Evaluating Double-Duty Actions in Rwanda's Secondary Cities.

The double burden of malnutrition (DBM) is escalating in low- and middle-income countries (LMICs), including in Rwanda, most notably in urbanizing areas. The 2019-2020 Rwanda Demographic Health Survey (DHS) revealed that 33% of children under 5 years old are stunted while 42% of women in urban areas are overweight or obese. This coexistence has contributed to a surge in non-communicable diseases (NCDs), particularly in secondary cities. Using the World Health Organization's (WHOs) "double-duty action" (DDA) concept, this study aims to identify and evaluate interventions with double-duty potential in Rwanda's Rusizi and Rubavu districts and generate key recommendations for their improvement. A desk review of national policies pinpointed four programs with the greatest DDA potential: early childhood development (ECD) centers, the school feeding program, farmer field schools (FFS), and the provision of nutrition-sensitive direct support. In-person interviews with key stakeholders assessed the implementation of each program and a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to generate context-specific recommendations for their improvement. The main finding of this research is that Rwanda's potential to address the DBM can be improved across multiple sectors by implementing a few key changes: targeting beliefs surrounding nutrition, improving trainings for community educators, enhancing parent-particularly father-involvement, and engaging in close monitoring and follow-up. These findings offer actionable streps that governments and nutrition stakeholders can take to improve similar interventions in other rapidly urbanizing LMICs.

A cross-cultural segmentation of western Balkan consumers: focus on preferences toward traditional fresh cow cheese.

BACKGROUND: Western Balkan countries (WBCs) have a long-standing culinary tradition. The promotion of traditional foods may be a tool for coping with modernisation trends in such transition economies. This paper explores consumer preferences toward food in this region, focusing on a traditional fresh cow cheese locally called 'Mladi Sir'. This product was quoted in all the preliminary focus groups as a common traditional product present in the six WBCs studied: Bosnia-Herzegovina, Croatia, Macedonia, Montenegro, Serbia and Slovenia. RESULTS: After a literature review investigating the concept of traditional food in WBCs and the implementation of focus groups, a survey including a conjoint analysis on preferences for fresh cow cheese was carried out in 2011 to collect data from 1200 respondents. Four clusters of consumers were identified: one focused more on the local origin; one oriented more toward the scale of production (on-farm and small dairy); the third favouring low prices and the fourth preferring high prices and industrial products. CONCLUSION: Policy makers and the supply chain could take these differences in consumer preferences regarding traditional food products into account in order to develop specific strategies.

Circular Economy in Mountain Value Chains: The Case of Three PDO Cheeses.

The circular economy (CE) has shown promise for achieving several of the UN's Sustainable Development Goals, replacing the linear system and reducing negative impacts on the environment. This research aims to assess the effective adoption of CE principles in three cheeses with geographical indication (GI) through an analysis of the practices identified in their respective value chains. Qualitative interviews show the persistence of historical practices that preserve the heritage behind the product, maintain autonomy in relation to external inputs and save energy or make intelligent use of by-products. Radical adoption of CE principles requires innovation to reduce the use of new inputs and greenhouse gas emissions. GI food products are generally not constrained by standards beyond those set by law, but their specifications can be modified, while respecting practices consistent with the link to the terroir. However, the remoteness of small businesses in deep rural areas, far from research centers, is slowing down the transfer of knowledge and the adoption of the latest technologies, particularly in mountainous areas. More participatory research and innovative initiatives are needed to ensure the transition to a circular economy for traditional mountain products, which are strongly linked to local culinary traditions and cultural identity.

Nutrition transition, double burden of malnutrition, and urbanization patterns in secondary cities of Bangladesh, Kenya and Rwanda.

BACKGROUND: By 2050, approximately 68% of the global population will live in cities, but nutrition data on urban populations of low- and middle-income countries are scarce. Fast growing secondary cities, combining characteristics and hurdles of urban and rural settings, are hotspots for the double burden of malnutrition. The Nutrition in City Ecosystems (NICE) project focuses on 6 secondary cities in Bangladesh, Kenya and Rwanda, to improve health and nutrition, and reduce poverty. To assess the baseline situation and guide future interventions, food insecurity, dietary diversity, nutrition status, and food production and purchasing patterns were explored. METHODS: In a cross-sectional study design, data were collected from urban and peri-urban households of Dinajpur and Rangpur in Bangladesh, Bungoma and Busia in Kenya, and Rubavu and Rusizi in Rwanda. Approximately 1200 households, in neighborhoods prone to malnutrition, were involved from April to June 2021. We assessed Household Food Insecurity Access Score (HFIAS), both current and before COVID-19, Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity for Women (MDD-W), anthropometric measurements, household and socioeconomic information, and questions related to food production and consumer behavior. Further we collected secondary data on low birthweight and anemia during pregnancy. RESULTS: All cities experienced a substantial increase in food insecurity during the COVID-19 pandemic. Stunting rates in children under 5 years varied among the cities and ranged from 7.8% in Busia to 46.6% in Rubavu, while half of adult women were overweight (between 42.1% in Rusizi and 55.8% in Bungoma). Furthermore, many women did not consume an adequately diverse diet (MDD-W < 5 for 29.3% in Bangladesh, 47.5% in Kenya, and 67.0% in Rwanda), however many of the urban and peri-urban households were engaged in farming (58-78%). CONCLUSIONS: The double burden of malnutrition is high in secondary cities and the COVID-19 pandemic has exacerbated levels of food insecurity. Demand for, and access to, an affordable healthy diverse diet that comprises local, nutritious, and agroecologically produced foods present a pathway for overcoming the complex challenges of malnutrition.

Nutrition in City Ecosystems (NICE): Protocol of a multi-sectoral development project to improve food and nutrition security of secondary city populations in Bangladesh, Kenya and Rwanda.

Background: Secondary cities tend to be better linked with local food systems than primate cities, acting as important platforms to trade agricultural produce with rural surrounding. COVID-19, conflicts and climate change continue to expose inefficiencies in food systems and have further exacerbated malnutrition, calling for substantial food systems transformations. However, tackling current food systems' challenges requires new approaches to ensure food and nutrition security. Nutritious and agroecologically produced food offer the potential to transform food systems by improving diets and alleviating pressure on the environment, as well as by creating jobs and reducing poverty. This paper describes the design of a project by a Swiss public-private consortium to improve food and nutrition security and to reduce poverty in city ecosystems in six secondary cities in Bangladesh, Kenya and Rwanda through governance/policy and supply and demand side interventions. Methods: The Nutrition in City Ecosystems (NICE) project promotes well-balanced nutrition for city populations through interdisciplinary agricultural, food, and health sector collaborations along city-specific value chains. Adopting a transdiciplinary systems approach, the main interventions of NICE are (i) advocacy and policy dialogue, (ii) building of decentralized institutional capacity in multi-sectoral collaborations, (iii) support of data-driven planning, coordination and resource mobilization, (iv) anchoring of innovations and new approaches in city-level partnerships, (v) capacity building in the agricultural, retail, health and education sectors, as well as (vi) evidence generation from putting policies into practice at the local level. NICE is coordinated by in-country partners and local offices of the Swiss public-private consortium partners. Discussion: The NICE project seeks to contribute to urban food system resilience and enhanced sustainable nutrition for city populations by (A) strengthening urban governance structures involving key stakeholders including women and youth, (B) generating income for producers along the supply chain, (C) triggering change in producers' and consumers' behavior such that nutritious and agroecologically produced foods are both in demand as well as available and affordable in urban markets, and (D) allowing a scale up of successful approaches to other national and international cities and city networks.

Understanding the motives for food choice in Western Balkan Countries.

Substantial empirical evidence exists regarding the importance of different factors underlying food choice in Western Europe. However, research results on eating habits and food choice in the Western Balkan Countries (WBCs) remain scarce. A Food Choice Questionnaire (FCQ), an instrument that measures the reported importance of nine factors underlying food choice, was administered to a representative sample of 3085 adult respondents in six WBCs. The most important factors reported are sensory appeal, purchase convenience, and health and natural content; the least important are ethical concern and familiarity. The ranking of food choice motives across WBCs was strikingly similar. Factor analysis revealed eight factors compared to nine in the original FCQ model: health and natural content scales loaded onto one factor as did familiarity and ethical concern; the convenience scale items generated two factors, one related to purchase convenience and the other to preparation convenience. Groups of consumers with similar motivational profiles were identified using cluster analysis. Each cluster has distinct food purchasing behavior and socio-economic characteristics, for which appropriate public health communication messages can be drawn.

Nutrition as a driver and outcome of agroecology.

The principles of agroecology do not explicitly state a link with nutrition. Yet, we argue that among them, input reduction, biodiversity, economic diversification, social values and diets, fairness, connectivity and participation are directly linked to nutrition. Nutrition can serve as a critical outcome and driver of agroecological practices and can drive transformative change across the food system.

The Challenge of Improving Soil Fertility in Yam Cropping Systems of West Africa.

Yam (Dioscorea spp.) is a tuber crop grown for food security, income generation, and traditional medicine. This crop has a high cultural value for some of the groups growing it. Most of the production comes from West Africa where the increased demand has been covered by enlarging cultivated surfaces while the mean yield remained around 10 t tuber ha-1. In West Africa, yam is traditionally cultivated without input as the first crop after a long-term fallow as it is considered to require a high soil fertility. African soils, however, are being more and more degraded. The aims of this review were to show the importance of soil fertility for yam, discuss barriers that might limit the adoption of integrated soil fertility management (ISFM) in yam-based systems in West Africa, present the concept of innovation platforms (IPs) as a tool to foster collaboration between actors for designing innovations in yam-based systems and provide recommendations for future research. This review shows that the development of sustainable, feasible, and acceptable soil management innovations for yam requires research to be conducted in interdisciplinary teams including natural and social sciences and in a transdisciplinary manner involving relevant actors from the problem definition, to the co-design of soil management innovations, the evaluation of research results, their communication and their implementation. Finally, this research should be conducted in diverse biophysical and socio-economic settings to develop generic rules on soil/plant relationships in yam as affected by soil management and on how to adjust the innovation supply to specific contexts.

Motives underlying food consumption in the Western Balkans: consumers' profiles and public health strategies.

OBJECTIVES: This study aims to identify subgroups of consumers based on the health motives underlying their food choice in Western Balkan Countries. METHODS: The survey (n = 2943) was based on the Food Choice Questionnaire (FCQ) and elicited information on socio-demographic characteristics, consumption frequency of healthy food products, nutrition knowledge and impulsiveness. Analysis of the FCQ data focused on items of "health and natural content" and "weight control" factors to identify clusters. RESULTS: The biggest group of the sample was weight control and health-concerned individuals (34 %), mainly urban women older than 50. The second group of respondents (31 %) was moderately motivated about health and weight. A third group was health concerned but paid less attention to weight control (21 %), mainly comprising men and people living with children. The last group consisted of unconcerned young men (14 %) eating less fruit and showing higher impulsiveness. CONCLUSIONS: Western Balkan consumers differ in the importance they attach to health and natural content and weight control. This insight is needed to target interventions.