Nutritional status in postconflict Afghanistan: evidence from the National Surveillance System Pilot and National Risk and Vulnerability Assessment

BACKGROUND: Two large-scale studies, the National Surveillance System (NSS) Pilot Study (2003-2004) and the National Risk and Vulnerability Assessment (NRVA) 2003, were conducted by government, United Nations, and nongovernmental organizations in Afghanistan, as part of wider efforts characterizing Afghan livelihoods in relation to particular outcomes of interest: vulnerability to poverty, food insecurity, and malnutrition. OBJECTIVE: To present the data from these two surveys with nutrition as the key outcome of interest, and to further construct the understanding of the underlying causes of malnutrition, thus providing public health practitioners and other sector specialists with insight into how a variety of sectoral programs can impact nutritional outcomes in Afghanistan. METHODS: The NSS gathered information on livelihoods, food security, and nutrition from 20 to 40 randomly selected households in each of 26 purposively selected sentinel sites (representative of livelihood zones) during November-December 2003 and May-June 2004. The NRVA gathered information nationally from households selected with a two-stage sampling (based on livelihood zone and then socioeconomic group) during July-September 2004. RESULTS: Acute malnutrition is below emergency levels for children under five. The level of chronic malnutrition in children under five indicates a problem of public health importance. Dietary diversity in Afghanistan is not as low as expected but still shows room for improvement, particularly in remote areas and with respect to food groups associated with adequate micronutrient intake. The findings also suggest that in addition to lack of adequate household food intake, recurrent illness and suboptimal infant and young child feeding and hygiene practices contribute to poor nutritional outcomes in this age group. The survey also found poor access to health care, markets, and water for household use. CONCLUSIONS: Improving nutritional status requires a multipronged approach, directly targeting malnutrition, coupled with economic growth, household livelihood security, social protection, access to public health services, and water and sanitation. Nutrition policy, programming, and monitoring need to reflect the immediate and underlying causes of malnutrition. Future research needs to be designed to quantify the relative contribution of underlying causes of poor nutrition, allowing practitioners to prioritize responses aimed at improving nutritional outcomes.     

The impact of the homestead food garden programme on food security in South Africa

The South African government has implemented homestead food garden (HFG) programmes directed at enhancing food production in order to reduce food insecurity, malnutrition, poverty and hunger. The present paper evaluated the impact of this programme on household food insecurity using surveys of 500 households. Endogenous switching regression, propensity score matching and household food insecurity average scores were employed in our analysis. Our findings demonstrated that participation in an HFG programme could significantly enhance the food security status of participants by increasing household food supply and consumption as well as by income derived from selling any excess production from the garden. Specifically, our empirical findings showed that participation in the HFG programme significantly reduced food insecurity among rural households by as much as 41.5%. Therefore, we recommend that policy makers should encourage more rural households to participate in the programme in order to reduce their food insecurity. Facilitating easy access to credit, extension services, fertilizer, irrigation facilities and land are policy options needed to promote farmers participation in HFG programmes. Furthermore, the formation of farmer-based organizations and the building of positive perceptions about HFGs are some of the key policy options that can be employed to improve households’ participation in the programme. Promotion of education, participating in off-farm activities, access to market, irrigation, extension and credit, and adoption of fertiliser are some policy interventions that can reduce food insecurity among rural house holds whether or not they participate in the HFG programme.     

“He said, she said”: who should speak for households about experiences of food insecurity in Bangladesh?

This paper examines the extent to which males and females from the same household respond differently to household food insecurity questions, and explores the reasons for these differences and the impact for measurement. The data derive from the 2001–2003 Bangladesh Food Insecurity Measurement and Validation Study. Male and female enumerators administered the food insecurity questionnaire to women and men in the same household during three survey rounds and debriefed a subsample of men and women regarding their response discrepancies. The rate of discordance in male-female responses to individual items was examined using contingency tables. Potential explanations for the discordance were informed by the joint respondent debriefing. These hypotheses were assessed through an examination of response patterns. To assess the impact of discordance on measurement, female and male responses to a scale of 13 food insecurity items were compared and the degree of differential classification was assessed. On average the rate of discordance was 15%, but it ranged for particular items from less than 1% to upwards of 53%. Item content interacted with gender to produce discordance; women and men seemed to respond differently due to separate spheres of responsibility within the same household, power imbalances influencing intra-household food allocation, and because men seemed to take more psychological responsibility for ensuring the household food supply. Nearly one-third of households were classified in a different food security category using female versus male responses to the items. The results suggest that the household food insecurity construct is not as useful in places like Bangladesh where certain food insecurity-related manifestations are not collectively or similarly shared by members of the same living space. Individual-level measures of food insecurity are needed to complement household data, along with surveys that allow for proportionate representation of potentially vulnerable individuals with different demographic characteristics across the population.     

Household resilience to food insecurity: evidence from Tanzania and Uganda

Resilience—the capacity that ensures adverse stressors and shocks do not have long-lasting adverse consequences—has become a key topic in both scholarly and policy debates. More recently some international organizations have proposed the use of resilience to analyze food and nutrition security. The objective of the paper is twofold: (i) analyze what the determinants of household resilience to food insecurity are and (ii) assess the role played by household resilience capacity on food security outcomes. The dataset employed in the analysis is a panel of three waves of household surveys recently collected in Tanzania and Uganda. First, we estimated the FAO’s Resilience Capacity Index (RCI), combining factor analysis and structural equation modeling. Then probit models were estimated to test whether the resilience is positively related to future food security outcomes and recovery capacity after a shock occurs. In both countries, the most important dimension contributing to household resilience was adaptive capacity, which in turn depended on the level of education and on the proportion of income earners to total household members. Furthermore, household resilience was significantly and positively related to future household food security status. Finally, households featuring a higher resilience capacity index were better equipped to absorb and adapt to shocks.     

Household food insecurity in Timor-Leste

Timor-Leste is among the world’s youngest and poorest countries. It suffers from seasonal food insecurity and has the third-highest stunting rate globally. Previously inadequately documented, this paper summarises recent advances in understanding household food security in Timor-Leste and the multifaceted approaches being used to overcome it. Information comes from the extensive annual surveys of the Seeds of Life (SoL) program in Timor-Leste. The hungry season prior to maize and rice harvests is the key issue in household food security in Timor-Leste. Farm households cope with the problem through crop diversification with tubers playing a lead role as grain stocks dwindle. Foraging for wild food resources, selling animals and other assets, and social networks are other coping strategies. To address seasonal food insecurity, the government has focused on rice importation and the improvement of agricultural productivity within a multi-dimensional program. Information on storage by households of the key staple, maize, indicates an improving trend in food security at the household level from 2006/2007 to 2010/2011 through a significant reduction in the percentage of ‘at risk’ households—those who grow insufficient maize for storage during the year. The current emphasis on the widespread dissemination of the new high-yielding SoL cultivars has the potential to augment these improving trends. Nevertheless this picture remains vulnerable to weather shocks—such as drought—which are anticipated to increase with climate change and it is important to build further resilience into the agricultural systems of Timor-Leste.     

Local processing and nutritional composition of indigenous fruits: The case of monkey orange (Strychnos spp.) from Southern Africa

Monkey orange (Strychnos spp.) is a widely distributed fruit species in Southern Africa commonly consumed by the local population. It has potential to improve the nutritional status of rural populations, being a precious food source in areas with periodic shortages, since it is rich in vitamin C, zinc, and iron. To improve the availability of this food outside its production season, processing and preservation techniques used at household level need upgrading as they are unreliable and their effects on nutritional quality are unknown. Based on this review, we recommend better indigenous fruit production as a sustainable solution to malnutrition in rural areas in transition countries.     

Malnutrition in South Asia—A Critical Reappraisal

Malnutrition continues to be a major public health challenge especially in South Asian developing countries. The aim of the present review is to spotlight the magnitude of the prevalence of malnutrition and its dynamics in South Asian region and to suggest potential approaches for the prevention and control of this issue of public health significance. An extensive review of literature, covering malnutrition and its determinants, health and economic consequences and pragmatic preventive strategies was performed on computer based bibliographic databases (PubMed, Google Scholar, Scopus, Medline and Sciencedirect.com) to retrieve abstracts and full texts for India, Pakistan, Bangladesh, Sri Lanka and Nepal. All relevant titles and abstracts were examined and evaluated for malnutrition and its prevalence in South Asia. The results revealed malnutrition to be a major public health problem and a potential cause of high disease burden and mortality in South Asia. Compelling evidence suggests malnutrition to be the leading cause of stunting, wasting and underweight with drastic economic consequences among vulnerable populations. Reduced cognitive performance and low productivity have also been associated with micronutrients malnutrition. Suboptimal breastfeeding, inadequate food supply, micronutrient deficiencies, low household income, poor health care system, increased healthcare costs, illiteracy, unhygienic and substandard living, inappropriate child's care and the caregiver, food insecurity and on top of that vicious cycle of poverty, have been recognized as principal indicators for growing malnutrition prevalence in South Asia. Global organizations, local governments, program managers, NGOs, academia, industry in particular and the society at large need to take up the challenge to completely confiscate malnutrition from the region for economic prosperity and a healthier future.     

Food insecurity in canadian adults receiving diabetes care

Purpose: The prevalence of adult-level household food insecurity was examined among clients receiving outpatient diabetes health care services. Methods: Participants were adults diagnosed with diabetes mellitus, who attended individual counselling sessions at Calgary's main clinic from January to April 2010. Clinicians were trained to administer the Household Food Security Survey Module (HFSSM), and did so with clients' assent during their scheduled sessions. Results: The prevalence of adult-level household food insecurity among 314 respondents was 15.0% (95% confidence interval [CI], 11.2 to 19.4); 6.7% (95% CI, 4.2 to 10.0) of clinic attendees were categorized as severely food insecure. The comparable rates obtained in Alberta in 2007 using the same instrument (HFSSM) were 5.6% and 1.2%, respectively. Conclusions: Household food insecurity rates among individuals with diabetes in active care are higher than rates reported in Canadian population surveys. Severe food insecurity, indicating reduced food intake and disrupted eating patterns, may affect this population's ability to follow a pattern of healthy eating necessary for effective diabetes management. This study reinforces the importance of assessing clients' inability to access food because of financial constraints, and indicates that screening with a validated measure may facilitate identification of clients at risk.     

Food biotechnology and nutrition in Africa: a case for Kenya

Household food consumption surveys indicate that the diet in Kenya is ill balanced and that many families cannot afford nutrient-rich foods such as meat and fruits. In this regard, rural populations-the majority of the Kenyan population-are much worse off than urban populations. Agriculture, the most important sector in the Kenyan economy, contributes 27% of the gross domestic product and generates 65% of the country's export earnings. Food-enhancing biotechnologies thus could increase national food yields and fill nutrition gaps by contributing to household and national food security and poverty reduction in Kenya. To overcome barriers to adopting biotechnology to improve food crops in Kenya and elsewhere in Africa, policy makers must create a receptive environment for, increase public understanding of, and stimulate investment in the new technology.     

Assessment of the nutritional status of preschool-age children during the second Intifada in Palestine

BACKGROUND: The Palestinian economy has dramatically deteriorated at all levels since the Al-Aqsa Intifada (uprising) began in 2000, resulting in an unprecedented catastrophe to the livelihoods of the Palestinians residing in the West Bank and Gaza. It was also marked by lack of household physical and financial access to food and health care, which placed children at increased risk of malnutrition and poor health. This prompted a significant increase in food aid from 2002 until the summer of 2003. OBJECTIVES: To assess the nutritional status of children 6 to 59 months of age after 1 year of food assistance. METHODS: In the West Bank and Gaza, a nationally representative sample of children 6 to 59 months of age was randomly selected with a validated multistage clustered design, with the Health Survey 1999 sample used as the sampling frame. The sample was stratified according to governorate, place of residence (urban, nonurban, or refugee camp), locality, and size of locality (number of households). A cross-sectional survey of nutritional status was carried out. Data were collected by interviews with the primary caregivers of the children. Measurements were made of children's weight and height or length. Food-intake data were collected by the 24-hour food-recall method with the use of a booklet of photographs of foods commonly eaten in Palestine. RESULTS: A total of 3,089 children were assessed, of whom 3.1% in the West Bank and 3.9% in the Gaza Strip were suffering from acute malnutrition; the prevalence of chronic malnutrition was 9.2% in the West Bank and 12.7% in the Gaza Strip (p = .02). Sex, refugee status, locality, and maternal education were not significantly associated with acute malnutrition by logistic regression analysis, whereas infants 6 to 23 months of age were significantly at risk. Calorie and protein intakes were generally lower than recommended dietary allowances. CONCLUSIONS: The prevalence rates of both acute and chronic malnutrition among children in the West Bank and Gaza are significantly higher than the national Palestinian averages. There is a need to establish nutritional surveillance systems to monitor the nutritional status of children in conflict areas.     

Comparison between self-reported and observed food handling behaviors among Latinas

The study was conducted to compare and identify the magnitude of differences between self-reported and observed food safety behaviors among women preparing a chicken and salad dish at home. The observed food safety practices also were compared according to sociodemographic variables and prior food safety education. Sixty Puerto Rican women who were the main meal preparers for their households were recruited in Hartford, Conn. Three household visits were made to (i) deliver food ingredients to prepare the chicken and salad meal, (ii) conduct household observation, and (iii) conduct a self-reported survey. The difference between self-reported and observed behaviors varied across food handling and sanitation behaviors. There was a high level of inaccuracy for socially desirable behaviors such as hand washing; the vast majority of participants reported practicing these behaviors but they were not observed doing so. Cutting board washing also was considerably overreported, questioning the validity of these self-reported data for regression analyses. There was a significant association (P < 0.05) between proper thawing method and prior food safety education, use of cutting board and higher income, and washing tomatoes and having a positive attitude towards food safety. Results revealed that overreporting errors must be considered when analyzing and/or interpreting data derived from self-reported food safety consumer surveys and that food safety education and positive food safety attitudes are associated with recommended food safety behaviors.     

Ethical and Ethnical Requirements in the Production of Food L. E. GRIVETTI

ABSTRACT: The presentation explores ethnic food and ethics aspects of food distribution and food security. Basic principles associated with human food selection and avoidance have been known for some time (since World War I). During intervening decades, however, persistent problems have remained, including mismatched food assistance, short-sighted economic policies, lack of political will, disrespect for women's labor and decision-making skills, and, more recently, debate over zero-risk and genetically modified foods (GMFs) to reduce hunger and malnutrition. Fieldwork investigations of regional food production systems where specific food security mechanisms are identified have improved and streamlined the distribution of food supplies during and after regional or local crises. Paradoxically, such studies raise an important ethical issue, given that these same data have been and can be used by insurgents to sabotage food supplies and disrupt relief efforts. The presentation concludes with personal perspectives on associations between ethnic foods, food-related ethics, and food security. Several approaches to improving food chain security are reviewed, including micro-finance, household gardens, selected GMF technology, and how to improve existing food-related programs.     

Spezifik der Ernährung in einigen Haushaltsgruppen der ehemaligen DDR — eine abschließende Dokumentation

Characteristic features of nutrition in some household groups of the former GDR — a final documentation Existing data of nutrition surveys made in individual households of the former GDR were processed and interpreted in order to characterize nutrition of individual population groups. The results revealed some remarkable differences in food consumption as well as energy and nutrient intake: in households of members of agricultural production cooperatives (especially on account of feeding this products to animals) as well as higher consumption of foodstuffs from their own production (in particular eggs, fruit and vegetables); higher food consumption in small households (predominantly in pensioner households); more frequent participation of employed persons (persons from households of workers/clerks [office workers], and members of agricultural production cooperatives) in communal feeding; excessive intake of energy and fat, in particular in pensioners.     

Aspirations and food security in rural Ethiopia

Despite some improvements in recent years, poverty and food insecurity remain widespread and the main challenges in Ethiopia. Much of the empirical literature focuses on identifying the resource-related constraints for farmers to achieve food security and move out of poverty, with little attention paid to ‘internal’ or psychological factors such as aspirations. Using individual and household data collected in rural Ethiopia, we examined if aspirations were strongly associated with well-being outcomes, in our case food security, as posited in the theoretical framework of aspirations failure. We found that aspirations of the household head were positively and strongly associated with various triangulating measures of household food security including per-capita calorie consumption, the food consumption score (FCS), the household dietary diversity score (HDDS), and negatively associated with the household food insecurity access scale (HFIAS). In contrast, results suggest that the aspirations of the spouse of the household head are negatively associated with per-capita calorie consumption and FCS. We discuss the channels through which aspirations may affect food security and the avenues for future research.     

Biofortification of sweet potato for food and nutrition security in South Africa

South Africa has a diverse population, with some pockets of society being in a first world setup and other pockets in a third world impoverished setup. Food provision in impoverished societies is particularly crucial. Sweet potato (Ipomoea batatas (L.) Lam.) is a hardy crop and prominent in ensuring household food security; through its rich supply of energy, high yield potential and market value. In addition, orange-fleshed cultivars in particular are prominent in combating vitamin A deficiency due to high content of naturally bio-available β-carotene. This paper reviews interventions with regard to biofortification of sweet potato in South Africa towards addressing food and nutrition security. The focus was on the development of biofortified (high β-carotene content) cultivars and screening procedures for desired varietal traits; assessment of β-carotene, anti-oxidant and mineral content and the processing potential of orange-fleshed cultivars. Efficacy of orange fleshed sweet potato to improve vitamin A status was shown and positive effects of household production of orange-fleshed sweet potato, in conjunction with other β-carotene rich vegetables, on dietary intake, vitamin A status and food security were recorded. Dissemination efforts were initially focused on home gardens, which gradually expanded to subsistence production and enterprises. During 2014/15, over 1 million cuttings were disseminated and 5 to 40 small-scale commercial farmers in six provinces planted 0.25 to 1 ha of orange-fleshed sweet potato as means for income generation. In order to exploit the nutritional benefits of sweet potato and its potential to reduce vitamin A malnutrition and food insecurity, it is recommended that policy makers set directives to incorporate orange-fleshed sweet potato in government programs related to health, rural development, social development and agricultural production. There is a great need for investment in promotion of orange-fleshed sweet potato, particularly to consumers and retailers. Private–public partnerships and investment by private companies will be crucial for upscaling the impact of orange-fleshed sweet potato on food and nutrition security.     

Short-term determinants of malnutrition among children in Malawi

Short-term determinants of Severe Acute Malnutrition in children in Malawi during the period 2003 to 2009 were investigated in the three regions that compose Malawi ?C northern, central and southern ?C through an OLS approach and a first-order autocorrelation model. Explanatory variables were selected according to the definition of food security provided by the 1996 World Food Summit. Monthly changes in the number of children admitted to Nutrition and Rehabilitation Units was the impact variable adopted. The explanatory variables selected included a proxy of household income spent on food and the monthly variation in domestic price of maize, its trend, cyclical, seasonal and irregular components, informal cross-border imports in maize, urea price, non-food price index, and number of Nutrition and Rehabilitation Units. The study integrates recently developed studies on food insecurity in Malawi with regional and monthly perspectives. Results verify that child malnutrition is a chronic problem fuelled by transitory food insecurity, including seasonal and temporary features, with the common determinant being the market dependence of households on food purchases during the lean season. This impact is exacerbated by regional-specific explanatory variables: the variation in seasonal and irregular maize price components and the non-food price index in the central region, along with the cyclical maize price component and net cross-border maize imports in southern Malawi.     

A simple model to evaluate integrated vegetable production for food security in KwaZulu-Natal,South Africa

The objective of this study was to investigate the effectiveness of combining agricultural science with local knowledge in developing a simple model to evaluate vegetable production for food security and small-scale economic development. Four sites were selected for a preliminary survey to determine local knowledge about vegetable production using semi-structured interviews. Then, agronomic trials were conducted with a reduced number of participants representing an average household to grow popular vegetables identified in the surveys with the aim of testing the hypothesis of year-round organic production under virtual dryland conditions. A food security evaluation model based on farmer crop yield, home consumption and local market value was developed. The situation analysis showed that on average the farmers used their crops mainly for home consumption (~ 76%) compared to local market (~ 24%). Crop yields from 0.1 ha were found to be adequate for food security needs of an average household in the rural areas of South Africa. The food security values of maize (the staple crop) and cabbage (a popular vegetable) were found to be about 52%. The study revealed clearly that for a household of five persons, an average fresh vegetable crop yield of 19 to 27 t ha^- 1 can be produced per annum if production occurs all year round. The study proposes the first simple linear food security value model based on crop yield and utilisation with farmer participation.