The Cost of Improving Nutritional Outcomes Through Food‐Assisted Maternal and Child Health and Nutrition Programmes in Burundi and Guatemala

Evidence on the cost‐effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food‐assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster‐randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full‐size family ration with an individual ration of corn–soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2‐year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start‐up costs and lengthening peak operating capacity

Translation of Policy for Reducing Undernutrition from National to Sub-national Levels in Rwanda

Understanding how countries improve children’s nutrition can inform policies and contribute to further improvements. We examined the relationship between improvements in nutrition in Rwanda (1992–2017) and political commitment to- and policy coherence in- nutrition. We reviewed nutrition-relevant Rwandan policies and programs (2000–2018) and conducted 90 semi-structured interviews with national (n = 32), mid-level (n = 38), and community (n = 20) nutrition stakeholders and 40 community-level focus group discussions (FGDs). FGDs and sub-national interviews were conducted in ten purposefully selected districts, five each in which stunting decreased (reduced) and increased or stagnated (non-reduced) between the 2010 and 2014/15 Rwanda Demographic and Health Surveys. Analysis consisted of thematic analysis and the assessment of events, policy developments, and strategies that influenced nutrition in Rwanda, including operationalization of political commitment and policy coherence for nutrition. Political and institutional commitment to nutrition increased in Rwanda as evidenced by the adoption of a multisectoral nutrition policy that was reinforced with national and subnational horizontal coordination platforms. These platforms strengthened multisectoral strategies to address nutrition and supported operational and institutional commitment. The role of mid-level actors in nutrition governance increased as responsibilities for planning, implementing, and monitoring nutrition programs were increasingly delegated to sub-national administrative levels. Variations in policy implementation existed between reduced and non-reduced districts. Despite improvements, challenges remained in coordination, financial commitment, and capacity to address, monitor, and evaluate nutrition. Political commitment to- and policy coherence in- nutrition at the national level are important for improving nutrition, and when reinforced institutionally, can be translated to sub-national levels where implementation occurs

Helen Keller International's Enhanced-Homestead Food Production Program in Burkina Faso (EHFP)

Please refer to this study by its ClinicalTrials.gov identifier: NCT01825226.Helen Keller International (HKI) has been implementing homestead food production (HFP) programs in Asia for the past 20 years and has recently begun implementing HFP programs in Africa as well. In general, these programs target women and are designed to improve maternal and child health and nutrition outcomes. The start date is February 2010 and estimated completion date is June 2017. The collaborators for this trial are: United States Agency for International Development (USAID); Bill and Melinda Gates Foundation. The International Food Policy Research Institute (IFPRI) sponsored this trial.PHN

A cluster-randomized controlled trial

PRIFPRI3; ISI; CRP4; HKI Homestead Food Production Programs; UNFSSPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

A review of measures and indicators for assessing the relationship between women’s empowerment and nutrition

In this review we sought to understand how the relationship between women’s empowerment and women’s and children’s diet and nutrition outcomes have been conceptualized and studied. Generalizations about the relationships between “women’s empowerment” and “nutrition” abound, with little understanding of what is meant by either of these general categories. The frameworks that are used to illustrate these relationships may be too general to be useful in understanding the relationship between a complex construct like women’s empowerment, and behavioral (e.g., diet diversity) and biological (e.g., stunting) outcomes that have both shared and different causes. In this paper we discuss the different women’s empowerment and diet and nutrition tools that have been used when assessing the relationship between the two, and assess how the different combinations of empowerment and diet/nutrition have been studied. Within five broad categories of empowerment, we provide summaries of the findings from the included studies. Considering the results of this review, we highlight gaps in how these relationships are conceptualized and measured, and suggest ways to deepen understanding of these relationships. This paper can be informative for researchers who want to know how the relationships between women’s empowerment and nutrition have been generally assessed, and for program implementers who are interested in understanding what components of women’s empowerment may be more promising in influencing diet and nutrition outcomes among women and children.Non-PRIFPRI5; G Cross-cutting gender theme; 2 Promoting Healthy Diets and Nutrition for allPHN

Social assistance programme impacts on women's and children's diets and nutritional status

Investments in social assistance programmes (SAPs) have accelerated alongside interest in using SAPs to improve health and nutrition outcomes. However, evidence of how design features within and across programme types influence the effectiveness of SAPs for improving diet and nutrition outcomes among women and children is limited. To address this, we reviewed evaluations of cash, in-kind and voucher programmes conducted between 2010 and 2020 among women and children, and examined associations between design features (targeting, including household and individual transfers, fortified foods and behaviour change communication) and positive impacts on diet (diet diversity, micronutrient intake) and nutrition (anthropometric indicators, haemoglobin, anaemia) outcomes. Our review has several key findings. First, SAPs improve dietary diversity and intake of micronutrient-rich foods among women and children, as well as improve several nutrition outcomes. Second, SAPs were more likely to impact diet and nutrition outcomes among women compared with children (23/45 [51%] vs. 52/144 [36%] of outcomes measured). Third, in-kind (all but one of which included fortified foods) compared with cash transfer programmes were more likely to significantly increase women's body mass index and children's weight-for-height/length Z-score, and both women's and children's haemoglobin and anaemia. However, there is limited evidence on the effectiveness of SAPs for improving micronutrient status and preventing increased prevalence of overweight and obesity for all populations and for improving diet and nutrition outcomes among men, adolescents and the elderly. Further research in these areas is urgently needed to optimize impact of SAPs on diet and nutrition outcomes as countries increase investments in SAPs.PRIFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOAPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

PROCOMIDA, a food-assisted maternal and child health and nutrition program, reduces child stunting in Guatemala: A cluster-randomized controlled intervention trial

Food-assisted maternal and child health and nutrition (FA-MCHN) programs may foster child growth during the first 1000 d (pregnancy and the first 2 y of a child's life), but evidence is scant. We evaluated the impact of an FA-MCHN program, PROCOMIDA, on linear growth (stunting [length-for-age z score (LAZ) < –2] and length-for-age difference [LAD]) among children aged 1–24 mo. PROCOMIDA was implemented in Guatemala by Mercy Corps and was available to beneficiaries throughout the first 1000 d.PRIFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOAPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

A multisectoral food-assisted maternal and child health and nutrition program targeted to women and children in the first 1000 days increases attainment of language and motor milestones among young Burundian children

Child development is affected by multiple factors throughout pregnancy and childhood. Multisectoral programs addressing these factors may improve children's development.PRIFPRI3; ISI; CRP4; IFPRIOA; 2 Promoting Healthy Diets and Nutrition for allPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

Multiple micronutrients rather than two or fewer micronutrients improves growth, nutritional status and child development outcomes in micronutrient-deficient children

PRISI; IFPRI3PHN