Food and Nutrition Bulletin

In light of the continuing rise in food prices during and after the 2008 world food crisis, whether food and cash transfers are equally effective in improving food security and diet quality is debatable.

To compare the effects of conditional food and cash transfers of the Ethiopian Productive Safety Net Program (PSNP) on household food security and dietary diversity.

Data on household dietary diversity, child anthropometry, food security, and preference of transfer modalities (food, cash, or mixed) were generated from a cross-sectional survey of 195 PSNP beneficiary households (67 receiving food and 128 receiving cash) in Hawella Tulla District, Sidama, southern Ethiopia.

Most beneficiaries (96%) reported food shortages, and 47% reported food shortages that exceeded 3 months. Households receiving cash had better household dietary diversity scores (p = .02) and higher consumption of oils and fats (p = .003) and vitamin A–rich foods (p = .002). Compared with households receiving food, households receiving cash were more affected by increases in food prices that forced them to reduce their number of daily meals (p < .001) and spend less on nonstaples (p < .001). While most households receiving food (82%) preferred to continue receiving food, households receiving cash (56%) preferred a mix of food and cash.

Households receiving cash had better household dietary diversity than households receiving food, a result suggesting that cash transfers may be more effective. However, the continuing rise in food prices may offset these benefits unless cash transfers are index-linked to food price fluctuations.

Consumer nutrition environment measures are important to understanding the food environment, which affects individual dietary intake. A nutrition environment measures survey for supermarkets (NEMS-S) has been designed on paper for use in Guatemala. However, a paper survey is not an inconspicuous data collection method.

To design, pilot test, and validate the Guatemala NEMS-S in the form of a mobile phone application (mobile app).

CommCare, a free and open-source software application, was used to design the NEMS-S for Guatemala in the form of a mobile app. Two raters tested the mobile app in a single Guatemalan supermarket. Both the interrater and the test—retest reliability of the mobile app were determined using percent agreement and Cohen's kappa score and compared with the interrater and test—retest reliability of the paper version.

Interrater reliability was very high between the paper survey and the mobile app (Cohen's kappa > 0.90). Test—retest reliability ranged from kappa 0.78 to 0.91. Between two certified NEMS-S raters, survey completion time using the mobile app was 5 minutes less than that with the paper form (35 vs. 40 minutes).

The NEMS-S mobile app provides for more rapid data collection, with equivalent reliability and validity to the NEMS-S paper version, with advantages over a paper-based survey of multiple language capability and concomitant data entry.

Mid-upper-arm circumference (MUAC) and calf circumference (CC) are correlated with body mass index (BMI) in adults and may be useful for screening women with underweight (BMI < 18.5 kg/m²). However, there is no consensus on appropriate MUAC and CC cutoff points in diverse populations, especially in women of reproductive age.

To assess the accuracy of different MUAC and CC cutoff points to screen for underweight and to identify the most appropriate cutoff points in a sample of women of reproductive age from rural northern Vietnam.

Anthropometric measurements (weight, height, MUAC, CC, and triceps and subscapular skinfold thicknesses) were obtained for 4,981 women of reproductive age who participated in a micronutrient intervention trial (PRECONCEPT) in Thái Nguyên Province, Viet- nam. Receiver operating characteristic (ROC) analysis was used to evaluate different cutoff values of MUAC and CC and identify the most appropriate cutoff values to predict underweight.

The overall prevalence of underweight was 32%. The MUAC value of 23.5 cm and the CC value of 31 cm were identified as the best cutoffs based on low misclassification (16% for MUAC and 21% for CC) and good balance of sensitivity (89% and 85%, respectively) and specificity (71% and 67%, respectively. The ROC curves were similar across different ethnic groups, with the area under the curve (AUC) values reaching 0.89 to 0.93 for MUAC and 0.83 to 0.89 for CC.

MUAC and CC perform adequately in screening for underweight in women. The utility of these measurements in predicting functional outcomes should be examined.

More than 50% of children in Nepal are malnourished. Economic growth and poverty reduction are not always sufficient to improve the health and nutritional status of children. Heifer Nepal uses livestock training as a tool for community development and poverty alleviation but does not directly address child health and nutrition.

To systematically assess the effects of Heifer activities on child health and nutrition.

The study was a 2-year, longitudinal, randomized, controlled trial in six communities in Nepal (both Terai and hills), pair-matched for specific characteristics, randomly assigned to receive Heifer community development activities at baseline (intervention) or 1 year (control). At 6-month intervals over a period of 2 years, child anthropometric and comprehensive household surveys were performed.

Four hundred fifteen households were enrolled containing 607 children 6 months to 5 years of age. The intervention and control communities were equivalent for baseline socioeconomic status, household size, ownership of land and animals, and child nutrition and health. At 12 months (prior to animal donations), the Terai intervention group had improved child weight (p = .04), improved child height (p = .05), and reduced sick days (p = .03), as well as increased household income (p = .004), increased ownership of animals (p = .04) and land (p = .04), and improved sanitation practices (p < .01). In all districts, longer participation in Heifer activities corresponded to more improvement in child height-for-age z-scores.

Heifer interventions resulted in improved socioeconomic status and household income per family member. Children under 60 months of age in the intervention group had greater incremental improvement in height-for-age and weight-for-age z-scores than children in the control group, and longer participation in Heifer activities was associated with better growth. Poverty alleviation programs, such as Heifer, may indirectly benefit child growth.

School feeding programs have been a key response to the recent food and economic crises and function to some degree in nearly every country in the world. However, school feeding programs are complex and exhibit different, context-specific models or configurations.

To examine the trade-offs, including the costs and cost-efficiency, of an innovative cluster kitchen implementation model in Bangladesh using a standardized framework.

A supply chain framework based on international standards was used to provide benchmarks for meaningful comparisons across models. Implementation processes specific to the program in Bangladesh were mapped against this reference to provide a basis for standardized performance measures. Qualitative and quantitative data on key metrics were collected retrospectively using semistructured questionnaires following an ingredients approach, including both financial and economic costs. Costs were standardized to a 200-feeding-day year and 700 kcal daily.

The cluster kitchen model had similarities with the semidecentralized model and outsourced models in the literature, the main differences involving implementation scale, scale of purchasing volumes, and frequency of purchasing. Two important features stand out in terms of implementation: the nutritional quality of meals and the level of community involvement. The standardized full cost per child per year was US$110. Despite the nutritious content of the meals, the overall cost-efficiency in cost per nutrient output was lower than the benchmark for centralized programs, due mainly to support and start-up costs.

Cluster kitchens provide an example of an innovative implementation model, combining an emphasis on quality meal delivery with strong community engagement. However, the standardized costs per child were above the average benchmarks for both low- and middle-income countries. In contrast to the existing benchmark data from mature, centralized models, the main cost drivers of the program were associated with support and start-up activities. Further research is required to better understand changes in cost drivers as programs mature.

In 2003, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) published “Guiding principles for complementary feeding of the breastfed child,” which includes a series of 10 recommendations.

To illustrate the challenges in creating operative criteria for the evaluation of concordance with the tenets of the WHO/PAHO Guiding Principles recommendations.

We set out to define operative criteria for the evaluation of adherence to the tenets of the WHO/ PAHO Guiding Principles. The 10 Guiding Principles were divided into subcomponents and examined carefully. Our indicators were based on evaluation variables collected by means of our prospectively designed data collection tool. The 2008 WHO-validated infant and young child feeding (IYCF) indicators were taken as a reference for evaluation.

After careful examination of the 10 WHO/ PAHO Guiding Principles, we were able to identify 28 specific subcomponents for evaluation. With our prospectively designed data collection tool, we were able to set evaluations for 17 of these 28 subcomponents.

The considerations for devising the criteria involved in evaluation instruments must be transparently available to clarify the interpretations and conclusions derived from their application. Evaluation criteria can be set for most, but not all, IYCF practices of the WHO/PAHO Guiding Principles. Indicators that focus on selected, food-related dimensions of child feeding can be measured in large surveys, whereas other dimensions of optimal feeding, such as hygienic food handling and adequate texture of food, are likely to require more complex measurement and evaluation approaches.

Energy deficiency is observed to be at odds with other food security indicators. In wealthier urban areas, the prevalence of energy deficiency is often higher than in poorer rural areas, whereas other food security indicators, such as food diversity, perform much better in urban than in rural areas.

To investigate to what extent differences in physical activity levels influence dietary quantity and quality.

Central to this analysis is the construction of a household activity index, a single measure that aims to capture the collective workload of the household. This paper uses data from Nepal and Uganda expenditure surveys that contain information on food consumption, as well as detailed information on how individual household members spend their time. Energy deficiency numbers are adjusted by the activity index, and the results are compared with the standard approach for calculating energy deficiency assuming light activity levels. Regressions are estimated to discuss demand for calories and diversity given the activity level.

Accounting for differences in activity level has a large effect on energy deficiency figures, particularly in rural areas. The analysis shows that a higher household activity level significantly increases the calories consumed but lessens food diversity, suggesting that households with high activity levels sacrifice diversity for quantity in order to meet their energy requirements.

Physical activity levels should be taken into account when interpreting empirical differences in food consumption levels for determining the prevalence of food insecurity and making allocation decisions for food security assistance.

School meals provide an excellent opportunity to improve children's diet.

To investigate dietary intakes and acceptance of nutritionally balanced school meals (“nutrimeals”) as compared with regular (“baseline”) school meals among Filipino students.

The study employed a before—after intervention design with one group. Students 13 to 16 years of age from a public school in Metro Manila (n = 112) consumed baseline school meals for 2 weeks followed by consumption of nutri-meals for 7 weeks. Served meals and plate waste were weighed to calculate food and nutrient intakes. Acceptability of meals was assessed daily in a random subsample using a seven-point hedonic scale. Analysis of covariance corrected for age and sex was conducted to test for differences in nutrient intakes and acceptability between nutri-meals and baseline meals.

Feeding nutri-meals resulted in a higher intake of vegetables (95.3 ± 13.8 g), fruit (76.5 ± 6.3 g), and fish (19.1 ± 3.3 g) than baseline meals. Energy and protein intakes significantly increased by 140.7 ± 2.8 kcal and 3.2 ± 0.1 g, respectively. The quality of fat intake improved compared with baseline meals (p < .001). Micronutrient intake from nutri-meals was significantly higher than that from baseline meals (except for zinc), contributing 6% to 79% of recommended daily intakes. Most students (> 90%) liked both baseline and nutri-meals; however, the mean acceptability score for baseline meals was slightly higher (0.2 ± 0.07 points, p = .004).

Nutritionally balanced nutri-meals may be a healthier and acceptable alternative to regular Filipino school meals. Further optimization of nutri-meals is required to meet the nutritional needs of adolescents and reduce sodium content.

Nutritionally adequate complementary foods made from locally available ingredients are of high priority in developing countries, including Ghana. The majority of complementary foods in these countries are cereal-based and are unable to meet the nutrient intakes recommended by the World Health Organization.

To evaluate the nutrient content and protein quality of local cereal—legume blends for complementary foods against recommendations and to determine the quantities of additional ingredients required to meet needs by using linear programming.

Nine cereal—legume combinations (maize, sorghum, or millet combined with cowpea, peanut, or soybean) and koko (a traditional Ghanaian maize-based complementary food) were evaluated based on the macronutrient targets for a daily ration of complementary food for the age group 12 to 24 months: 264 kcal, 6.5 g of protein, and 8.2 to 11.7 g of fat. Protein quality was assessed by the Protein Digestibility Corrected Amino Acid Score (PDCAAS). Linear programming was then used to determine the amounts of additional oil, sugar, and lysine needed to meet macronutrient requirements.

No traditional cereal—legume food met all complementary food macronutrient requirements on its own. Cereal—legume blends made with peanut or cowpeas were low in quality protein, while those with soybean were low in fat. Lysine was the limiting amino acid (PDCAAS 0.50 to 0.82) in all blends. Adding lysine increased utilizable protein by 1% to 10% in soybean blends, 35% to 40% in peanut blends, and 14% to 24% in cowpea blends. Peanut—maize, peanut—millet, and all soybean—cereal blends were able to meet macronutrient targets; most micronutrients remained below recommended levels.

Traditional cereal—legume blends made from locally available ingredients do not meet energy, quality protein, and fat recommendations for complementary foods; however, such complementary food blends may be optimized to meet nutrient requirements by using linear programming as a tool to determine the exact levels of fortificants to be added (including, but not limited to, added fat, amino acids, and micronutrients).

Translating national policies and guidelines into effective action at the subnational level (e.g., province or region) is a prerequisite for ensuring an impact on nutrition. In several countries, including Vietnam, the focus of this paper, this process is affected by the quality of the decentralized process of planning and action.

This study examined how provincial planning processes for nutrition occurred in Vietnam during 2009 and 2010. Key goals were to understand variability in processes across provinces, identify factors that influenced the process, and assess the usefulness of the process for individuals involved in planning and action.

A qualitative case-study methodology was used. Data were drawn from interviews with 51 government officials in eight provinces.

The study found little variability in the planning process among these eight provinces, probably due to a planning process that was predominantly a fiscal exercise within the confines of a largely centralized structure. Respondents were almost unanimous about the main barriers: a top-down approach to planning, limited human capacity for effective planning at subnational levels, and difficulty in integrating actions from multiple sectors. Provincial-level actors were deeply dissatisfied with the nature of their role in the process.

Despite the rhetoric to the contrary, too much power is probably still retained at the central level. A strategic multiyear approach is needed to strengthen the provincial planning process and address many of the key barriers identified in this study.