Socioecologically informed use of remote sensing data to predict rural household poverty.

Tracking the progress of the Sustainable Development Goals (SDGs) and targeting interventions requires frequent, up-to-date data on social, economic, and ecosystem conditions. Monitoring socioeconomic targets using household survey data would require census enumeration combined with annual sample surveys on consumption and socioeconomic trends. Such surveys could cost up to $253 billion globally during the lifetime of the SDGs, almost double the global development assistance budget for 2013. We examine the role that satellite data could have in monitoring progress toward reducing poverty in rural areas by asking two questions: (i) Can household wealth be predicted from satellite data? (ii) Can a socioecologically informed multilevel treatment of the satellite data increase the ability to explain variance in household wealth? We found that satellite data explained up to 62% of the variation in household level wealth in a rural area of western Kenya when using a multilevel approach. This was a 10% increase compared with previously used single-level methods, which do not consider details of spatial landscape use. The size of buildings within a family compound (homestead), amount of bare agricultural land surrounding a homestead, amount of bare ground inside the homestead, and the length of growing season were important predictor variables. Our results show that a multilevel approach linking satellite and household data allows improved mapping of homestead characteristics, local land uses, and agricultural productivity, illustrating that satellite data can support the data revolution required for monitoring SDGs, especially those related to poverty and leaving no one behind.

Assessing and understanding non-responsiveness of maize and soybean to fertilizer applications in African smallholder farms.

Use of mineral fertilizers is essential to enhance crop productivity in smallholder farming systems of Sub-Saharan Africa, but various studies have reported 'non-responsiveness' where application of inorganic fertilizers does not lead to satisfactory yield gains. This phenomenon is not well defined nor are its extent and causes well understood. In order to close these knowledge gaps, we assessed the effects of commonly recommended nitrogen (N), phosphorus (P) and/or potassium (K) fertilizer inputs on maize grain and soybean production on farmer fields across prevalent land slope and/or soil texture gradients (2 × 2 matrix) in four agroecosystems over two growing seasons. The extent of the problem in the two cropping systems was compared by decomposing frequency distributions into various ranges of fertilizer effect sizes that represent specific degrees of non-responsiveness and responsiveness. Key soil properties and rainfall variables for field trials were also determined to identify the factors that are limiting crop yield increases by mineral fertilizer input. Significant differences were found in mean fertilizer effect on crop productivity and frequency of non-responsiveness among the study areas and growing seasons, with some explicit contrasts between maize and soybean. The application of mineral fertilizers failed to increase maize yields by more than 0.5 t ha-1 in up to 68 % of farmer fields and soybean yields by more than 150 kg ha-1 in up to 65 % of farmer fields for specific study areas and/or growing seasons, while for others crop responses exceeded those levels. Unlike hypothesized, there were no consistent differences in crop fertilizer responses between the soil texture and land slope classes at any of the study sites. The variation in fertilizer effects on maize grain productivity across the study areas and growing seasons was most strongly related to the soil silt and clay content, and exchangeable cation balances of calcium (Ca), magnesium (Mg) and K, whereas fertilizer effects on soybean were most strongly influenced by the evenness in rainfall during growing seasons, and the soil silt content, extractable P, and ratio of total C and total N. Findings from our study emphasize that non-responsiveness by maize and soybean crops in African smallholder agroecosystems is dependent on multiple interacting factors, and requires careful scrutiny to ensure returns on investments.

Meta-analysis on the potential for increasing nitrogen losses from intensifying tropical agriculture.

Fertilized temperate croplands export large amounts of reactive nitrogen (N), which degrades water and air quality and contributes to climate change. Fertilizer use is poised to increase in the tropics, where widespread food insecurity persists and increased agricultural productivity will be needed, but much less is known about the potential consequences of increased tropical N fertilizer application. We conducted a meta-analysis of tropical field studies of nitrate leaching, nitrous oxide emissions, nitric oxide emissions, and ammonia volatilization totaling more than 1,000 observations. We found that the relationship between N inputs and losses differed little between temperate and tropical croplands, although total nitric oxide losses were higher in the tropics. Among the potential drivers we studied, the N input rate controlled all N losses, but soil texture and water inputs also controlled hydrological N losses. Irrigated systems had significantly higher losses of ammonia, and pasture agroecosystems had higher nitric oxide losses. Tripling of fertilizer N inputs to tropical croplands from 50 to 150 kg N ha-1  year-1 would have substantial environmental implications and would lead to increases in nitrate leaching (+30%), nitrous oxide emissions (+30%), nitric oxide (+66%) emissions, and ammonia volatilization (+74%), bringing tropical agricultural nitrate, nitrous oxide, and ammonia losses in line with temperate losses and raising nitric oxide losses above them.

Nonlinear response of nitric oxide fluxes to fertilizer inputs and the impacts of agricultural intensification on tropospheric ozone pollution in Kenya.

Crop yields in sub-Saharan Africa remain stagnant at 1 ton ha-1 , and 260 million people lack access to adequate food resources. Order-of-magnitude increases in fertilizer use are seen as a critical step in attaining food security. This increase represents an unprecedented input of nitrogen (N) to African ecosystems and will likely be accompanied by increased soil emissions of nitric oxide (NO). NO is a precursor to tropospheric ozone, an air pollutant and greenhouse gas. Emissions of NO from soils occur primarily during denitrification and nitrification, and N input rates are a key determinant of emission rates. We established experimental maize plots in western Kenya to allow us to quantify the response function relating NO flux to N input rate during the main 2011 and 2012 growing seasons. NO emissions followed a sigmoid response to fertilizer inputs and have emission factors under 1% for the roughly two-month measurement period in each year, although linear and step relationships could not be excluded in 2011. At fertilization rates above 100 kg N ha-1 , NO emissions increased without a concomitant increase in yields. We used the geos-chem chemical transport model to evaluate local impacts of increased NO emissions on tropospheric ozone concentrations. Mean 4-hour afternoon tropospheric ozone concentrations in Western Kenya increased by up to roughly 2.63 ppbv under fertilization rates of 150 kg N ha-1 or higher. Using AOT40, a metric for assessing crop damage from ozone, we find that the increased ozone concentrations result in an increase in AOT40 exposure of approximately 110 ppbh for inputs of 150 kg N ha-1 during the March-April-May crop growing season, compared with unfertilized simulations, with negligible impacts on crop productivity. Our results suggest that it may be possible to manage Kenyan agricultural systems for high yields while avoiding substantial impacts on air quality.

Effects of fertilizer on inorganic soil N in East Africa maize systems: vertical distributions and temporal dynamics.

Fertilizer applications are poised to increase across sub-Saharan Africa (SSA), but the fate of added nitrogen (N) is largely unknown. We measured vertical distributions and temporal variations of soil inorganic N following fertilizer application in two maize (Zea mays L.)-growing regions of contrasting soil type. Fertilizer trials were established on a clayey soil in Yala, Kenya, and on a sandy soil in Tumbi, Tanzania, with application rates of 0-200 kg N/ha/yr. Soil profiles were collected (0-400 cm) annually (for three years in Yala and two years in Tumbi) to examine changes in inorganic N pools. Topsoils (0-15 cm) were collected every 3-6 weeks to determine how precipitation and fertilizer management influenced plant-available soil N. Fertilizer management altered soil inorganic N, and there were large differences between sites that were consistent with differences in soil texture. Initial soil N pools were larger in Yala than Tumbi (240 vs. 79 kg/ha). Inorganic N pools did not change in Yala (277 kg/ha), but increased fourfold after cultivation and fertilization in Tumbi (371 kg/ha). Intra-annual variability in NO-3 -N concentrations (3-33 µg/g) in Tumbi topsoils strongly suggested that the sandier soils were prone to high leaching losses. Information on soil inorganic N pools and movement through soil profiles can h vulnerability of SSA croplands to N losses and determine best fertilizer management practices as N application rates increase. A better understanding of the vertical and temporal patterns of soil N pools improves our ability to predict the potential environmental effects of a dramatic increase in fertilizer application rates that will accompany the intensification of African croplands.

Opposing effects of different soil organic matter fractions on crop yields.

Soil organic matter is critical to sustainable agriculture because it provides nutrients to crops as it decomposes and increases nutrient- and water-holding capacity when built up. Fast- and slow-cycling fractions of soil organic matter can have different impacts on crop production because fast-cycling fractions rapidly release nutrients for short-term plant growth and slow-cycling fractions bind nutrients that mineralize slowly and build up water-holding capacity. We explored the controls on these fractions in a tropical agroecosystem and their relationship to crop yields. We performed physical fractionation of soil organic matter from 48 farms and plots in western Kenya. We found that fast-cycling, particulate organic matter was positively related to crop yields, but did not have a strong effect, while slower-cycling, mineral-associated organic matter was negatively related to yields. Our finding that slower-cycling organic matter was negatively related to yield points to a need to revise the view that stabilization of organic matter positively impacts food security. Our results support a new paradigm that different soil organic matter fractions are controlled by different mechanisms, potentially leading to different relationships with management outcomes, like crop yield. Effectively managing soils for sustainable agriculture requires quantifying the effects of specific organic matter fractions on these outcomes.

Monitoring the world's agriculture.

To feed the world without further damaging the planet, Jeffrey Sachs and 24 foodsystem experts call for a global data collection and dissemination network to track the myriad impacts of different farming practices.

Understanding variability in crop response to fertilizer and amendments in sub-Saharan Africa.

Improved understanding of soil fertility factors limiting crop productivity is important to develop appropriate soil and nutrient management recommendations in sub-Saharan Africa. Diagnostic trials were implemented in Kenya, Malawi, Mali, Nigeria and Tanzania, as part of the African Soils Information Service (AfSIS) project, to identify soil fertility constraints to crop production across various cropping systems and soil fertility conditions. In each country, one to three sites of 10 km × 10 km were included with each site having 12-31 field trials. The treatments tested included a control, an NPK treatment, three treatments in which the N, P and K nutrients were omitted one at a time from the NPK treatment, and three treatments in which secondary and micronutrients (Ca, Mg, S, Zn and B) simply referred here as multi-nutrients, manure and lime were added to the NPK. The field trials were conducted for 1-2 seasons; the test crop was maize except in Mali where sorghum was used. Nitrogen was limiting in all sites and generally the most limiting nutrient except in Sidindi (Kenya) and Kontela (Mali) where P was the most limiting. The general pattern in Kiberashi (Tanzania) shows none of the nutrients were limiting. K is mainly limiting in only one site (Mbinga) although incidences of K limitation were seen in almost all sites. Addition of multi-nutrients and manure further improved the yields of NPK in most sites. Cluster analyses revealed that maize crop in 11% of fields were highly responsive to nitrogen application, 25% (i.e., 21% poor and 4% fertile) 'non-responsive' to any nutrient or soil amendment, 28% being 'low responsive' and 36% of 'intermediate response'. This study indicates that constraints to crop production vary considerably even within a site, and that addressing limitations in secondary and micronutrients, and increasing soil carbon can improve response to fertilizers. For sustainable crop production intensification in smallholder farming systems in SSA, there is need to develop management strategies to improve efficiency of fertilizer use and of other inputs, recognizing the site-specific nutrient response patterns at various spatial scales.

Monitoring and evaluation to support adaptive co-management: Lessons learned from the Millennium Villages Project.

This article focuses attention on monitoring and evaluation approaches that will help resource managers to manage for change and uncertainty in adaptive co-management (ACM). ACM is a learning-by-doing approach that aims to build flexible community-based natural resource governance systems through collaborative or otherwise participatory means. We describe the framework for monitoring and evaluation that we developed and applied in ten African countries, which includes fixed indicators and measures for co-management performance monitoring, a process evaluation element, a platform for repeat ecological surveillance, and a longitudinal household survey. We comment on the usefulness of this framework, and its applicability to a wide range of geographic contexts. We then present a four step model to assist managers in applying the framework to specific co-management problems. The model suggests a cascade approach to defining key evaluations questions at a systems, network, individual and synthesis level. We illustrate the application of our model and framework by means of a case study of a co-managed agroforestry program in western Kenya.

The effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomised controlled assessment.

BACKGROUND: Simultaneously addressing multiple Millennium Development Goals (MDGs) has the potential to complement essential health interventions to accelerate gains in child survival. The Millennium Villages project is an integrated multisector approach to rural development operating across diverse sub-Saharan African sites. Our aim was to assess the effects of the project on MDG-related outcomes including child mortality 3 years after implementation and compare these changes to local comparison data. METHODS: Village sites averaging 35,000 people were selected from rural areas across diverse agroecological zones with high baseline levels of poverty and undernutrition. Starting in 2006, simultaneous investments were made in agriculture, the environment, business development, education, infrastructure, and health in partnership with communities and local governments at an annual projected cost of US$120 per person. We assessed MDG-related progress by monitoring changes 3 years after implementation across Millenium Village sites in nine countries. The primary outcome was the mortality rate of children younger than 5 years of age. To assess plausibility and attribution, we compared changes to reference data gathered from matched randomly selected comparison sites for the mortality rate of children younger than 5 years of age. Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT01125618. FINDINGS: Baseline levels of MDG-related spending averaged $27 per head, increasing to $116 by year 3 of which $25 was spent on health. After 3 years, reductions in poverty, food insecurity, stunting, and malaria parasitaemia were reported across nine Millennium Village sites. Access to improved water and sanitation increased, along with coverage for many maternal-child health interventions. Mortality rates in children younger than 5 years of age decreased by 22% in Millennium Village sites relative to baseline (absolute decrease 25 deaths per 1000 livebirths, p=0·015) and 32% relative to matched comparison sites (30 deaths per 1000 livebirths, p=0·033). INTERPRETATION: An integrated multisector approach for addressing the MDGs can produce rapid declines in child mortality in the first 3 years of a long-term effort in rural sub-Saharan Africa. FUNDING: UN Human Security Trust Fund, the Lenfest Foundation, Bill & Melinda Gates Foundation, and Becton Dickinson.

Identifying potential synergies and trade-offs for meeting food security and climate change objectives in sub-Saharan Africa.

Potential interactions between food production and climate mitigation are explored for two situations in sub-Saharan Africa, where deforestation and land degradation overlap with hunger and poverty. Three agriculture intensification scenarios for supplying nitrogen to increase crop production (mineral fertilizer, herbaceous legume cover crops--green manures--and agroforestry--legume improved tree fallows) are compared to baseline food production, land requirements to meet basic caloric requirements, and greenhouse gas emissions. At low population densities and high land availability, food security and climate mitigation goals are met with all intensification scenarios, resulting in surplus crop area for reforestation. In contrast, for high population density and small farm sizes, attaining food security and reducing greenhouse gas emissions require mineral fertilizers to make land available for reforestation; green manure or improved tree fallows do not provide sufficient increases in yields to permit reforestation. Tree fallows sequester significant carbon on cropland, but green manures result in net carbon dioxide equivalent emissions because of nitrogen additions. Although these results are encouraging, agricultural intensification in sub-Saharan Africa with mineral fertilizers, green manures, or improved tree fallows will remain low without policies that address access, costs, and lack of incentives. Carbon financing for small-holder agriculture could increase the likelihood of success of Reducing Emissions from Deforestation and Forest Degradation in Developing Countries programs and climate change mitigation but also promote food security in the region.

Effective monitoring of agriculture: a response.

The development of effective agricultural monitoring networks is essential to track, anticipate and manage changes in the social, economic and environmental aspects of agriculture. We welcome the perspective of Lindenmayer and Likens (J. Environ. Monit., 2011, 13, 1559) as published in the Journal of Environmental Monitoring on our earlier paper, "Monitoring the World's Agriculture" (Sachs et al., Nature, 2010, 466, 558-560). In this response, we address their three main critiques labeled as 'the passive approach', 'the problem with uniform metrics' and 'the problem with composite metrics'. We expand on specific research questions at the core of the network design, on the distinction between key universal and site-specific metrics to detect change over time and across scales, and on the need for composite metrics in decision-making. We believe that simultaneously measuring indicators of the three pillars of sustainability (environmentally sound, social responsible and economically viable) in an effectively integrated monitoring system will ultimately allow scientists and land managers alike to find solutions to the most pressing problems facing global food security.

Ecological approaches to human nutrition.

BACKGROUND: Malnutrition affects a large number of people throughout the developing world. Approaches to reducing malnutrition rarely focus on ecology and agriculture to simultaneously improve human nutrition and environmental sustainability. However, evidence suggests that interdisciplinary approaches that combine the knowledge bases of these disciplines can serve as a central strategy in alleviating hidden hunger for the world's poorest. OBJECTIVE: To describe the role that ecological knowledge plays in alleviating hidden hunger, considering human nutrition as an overlooked ecosystem service. METHODS: We review existing literature and propose a framework that expands on earlier work on econutrition. We provide novel evidence from case studies conducted by the authors in western Kenya and propose a framework for interdisciplinary collaboration to alleviate hidden hunger, increase agricultural productivity, and improve environmental sustainability. RESULTS: Our review supports the concept that an integrated approach will impact human nutrition. We provide evidence that increased functional agrobiodiversity can alleviate anemia, and interventions that contribute to environmental sustainability can have both direct and indirect effects on human health and nutritional well-being. CONCLUSIONS: Integrated and interdisciplinary approaches are critical to reaching development goals. Ecologists must begin to consider not only how their field can contribute to biodiversity conservation, but also, the relationship between biodiversity and provisioning of nontraditional ecosystem services such as human health. Likewise, nutritionists and agronomists must recognize that many of the solutions to increasing human wellbeing and health can best be achieved by focusing on a healthy environment and the conservation of ecosystem services.

The Millennium Villages Project: a retrospective, observational, endline evaluation.

BACKGROUND: The Millennium Villages Project (MVP) was a 10 year, multisector, rural development project, initiated in 2005, operating across ten sites in ten sub-Saharan African countries to achieve the Millennium Development Goals (MDGs). In this study, we aimed to estimate the project's impact, target attainment, and on-site spending. METHODS: In this endline evaluation of the MVP, we retrospectively selected comparison villages that best matched the project villages on possible confounding variables. Cross-sectional survey data on 40 outcomes of interest were collected from both the project and the comparison villages in 2015. Using these data, as well as on-site spending data collected during the project, we estimated project impacts as differences in outcomes between the project and comparison villages; target attainment as differences between project outcomes and prespecified targets; and on-site spending as expenditures reported by communities, donors, governments, and the project. Spending data were not collected in the comparison villages. FINDINGS: Averaged across the ten project sites, we found that impact estimates for 30 of 40 outcomes were significant (95% uncertainty intervals [UIs] for these outcomes excluded zero) and favoured the project villages. In particular, substantial effects were seen in agriculture and health, in which some outcomes were roughly one SD better in the project villages than in the comparison villages. The project was estimated to have no significant impact on the consumption-based measures of poverty, but a significant favourable impact on an index of asset ownership. Impacts on nutrition and education outcomes were often inconclusive (95% UIs included zero). Averaging across outcomes within categories, the project had significant favourable impacts on agriculture, nutrition, education, child health, maternal health, HIV and malaria, and water and sanitation. A third of the targets were met in the project sites. Total on-site spending decreased from US$132 per person in the first half of the project (of which $66 was from the MVP) to $109 per person in the second half of the project (of which $25 was from the MVP). INTERPRETATION: The MVP had favourable impacts on outcomes in all MDG areas, consistent with an integrated rural development approach. The greatest effects were in agriculture and health, suggesting support for the project's emphasis on agriculture and health systems strengthening. The project conclusively met one third of its targets. FUNDING: The Open Society Foundations, the Islamic Development Bank, and the governments of Japan, South Korea, Mali, Senegal, and Uganda.

Econutrition: implementation models from the Millennium Villages Project in Africa.

Econutrition integrates environmental health and human health, with a particular focus on the interactions among the fields of agriculture, ecology, and human nutrition. Soil loss and degradation and human undernutrition are major barriers to economic development in Africa. A primary aim of the Millennium Villages Project in Africa is to meet the Millennium Development Goals by integrated multisectoral interventions in health and nutrition, agriculture, and environmental sustainability in hunger and poverty hot spots in Africa. Econutrition is only one example of how interdisciplinary approaches are not only critical to alleviating extreme poverty but also fundamental to linking basic science understanding in multiple areas. Human health and agricultural productivity gain, and the costs of the gains are lowered, when we take the opportunity to apply different disciplines through cross-sectoral, thematically linked interventions.

Functional traits in agriculture: agrobiodiversity and ecosystem services.

Functional trait research has led to greater understanding of the impacts of biodiversity in ecosystems. Yet, functional trait approaches have not been widely applied to agroecosystems and understanding of the importance of agrobiodiversity remains limited to a few ecosystem processes and services. To improve this understanding, we argue here for a functional trait approach to agroecology that adopts recent advances in trait research for multitrophic and spatially heterogeneous ecosystems. We suggest that trait values should be measured across environmental conditions and agricultural management regimes to predict how ecosystem services vary with farm practices and environment. This knowledge should be used to develop management strategies that can be easily implemented by farmers to manage agriculture to provide multiple ecosystem services.

Farm management, not soil microbial diversity, controls nutrient loss from smallholder tropical agriculture.

Tropical smallholder agriculture is undergoing rapid transformation in nutrient cycling pathways as international development efforts strongly promote greater use of mineral fertilizers to increase crop yields. These changes in nutrient availability may alter the composition of microbial communities with consequences for rates of biogeochemical processes that control nutrient losses to the environment. Ecological theory suggests that altered microbial diversity will strongly influence processes performed by relatively few microbial taxa, such as denitrification and hence nitrogen losses as nitrous oxide, a powerful greenhouse gas. Whether this theory helps predict nutrient losses from agriculture depends on the relative effects of microbial community change and increased nutrient availability on ecosystem processes. We find that mineral and organic nutrient addition to smallholder farms in Kenya alters the taxonomic and functional diversity of soil microbes. However, we find that the direct effects of farm management on both denitrification and carbon mineralization are greater than indirect effects through changes in the taxonomic and functional diversity of microbial communities. Changes in functional diversity are strongly coupled to changes in specific functional genes involved in denitrification, suggesting that it is the expression, rather than abundance, of key functional genes that can serve as an indicator of ecosystem process rates. Our results thus suggest that widely used broad summary statistics of microbial diversity based on DNA may be inappropriate for linking microbial communities to ecosystem processes in certain applied settings. Our results also raise doubts about the relative control of microbial composition compared to direct effects of management on nutrient losses in applied settings such as tropical agriculture.

Assessing nutritional diversity of cropping systems in African villages.

BACKGROUND: In Sub-Saharan Africa, 40% of children under five years in age are chronically undernourished. As new investments and attention galvanize action on African agriculture to reduce hunger, there is an urgent need for metrics that monitor agricultural progress beyond calories produced per capita and address nutritional diversity essential for human health. In this study we demonstrate how an ecological tool, functional diversity (FD), has potential to address this need and provide new insights on nutritional diversity of cropping systems in rural Africa. METHODS AND FINDINGS: Data on edible plant species diversity, food security and diet diversity were collected for 170 farms in three rural settings in Sub-Saharan Africa. Nutritional FD metrics were calculated based on farm species composition and species nutritional composition. Iron and vitamin A deficiency were determined from blood samples of 90 adult women. Nutritional FD metrics summarized the diversity of nutrients provided by the farm and showed variability between farms and villages. Regression of nutritional FD against species richness and expected FD enabled identification of key species that add nutrient diversity to the system and assessed the degree of redundancy for nutrient traits. Nutritional FD analysis demonstrated that depending on the original composition of species on farm or village, adding or removing individual species can have radically different outcomes for nutritional diversity. While correlations between nutritional FD, food and nutrition indicators were not significant at household level, associations between these variables were observed at village level. CONCLUSION: This study provides novel metrics to address nutritional diversity in farming systems and examples of how these metrics can help guide agricultural interventions towards adequate nutrient diversity. New hypotheses on the link between agro-diversity, food security and human nutrition are generated and strategies for future research are suggested calling for integration of agriculture, ecology, nutrition, and socio-economics.

Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries.

BACKGROUND: In sub-Saharan Africa, ~ 40% of children <5 y old are stunted, with levels that have remained largely unchanged over the past 2 decades. Although the complex determinants of undernutrition are well recognized, few studies have evaluated strategies that combine nutrition-specific, health-based approaches with food system- and livelihood-based interventions. OBJECTIVE: We examined changes in childhood stunting and its determinants after 3 y of exposure to an integrated, multisector intervention and compared these changes with national trends. DESIGN: A prospective observational trial was conducted across rural sites in 9 sub-Saharan African countries with baseline levels of childhood stunting >20%. A stratified random sample of households and resident children <2 y old from villages exposed to the program were enrolled in the study. Main outcome measures included principal determinants of undernutrition and childhood stunting, which was defined as a height-for-age z score less than -2. National trends in stunting were generated from demographic and health surveys. RESULTS: Three years after the start of the program in 2005-2006, consistent improvements were observed in household food security and diet diversity, whereas coverage with child care and disease-control interventions improved for most outcomes. The prevalence of stunting in children <2 y old at year 3 of the program (2008-2009) was 43% lower (adjusted OR: 0.57; 95% CI: 0.38, 0.83) than at baseline. The average national stunting prevalence for the countries included in the study had remained largely unchanged over the past 2 decades. CONCLUSION: These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting.