Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria.

Background: Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions. Objectives: This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females. Methods: We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression. Results: The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake. Conclusions: We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.

Viewpoint: Finance needs of the agricultural midstream.

Recent literature suggests that agricultural value chains are changing rapidly and places an increasing focus on the importance of actors and activities taking place in the "midstream" of these value chains, after production and prior to final sale. This article discusses the financial needs of midstream actors in agricultural value chains, emphasizing differences across midstream activities and highlighting how value chain characteristics can influence both financial needs and potential remedies. The paper concludes with a brief discussion of the prospects of digital financial services and policy levers for government actors in this space.

Measuring consumption over the phone: Evidence from a survey experiment in urban Ethiopia.

The paucity of reliable, timely household consumption data in many low- and middle-income countries have made it difficult to assess how global poverty has evolved during the COVID-19 pandemic. Standard poverty measurement requires collecting household consumption data, which is rarely collected by phone. To test the feasibility of collecting consumption data over the phone, we conducted a survey experiment in urban Ethiopia, randomly assigning households to either phone or in-person interviews. In the phone survey, average per capita consumption is 23 percent lower and the estimated poverty headcount is twice as high than in the in-person survey. We observe evidence of survey fatigue occurring early in phone interviews but not in in-person interviews; the bias is correlated with household characteristics. While the phone survey mode provides comparable estimates when measuring diet-based food security, it is not amenable to measuring consumption using the 'best practice' approach originally devised for in-person surveys.

Changes in women's empowerment in the household, women's diet diversity, and their relationship against the background of COVID-19 in southern Bangladesh.

The COVID-19 pandemic in Bangladesh, associated public health measures, and people's reactions were projected to have caused job losses among women, a decline in women's empowerment and reduced women's diet diversity. Using a November 2020 telephone survey to re-interview adult female respondents of a November 2019 in-person survey, contrary to expectations we find that more women found than lost jobs, and women's diet diversity increased over the year partly marked by the COVID-19 pandemic. We did not find evidence of a decline in women's involvement in food purchase decisions, nor women's autonomy over use of household income. The change in women's outside employment is neither statistically related to changes in women's involvement in food purchase decisions, changes women's autonomy over use of household income, nor changes in women's diet diversity. Change in women's involvement in food purchase decisions is positively related with change in women's diet diversity and change in women's autonomy over income use is negatively related with change in women's diet diversity.

Resilience in maternal and child nutrition outcomes in a refugee-hosting community in Cameroon: A quasi-experimental study.

Refugees may be perceived as a burden to their host communities, and nutrition insecurity is a critical area of contention. We explored the relationship between refugee presence and a host community's resilience in nutrition outcomes in Cameroon. We also tested an analytical framework for evaluating community resilience during shocks. We used data from repeated cross-sectional Demographic and Health Surveys in Cameroon (2004 and 2011), data on refugee movement, and data on extreme climatic events, epidemics, and conflicts from multiple sources. Outcome variables were maternal underweight, maternal anaemia, and child underweight, anaemia, stunting and wasting. The exposure variable was residence within an area in which refugees settled. We used a genetic matching algorithm to select controls from the rest of the country after excluding areas experiencing concurrent shocks. We used a difference-in-differences analysis to compare outcomes between the exposed and control areas. The 2004 survey comprised 10,656 women and 8,125 children, while the 2011 survey comprised 15,426 women and 11,732 children. Apart from anaemia which showed a decreasing trend in both the refugee-hosting community and the rest of the country, all other indicators (wasting, underweight and stunting) showed increasing trends in the refugee-hosting community but decreasing trends in the rest of the country. The matched control group showed a similar trend of decreasing trend for all the indicators. Controlled comparisons showed no evidence of an association between changes in nutrition outcomes and the presence of refugees. These findings contest a common perception that refugees negatively impact hosting communities. The difference-in-differences analysis and an improved matching technique offer a method for exploring the resilience of communities to shocks.

Sweet or not: Using information and cognitive dissonance to nudge children toward healthier food choices.

In the interest of public health, it is important to nudge children toward healthier food choices (e.g., beverages with less added sugar). We conducted a field experiment in a peri-urban region in Vietnam to evaluate the effects of information and cognitive dissonance on the food choices of children. Our sample consisted of more than 1200 primary school children, randomly assigned into three groups: control, health information, and health information plus hypocrisy inducement. The third group was intended to raise cognitive dissonance by illustrating the gap between what people know they should do (socially desired behaviors) and what they actually do (transgressions). The results indicate that health information increased the likelihood of selecting milk with less sugar by around 30 %, as compared to the control group. Hypocrisy inducement did not make any additional contribution to healthier food choices. The treatment effects declined when there was a delay between the treatment and the behavioral choice. We discuss the practical implications of our findings for short-term intervention field studies.

Migration, labor and women's empowerment: Evidence from an agricultural value chain in Bangladesh.

As a substantial portion of the rural labor force migrates to urban areas, it is commonly assumed that women could take over traditionally male tasks in agricultural production, with potentially empowering outcomes for women. We study how changes in the supply of labor may influence female labor participation and empowerment outcomes. Using a detailed panel dataset on jute producers in the delta region of Bangladesh, we test whether out-migration of household members and perceived labor shortages are associated with the share of household and hired labor performed by women, and women's empowerment. When a household experiences reduced household or hired labor supply, we observe a relatively larger use of female household labor, but a reduced share of female hired labor. We also find that reduced labor supply is not associated with significant reductions in gender wage gaps, or enhanced women's empowerment. These findings suggest that given existing gender norms, male and female labor are not perfect substitutes for one another, and as a result, male outmigration is not associated with improved outcomes for women in cash crop production in the short run. Our results demonstrate a need for better understanding of the role of gender in rural labor markets, particularly in contexts of rapid urbanization.

Food Consumption and Food Security during the COVID-19 Pandemic in Addis Ababa.

International humanitarian organizations have expressed substantial concern about the potential for increases in food insecurity resulting from the COVID-19 pandemic. We use a unique panel survey of a representative sample households in Addis Ababa to study both food security and food consumption during the pandemic. In contrast to some other countries in the region, Ethiopia never went into a full lockdown severely restricting movement. Despite subjective income measures suggesting a large proportion of households have been exposed to job loss or reduced incomes, we find that relative to a survey conducted in August and September of 2019, food consumption and household dietary diversity are largely unchanged or slightly increased by August 2020. We find some changes in the composition of food consumption, but they are not related to shocks found in previous phone surveys conducted with the same households. The results therefore suggest the types of subjective questions about income typically being asked in COVID-19 phone surveys may not appropriately reflect the magnitude of such shocks. They also imply, at least indirectly, that in the aggregate food value chains have been resilient to the shock associated with the pandemic.

Can conditional cash transfers improve maternal health care? Evidence from El Salvador's Comunidades Solidarias Rurales program.

There is growing evidence on positive human capital impacts of large, poverty-focused cash transfer programs. However, evidence is inconclusive on whether cash transfer programs affect maternal health outcomes, and if so, through which pathways. We use a regression discontinuity design with an implicit threshold to evaluate the impact of Comunidades Solidarias Rurales in El Salvador on four maternal health service utilization outcomes: (a) prenatal care; (b) skilled attendance at birth; (c) birth in health facilities; and (d) postnatal care. We find robust impacts on outcomes at the time of birth but not on prenatal and postnatal care. In addition to income effects, supply-side health service improvements and gains in women's agency may have played a role in realizing these gains. With growing inequalities in maternal health outcomes globally, results contribute to an understanding of how financial incentives can address health systems and financial barriers that prevent poor women from seeking and receiving care at critical periods for both maternal and infant health.

Vitamin A intakes remain higher among intervention participants 3 years after a biofortification intervention in Mozambique.

The Reaching End Users (REU) project introduced orange sweet potatoes (OSP) to farmers in northern Mozambique between 2006 and 2009, and the associated cluster randomised control trial found increased vitamin A intake among targeted children and women of child-bearing age and reduced prevalence of inadequate vitamin A intake. Yet little is known about whether successful agricultural-nutrition interventions have lasting effects. This study measures the lasting effects of the REU project, 3 years after the project ended, on vitamin A intake. To do so, dietary intake data were collected in the same thirty-six villages as the original study, focusing on both women of child-bearing age and children under 6 years old, the latter including both children who had been measured before and younger children (under 3 years old) in the same farmer groups. The dietary intake is then converted to micronutrient intake to compare treated households with control households. Vitamin A intake remains higher in treated villages than in control villages among both children under 3 years old, who had not been born when the original intervention ended, and mothers of child-bearing age. Differences in vitamin A intake can wholly be attributed to differences in OSP intake. Therefore, the REU project appears to have had lasting impacts on vitamin A intake beyond the intervention period. Had the vine retention component been enhanced, lasting impacts could have been even larger.

The impact of the use of new technologies on farmers' wheat yield in Ethiopia: evidence from a randomized control trial.

In 2013, Ethiopia's Agricultural Transformation Agency introduced the Wheat Initiative to increase smallholder productivity. In this article, we measure the impacts of the Wheat Initiative package of technologies, and its marketing assistance component alone, on yields among a promotional group of farmers. The package includes improved techniques, improved inputs, and a guaranteed market for the crop. Relying on crop-cut measures and farmers' own assessments, we find that full package led to an average 14% higher yields. Implementation of the Wheat Initiative was successful in making certified seed and fertilizer accessible to farmers and increasing their uptake, though only 61% of the intervention group adopted row planting and few farmers received marketing assistance. The measured yield difference may underestimate the true yield difference associated with the technology because of incomplete adoption of the recommended practices by intervention farmers and adoption of some practices by control farmers.

Biofortification, Crop Adoption and Health Information: Impact Pathways in Mozambique and Uganda.

Biofortification is a promising strategy to combat micronutrient malnutrition by promoting the adoption of staple food crops bred to be dense sources of specific micronutrients. Research on biofortified orange-fleshed sweet potato (OFSP) has shown that the crop improves the vitamin A status of children who consume as little as 100 grams per day, and intensive promotion strategies improve dietary intakes of vitamin A in field experiments. However, little is known about OFSP adoption behavior, or about the role that nutrition information plays in promoting adoption and changing diet. We report evidence from similar randomized field experiments conducted in Mozambique and Uganda to promote OFSP. We further use causal mediation analysis to study impact pathways for adoption and dietary intakes. Despite different agronomic conditions and sweet potato cropping patterns across the two countries, the project had similar impacts, leading to adoption by 61% to 68% of farmers exposed to the project, and doubling vitamin A intakes in children. In both countries, two intervention models that differed in training intensity and cost had comparable impacts relative to the control group. The project increased the knowledge of key nutrition messages; however, added knowledge of nutrition messages appears to have minimally affected adoption, conditional on assumptions required for causal mediation analysis. Increased vitamin A intakes were largely explained by adoption and not by nutrition knowledge gained, though in Uganda a large share of impacts on vitamin A intakes cannot be explained by mediating variables. Similar impacts could likely have been achieved by reducing the scope of nutrition trainings. JEL codes: I15, O12, O13, Q12.

Introduction of ß-carotene-rich orange sweet potato in rural Uganda resulted in increased vitamin A intakes among children and women and improved vitamin A status among children.

Vitamin A deficiency (VAD) persists in Uganda and the consumption of ß-carotene-rich orange sweet potato (OSP) may help to alleviate it. Two large-scale, 2-y intervention programs were implemented among Ugandan farmer households to promote the production and consumption of OSP. The programs differed in their inputs during year 2, with one being more intensive (IP) and the other being reduced (RP). A randomized, controlled effectiveness study compared the impact of the IP and RP with a control on OSP and vitamin A intakes among children aged 6-35 mo (n = 265) and 3-5 y (n = 578), and women (n = 573), and IP compared with control on vitamin A status of 3- to 5-y-old children (n = 891) and women (n = 939) with serum retinol <1.05 µmol/L at baseline. The net OSP intake increased in both the IP and RP groups (P < 0.01), accounting for 44-60% of vitamin A intake at follow-up. The prevalence of inadequate vitamin A intake was reduced in the IP and RP groups compared with controls among children 6-35 mo of age (>30 percentage points) and women (>25 percentage points) (P < 0.01), with no differences between the IP and RP groups of children (P = 0.75) or women (P = 0.17). There was a 9.5 percentage point reduction in prevalence of serum retinol <1.05 µmol/L for children with complete data on confounding factors (n = 396; P < 0.05). At follow-up, vitamin A intake from OSP was positively associated with vitamin A status (P < 0.05). Introduction of OSP to Ugandan farming households increased vitamin A intakes among children and women and was associated with improved vitamin A status among children.

A large-scale intervention to introduce orange sweet potato in rural Mozambique increases vitamin A intakes among children and women.

ß-Carotene-rich orange sweet potato (OSP) has been shown to improve vitamin A status of infants and young children in controlled efficacy trials and in a small-scale effectiveness study with intensive exposure to project inputs. However, the potential of this important food crop to reduce the risk of vitamin A deficiency in deficient populations will depend on the ability to distribute OSP vines and promote its household production and consumption on a large scale. In rural Mozambique, we conducted a randomised, controlled effectiveness study of a large-scale intervention to promote household-level OSP production and consumption using integrated agricultural, demand creation/behaviour change and marketing components. The following two intervention models were compared: a low-intensity (1 year) and a high-intensity (nearly 3 years) training model. The primary nutrition outcomes were OSP and vitamin A intakes by children 6-35 months and 3-5·5 years of age, and women. The intervention resulted in significant net increases in OSP intakes (model 1: 46, 48 and 97 g/d) and vitamin A intakes (model 1: 263, 254 and 492 µg retinol activity equivalents/d) among the younger children, older children and women, respectively. OSP accounted for 47-60 % of all sweet potato consumed and, among reference children, provided 80 % of total vitamin A intakes. A similar magnitude of impact was observed for both models, suggesting that group-level trainings in nutrition and agriculture could be limited to the first project year without compromising impact. Introduction of OSP to rural, sweet potato-producing communities in Mozambique is an effective way to improve vitamin A intakes.