by Tushaar Shah, Resources for the Future, Washington, DC/International Water Management Institute, Colombo, Sri Lanka, 2009, x + 310 pp., cloth, $49.95 (ISBN 978‐1‐933‐115‐60‐3). Shah begins by sa...

Taming the Anarchy: Groundwater Governance in South Asia

Nutrition-Sensitive Agriculture: A Systematic Review of Impact Pathways to Nutrition Outcomes.

BACKGROUND Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (AT P < 0.05) in children aged 6-23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose-response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ. CONCLUSIONS Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

Eggs are a highly nutritious food but have been shown to be infrequently consumed in many low-income countries, especially by women and children. We collate country-level data on egg production, availability, consumption, prices, industry structure, and contextual trends and use these to estimate current patterns and likely future outcomes under four alternative scenarios. These scenarios are as follows: incremental change based on expected economic growth and urbanisation (the base scenario); enhanced productivity of independent small producers; aggregated production in egg hubs; and the accelerated spread of large-scale intensive production. All scenarios are modelled out to 2030 using a mix of regression and deterministic models. We find that children's consumption of eggs is highly correlated with national availability, and both are a function of egg prices. Eggs are unavailable, expensive, and infrequently consumed by children in much of South Asia and sub-Saharan Africa. The base scenario results in modest increases in production in low-income regions. Focusing efforts on independent small producers can only boost rural consumption in a handful of countries where poultry ownership is unusually high and would be expensive and logistically challenging to scale. Aggregation of production, with minimum flock sizes of 5,000 layers per farm, is a more promising pathway to increasing availability in rural areas. To meet the needs of urban populations, large-scale intensive production is needed. Intensive production brings down prices significantly, allowing many more poor households to access and consume eggs. Recent experience in countries such as Thailand confirms that this is both feasible and impactful.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/mcn.12679

An egg for everyone: Pathways to universal access to one of nature's most nutritious foods

Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother-child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention-to-treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-for-age (LAZ)/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WLZ)/weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0-32) at baseline and 29.8 ± 5.4 months (range: 13-48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/mcn.12677

An agriculture-nutrition intervention improved children's diet and growth in a randomized trial in Ghana.

Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale-up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in-country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in-depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non-governmental organizations' breastfeeding efforts.

/pdf/factors-influencing-the-implementation-of-the-becoming-3s4itfufw4.pdf

Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana

The current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity.

/pdf/stories-of-change-in-nutrition-in-ghana-a-focus-on-stunting-2iqon8xvdt.pdf

Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018)

Child Feeding Practices among Mothers of Children 6–24 Months of Age in a Rural Setting in Ghana

Irrigated agriculture can support food and nutrition security, increase rural employment and incomes and can act as a buffer against growing climate variability and change. However, irrigation development has been slow in Africa south of the Sahara and Ghana is no exception. Out of a total potential irrigated area of close to 2 million ha, less than 20,000 ha large-scale irrigation and less than 200,000 ha of small-scale irrigation have been developed; but the latter is only an estimate. To identify entry points for accelerating small-scale irrigation development in Ghana, a national and a regional stakeholder Net-Map workshop were held in Accra and Tamale, respectively. The workshops suggest that a wide variety of actors from government, the private sector, international organizations and funders, research organizations and NGOs are involved in the diffusion of small-scale irrigation technologies. However, there are important differences between actors perceived to be key at the national and at the regional levels in northern Ghana. At the national level, diffusion of small-scale irrigation technologies is considered to be largely influenced by the Ghana Irrigation Development Authority together with a series of private sector actors focused on importation, distribution and financing of technologies. Farmers are considered to have no influence over the diffusion of small-scale irrigation, suggesting that small-scale irrigation is largely considered a supply-driven process. In northern Ghana, on the other hand, farmers are considered to be key influencers, although participants noted that much of this was potential influence, together with a larger and more diversified set of government stakeholders that are seen as regulators and possibly gatekeepers. For irrigation diffusion to successfully move from importation to distribution to benefiting smallholder farmers, all of these actors have to come together to better understand farmers’ needs and challenges. A multi-stakeholder platform could help to increase communication between farmers as the ultimate beneficiaries of small-scale irrigation technologies and the many other actors interested in supporting this process.

/pdf/smallholder-irrigation-technology-diffusion-in-ghana-1pr1xhk0by.pdf

Afua Atuobi-Yeboah

Papers

An agriculture-nutrition intervention improved children's diet and growth in a randomized trial in Ghana.

Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana

Stories of Change in Nutrition in Ghana: a focus on stunting and anemia among children under-five years (2009 – 2018)

Child Feeding Practices among Mothers of Children 6–24 Months of Age in a Rural Setting in Ghana

Smallholder irrigation technology diffusion in Ghana: Insights from stakeholder mapping