Forest conservation in central and West Africa: Opportunities and risks for gender equity

In recent years, the forestry sector has tried to mainstream gender1 into legislation, policies and programs in order to promote “women’s empowerment” (FAO 2007). This focus on women in gender mainstreaming has arisen because women have often been more excluded from forest conservation governance, employment and decision making than men (FAO 2007). Case studies have shown how the inclusion of women in forest conservation programs can empower women by, for example, increasing women’s incomes or promoting female participation in forest management committees (Schroeder 1995; Yatchou 2011)

Associations of gender inequality with child malnutrition and mortality across 96 countries.

National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.This is the final version of the article. It first appeared from Cambridge University Press via http://dx.doi.org/10.1017/gheg.2016.

Economic and Gender Inequalities are Important Determinants of Anaemia and Acute Malnutrition in Children aged <5 years in Low- and Middle-Income Countries

Background: Poverty is a known determinant of malnutrition, especially in less-affluent countries. However the large variance in malnutrition, prevalence noted across these countries cannot be fully explained by differences in national wealth alone. Therefore, additional socioeconomic factors e.g. inequalities, are likely to also contribute towards this variance. This study aimed to explore the possible associations between economic and gender inequalities with malnutrition in children aged <5years, specifically anaemia and global acute malnutrition (GAM), using data from Low and Middle-Income Countries. / Methods: Anaemia and GAM prevalence data was obtained for 48 countries from the DHS STATcompiler and for 7 countries for which this data was unavailable, it was obtained from the World Bank, WHO and UNICEF data. The World Bank’s Gini Index and UNDP’s Gender Inequality Index (GII) were used to measure economic inequality and gender inequality respectively. The World Bank’s GDP/Capita adjusted for purchasing power parity was used as the measure of countries’ wealth.Maternal biological factors (average women’s height, total fertility rate and maternal age at first birth) and demographic factors (women’s literacy rate and percentage of people living in urban settings) were mostly obtained from the DHS STATcompiler, with some few from the World Bank databases. Concentration curves and indices were used to measure and display the magnitude of inequalities in the distribution of anaemia and GAM across countries, when ranked by Human Development Index (HDI) and GII. Associations between GII and income inequality and anaemia and GAM were explored, separately, using linear regression. The associations were later adjusted for countries’ wealth and maternal biological and demographic factors. A final multivariable model was constructed, each for anaemia and GAM, including all significant factors observed in the initial analysis. / Results: When ranked by GII, the prevalence distribution of both anaemia and GAM were highly unequal across countries, being higher and lower in countries with high and low GII scores respectively. A similar pattern was observed when ranking by HDI, with malnutrition prevalence concentrating more in countries with lower HDI scores. After adjusting for country’s wealth level and maternal biological and demographic factors, GII showed a significant, independent and positive association with anaemia prevalence, explaining 50% of the variance between countries. The Gini index showed a significant, independent and negative association with GAM, explaining about 30% of the variance. Conclusions: Gender inequality and/or low women’s status in society may explain, independently, the high anaemia prevalence in many low- and middle-income countries. In contrast, poverty appears to be more important than income inequality for explaining GAM prevalence. Future analysis using a larger sample of countries, or using multilevel modelling for analysis, may provide further insights into the associations between wealth and inequalities and the global burden of malnutrition

Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries: a secondary data analysis

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24,045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission, and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage points difference for length values, 95%CI: 6.0; 7.9, p<0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage points difference for weight-for-length z-score values, 95%CI: 14.3; 16.9, p<0.01), and anthropometric indices that were flagged as outliers (a 2.7 percentage points difference for any anthropometric index being flagged as an outlier, 95%CI: 1.7; 3.8, p<0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95%CI: 1.09; 1.56, p<0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care

Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis.

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants &lt;6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants &lt;6mo and children aged 6-60 months (older children). Infants &lt;6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants &lt;6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P &lt; 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P &lt; 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P &lt; 0.01). A high proportion of both infants &lt;6mo and older children were discharged as recovered. Infants &lt;6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P &lt; 0.01). Infants &lt;6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants &lt;6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care

Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis.

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care

The REFANI-N study protocol: a cluster-randomised controlled trial of the effectiveness and cost-effectiveness of early initiation and longer duration of emergency/seasonal unconditional cash transfers for the prevention of acute malnutrition among children, 6-59 months, in Tahoua, Niger.

BACKGROUND: The global burden of acute malnutrition among children remains high, and prevalence rates are highest in humanitarian contexts such as Niger. Unconditional cash transfers are increasingly used to prevent acute malnutrition in emergencies but lack a strong evidence base. In Niger, non-governmental organisations give unconditional cash transfers to the poorest households from June to September; the 'hunger gap'. However, rising admissions to feeding programmes from March/April suggest the intervention may be late. METHODS/DESIGN: This cluster-randomised controlled trial will compare two types of unconditional cash transfer for 'very poor' households in 'vulnerable' villages defined and identified by the implementing organisation. 3,500 children (6-59 months) and 2,500 women (15-49 years) will be recruited exhaustively from households targeted for cash and from a random sample of non-recipient households in 40 villages in Tahoua district. Clusters of villages with a common cash distribution point will be assigned to either a control group which will receive the standard intervention (n = 10), or a modified intervention group (n = 10). The standard intervention is 32,500 FCFA/month for 4 months, June to September, given cash-in-hand to female representatives of 'very poor' households. The modified intervention is 21,500 FCFA/month for 5 months, April, May, July, August, September, and 22,500 FCFA in June, providing the same total amount. In both arms the recipient women attend an education session, women and children are screened and referred for acute malnutrition treatment, and the households receive nutrition supplements for children 6-23 months and pregnant and lactating women. The trial will evaluate whether the modified unconditional cash transfer leads to a reduction in acute malnutrition among children 6-59 months old compared to the standard intervention. The sample size provides power to detect a 5 percentage point difference in prevalence of acute malnutrition between trial arms. Quantitative and qualitative process evaluation data will be prospectively collected and programme costs will be collected and cost-effectiveness ratios calculated. DISCUSSION: This randomised study design with a concurrent process evaluation will provide evidence on the effectiveness and cost-effectiveness of earlier initiation of seasonal unconditional cash transfer for the prevention of acute malnutrition, which will be generalisable to similar humanitarian situations. TRIAL REGISTRATION: ISRCTN25360839 , registered March 19, 2015