Making the achievement of zero hunger and malnutrition a policy priority: A critical assessment of recent national Zero Hunger Strategic Reviews from Asia and the Pacific.

BACKGROUND AND OBJECTIVES: Through Zero Hunger Strategic Reviews, national governments articulate how they can achieve the second Sustainable Development Goal targets of zero hunger and zero malnutrition by 2030. To suggest how such strategic reviews might accelerate progress towards those goals, an in-depth critical assessment was undertaken of Zero Hunger Strategic Reviews carried out between 2015 and 2019 in 13 countries in Asia and the Pacific. The appraisal focused on the conceptual frameworks used to guide the content of the processes and, secondly, on how well those involved understood the factors that drive or block policy change in their respective countries. METHODS AND STUDY DESIGN: The qualitative study involved a desk review of: (1) all reports produced for the 13 strategic reviews; (2) guidance notes for their implementation; and (3) conceptual frameworks pertinent to them. RESULTS: More explicit use of globally accepted conceptual frameworks would strengthen the national strategic reviews. More importantly, none considered closely the challenges that would arise as efforts are made to obtain approval for policy reforms and increased allocations of public resources to address hunger and malnutrition more effectively. CONCLUSIONS: Any recommendations from such strategic reviews will need to be assessed against competing development priorities and then planned, coordinated, and implemented effectively. While accurate technical understanding is necessary to take strategic action, the best plans to eliminate hunger and malnutrition will flounder if efforts are not also made to advocate for policy change, to build political leadership, and to hold accountable those responsible for the actions required.

Limits to commercially iodized salt to address dietary iodine deficiency in rural Papua New Guinea.

BACKGROUND AND OBJECTIVES: Fortifying commercial table salt with iodine is the principal strategy used globally to prevent dietary iodine deficiency. However, the costs of providing fortified salt to remote communities may result in it not being locally available or too expensive for many households. This study shows that barriers to consuming adequately iodized salt remain significant for remote rural households in Papua New Guinea (PNG). METHODS AND STUDY DESIGN: Using data from a rural household survey conducted in four areas of PNG in 2018, two issues are examined. First, we contrast the characteristics of households that reported consuming or not consuming iodized table salt, respectively. Second, the adequacy of the iodine content of samples of table salt consumed was assessed in the laboratory. RESULTS: Nine percent of the 1,026 survey households reported not consuming iodized table salt. These households tend to live in remote communities, are among the poorest households, have received no formal education, and have experienced recent food insecurity. Second, 17 percent of the 778 salt samples tested had inadequate iodine. The brand of salt most commonly consumed had the highest share of samples with inadequate iodine levels. CONCLUSIONS: Particularly in remote communities, ensuring that individuals consume sufficient iodine will require going beyond salt iodization to use other approaches to iodine supplementation. To ensure that the iodine intake of those using commercial table salt is adequate, closer monitoring of the iodine content in table salt produced or imported into PNG and enforcement of salt iodization regulations is required.

Study of the Determinants of Chronic Malnutrition in Northern Nigeria: Quantitative Evidence from the Nigeria Demographic and Health Surveys International Food Policy Research Institute (IFPRI) Working Paper 45 (September 2017).

BACKGROUND: Close to half of all children younger than 5 years in the Northeast and Northwest geopolitical zones were estimated to be stunted in their growth for their age in 2013 compared to 22% of children in the rest of Nigeria. OBJECTIVES: We examine the drivers of chronic child undernutrition in northern Nigeria and how those drivers differ from other areas of the country. METHODS: Both a standard child-level regression-based approach and decomposition analysis were used to address the determinants of stunting and decompose how drivers differ between northern Nigeria and other areas of the country using 2008 and 2013 Nigeria DHS data. RESULTS: There are strong differences in the levels of the determinants of undernutrition in young children between the 2 parts of the country. However, equally important, the decomposition analysis shows that there are significant differences between northern Nigeria and other areas of Nigeria in the effect of the same determinant of nutritional status in accelerating or retarding the linear growth of young children. CONCLUSIONS: A national program to address child undernutrition must recognize this heterogeneity in its design. To impose across Nigeria, a single set of approaches to address the factors which results in stunted children is likely to fail for large numbers of children if these strong geographical differences in how these determinants operate to affect child nutritional status are not considered. Solutions need to be developed within northern Nigeria to more closely reflect the way the determinants of nutritional status operate in this area of the country.

Spatial determinants of poverty in rural Kenya.

This article investigates the link between poverty incidence and geographical conditions within rural locations in Kenya. Evidence from poverty maps for Kenya and other developing countries suggests that poverty and income distribution are not homogenous. We use spatial regression techniques to explore the effects of geographic factors on poverty. Slope, soil type, distance/travel time to public resources, elevation, type of land use, and demographic variables prove to be significant in explaining spatial patterns of poverty. However, differential influence of these and other factors at the location level shows that provinces in Kenya are highly heterogeneous; hence different spatial factors are important in explaining welfare levels in different areas within provinces, suggesting that targeted propoor policies are needed. Policy simulations are conducted to explore the impact of various interventions on location-level poverty levels. Investments in roads and improvements in soil fertility are shown to potentially reduce poverty rates, with differential impacts in different regions.

Cross-sectoral coordination failure: how significant a constraint in national efforts to tackle malnutrition in Africa?

BACKGROUND: Malnutrition arises from multifaceted causes and requires action from multiple sectors to address. Consequently, oversight and direction are said to be required to ensure that public goods and services needed to reduce malnutrition are delivered by the sectors responsible in a coordinated fashion. To do so, many countries have established cross-sectoral national nutrition coordination agencies. OBJECTIVE: The performance of such agencies established recently in three African countries is evaluated to determine how critical their intersectoral coordination function is to national public efforts to reduce malnutrition. METHODS: This evaluation uses qualitative information on the national institutional frameworks within which nutrition activities are carried out in Mozambique, Nigeria, and Uganda, countries with such agencies, and in Ghana, which has none. Results. None of the agencies has so far effectively carried out the three functions on which they were evaluated: cross-sectoral coordination, advocacy to sustain political commitment to address malnutrition, and resource mobilization. No cross-sectoral national nutrition initiatives are being implemented. Nutrition does not feature strategically in the master development frameworks in any country. No additional government resources have been mobilized, although international resources have been. CONCLUSIONS: The agencies have proven of limited value to the malnourished in these countries. However, cross-sectoral barriers are not the primary reason for this ineffectiveness. Rather, inability to maintain continued political commitment for efforts to address malnutrition-in short, advocacy-is the principal deficiency in performance. Cross-sectoral coordination only becomes important if malnutrition itself is treated as a politically important problem, thereby stimulating action in various sectors.