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Predictors of anaemia in mothers and children in Uttar Pradesh, India
- Leila M Larson, Tinku Thomas, Anura V Kurpad, Reynaldo Martorell, John Hoddinott, Victoria Oluwapamilerin Adebiyi, Sumathi Swaminathan, Lynnette M Neufeld
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- Journal:
- Public Health Nutrition / Volume 27 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 08 January 2024, e30
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Objective:
Anaemia affects more than half of Indian women and children, but the contribution of its causes remains unquantified. We examined interrelationships between Hb and nutritional, environmental, infectious and genetic determinants of anaemia in non-pregnant mothers and children in Uttar Pradesh (UP).
Design:We conducted a cross-sectional survey of households in twenty-five districts of UP between October and December 2016. We collected socio-demographic data, anthropometry and venous blood in 1238 non-pregnant mothers and their children. We analysed venous blood samples for malaria, Hb, ferritin, retinol, folate, Zn, vitamin B12, C-reactive protein, α1-acid glycoprotein (AGP) and β-thalassaemia. We used path analysis to examine pathways through which predictors of anaemia were associated with Hb concentration.
Setting:Rural and urban households in twenty-five districts of UP.
Participants:Mothers 18–49 years and children 6–59 months in UP.
Results:A total of 36·4 % of mothers and 56·0 % of children were anaemic, and 26·7 % of women and 44·6 % of children had Fe deficiency anaemia. Ferritin was the strongest predictor of Hb (β (95 % CI) = 1·03 (0·80, 1·27) g/dL in women and 0·90 (0·68, 1·12) g/dL in children). In children only, red blood cell folate and AGP were negatively associated with Hb and retinol was positively associated with Hb.
Conclusions:Over 70 % of mothers and children with anaemia had Fe deficiency, needing urgent attention. However, several simultaneous predictors of Hb exist, including nutrient deficiencies and inflammation. The potential of Fe interventions to address anaemia may be constrained unless coexisting determinants are jointly addressed.
Investing in Nutrition: A Global Best Investment Case
- Bjorn Larsen, John Hoddinott, Saleema Razvi
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- Journal:
- Journal of Benefit-Cost Analysis / Volume 14 / Issue S1 / Spring 2023
- Published online by Cambridge University Press:
- 30 June 2023, pp. 235-254
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Undernutrition and micronutrient deficiencies are key drivers of infant and child mortality and are causes of impaired human potential for hundreds of millions of children every year. Investing in nutrition in the first 1,000 days from conception not only supports individual lifetime health, education, and productivity, but is also key to breaking the intergenerational cycle of malnutrition and enhance equitable development pathways for low- and middle-income countries. This paper provides a cost–benefit analysis of three nutrition interventions: 1) provision of preventive small-quantity lipid-based nutrient supplements (SQ-LNS) to children 6−23 months of age; 2) Complementary Feeding Promotion (CFP) for children 6−23 months of age; 3) provision of multiple micronutrient (MMN) and calcium (Ca) supplements to pregnant women. The benefit–cost ratios (BCRs) for MMN supplementation for pregnant women replacing iron and folic acid (37.5), as well as MMN and Ca combined (19-24), are the highest. The BCRs for CFP for children in the two highest socio-economic status (SES) quintiles and SQ-LNS for children in the three lowest SES quintiles are fairly similar at 16 and 14, respectively. The lowest BCR is for CFP for children in the three lowest SES quintiles due to the high cost of accomplishing behavioral change for improved complementary feeding in resource-poor households.
Qualitative exploration of the dynamics of women’s dietary diversity. How much does economic empowerment matter?
- Michael Nnachebe Onah, John Hoddinott, Susan Horton
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- Journal:
- Public Health Nutrition / Volume 25 / Issue 6 / June 2022
- Published online by Cambridge University Press:
- 29 November 2021, pp. 1461-1471
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Objective:
This study qualitatively examined dietary diversity among married women of reproductive age who engaged in two socio-economic activities to explore the dynamics of food availability, access, costs and consumption.
Design:Qualitative in-depth interviews. The food groups in the Minimum Dietary Diversity for women were used to explore women’s dietary diversity. IDI were used to develop a roster of daily food consumption over a week. We explored food items that were considered expensive and frequency of consumption, food items that women require permission to consume and frequency of permission sought and the role of economic empowerment. Data analysis followed an inductive–deductive approach to thematic analysis.
Setting:Rural and peri-urban setting in Enugu State, Nigeria.
Participants:Thirty-eight married women of reproductive age across two socio-economic groupings (women who work only at home and those who worked outside their homes) were recruited in April 2019.
Results:Economic empowerment improved women’s autonomy in food purchase and consumption. However, limited income restricted women from full autonomy in consumption decisions and access. Consumption of non-staple food items, especially flesh proteins, would benefit from women’s economic empowerment, whereas staple food items would not benefit so much. Dietary diversity is influenced by food production and purchase where factors including seasonal variation in food availability, prices, contextual factors that influence women’s autonomy and income are important determinants.
Conclusion:With limited income, agency and access to household financial resources coupled with norms that restrict women’s income earning, women continue to be at risk for not achieving adequate dietary diversity.
Chapter 20 - Benefits and Costs of the Food and Nutrition Targets for the Post-2015 Development Agenda
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 367-374
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Summary
Nutrition has always been a key development indicator. Good nutrition allows for healthy growth and development of children, and inadequate nutrition is a major contributing factor to child mortality. Good nutrition is also important for cognitive development, and hence educational success, both of which are important determinants of labour productivity and hence economic growth. Good nutrition also implies balance – neither undernutrition nor overnutrition. In what follows we will first briefly review the evolution of nutrition goals, from the Millennium Development Goals (MDGs) to 2015, to the World Health Organization targets to 2025, and the proposed Sustainable Development Goals (SDGs) to 2030. We then comment briefly on the proposed SDG for nutrition, and provide an economic perspective on the goal (using Hoddinott et al, 2013), suggesting that the benefit:cost ratio of nutrition investments is very attractive.
20 - Benefits and Costs of the Food and Nutrition Targets for the Post-2015 Development Agenda
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- By Susan Horton, CIGI Chair in Global Health Economics, University of Waterloo, Canada, John Hoddinott, H. E. Babcock Professor of Food & Nutrition Economics and Policy, Cornell University, Ithaca, New York, USA
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 367-374
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Summary
Introduction
Nutrition has always been a key development indicator. Good nutrition allows for healthy growth and development of children, and inadequate nutrition is a major contributing factor to child mortality. Good nutrition is also important for cognitive development and, hence, educational success, both of which are important determinants of labor productivity and hence economic growth. Good nutrition also implies balance – neither undernutrition nor overnutrition.
In what follows we will first briefly review the evolution of nutrition goals, from the Millennium Development Goals (MDGs) to 2015, to the World Health Organization targets to 2025, and the Sustainable Development Goals (SDGs) to 2030. We then comment briefly on the SDG target for nutrition and provide an economic perspective on the goal (using Hoddinott et al., 2013), suggesting that the benefit-cost ratio of nutrition investments is very attractive.
The Evolution of the Nutrition Goals
Stunting – low height for age – is an excellent nutrition indicator to include in the SDGs. It improves on the earlier nutrition indicator used in the MDGs. MDG 1 had two quantitative targets and one qualitative: halving the poverty rate, halving the number “hungry,” and a more aspirational goal regarding access to employment. “Hunger,” in turn, was defined in terms of the number of children who were underweight (using the WHO Child Growth Standards), hence the specific goal was to halve the proportion of children underweight over the period 1990 to 2015.
Over the decade or so since the MDGs were set, our understanding of undernutrition and its measurement has advanced further. Underweight (weight for age) is a composite measure, which aggregates two different aspects of undernutrition, namely weight for height (or wasting, a measure of current nutritional status) and height for age (or stunting, a measure of long-run nutritional status). The underweight goal has served its purpose to focus attention on nutrition. Going forward we can improve on the original MDG target in two ways. First, stunting is a better indicator than underweight. And second, in a world with some regions with growing population, a goal of halving the proportion who are hungry is a weaker goal (easier to achieve) than one of halving the current number who are hungry.
Randomized control trials demonstrate that nutrition-sensitive social protection interventions increase the use of multiple-micronutrient powders and iron supplements in rural pre-school Bangladeshi children
- John Hoddinott, Akhter Ahmed, Shalini Roy
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- Journal:
- Public Health Nutrition / Volume 21 / Issue 9 / June 2018
- Published online by Cambridge University Press:
- 22 February 2018, pp. 1753-1761
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Objective
To examine the impact of a nutrition-sensitive social protection intervention on mothers’ knowledge of Fe deficiency, awareness of multiple-micronutrient powders (MMP) and the consumption of MMP and other Fe supplements by their children aged 6–59 months.
DesignTwo randomized controlled trials with treatment arms including cash transfers, food transfers, cash and food transfers, cash and nutrition behaviour change communication (BCC), and food and nutrition BCC were implemented over two years. Both included a control group that received no transfer or BCC. Transfer recipients were mothers living in poor households with at least one child aged less than 2 years at baseline. Probit models were used to analyse endline data.
SettingRural areas in north-west and south Bangladesh.
SubjectsMothers (n 4840) and children 6–59 months (n 4840).
ResultsA transfer accompanied by nutrition BCC increased the share of mothers with knowledge of Fe deficiency (11·9 and 9·2 percentage points for North and South, respectively, P≤0·01), maternal awareness of MMP (29·0 and 22·2 percentage points, P≤0·01), the likelihood that their children 6–59 months had ever consumed MMP (32 and 11·9 percentage points, P≤0·01), consumed MMP in the preceding week (16·9 and 3·9 percentage points, P≤0·01) and consumed either MMP or an Fe supplement in the preceding week (22·3 and 7·1 percentage points, P≤0·01). Improvements were statistically significant relative to groups that received a transfer only.
ConclusionsNutrition-sensitive social protection (transfers with BCC added) may be a promising way to advance progress on micronutrient deficiencies.
6 - Hunger and Malnutrition
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- By John Hoddinott, Poverty Health and Nutrition Division, International Food Policy Research Institute, Mark Rosegrant, Environment and Production Technology Division, International Food Policy Research Institute, Maximo Torero, nternational Food Policy Research Institute
- Edited by Bjørn Lomborg
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- Book:
- Global Problems, Smart Solutions
- Published online:
- 05 June 2014
- Print publication:
- 14 November 2013, pp 332-389
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Summary
Introduction: the challenge of hunger and undernutrition
Current estimates suggest that there are approximately 925 million hungry people in the world. Just under 180 million pre-school children are stunted – that is, they are the victims of chronic undernutrition. This deprivation is not because of insufficient food production. Approximately 2,100 kcal/person/day, provides sufficient energy for most daily activities; current per capita global food production, at 2,796 kcal/person/day, is well in excess of this requirement. Given that there is more than enough food in the world to feed its inhabitants, global hunger is not an insoluble problem.
Deprivation in a world of plenty is an intrinsic rationale for investments that reduce hunger and undernutrition; our focus in this chapter, as with previous Copenhagen Consensus papers on this topic, Behrman et al. (2004) and Horton et al. (2008), is on the instrumental case for doing so. In its simplest form, the central argument of this chapter is that these investments are simply good economics. Our solutions, however, represent a partial departure from those earlier Copenhagen Consensus papers. First, we re-introduce attention to solutions to hunger with a focus on investments that will increase global food production. This might seem strange given our observation that global food production exceeds global food needs. But as we argue in this chapter, these investments are needed for two reasons: to lower prices so as to make food more affordable; and because, given the consequences of climate change, there can be no complacency regarding global food production. Second, previous Copenhagen Consensus papers on hunger and undernutrition have considered very specific interventions that focus on single dimensions of undernutrition. In this chapter, we examine the economic case for bundling these. Our proposed investments are:
Investment 1: Accelerating yield enhancements
Investment 2: Market innovations that reduce hunger
Investment 3: Interventions that reduce the micronutrient malnutrition and reduce the prevalence of stunting
We begin with background material that contextualizes our proposed solutions:
What are the causes of hunger?
How many hungry and undernourished people are there in the world?
And what are the likely trends in hunger over the next twenty-five–thirty-five years?
We then describe our three proposed investments, explaining how each addresses the problems of hunger and undernutrition and describing their costs and benefits. Caveats and cautions are noted in the third section and our concluding section summarizes the case for these investments.
21 - Hunger and malnutrition
- Edited by Bjørn Lomborg, Copenhagen Business School
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- Book:
- Solutions for the World's Biggest Problems
- Published online:
- 08 July 2009
- Print publication:
- 18 October 2007, pp 390-404
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Summary
Describing the problem: hunger and malnutrition
Severe hunger episodes, such as famines, receive considerable press coverage and attract public attention. But chronic hunger and malnutrition are considerably more prevalent. At least 12 million low-birth-weight (LBW) births occur per year and around 162 million pre-school children and almost a billion people of all ages are malnourished. In poorly nourished populations, reductions in hunger and improved nutrition convey considerable productivity gains and save resources that otherwise would be used for the care of malnourished people who are more susceptible to infectious diseases and premature mortality. It is these potential gains in productivity and reductions in economic costs that provide the focus of this chapter.
Hunger
This is the “condition, in which people lack the basic food intake to provide them with the energy and nutrients for fully productive lives” (Hunger Task Force, 2004, p. 33). It is measured in terms of calories relative to requirements that vary by age, sex and activities. The most widely cited data on hunger come from the Food and Agriculture Organization (FAO). FAO (2003) estimates that over the last decade, the number of people undernourished in the developing world declined slightly from 816 to 798 million, or from 20 to 17% of the population. Two regions, Asia and the Pacific and sub-Saharan Africa account for nearly 90% of the world's hungry. However, in Asia, both the number (505 million) and prevalence of undernourishment fell during the 1990s in contrast to increases in Africa (198 million).
6 - Hunger and Malnutrition
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- By Jere R. Behrman, William R. Kenan, Jr., Professor in Economics and Director Population Studies Center, University of Pennsylvania, Harold Alderman, Lead Human Development Economist Africa Region of the World Bank, Washington, DC, John Hoddinott, Senior Research Fellow Food Consumption and Nutrition Division of the International Food Policy Research Institute, Washington, DC
- Edited by Bjørn Lomborg
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- Book:
- How to Spend $50 Billion to Make the World a Better Place
- Published online:
- 27 July 2009
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- 12 June 2006, pp 95-107
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Summary
Introduction: the challenge of hunger and malnutrition
Alongside the tragedy of acute famine, which is frequently shown on our televisions, there is a much bigger problem of chronic hunger and malnutrition in developing countries. Although this carries a very real human cost, it is the purpose of this chapter to look purely at the economic aspects: Assuring better nutrition can both reduce the economic drain on poor societies and help them become wealthier by increasing individuals' productivity.
This chapter reviews the nature and scale of the problem and the economic benefits that would flow from successful solutions. Four opportunity areas for effective use of resources to reduce malnutrition are then proposed:
Reducing the prevalence of Low Birth Weight.
Promotion of infant and child nutrition and exclusive breastfeeding.
Reducing the prevalence of iron deficiency anemia and vitamin A, iodine, and zinc deficiencies.
Investment in technology in developing country agriculture.
Using resources to address these opportunities would yield benefits greater than the cost, so these opportunities are economically justified. Benefits would, of course, also be realized on a wider social and human scale.
The nature of the challenge
Hunger has been described as “a condition in which people lack the basic food intake to provide them with the energy and nutrients for fully productive lives.” Malnutrition, in its strict sense, can be associated with over-consumption of food, resulting for example in obesity, diabetes, or heart disease. Such problems are of increasing importance in some parts of the developing world.
7 - Malnutrition and hunger
- Edited by Bjørn Lomborg, Aarhus Universitet, Denmark
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- Book:
- Global Crises, Global Solutions
- Published online:
- 22 September 2009
- Print publication:
- 25 October 2004, pp 363-442
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Summary
Introduction: The Challenge of Malnutrition and Hunger
While episodes of severe hunger such as famines receive considerable press coverage and attract much public attention, chronic hunger and malnutrition is considerably more prevalent in developing countries. It is estimated that at least 12 m low-birth-weight (LBW) births occur per year and that around 162 million pre-school children and almost a billion people of all ages are malnourished. In poorly nourished populations, reductions in hunger and improved nutrition convey considerable productivity gains as well as saving resources that would otherwise be used for the care of malnourished people who are more susceptible to infectious diseases and premature mortality. While reducing hunger and malnutrition is often justified on intrinsic grounds, it is these potential gains in productivity and reductions in economic costs that provide the focus of our challenge paper.
Poverty, hunger and malnutrition are linked. Strauss and Thomas (1995, 1998) and Hoddinott, Skoufias and Washburn (2000) document the empirical literature relating dimensions of access and intakes of calories to household consumption levels. A reasonable reading of these studies suggests an income–calorie elasticity of around 0.2–0.3, though careful studies have also found estimates both higher and lower than this range. Behrman and Rosenzweig (2004) report that cross-country variation in GDP per worker in PPP terms is inversely related to the percentage of LBW (< 2.5 kg) births among all births and is consistent with almost half of the variation in the percentage of births that are LBW across countries.