVA concentration of PVA-biofortified phutu composite dishes was higher than that of the white phutu composite dishes (controls). The OFSP had a significantly lower protein concentration, but was significantly higher in other nutrients, including PVA relative to the CFSP (p<0.05). The third investigation determined the effect of replacing white maize and CFSP with PVA-biofortified maize and OFSP, respectively, on the sensory properties and consumer acceptance of traditional and indigenous dishes of KZN, SA. The sensory acceptability of the composite dishes and sweet potatoes was evaluated by 60 participants each from the two rural areas (Swayimane and Umbumbulu), using a five-point facial hedonic scale and a paired preference test. Focus group discussions (FGDs) were conducted with 56 participants recruited from the consumer panel to assess consumer perceptions about the composite dishes made with PVA-biofortified phutu and OFSP. The majority of the participants rated the composite dishes containing PVA-biofortified phutu as “good” and the acceptability of the composite dishes varied significantly (p<0.05). Compared to other age groups, the 50-59 year age group showed a higher preference for the white phutu and curried chicken composite dish, whereas the 30-39 year age group showed a higher preference for the PVA-biofortified phutu and curried chicken composite dish. The acceptability of OFSP and CFSP was similar. The FGDs indicated that participants had positive perceptions of the PVA-biofortified phutu when served with curried chicken or cabbage. However, they had mixed perceptions when served with curried bambara groundnut. The older FGD participants perceived that some of the composite dishes, such as phutu and curried bambara groundnut, would not be acceptable to younger consumers as they were not accustomed to bambara groundnut, especially its sensory attributes such as taste, texture and aroma. There were positive responses to the proposal to replace the CFSP with OFSP. Most of the FGD participants perceived the OFSP to be butternut due to its orange colour, sweet taste and visual appeal. The FGD participants expressed a willingness to grow and purchase the PVA-biofortified maize and PVA-biofortified OFSP, if planting materials were made available or if the two types of biofortified crops were available in the local markets for utilisation as staple foods. The study findings show that under- and over-nutrition, and poor dietary diversity are prevalent in rural KZN. There was a low intake of several nutrients, including dietary fibre and several micronutrients. The study findings indicate that there is a need to increase the availability, accessibility, and utilisation of diverse foods through appropriate agricultural and nutritional interventions. Biofortification could be used as a complementary strategy to assist with the alleviation of VAD in SSA. Although, in several studies, PVA-biofortified foods have been found less acceptable compared to counterpart white maize foods, the PVA-biofortified foods investigated in this study were perceived positively by most of the participants. Overall, the study findings suggest that PVA-biofortified maize and OFSP can replace white maize and CFSP, respectively, in selected traditional dishes of the rural communities studied, to alleviate VAD. Further research should be conducted using a larger sample size, larger area and with different PVA-biofortified maize food types and varieties of OFSP, to obtain results for large rural populations in all provinces of SA

Ecosystem services and drivers of change in mangroves and seagrasses in Maputo Bay, Mozambique

Tese de mestrado, Ecologia e Gestão Ambiental, Universidade de Lisboa, Faculdade de Ciências, 2021The African coast has a high diversity of species and ecosystems, that provide ecosystem services (ES) and assure the subsistence of local populations. However, the supply of these ES is often endangered due to ecosystem degradation caused by direct and indirect drivers of change, which threaten people’s livelihoods and food security. This master thesis (integrated in the COBIONET project, funded by FCT/AGA KHAN Development Network) aimed to identify, classify and quantify ES provided by Maputo’s Bay (MB) mangrove forests and seagrass meadows, with a special focus on marine macroinvertebrates (MMI). The condition of both ecosystems and their link with the main direct drivers of change (e.g. alien species; climate change; land-use and land-cover changes; pollution; overexploitation (deforestation and overfishing)) and indirect drivers of change (e.g. overpopulation) was also assessed, allowing the understanding of how they may influence mangroves and seagrasses ES, as well as MMI ES. This led to the development of potential scenarios for the supply of MMI ES in the MB, and its connection with local food security. The work culminated with a conceptual model highlighting the connections between the drivers of change, the condition of the ecosystems, the main ES provided by the MMI from mangrove forests and seagrass meadows, and the expected management goals linked to a sustainable use of marine resources. The results from this thesis provided baseline information about the complexity of the MB, representing a practical starting point of exploration that may be used for future studies.A costa africana tem uma grande diversidade de espécies e ecossistemas, que fornecem serviços de ecossistema (ES – Ecosystem Services) e garantem a subsistência de vasto número de pessoas. No entanto, o fornecimento desses ES é frequentemente ameaçado por diversas pressões que levam à degradação do meio, colocando em causa a subsistência das comunidades locais e a sua segurança alimentar. Esta dissertação de mestrado, integrada no projeto COBIONET, financiado pela Fundação FCT / AGA KHAN, teve como principais objetivos a compreensão dos ES das florestas de mangal e pradarias marinhas da baía de Maputo (MB – Maputo Bay) e sua associação à condição destes habitats e principais pressões diretas e indiretas que os afetam, bem como a sua relação com os ES proporcionados pelos macroinvertebrados marinhos (MMI – Marine MacroInvertebrates) que neles habitam. Este estudo pretendeu ainda levar a cabo uma abordagem holística identificando lacunas de conhecimento e integrando avanços sobretudo relacionados com os ES dos MMI, de modo a desenvolver um modelo conceptual de ES que ligasse as pressões e condição dos ecossistemas com o fluxo de ES dos MMI e os diferentes objetivos de gestão. Pretendeu-se ainda compreender a importância dos MMI para a segurança alimentar das populações locais da MB, englobando práticas tradicionais e o uso sustentável desses recursos em florestas de mangal e pradarias marinhas. Utilizando dados digitais disponíveis, este estudo pretendeu fornecer uma ferramenta com informações de base para os decisores identificarem ações de mitigação e conservação aplicadas aos MMI das florestas de mangal e pradarias marinhas da MB. A condição dos mangais e pradarias marinhas, avaliada através da razão entre a área da Reserva Marinha Parcial da Ponta do Ouro (POPMR) e da área marinha total na província de Maputo (ZEE de Maputo), revelou-se longe dos níveis desejáveis. Por outro lado, o estudo das principais pressões diretas e indiretas, revelou uma elevada utilidade para compreensão da dinâmica geral da baía, dando uma perspetiva dos possíveis futuros cenários da área, se as pressões em questão não forem eliminadas ou mitigadas. Em termos de pressões diretas, foram consideradas: (1) espécies exóticas de MMI: apenas uma foi descoberta, porém já causa insatisfação entre os pescadores; (2) alterações climáticas: avaliadas através da variação da temperatura da superfície do mar (SST – Sea Surface Temperature) e do nível do mar (SL – Sea Level) ao longo do tempo, as quais revelaram estar a subir apesar de algumas oscilações; (3) alterações no uso e ocupação do território (LUCL – Land Use Land Cover) - estudo efetuado com ferramentas de mapeamento, que evidenciou uma crescente cobertura urbana e agrícola em detrimento da cobertura (semi)natural, a qual inclui florestas de mangal; (4) sobreexploração, a qual foi dividida em desflorestação e sobrepesca, ambas a aumentar. Relativamente à desflorestação, as florestas de mangal periurbanas foram consideradas mais vulneráveis devido à dependência das comunidades locais deste recurso. A sobrepesca trouxe à luz o problema da intensa captura acessória (bycatch) e a provável situação de exploração insustentável dos stocks de algumas espécies, da qual é exemplo a alta procura de espécies de camarão, tanto na pesca artesanal como na semi-industrial; e (5) poluição, um problema que pode ter várias fontes e cujas verdadeiras consequências não estão bem estudadas ao nível da MB, causando assim motivo de preocupação. Em relação às pressões indiretas, considerou-se apenas a sobrepopulação, sendo um problema exponencialmente crescente na área de estudo e que pode funcionar como um catalisador para todas as demais pressões diretas referidas. No que toca à identificação, classificação e quantificação do ES proporcionados pelas florestas de mangal, pradarias marinhas e os seus MMI, o mapeamento foi utilizado como proxy para a identificação do local onde os ES em estudo poderiam ser encontrados com maior probabilidade; o mapeamento foi desenvolvido com recurso ao software ArcGIS, e apesar das suas incontornáveis vantagens, foi uma ferramenta que revelou ter algumas limitações, já que algumas porções de floresta de mangal não foram identificadas, principalmente no estuário Espírito Santo. Quanto ao processo de identificação e classificação, este seguiu a Common International Classification of Ecosystem Services (CICES), dando ao mesmo tempo correspondência à Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) para uma perspetiva mais ampla; já para a quantificação, foram aplicados diferentes indicadores para compreender a oferta de ES, processo que revelou algumas falhas, atendendo à escassa quantidade de dados disponíveis. Foi confirmado o potencial das florestas de mangal e das pradarias marinhas em termos de serviços de provisão, regulação e manutenção, e culturais. Na seção de regulação e manutenção os ES destacaram se, principalmente devido ao potencial destes ecossistemas para mitigar os efeitos de muitas das pressões diretas identificadas, bem como por serem importantes áreas de viveiro (nursery), inclusive para espécies de MMI: as florestas de mangal são vitais para a proteção de espécies edíveis como o caranguejo Scylla serrata e camarões, principalmente o Fenneropenaeus indicus (camarão-branco); as pradarias marinhas estão intimamente ligadas à apanha do ouriço-do-mar e amêijoas, também estes edíveis. Ao nível de regulação e manutenção, o ES “ciclo hidrológico e regulação do fluxo de água” foi quantificado e considerado decrescente, refletindo a diminuição gradual da área de floresta de magal, que funciona como barreira natural. Quanto à seção de serviços culturais, o ES “as características dos sistemas vivos que permitem a investigação científica ou a criação de conhecimento ecológico tradicional” mostrou-se crescente, refletindo o aumento do número de publicações científicas; o ES “características dos sistemas vivos que são ressonantes em termos de cultura ou património” foi globalmente decrescente quando se considerou o número total de hóspedes que permaneceram em Maputo ao longo do tempo, embora os visitantes internacionais tenham apresentado um maior crescimento do que os visitantes nacionais. Relativamente aos MMI, é importante primeiro reconhecer que todas as informações resultaram de uma base de dados digital (BD) fornecida pela equipa do projeto COBIONET. No contexto da sua distribuição, os phyla Arthropoda e Mollusca demonstraram ser predominantes, sendo o primeiro mais presente em florestas de mangal e o segundo em pradarias marinhas. No que toca aos seus ES, a secção de provisão destacou-se pela sua importância na segurança alimentar, que é um dos pontos fundamentais desta dissertação e um importante Objetivo de Desenvolvimento Sustentável da Agenda 2030 da ONU para o Desenvolvimento Sustentável. Em termos de provisão, o potencial dos MMI foi identificado e estudado através de indicadores de produção, no que diz respeito à pesca artesanal e semi-industrial, tendo as licenças de pesca artesanal também sido contabilizadas. A pesca artesanal, com um número crescente de licenças, tem aumentado a sua produção ao longo dos anos, porém, tem como alvo comum à pesca semi-industrial espécies de camarão, revelando a sua importância como fonte proteica e económica para a baía. Destacam-se as espécies Fenneropenaues indicus (camarão-branco) e Metapenaeus monoceros (camarão-negro), cujos stocks estão provavelmente em declínio, refletindo a sobreexploração deste recurso – realidade corroborada pela crescente procura desta iguaria já ter levado à expansão de área de pesca, a qual está já a ser praticada parcialmente dentro da POPMR, ao largo da península de Machangulo. Para o estudo dos ES de regulação e manutenção foi aplicado a riqueza específica funcional, estimada com base na informação contida na base de dados compilada durante este estudo. Os ES possíveis de serem quantificados foram os seguintes: “manutenção de populações e habitat de viveiro”; “processos de decomposição e fixação e os seus efeitos na qualidade do solo”; “ciclo hidrológico e regulação do fluxo de água”; e “regulação da condição química da água salgada por processos vivos”. Os resultados mostraram que a oferta de todos os ES estava a aumentar indicando, aparentemente, que embora os MMI enfrentem muitas pressões, o seu efeito ainda não é visível a esta escala. Os ES culturais passíveis de serem avaliados foram “características dos sistemas vivos que permitem a investigação científica ou a criação de conhecimento ecológico tradicional”, “características dos sistemas vivos que permitem a educação e o treino” e “características dos sistemas vivos que possibilitam atividades promotoras da saúde, da recuperação ou do disfrutar por meio de interações ativas ou imersivas”. Todos revelaram estar em crescimento, os dois primeiros devido à crescente riqueza específica ao longo do tempo em termos de MMI, e o último pelo crescente número de licenças para a pesca recreativa e desportiva. Com toda a informação recolhida, o trabalho resultou no desenvolvimento de um modelo conceptual, com destaque nas ligações entre as pressões diretas e indiretas, o estado/condição dos ecossistemas, os principais ES fornecidos pelos MMI das florestas de mangal e pradarias marinhas da MB, e objetivos de uma gestão sustentável relacionados com a segurança alimentar e estado ecológico. Os resultados obtidos serão úteis para estudos futuros, representando um ponto de partida prático de exploração da MB ou áreas de estudo que reúnam condições semelhantes

Drivers of the trend in child stunting and the role of omega-3 long-chain polyunsaturated fatty acids in relation to child growth and development in rural Ethiopia

Despite the significant progress the world has made over the past few decades, millions of children in low- and middle-income countries still suffer from poor growth and development. Growth faltering during the critical window period of the first 1,000 days after conception is associated with multiple adverse consequences limiting human potential and economic growth. Recognizing the magnitude of the problem and its severe consequences, the World Health Assembly in 2012 endorsed a Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition with six global targets, chief among which is the target to reduce the number of stunted children by 40% in 2025. Identifying priority areas of action in high nutrition-burden countries is the first step to accelerate current progress and achieve the global nutrition targets. For the purpose of facilitating evidence-based decision-making, the first part of this Ph.D. thesis explores nutrition-specific and -sensitive factors that can contribute to a reduction in chronic child undernutrition in low- and middle-income countries. We pooled data from 50 Demographic and Health Surveys conducted in 14 low- and middle-income countries to explain the trend in under-five stunting prevalence over the past two decades. A four-level mixed-effects linear probability model, accounting for clustering of data by sampling clusters, survey-rounds, and countries, was fitted to estimate the association between the change in a range of distal to proximal determinants at a country-level and stunting risk for an individual child while adjusting for time trend and child-level covariates. Furthermore, innovative approaches that maximize the impact of existing nutrition interventions are highly required to assist the progress in low- and middle-income countries. Complementary feeding interventions in low-income settings to date have been focused on the energy and micronutrient content of diets and yielded only small to moderate effects on growth and development. Increasing evidence support the hypothesis that environmental enteric dysfunction, chronic gut inflammation with morphological and functional derangements, and systemic inflammation occurring at a high prevalence in children living in poor settings, could be an important missing link that mediates and reduces the expected benefits from interventions. There is evidence that omega-3 long-chain polyunsaturated fatty acids (n-3 LCPs) may improve gut integrity, reduce inflammation and enhance maturation of the immune system, which could lead to amelioration of this condition and the associated growth impairment. Additionally, some studies in high-income populations showed that n-3 LCPs may have benefits for infant neurocognitive development. However, there is limited evidence from studies testing these potential benefits in infants and young children in a low-income setting. Therefore, in the second part of the PhD thesis, we hypothesized that an increased intake of n-3 LCPs would result in reduced morbidity and inflammation, and improved growth and development of children aged 6-24 months in a low-income setting. To test these proposed hypotheses, we conducted the OME3JIM project involving a 2 x 2 factorial randomized controlled trial of n-3 LCPs-rich fish-oil supplementation (500 mg/day n-3-LCPs) through lactation (MI), complementary feeding (CI), or a combination of both (MCI). We enrolled 360 pairs of lactating mothers and their infants 6-12 months old from three rural communities in Jimma district, southwest Ethiopia. The primary study outcomes were child linear growth, i.e., monthly changes in length-for-age z score (LAZ) over the 12 months intervention follow-up, and the evolution of developmental performance from baseline through 6 and 12 months of the intervention, using the Denver II and the Ages and Stages Questionnaire: Social Emotional tools. Secondary outcomes included LCP concentrations in maternal milk and child blood, anthropometry measurements of weight-for-length z score (WLZ), head-circumference and mid-upper arm circumference (MUAC), nutritional status (stunting, wasting and anemia), common childhood morbidities, and inflammation using C-reactive protein. Chapter 3 presents results of the study on the trend in child stunting. Stunting followed a declining trend in all the 14 countries studied at an average annual reduction rate of 1.04 percentage points (pp). Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women’s decision-making, and an increase in urbanization over time within a country were significantly associated with a lower risk of stunting. Improvements in households’ access to improved sanitation facilities and drinking water sources, and children’s access to basic vaccinations were the important intermediate service-related drivers of stunting risk identified, whereas an improvement in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. Our findings indicate that although there has been progress in reducing stunting, the rate of reduction in the studied countries was below the average 3.9 pp annual reduction rate required to meet the global target set for 2025. Furthermore, our findings reinforce the need for a combination of nutrition-specific and -sensitive interventions on top of economic development to tackle the problem of chronic childhood undernutrition. The identified drivers will help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic child undernutrition. Results of the OME3JIM study are presented and discussed in Chapters 4-6. From the total of 360 mother-infant pairs enrolled, 87% completed all the 12 months study follow-ups and the mean (SD) duration of supplementation was 11.0 (2.9) months. Compliance rate for the child and the maternal interventions were ~80% and ~70%, with no difference between study arms. All statistical analyses were conducted following the intention-to-treat principle. In Chapter 4, we present the efficacy of fishoil supplementation of lactating mothers on human milk LCP concentrations using a random sub-sample of 154 study participants. Fish-oil supplementation during lactation increased maternal milk concentrations of docosahexaenoic acid (DHA) by 39.0% (P < 0.001) and eicosapentaenoic acid (EPA) by 36.2% (P < 0.001), whereas the ratio of arachidonic acid (AA)/(DHA + EPA) decreased by 53.5% (P < 0.001), compared to the control. However, the maternal milk DHA concentration still remained lower than international norms after the intervention. The results demonstrate that fish-oil supplementation during lactation improves n-3 LCPs status of the maternal milk. In these mothers with a very low baseline breastmilk DHA status, which further declines over the course of lactation, a higher dose of supplementation may be required to attain optimal breastmilk DHA levels. Chapter 5 presents the independent and combined effects of the fish-oil intervention through lactation and complementary food on child n-3 LCPs status, health and growth. Fish-oil supplementation significantly increased child blood n-3 LCPs concentrations (P < 0.01) and decreased the AA/(DHA + EPA) ratio (P < 0.001) in all the MI, CI and MCI intervention arms as compared to the control. Fish-oil intervention also resulted in a better ponderal growth of children, as indicated by the small, but statistically significant, positive effects on monthly WLZ changes in the CI (effect size: 0.022/month; 95% CI: 0.005, 0.039/month; P = 0.012) and MCI arms (effect size: 0.018/month; 95% CI: 0.001, 0.034/month; P = 0.041). We also noted a non-significant trend towards larger monthly MUAC increments in the CI and MCI arms compared to the control. No further effects were detected on the primary study outcome linear growth or on the other secondary outcomes of growth, nutritional status, morbidity, and inflammation. Chapter 6 presents the effects of the same intervention on child development performance. There was no difference between study arms on the evolution of overall and social-emotional developmental performance over time (intervention by time interaction: F = 1.09; P = 0.35, and F = 0.61; P = 0.61, respectively). Overall, the findings from the OME3JIM trial did not support our primary study hypotheses that dietary n-3 LCPs supplementation through lactation and/or complementary feeding improves linear growth and development of infants and young children from a rural setting in Ethiopia. n-3 LCP supplementation given directly to children or in combination with maternal supplementation was found to modestly increase relative weight gain. In conclusion, this PhD research provides evidence on a set of potentially important proximal to distal factors that can contribute to reduction in chronic childhood undernutrition in low- and middle-income countries. It also contributes to the limited literature on the effects of n-3 LCP supplementation in infants and young children in a rural sub-Saharan African setting. In Chapter 7 the implications of the study findings are discussed and recommendations for future research and policy are provided. It is underlined that economic development and nutrition-sensitive interventions, on top of nutrition-specific programs, could play an important role in further reduction of the high stunting burden in low- and middle-income countries. Future follow-up of the OME3JIM cohort is also recommended to determine whether there are long-term effects of the fish-oil intervention