Food production and consumption in Bamyan Province, Afghanistan: the challenges of sustainability and seasonality for dietary diversity

In Asia, high levels of malnutrition threaten the health and livelihoods of millions of households. This paper concentrates on linkages between agriculture and nutrition in Afghanistan where food and nutrition insecurity are increasing and agricultural sustainability is increasingly compromised by climate change. We explore seasonal patterns of food production and consumption in the remote and robust ecological environment of Shah Foladi, Bamyan Province. Analysis of qualitative data from household interviews in eight villages has provided a wealth of insights into the seasonality of diets. Even within a broadly homogeneous environment, households were found to be markedly heterogeneous in respect of their assets, production, market, finance and employment strategies. The so-called ‘lean season’ was found to vary accordingly. Nevertheless, a general lack of dietary diversity during much of the year is likely to cause micronutrient malnutrition, especially for the vulnerable groups of children, adolescent girls and women. Potential interventions are proposed which need to account for the local context in order to overcome the natural and political constraints. These strategies include agricultural innovation and multi-sectoral policy approaches. In the end, reducing national insecurity is a pre-requisite for sustainable improvement in nutrition-sensitive agricultural development

Feeding the Worlth Healthily: the Challenge of Measuring the effects of Agriculture on Health

Agricultural production, food systems and population health are intimately linked. While there is a strong evidence base to inform our knowledge of what constitutes a healthy human diet, we know little about actual food production or consumption in many populations and how developments in the food and agricultural system will affect dietary intake patterns and health. The paucity of information on food production and consumption is arguably most acute in low- and middle-income countries, where it is most urgently needed to monitor levels of under-nutrition, the health impacts of rapid dietary transition and the increasing ‘double burden’ of nutrition-related disease. Food availability statistics based on food commodity production data are currently widely used as a proxy measure of national-level food consumption, but using data from the UK and Mexico we highlight the potential pitfalls of this approach. Despite limited resources for data collection, better systems of measurement are possible. Important drivers to improve collection systems may include efforts to meet international development goals and partnership with the private sector. A clearer understanding of the links between the agriculture and food system and population health will ensure that health becomes a critical driver of agricultural change

Identifying an essential package for school-age child health: economic analysis

This chapter presents the investment case for providing an integrated package of essential health services for children attending primary schools in low- and middle- income countries (LMICs). In doing so, it builds on chapter 20 in this volume (Bundy, Schultz, and others 2017), which presents a range of relevant health services for the school- age population and the economic rationale for adminis- tering them through educational systems. This chapter identifies a package of essential health services that low- and middle-income countries (LMICs) can aspire to implement through the primary and secondary school platforms. In addition, the chapter considers the design of such programs, including targeting strategies. Upper- middle-income countries and high-income countries (HICs) typically aim to implement such interventions on a larger scale and to include and promote additional health services relevant to their populations. Studies have docu- mented the contribution of school health interventions to a range of child health and educational outcomes, partic- ularly in the United States (Durlak and others 2011; Murray and others 2007; Shackleton and others 2016). Health services selected for the essential package are those that have demonstrated benefits and relevance for children in LMICs. The estimated costs of implementation are drawn from the academic literature. The concept of a package of essential school health interventions and its justification through a cost-benefit perspective was pioneered by Jamison and Leslie (1990). As chapter 20 notes, health services for school-age children can promote educational outcomes, including access, attendance, and academic achievement, by mitigat- ing earlier nutrition and health deprivations and by addressing current infections and nutritional deficiencies (Bundy, Schultz, and others 2017). This age group is partic- ularly at risk for parasitic helminth infections (Jukes, Drake, and Bundy 2008), and malaria has become prevalent in school-age populations as control for younger children delays the acquisition of immunity from early childhood to school age (Brooker and others 2017). Furthermore, school health services are commonly viewed as a means for build- ing and reinforcing healthy habits to lower the risk of non- communicable disease later in life (Bundy 2011). This chapter focuses on packages and programs to reach school-age children, while the previous chapter, chapter 24 (Horton and Black 2017), focuses on early childhood inter- ventions, and the next chapter, chapter 26 (Horton and others 2017), focuses on adolescent interventions. These packages are all part of the same continuum of care from age 5 years to early adulthood, as discussed in chapter 1 (Bundy, de Silva, and others 2017). A particular emphasis of the economic rationale for targeting school-age children is to promote their health and education while they are in the process of learning; many of the interventions that are part of the package have been shown to yield substantial benefits in educational outcomes (Bundy 2011; Jukes, Drake, and Bundy 2008). They might be viewed as health interventions that leverage the investment in education. Schools are an effective platform through which to deliver the essential package of health and nutrition ser- vices (Bundy, Schultz, and others 2017). Primary enroll- ment and attendance rates increased substantially during the Millennium Development Goals era, making schools a delivery platform with the potential to reach large num- bers of children equitably. Furthermore, unlike health centers, almost every community has a primary school, and teachers can be trained to deliver simple health inter- ventions, resulting in the potential for high returns for relatively low costs by using the existing infrastructure. This chapter identifies a core set of interventions for children ages 5–14 years that can be delivered effectively through schools. It then simulates the returns to health and education and benchmarks them against the costs of the intervention, drawing on published estimates. The invest- ment returns illustrate the scale of returns provided by school-based health interventions, highlighting the value of integrated health services and the parameters driving costs, benefits, and value for money (the ratio of benefits to costs). Countries seeking to introduce such a package need to undertake context-specific analyses of critical needs to ensure that the package responds to the specific local needs

Efficiency, food security and differentiation in small-scale irrigation agriculture: Evidence from North West Nigeria

Ambiguity over the effectiveness of agricultural intervention is more pronounced in rural areas where the majority of North West Nigeria’s poor population, and those involved in agriculture, reside. Further characterising these areas is the paucity of research on the issue of differentiation within the smallholder community. Specifically, definite classification of households based on efficiency, food security and income status remains inadequate. The study explores smallholder households’ differentials on the basis of these three phenomena, and other factors that affect smallholder typologies. Data was collected from 306 randomly selected smallholders involved in the Middle Rima Valley Irrigation Project, Sokoto State, Nigeria. Smallholders’ technical efficiency and households’ Food Consumption Score (FCS) were assessed. Also, Pearson correlation analysis, a segmentation approach using cluster analysis and multinomial regression model were used for the study. The study showed that the mean efficiency level of smallholder farms was 85.9% and that the majority of the households were food insecure

Protracted crisis, food security and the fantasy of resilience in Sudan

In the past decade, food security and nutrition practices have become central in the promotion of resilience in protracted crises. Such approaches have been welcomed by the aid community because of their potential for linking relief and development. Social and political analysts, however, have criticized resilience approaches for failing to consider power relations and because they entail an acceptance of crisis or repeated risk. In this context, regimes of food security and nutrition practices have become increasingly targeted, privatized and medicalized, focussing on individual behaviour and responsibility rather than responsibility of the state or international actors. This article uses examples from Sudan to examine how and why the resilience ‘regime of practices’ has functioned as a form of neoliberal governmentality, and argues that it has created a fantasy in which conflict in Darfur is invisible. This allowed food aid to be withdrawn and removed the need for protection despite ongoing conflict and threats to livelihoods; thus crisis-affected populations have been abandoned

Micronutrient malnutrition and biofortification: recent advances and future perspectives

Micronutrients malnutrition is of great public health importance in several parts of the world, especially the developing and underdeveloped countries. It has been estimated that about 2 billion people, about one third of the world’s population, are deficient in one or more mineral elements. Although required in traces, these mineral elements are involved in many vital metabolic functions. Micronutrient deficiencies in humans can be remedied through food diversification, mineral supplementation, food fortification, and biofortification. Biofortification is the strategy of increasing the content of bioavailable nutrients in the edible parts of staple food crops for better human nutrition. Staple crops such as maize, rice, and wheat provide most of the calories for low-income families around the globe. However, staple crop-based diets fall far short in providing the required amounts of micronutrients and heavy reliance on staple food is the root cause of micronutrient malnutrition. Biofortification includes the enhanced uptake of such minerals from soils, their transport to edible plant parts, and improving the bioavailability of these minerals. International initiatives have recently released several plant cultivars with increased bioavailable micronutrient concentrations in their edible parts. The use of these biofortified cultivars is expected to mitigate micronutrient malnourishment in large populations especially in Africa. Crop breeding, genetic manipulation, and application of mineral fertilizers are the bases of biofortification strategies and have enormous potential to address micronutrient malnourishment. In this chapter, crop biofortification for zinc, iron, vitamin A, and iodine has been discussed. Biofortification is a proven strategy to combat micronutrient deficiency in large populations, particularly for those living in developing countries. However, to make it more effective, efficient, and acceptable for people, better planning, implementation, monitoring, and evaluation of biofortification programs are needed to produce cost-effective and socially acceptable biofortified food crops. Food safety, quality assurance, and legal framework also need to be considered while developing any biofortification strategy