The need for multisectoral food chain approaches to reduce trans fat consumption in India.

BACKGROUND: The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. METHODS: Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). RESULTS: Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. CONCLUSIONS: A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production

Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India: A Case Study of the Food Environments of Rural Villages and an Urban Slum.

OBJECTIVE: To describe the food environment in rural villages and an urban slum setting in India with reference to commercially available unbranded packaged snacks and street foods sold by vendors, and to analyze the type and quantity of fat in these foods. DESIGN: Cross-sectional. SETTING: Two low-income villages in Haryana and an urban slum in Delhi. PARTICIPANTS: Street vendors (n = 44) were surveyed and the nutritional content of snacks (n = 49) sold by vendors was analyzed. MAIN OUTCOME MEASURES: Vendors' awareness and perception of fats and oils, as well as the type of snacks sold, along with the content and quality of fat present in the snacks. ANALYSIS: Descriptive statistics of vendor survey and gas chromatography to measure fatty acid content in snacks. RESULTS: A variety of snacks were sold, including those in unlabeled transparent packages and open glass jars. Mean fat content in snacks was 28.8 g per 100-g serving in rural settings and 29.6 g per 100-g serving in urban settings. Sampled oils contained high levels of saturated fats (25% to 69% total fatty acids) and trans fats (0.1% to 30% of total fatty acids). CONCLUSIONS AND IMPLICATIONS: Interventions need to target the manufacturers of oils and fats used in freshly prepared products to improve the quality of foods available in the food environment of low-socioeconomic groups in India

Innovative matrix for applying a food systems approach for developing interventions to address nutrient deficiencies in indigenous communities in India: a study protocol.

BACKGROUND: Indigenous communities retain knowledge of the land and food resources rooted in historical continuity within their region of residence. Food systems research can be leveraged to identify strategies to encourage sustainable use of complex multi-species agroforestry systems by indigenous communities contributing to nutritional needs while simultaneously preserving the ecosystems and their benefits to society. Till date, the analyses of food systems have predominantly focused on high income countries often overlooking the alternatives (dietary and production) that would be most relevant to low and middle income countries (LMIC). Thus, innovative methodological approaches are needed to comprehensively characterize diverse food systems in LMICs with special reference to indigenous communities. DESIGN: This protocol paper describes a food systems approach that will be employed to understand diverse and dynamic food systems of vulnerable tribal communities of Jharkhand, India and leverage their agroforestry systems to improve dietary diversity, nutrition status and address food security. Four tribal groups namely Santhal, Ho, Munda and Sauria Paharia of Godda, West Singhbhum and Khunti districts of Jharkhand would be studied. This will be an exploratory cross-sectional study design, along with a longitudinal component to capture seasonality in dietary intake and agricultural diversity. A mixed methods approach will be used based on a conceptual framework on drivers of food systems, food supply chain, food environment (both wild & cultivated, and market food environments), as well as consumer behaviour and maternal and child health outcomes in tribal communities. The quantitative surveys will be conducted on socio-economic, demographic profile of households, their availability of, access to and utilization of food environment and nutritional status of reproductive age group women and children under 5 years. Qualitative enquiries will examine barriers and facilitators to increase sustainable production, procurement and consumption of indigenous foods. The final outcome would be development of interventions to promote indigenous food consumption. DISCUSSION: By utilizing a combination of value chain analysis and 'Optifoods linear programming software' that will use above information on indigenous community, dietary intake, nutritional status and food environment, evidence based interventions promoting indigenous food systems aimed at addressing food and nutritional security of tribal communities will be developed

Pathways of Climate Change Impact on Agroforestry, Food Consumption Pattern, and Dietary Diversity Among Indigenous Subsistence Farmers of Sauria Paharia Tribal Community of India: A Mixed Methods Study

Climate change poses severe threats to the social, cultural, and economic integrity of indigenous smallholder subsistence farmers, who are intricately linked with their natural ecosystems. Sauria Paharia, a vulnerable indigenous community of Jharkhand, India, are smallholder farmers facing food and nutrition insecurity and have limited resources to cope with climate change. Eighteen villages of Godda district of Jharkhand inhabited by Sauria Paharia community were randomly selected to conduct a mixed methods study. In 11 out of 18 study villages, we conducted focus group discussions (FGDs) to examine the perception of this indigenous community regarding climate change and its impact on agroforestry and dietary diversity. In all 18 villages, household and agricultural surveys were conducted to derive quantitative estimates of household food consumption patterns and agroforestry diversity, which were triangulated with the qualitative data collected through the FGDs. The FGD data revealed that the community attributed local climatic variability in the form of low and erratic rainfall with long dry spells, to reduced crop productivity, diversity and food availability from forests and waterbodies. Declining agroforestry-produce and diversity were reported to cause reduced household income and shifts from subsistence agricultural economy to migratory unskilled wage laboring leading to household food insecurity. These perceptions were supported by quantitative estimates of habitual food consumption patterns which revealed a predominance of cereals over other food items and low agroforestry diversity (Food Accessed Diversity Index of 0.21 ± 0.15). The adaptation strategies to cope with climate variability included use of climate-resilient indigenous crop varieties for farming, seed conservation and access to indigenous forest foods and weeds for consumption during adverse situations and lean periods. There were mixed views on cultivation of hybrid crops as an adaptation strategy which could impact the sustained utilization of indigenous food systems. Promoting sustainable adaptation strategies, with adequate knowledge and technology, have the potential to improve farm resilience, income, household food security and dietary diversity in this population

Why women choose to give birth at home: a situational analysis from urban slums of Delhi

Objectives: Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events. Design: Cross-sectional survey using quantitative and qualitative methods. Setting: Urban poor settlements in Delhi, India. Participants: A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities. Results: Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births. Conclusions: Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births

Analysing the Policy Space for the Promotion of Healthy Sustainable Edible Oils in India

OBJECTIVE: To identify opportunities and challenges for the promotion of healthy, sustainable oil consumption in India. // DESIGN: We use a framework for policy space analysis which distinguishes between policy context, process and characteristics. // SETTING: We focus on the Indian edible oils sector and on factors shaping the policy space at a national level. // PARTICIPANTS: The study is based on the analysis of policy documents and semi-structured interviews with key experts and stakeholders in the edible oils sector. // RESULTS: We find opportunities associated with the emergence of multisectoral policy frameworks for climate adaptation and non-communicable disease (NCD) prevention at a national level which explicitly include the oils sector, the existence of structures for sectoral policy coordination, some supportive factors for the translation of nutrition evidence into practice, and the possibility of integrating nutrition-sensitive approaches within current state-led agricultural interventions. However, the trade-offs perceived across sustainability, NCD prevention and food security objectives in the vegetable oils sector are considered a barrier for policy influence and implementation. Sustainability and nutrition advocates tend to focus on different segments of the value chain, missing potential synergies. Moreover, policy priorities are dominated by historical concerns for food security, understood as energy provision, as well as economic and strategic priorities. // CONCLUSIONS: Systematic efforts towards identifying synergistic approaches, from agricultural production to distribution of edible oils, as well as increased involvement of nutrition advocates with upstream policies in the oils sector, could increase policy influence for advocates of both nutrition and sustainability

Indigenous Foods to Address Malnutrition: An Inquiry into the Diets and Nutritional Status of Women in the Indigenous Community of Munda Tribes of Jharkhand, India

Background: Indigenous people globally experience poor nutrition outcomes, with women facing the greater burden. Munda, a predominant tribe in Jharkhand, India, live in a biodiverse food environment but yet have high levels of malnutrition. Objectives: To assess diets and the nutritional status of Munda tribal women and explore associations with their Indigenous food consumption, dietary diversity, and socioeconomic and demographic profiles. Methods: A cross-sectional study with a longitudinal component to capture seasonal dietary intake was conducted in 11 villages of the Khunti district, Jharkhand. Household surveys and FFQs, supplemented with 2-d 24-h dietary recall and anthropometric assessments on 1 randomly selected woman per household were conducted. Results: Limited access to diverse foods from a natural food environment (Food Accessed Diversity Index score of 0.3 ± 0.3) was observed. More than 90% women in both seasons had usual nutrient intakes below the estimated average requirements for all nutrients except protein and vitamin C; 35.5% of women were underweight. The mean Minimum Dietary Diversity Score among women (MDDS) was low [2.6 ± 0.6 in wet monsoon; 3 ± 0.7 in winters (acceptable ≥5)]. Higher MDDS contributed to higher usual nutrient intakes (P <0.001). Indigenous food intakes in both seasons (wet monsoon and winter) were low, e.g. Indigenous green leafy vegetables [10.5 and 27.8% of the recommended dietary intake (RDI), respectively], other vegetables (5.2% and 7.8% of RDI, respectively), and fruits (5.8 and 22.8% of RDI, respectively). Despite low intakes, the Indigenous food consumption score was positively associated with usual intake of vitamin A, riboflavin, vitamin C, pyridoxine, and calcium (P < 0.05) in the wet monsoon and thiamine, riboflavin, and zinc (P < 0.001) in winters. After adjusting for covariates, Indigenous food consumption was associated with a higher usual intake of vitamin A (P < 0.001) in the wet monsoon season. Conclusion: Contextual food-based interventions promoting Indigenous foods and increasing dietary diversity have the potential to address malnutrition in Munda women. Curr Dev Nutr 2022;6:nzac102

Reproductive healthcare utilization in urban poor settlements of Delhi: Baseline survey of ANCHUL (Ante Natal and Child Health care in Urban Slums) project

Background: Disparity in utilization of reproductive healthcare services between the urban poor and the urban non-poor households in the developing nations is well known. However, disparity may also exist within urban poor households. Our objective was to document the extent of disparity in reproductive healthcare utilization among the urban poor and to identify the socio-demographic determinants of underutilization with a view to characterizing this vulnerable subpopulation. Methods: A survey of 16,221 households was conducted in 39 clusters from two large urban poor settlements in Delhi. From 13,451 consenting households, socio-demographic data and information on births, maternal and child deaths within the previous year was collected. Details of antenatal care (ANC) was collected from 597 pregnant women. Information on ANC and postnatal care was also obtained from 596 recently delivered (within six months) mothers. All data were captured electronically using a customized and validated smart phone application. Households were categorized into quintiles of socio-economic position (SEP) based on dwelling characteristics and possession of durable assets using principal component analysis. Potential socio-demographic determinants of reproductive healthcare utilization were examined using random effects logistic regression. Results: The prevalence of facility based birthing was 77 % (n = 596 mothers). Of the 596 recently delivered mothers only 70 % had an ANC registration card, 46.3 % had ANC in their first trimester, 46 % had visited a facility within 4 weeks post-delivery and 27 % were using modern contraceptive methods. Low socio-economic position was the most important predictor of underutilization with a clear gradient across SEP quintiles. Compared to the poorest, the least poor women were more likely to be registered for ANC (OR 1.96, 95 %CI 0.95-4.15) and more likely to have made ≥ 4 ANC visits (OR 5.86, 95 %CI 2.82-12.19). They were more likely to have given birth in a facility (OR 4.87, 95 %CI 2.12-11.16), to have visited a hospital within one month of childbirth (OR 3.18, 95 %CI 1.62-6.26). In general, government funded health insurance and conditional cash transfers schemes were underutilized in this community. Conclusion: The poorest segment of the urban poor population utilizes reproductive healthcare facilities the least. Strategies to improve access and utilization of healthcare services among the poorest of the poor may be necessary to achieve universal health coverage. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0635-8) contains supplementary material, which is available to authorized users

Innovative matrix for applying a food systems approach for developing interventions to address nutrient deficiencies in indigenous communities in India: a study protocol

Background: Indigenous communities retain knowledge of the land and food resources rooted in historical continuity within their region of residence. Food systems research can be leveraged to identify strategies to encourage sustainable use of complex multi-species agroforestry systems by indigenous communities contributing to nutritional needs while simultaneously preserving the ecosystems and their benefits to society. Till date, the analyses of food systems have predominantly focused on high income countries often overlooking the alternatives (dietary and production) that would be most relevant to low and middle income countries (LMIC). Thus, innovative methodological approaches are needed to comprehensively characterize diverse food systems in LMICs with special reference to indigenous communities

Leveraging Traditional Ecological Knowledge and Access to Nutrient-Rich Indigenous Foods to Help Achieve SDG 2: An Analysis of the Indigenous Foods of Sauria Paharias, a Vulnerable Tribal Community in Jharkhand, India

Indigenous food systems of traditional communities are potentially sustainable, have nutrient rich food sources and can enhance dietary diversity. Sauria Paharias, are one of the particularly vulnerable tribal groups of Jharkhand India, who despite residing in rich biodiverse environment and possessing traditional ecological knowledge, lag behind various health, and nutritional indicators. Our study explored their traditional ecological knowledge around indigenous foods (IFs), their routine consumption, access, and nutritive values. A cross-sectional mixed methods study was carried out in 18 villages of Godda district, Jharkhand. Free list of all IFs known to the community was developed using focus group discussions. This was followed by enumerating commonly consumed as well as little or historically used IFs. Following the taxonomic classification of these foods, their nutritive values were searched in literature or food samples were analyzed in accredited laboratories. Reasons for consumption and non-consumption of specific IFs were explored. The community was aware of a large number of IFs (n = 193) but only 50% of these were routinely consumed. Rest were either little used or historically consumed. About 47.6% IFs (n = 92) were identified using taxonomic classification; of which 87 IFs were classified based on their common names in secondary literature and five food items were collected, herbariums were prepared and identified. Nutritive values were documented for 84 IFs (this included both routinely consumed as well as little used); out of which 55 foods were found to have nutritive values in existing literature and 29 foods were analyzed in laboratory. Many of these IFs were rich in micronutrients like calcium, iron, zinc, folic acid, vitamin A, and vitamin C. Common reasons for preferences or non-consumption of specific IFs included taste, availability, access seasonality, opportunity cost of access and processing time. Promoting adequate intake of commonly accessed nutrient rich IFs and revival of little used IFs while addressing the causes of non-consumption and mainstreaming them into the daily diets could be an effective strategy to increase the intake of micronutrients. Policies focusing on incorporation of nutrient rich IFs into dietary diversification strategies and ongoing supplementary feeding programs can help address malnutrition in the community