Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi.

This study assessed caregivers' knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers' reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child's health benefits motivated mothers to adopt improved IYCF practices.

Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia.

Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children's dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric measurements were taken. A difference-in-differences model was applied. The sample comprised 743 households with children ≥6 months of age at baseline and 921 at impact. After 1 year of NE, 69 % of the intervention households reported to have participated in the NE. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3·6 and 3·9, respectively). In particular, the consumption of pro-vitamin A-rich foods and other fruits and vegetables increased. No treatment effects on height-for-age Z-scores could be shown. NE led to improvements in children's diets. For effects on growth, it is assumed that longer NE activities are required to achieve sustainable behaviour change of age-appropriate infant feeding.

Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial.

OBJECTIVE: Lack of diversity is a major factor contributing to inadequate nutrient intakes among children during the complementary feeding period in many rural areas in developing countries. This has been attributed to inadequate feeding practices and nutrition knowledge among their caregivers. The aim of the present study was to assess the effect of an educational intervention on children's dietary diversity and nutrition knowledge of caregivers. DESIGN: Cluster randomization was applied and twenty matched village pairs were randomly assigned to the intervention or control group. The nutrition education intervention consisted of four sessions comprising of group trainings and cooking demonstrations that were conducted over a period of 5 months. SETTING: Households in rural communities in Bondo and Teso South sub-counties, western Kenya. SUBJECTS: Caregivers with children aged 6-17 months receiving nutrition education. RESULTS: The children's dietary diversity scores (CDDS) and nutrition knowledge scores of the caregivers improved significantly in the intervention group at endline. The treatment effect on CDDS was positive and significant (P=0.001). The CDDS rate of the children in the intervention group was 27% larger than it would have been without the treatment effect. The intervention also had a significant effect on the caregivers' nutrition knowledge scores (incidence rate ratio=2.05; P<0.001). However, the nutrition knowledge of the caregivers did not have a significant effect on CDDS (P=0.731). CONCLUSIONS: The nutrition education intervention led to improvements in children's dietary diversity and nutrition knowledge of the caregivers.

Breast cancer risk among women with long-standing lactation and reproductive parameters at low risk level: a case-control study in Northern Tanzania.

Breast cancer is the leading cause of death among women worldwide. Studies in industrialised countries identified age at menarche, age at first full-term pregnancy, and lactation as determining factors in the aetiology of breast cancer. 115 female breast cancer patients (cases) and 230 age- and district-matched women clinically free from breast cancer (controls) were interviewed about their reproductive history and socioeconomic condition. Semi-structured interviews including anthropometric measurements were conducted by trained enumerators. The median age was 50 years (min/max 26 to 85 years). Estimated median BMI at age 20 was 21 kg/m(2) in both cases and controls. Median lifelong lactation of the mothers was 96 months (cases) and 108 months (controls). A high BMI at 20 years was associated with an increased breast cancer risk (OR 1.31 95% CI 1.11-1.55, P < 0.01). The odds ratio for lifelong lactation was slightly below one (OR 0.99 95% CI 0.98-1.00, P < 0.01). There was no significant association in risk for BMI at interview (median 25 kg/m(2) of cases and 26 kg/m(2) of controls), age at menarche (median 16 years), and age at first full-term pregnancy (median 20 years). The association of increased risk with higher BMI at age 20 years remained significant after stratification for menopause (premenopausal: OR 1.41 95% CI 1.10-1.81, P = 0.01; postmenopausal: OR 1.38 95% CI 1.06-1.80, P = 0.02). Late age at menarche and prolonged lifelong lactation were associated with a risk reduction among premenopausal women (ORmenarche 0.74 95% CI 0.56-1.00, P = 0.05; ORlactation 0.98 95% CI 0.97-0.99, P < 0.01). In conclusion, long-standing lactation and reproductive behaviour are associated with a lower breast cancer risk in the region. As current changes in lifestyle affect age at menarche, reproductive behaviour, and nutritional status, an increased incidence of breast cancer is to be expected. Preventive efforts should include advice on reproductive and breastfeeding behaviour.

Dietary patterns and breast cancer risk among women in northern Tanzania: a case-control study.

BACKGROUND: Breast cancer is the second most common cancer among women in the Kilimanjaro Region of Tanzania. It was tested within a case-control study in this region whether a specific dietary pattern impacts on the breast cancer risk. METHODS: A validated semi-quantitative Food Frequency Questionnaire was used to assess the dietary intake of 115 female breast cancer patients and 230 healthy age-matched women living in the same districts. A logistic regression was performed to estimate breast cancer risk. Dietary patterns were obtained using principal component analysis with Varimax rotation. RESULTS: The adjusted logistic regression estimated an increased risk for a "Fatty Diet", characterized by a higher consumption of milk, vegetable oils and fats, butter, lard and red meat (OR = 1.42, 95 % CI 1.08-1.87; P = 0.01), and for a "Fruity Diet", characterized by a higher consumption of fish, mango, papaya, avocado and watery fruits (OR = 1.61, 95 % CI 1.14-2.28; P = 0.01). Both diets showed an inverse association with the ratio between polyunsaturated and saturated fatty acids (P/S ratio). CONCLUSION: A diet characterized by a low P/S ratio seems to be more important for the development of breast cancer than total fat intake.

Relationship between financial speculation and food prices or price volatility: applying the principles of evidence-based medicine to current debates in Germany.

There is an unresolved debate about the potential effects of financial speculation on food prices and price volatility. Germany's largest financial institution and leading global investment bank recently decided to continue investing in agricultural commodities, stating that there is little empirical evidence to support the notion that the growth of agricultural-based financial products has caused price increases or volatility. The statement is supported by a recently published literature review, which concludes that financial speculation does not have an adverse effect on the functioning of the agricultural commodities market. As public health professionals concerned with global food insecurity, we have appraised the methodological quality of the review using a validated and reliable appraisal tool. The appraisal revealed major shortcomings in the methodological quality of the review. These were particularly related to intransparencies in the search strategy and in the selection/presentation of studies and findings; the neglect of the possibility of publication bias; a lack of objective or rigorous criteria for assessing the scientific quality of included studies and for the formulation of conclusions. Based on the results of our appraisal, we conclude that it is not justified to reject the hypothesis that financial speculation might have adverse effects on food prices/price volatility. We hope to initiate reflections about scientific standards beyond the boundaries of disciplines and call for high quality, rigorous systematic reviews on the effects of financial speculation on food prices or price volatility.

Prevalence and predictors of food insecurity among university students - Results from the Justus Liebig University Giessen, Germany.

This study aimed to assess the prevalence and associated factors of food insecurity (FI) among university students in Germany during the COVID-19 pandemic. We conducted a cross-sectional study (n = 626) between November and December 2021 at the Justus Liebig University in Giessen, Germany, using an online questionnaire. The analysis of FI was based on the Food Insecurity Experience Scale (FIES) by the Food and Agriculture Organization (FAO). We statistically validated our data using the Rasch model. Moreover, demographic, socio-economic and educational variables were collected using a questionnaire developed by the Food Insecurity among European University Students during the COVID-19 Pandemic (FINESCOP) consortium. Overall, 27.5 % of the university students are food insecure. The proportion of university students experiencing moderate or severe food insecurity (FImod+sev) is 10.4 % and the proportion experiencing severe food insecurity (FIsev) 0.9 %. Results from a logistic regression showed that students have a higher chance to be food insecure if they were not born in Europe and if their parents have a secondary or lower educational level. We further found an association between age and FI. Also receiving a student loan during the pandemic and getting food assistance increased the likelihood of being food insecure. Our results show that FI is prevalent among this particularly vulnerable population group. Thus, public health, as well as policy efforts may need to become more target group-specific in accordance with the identified circumstances and specific characteristics to avoid that university students suffer from FI.

Is Responsive Feeding Difficult? A Case Study in Teso South Sub-County, Kenya.

Responsive infant and young child feeding as a reciprocal relationship between the child and his or her caregiver is recommended by the WHO but has received less attention than dietary diversity or meal frequency up to now. The current study assessed common (non)responsive child feeding practices and factors that facilitate or hinder caregivers to improve feeding practices in rural Teso South Sub-County, Western Kenya. The qualitative study used focus group discussion (n = 93) and Trials of Improved Practices (TIPs) (n = 48) to identify challenges and opportunities in household food distribution and feeding practices. Overall, the implementation of responsive feeding practices was feasible for the caregivers. Parents reported mainly positive experiences in terms of the child's feeding behavior and effects on child health. Traditional beliefs, practices, and cultural norms hindered some households to change intrahousehold food distribution. Households who manage to implement responsive feeding even in food insecure regions should be consulted to (a) improve existing nutrition education messages that acknowledge these cultural norms, (b) to include more responsive feeding information in nutrition education material, and (c) to address gender norms to create awareness of the importance of responsive feeding practices and the need for adequate time allocation for infant and young child feeding.

Dietary Diversity of Women across Agricultural Seasons in the Kapchorwa District, Uganda: Results from a Cohort Study.

Small-holder farm households in developing countries mainly depend on rain-fed agriculture activities, thus seasonality affects eating habits and contributes to micronutrient deficiencies. This study assessed women's dietary diversity score (WDDS) across three agricultural seasons in the Kapchorwa District, Uganda. In each season, 445 women with under five-year-old children from small-holder farm households were interviewed on socio-demographic characteristics as well as dietary practices between May 2016 and January 2017. Linear regression models estimated differences in WDDS across seasons. The mean WDDS at the lean, harvest and post-harvest seasons was 4.33 ± 1.21, 4.63 ± 1.30 and 4.36 ± 1.21, respectively. Mean WDDS was higher in urban regions across all seasons. Women in urban regions generated more income through off-farm activities, had better access to markets and consumed significantly more 'meat, poultry and fish' (p < 0.001), dairy products (p < 0.05), 'vitamin A-rich fruits and vegetables' (p < 0.001) and 'other vegetables' (p < 0.001) during the lean season, whilst rural women ate more dark green leafy vegetables (p < 0.001) during the same period. Poorer households in the rural setting were more likely to be affected by seasonally limited food availability and accessibility. Hence, strengthening the linkages between market participation, agricultural activities, improved food storage and preservation techniques and dietary intake is recommended.

Missing association between nutrient concentrations in leaves and edible parts of food crops - A neglected food security issue.

Crop nutrient deficiencies are determined based on leaf nutrient composition, and rarely on food composition. Consequently, it remains unclear whether leaf nutrients are useable to form conclusions on quality of produced foods. This study aimed to investigate the relationships between plant macro- (Mg, P, S, K, Ca) and micronutrient (Fe, Zn, Mn, Cu) concentrations of leaves and edible parts of three East African staple crops: Zea mays, Manihot esculenta, and Musa acuminata. Low phloem mobile nutrients Ca, Mn, Fe, Zn, and Cu showed the largest differences in correlations between leaves and edible parts. Perennial crops showed lower correlations between nutrient concentrations of leaves and edible parts than annuals. Leaves may provide information on plant health, however do not provide enough information to gauge both yields and food quality, particularly regarding micronutrients. Therefore, agricultural and nutritional scientists should harmonize methods to develop sustainable management options for increased food and nutrition security.

Seasonal Variations in Dietary Diversity and Nutrient Intakes of Women and Their Children (6-23 Months) in Western Kenya.

Seasonal variations in food availability and access contributes to inadequate nutrient intakes, particularly in low income countries. This study assessed the effect of seasonality on dietary diversity (DD) and nutrient intakes of women and children aged 6-23 months in a rural setting in Western Kenya. A longitudinal study was conducted among 426 mother-child pairs during the harvest and post-harvest seasons in 2012. Dietary intakes were assessed using 24-h dietary recalls and dietary diversity scores (DDS) and nutrient intakes calculated for both seasons. Effect of seasonality on women dietary diversity scores (WDDS) and children's dietary diversity scores (CDDS) were assessed using generalised linear mixed models (GLMM). The proportion of women consuming diets with high DDS (>4 out of 9 food groups) increased from 36.4 to 52.4% between the two seasons, with mean WDDS being significantly higher in November compared to July/August (4.62 ± 1.43 vs. 4.16 ± 1.14, P < 0.001). A significantly higher proportion of children consumed foods from ≥4 out of 7 food groups in November compared to July/August (62.4 vs. 52.6%, P = 0.004). Mean CDDS (3.91 vs. 3.61, P = 0.004) was low but significantly higher in November compared to July/August. Estimated marginal mean WDDS increased from 4.17 to 4.38, and decreased for CDDS from 3.73 to 3.60 between the seasons. Seasonality had a small but significant effect on WDDS, P = 0.008 but not on CDDS, P = 0.293. Increase in CDDS in November was due to age and not seasonal effect. Higher women education and household food security were associated with higher WDDS and CDDS. Intakes of iron, calcium and vitamin E were higher among women in November and significantly different between the seasons. Agro-ecological zone, ethnic group and home gardening influenced nutrient intakes of the women. Seasonality had an effect on the DD of women but not of children, thus other factors apart from food availability influence the quality of children's diets during the complementary feeding period. With increasing age and transition to family foods, children's DD is expected to be affected by seasonality. Integrated interventions to alleviate seasonal food insecurity and strengthen rural households' resilience against seasonal deterioration in diet quality are recommended.

Changes in Vegetable Consumption in Times of COVID-19-First Findings From an International Civil Science Project.

The crisis related to the COVID-19 pandemic influenced food security and nutrition through both direct and indirect pathways. This ranged from short-term to long-term impacts, not only on health but also on food systems and thus on nutrition. This study aimed to identify how the observed constraints affected the food intake of populations across the globe. Here, special attention was paid to the consumption of vegetables and legumes and the diversity within these food groups. An online survey on Food and COVID-19 was conducted using a semi-structured questionnaire translated into several languages. Binary logistic regression models and Poisson regression models were calculated to evaluate changes in consumption patterns and to test potential determinants for the changes. For more detailed information on reasons for changes open ended questions were analysed qualitatively. Time spend at home, working from home, and mental stress were important drivers for changes in dietary intake according to the 1,042 respondents included in this analysis. The participants observed a change in food quantity (38%) and vegetable intake (27%). No changes were observed for the number of vegetable groups consumed, while significant reductions in diversity were detected within all vegetable groups. Moreover, associations between the number of consumed vegetable types during the COVID-19 pandemic and income regions as well as gender were found. The regression analysis showed that the level of decrease in vegetable diversity in the different vegetable groups were often depending on educational and occupational status, gender and household environment. Changes in food prices were related to changes in vegetable intake per se, overall vegetable diversity, and diversity within the provitamin A rich vegetable group. Food systems are not static and are transitioning quickly as could be observed during the Covid-19 pandemic. There is a need for a nutrition strategy to strengthen the resilience of vulnerable households to consume a diverse diet in adequate amount even in times of a pandemic.

Determinants of Children's Fruit Intake in Teso South Sub-County, Kenya-A Multi-Phase Mixed Methods Study among Households with Children 0-8 Years of Age.

Fruits are micronutrient-rich sources which are often underrepresented in children's diets. More insights into the determinants of children's fruit consumption are needed to improve nutrition education in Teso South Sub-County, Kenya. A multiphase mixed method study was applied among 48 farm households with children 0-8 years of age. A market survey together with focus group discussions were used to design a formative research approach including qualitative and quantitative data collection methods. The unavailability of fruits and the inability to plant fruit trees in the homesteads were the main challenges to improve fruit consumption behaviour, although a number of different fruit species were available on the market or in households. Perceived shortage of fruits, financial constraints to purchase fruits and taste were important barriers. Fruits as snacks given between meals was perceived as helpful to satisfy children. The mean number of fruit trees in the homesteads was positively associated with fruit consumption. Field trials are needed to test how best fruit trees within home gardens and on farms can be included, acknowledging limited space and constraints of households with young children. This should be combined with nutrition education programs addressing perceptions about the social and nutrient value of fruits for children.

Soil and farm management effects on yield and nutrient concentrations of food crops in East Africa.

Crops that grow on soils with higher fertility often have higher yields and higher tissue nutrient concentrations. Whether this is the case for all crops, and which soil and management factors, or combinations mostly affect yields and food nutrient concentrations however, is poorly understood. Here, the main aim was to evaluate effects of soil and management factors on crop yields and food nutrient concentrations in (i) grain, fruit and tuber crops, and (ii) between high and low soil fertility areas. Total elemental concentrations of Mg, P, S, K, Ca, Fe, Zn, Mn and Cu were measured using a portable X-Ray Fluorescence Spectrometer (pXRF) in maize grain (Zea mays; Teso South, Kenya: n = 31; Kapchorwa, Uganda n = 30), cassava tuber (Manihot esculenta; Teso South: n = 27), and matooke fruit (Musa acuminata; Kapchorwa, n = 54). Soil properties measured were eCEC, total N and C, pH, texture, and total elemental content. Farm management variables (fertilisation, distance to household, and crop diversity) were collected. Canonical Correspondence Analyses (CCA) with permutation rank tests identified driving factors of alterations in nutrient concentrations. Maize grain had higher correlations with soil factors (CCA > 80%), than cassava tuber (76%) or matooke fruit (39%). In contrast, corresponding correlations to management factors were much lower (8-39%). The main soil properties affecting food nutrients were organic matter and texture. Surprisingly, pH did not play an important role. A positive association of crop diversity with nutrient concentration and yield in lower fertility areas was observed. Considering, food nutrient composition, apart from yield, as response variables in agronomic trials (e.g. fertilisation or soil improvement strategies), would contribute towards discounting the notion that crops growing on fertile soils always produce healthy and high quality foods.

Do we need more drought for better nutrition? The effect of precipitation on nutrient concentration in East African food crops.

Soil, inputs, and environmental factors such as weather control plant nutrient availability and nutrient content in food. Drought periods affect nutrient bioavailability. Nutrient transport within the plant and allocation of nutrients within organs of the plant is water dependent and therefore drought susceptible. This study compared Kapchorwa, Uganda and Teso South, Kenya that experienced drought during the second season in 2016. The main research questions were: (i) do droughts have an impact on the nutrient composition of food; (ii) is there a difference in nutrient concentrations in food based on their xylem or phloem mobility? Maize (Zea mays) grain (n = 62) and matooke (Musa acuminata) fruit samples (n = 90) in Kapchorwa, and maize grain (n = 61) and cassava (Manihot esculenta) tuber (n = 64) in Teso South were collected during a normal season (March-July) and drought season (October-December) in 2016. Crop samples were analysed using a pXRF for P, K, Ca, Mg, S, Fe, Mn, Cu, and Zn. The Standardized Precipitation Index (SPI) was calculated using TAMSAT database to compare drought intensities. The drought in Kapchorwa (SPI: -1.14 to -0.32) was severer and began 2 months prior to Teso South (SPI: 0.09 to 0.55). Nutrient concentration in Kapchorwa decreased significantly from normal to drought in both crops. In contrast, during the moderate drought in Teso South, nutrient concentrations increased significantly. Lacking nutrient phloem mobility is suggested to play a vital role in mobilisation of micronutrients (Fe, Mn, and Cu) as shown by their decreased concentration under severe drought in the yield. Total nutrients assimilated in crop samples were significantly higher in the normal than the drought for almost all samples. Micronutrients and yields during drought were strongly affected, leading to a double-burden for consumers through affected quantity and quality. Future research considerations should particularly include the focus on potential nutrient increases during mild drought.

Agricultural Assistance to Vulnerable, Food-Insecure Female-Headed Households in Kyrgyzstan.

Agriculture can be an important engine of growth and poverty reduction. But the general trends in agricultural production in Kyrgyzstan over the last couple of decades have been negative. Numerous reasons for this unfavorable situation have been published. Natural causes, such as environmental degradation, distorted production in favor of export crops, economic crisis, and a poor education system. This paper is concerned with the question how vulnerable female-headed households in rural areas of Kyrgyzstan may improve their own food security situation and increase agricultural production. The study will propose possible measures to improve production of vegetables. The findings are based on a review of general policies and of the objectives of certain institutions.

Latin America and the Caribbean: Strategies to Fight Hidden Hunger.

The Latin American and the Caribbean (LAC) region has shown significant progress in the decline of hunger and malnutrition in the last decade. However, besides the food availability, the region is still affected by undernourishment, and even more worryingly it is witnessing increasing prevalence of the "double burden" in malnutrition by having a coincidence in the prevalence of undernourishment as insufficient calorie intake and overweight/obesity as excess body fat. The governments in the LAC region recognize the problem and have many nutrition-related and nutrition-sensitive policies in place. This paper proposes a model that intends to enrich the wide gamma of nutrition-sensitive policies and add value to the holistic and sustainable approach in eradicating hidden hunger. The community-based nutrition strategy model consists of 4 main strategies: (1) diversification of agricultural production; (2) training and technical assistance; (3) identification and support of local producers' organizations and (4) supporting the establishment of agro-industry. It considers education as a core cross-cutting strategy and contemplates education in nutrition, sanitation, finance, and sustainable agriculture. The model includes education, training, technical assistance, and infrastructure in its interventions aiming at the improvement of the human, physical, social, and natural capital in the community. It also contemplates baseline assessment of wide gamma of indicators and continuous monitoring and evaluation which would guarantee its successful implementation and necessary adaptation to reach the desired objectives. The model regards reaching dietary diversity as its primary objective but considers income generation as another important element. As such it incorporates nutrition strategies as a part of a wider rural development strategy and suggests a sustainable approach to building healthy and resilient communities.

Nutrition education improves dietary diversity of children 6-23 months at community-level: Results from a cluster randomized controlled trial in Malawi.

BACKGROUND: Low dietary quality and quantity and inappropriate feeding practices can cause undernutrition. Poor nutritional status in early childhood is associated with growth faltering. The objective of the study was to assess the potential of community-based nutrition education to improve height-for-age z-scores in children 6-23 months of age. METHODS AND FINDINGS: We carried out a cluster-randomized-controlled trial to assess the effectiveness of nutrition education. A total of 24 Extension Planning Area Sections served as clusters. The selection criteria were: the position of the extension officer was staffed and the sections had been selected by the project for activities in its first project year. The sections were randomized into intervention and control restricted on mean height for age Z-score using baseline information. In the intervention area, food security activities and community-based nutrition education was implemented. The control area received food security activities only. At baseline (2011) and endline (2014), caregivers with a child below two years of age were enrolled. Data assessment included anthropometric measurements, interviews on socio-economic status, dietary intake and feeding practices. A difference-in-differences estimator was used to calculate intervention effects. A positive impact on child dietary diversity was observed (B (SE) = 0.39 (0.15), p = 0.01; 95%CI 0.09-0.68). There was a non-significant positive intervention effect on mean height-for-age z-scores (B (SE) = 0.17 (0.12), p = 0.15; 95%CI -0.06-0.41). LIMITATIONS: The 24h dietary recalls used to measure dietary diversity did not consider quantities of consumed foods. Unrecorded poor quality of consumed foods might have masked a potential benefit of increased child dietary diversity on growth. CONCLUSIONS: Participatory community-based nutrition education for caregivers improved child dietary diversity even in a food insecure area. Nutrition education should be part of programs in food insecure settings aiming at ameliorating food insecurity among communities.

Strategies to Fight Hidden Hunger in Ethiopia, Egypt, Sudan and Tunisia.

The four countries, Ethiopia, Egypt, Sudan, and Tunisia, face different nutrition challenges and have different experiences and policies in place to combat hunger. Stunting rates among children below 5 years are highest in Ethiopia and Sudan (38%) compared to Sudan and Tunisia (21 and 11-9%). Children below 5 years in Egypt and Tunisia also suffer from higher risks to become overweight and obese; 14-16% are considered overweight. Food security is limited in all countries, especially in Sudan. All four countries have nutrition and/or poverty alleviation policies in place but implementation is challenging or very weak to realize the plan. However, some successes are observed. The authors recommend that to solve the malnutrition problems in the countries: (1) implementation of the respective policies has to be given better attention than writing and approval of it, (2) it is important to consider the country-specific comparative advantage of livestock production, (3) cultivation of nutritious crops for any level of rural and urban population, and (4) and nutrition has to be put on top of the national agenda like food security. Furthermore, both national and international concerning organizations should support these countries to build their capacity in terms of technical skills and technological options.

Determinants of Child Malnutrition and Infant and Young Child Feeding Approaches in Cambodia.

Women's diets often decrease with regard to amounts per meal and day as well as diversity if a household's access to food is limited. The result is a monotonous diet that, in particular, negatively affects women's nutritional status during pregnancy and lactation and, thus, the infant. The infant's diet is of utmost importance, as it needs to meet the nutrient requirements especially during the first 2 years of life, a critical window for the child's healthy development. In Cambodia, infant and young child feeding (IYCF) practices are poor. Preparation of a special complementary meal in addition to breast milk feeds for children aged 6-23 months is often not a common habit. Instead, children eat watery, plain rice porridges that do not meet the nutrient requirements at this young age. A lack of adequate caring practices such as responsive feeding exacerbates the risk of malnutrition. Caregivers are often unaware of the importance of nutrition during the first 2 years of life regarding its effects on children's growth. In 2012, a randomized controlled trial (RCT) was started in two provinces of northern Cambodia: Oddar Meanchey and Preah Vihear. To contribute to reducing child mortality by addressing malnutrition among children 6-23 months of age, the Food and Agriculture Organization of the United Nations (FAO) implemented a nutrition-sensitive agriculture project with nutrition-specific actions, i.e. a nutrition education intervention was embedded in a food security project. Wealth, a child's age, and maternal education were identified as determinants of a child's dietary diversity. The older the child and/or the wealthier the household, the more diverse the child's diet. Maternal education was positively associated with the child's dietary diversity. Household dietary diversity was significantly associated with child dietary diversity in a model including group, child's age, maternal education, and wealth as confounders. The RCT also showed that a 2- to 3-month nutrition education programme carried out by government and community health volunteers as well as local NGOs addressing caregivers with a child between 5 and 18 months of age has great potential to improve IYCF practices. Since no impact on average height-for-age Z-scores could be demonstrated in this RCT, we suggest for Cambodia that (1) more emphasis be put on animal-source food and other protein sources in nutrition education, (2) nutrition education be implemented in the community through trained government and community members including peers as trainers, (3) sessions on family nutrition be included in the curriculum and the continuation of breastfeeding be emphasized, and (4) nutrition education be institutionalized, including continuous in-service training for sustainability.