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Ogutu S, Mockshell J, Garrett J, Ritter T, Labarta R, Alvarez D, Nedumaran S, Gonzalez C, Gotor E. Women's empowerment, household dietary diversity, and child anthropometry among vulnerable populations in Odisha, India. PLoS One 2024; 19:e0305204. [PMID: 39106283 DOI: 10.1371/journal.pone.0305204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/26/2024] [Indexed: 08/09/2024] Open
Abstract
Women's empowerment has been promoted by researchers and development practitioners as one of the most promising strategies to address widespread hunger and malnutrition. However, the relationship between women's empowerment and dietary diversity and child nutrition has rarely been studied among vulnerable populations or individuals at greater risk of poor physical and social health status. Moreover, the effects of different domains of women's empowerment on nutritional outcomes, including dietary diversity and child anthropometry, have rarely been examined, especially with panel data. Using two rounds of panel data from 1900 households and fixed effects regression models, we analyze the effect of women's empowerment on household dietary diversity score (HDDS) and child anthropometry among the particularly vulnerable tribal groups in Odisha, India. We also estimate the effects of various decision-making domains of women's empowerment on HDDS and child anthropometry to understand which empowerment domains matter for nutrition. Results show that women's empowerment is positively associated with HDDS (coef. 0.41 food groups; p < 0.1) and reduces the prevalence of underweight (coef. 39%; p < 0.05) and wasting (coef. 56%; p < 0.1) in children but has no effect on the prevalence of child stunting. Women's empowerment in agricultural input use; output sales; income; food purchases; and credit, group membership, and employment contribute to improved dietary diversity and child nutrition. We conclude that women's empowerment contributes to improved dietary diversity and child nutrition and is a promising strategy to improve farm household diets and child nutrition among vulnerable populations. Strengthening women's empowerment through the promotion of women's access to land and other agricultural inputs, market participation, access to information, capital, and credit is important.
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Affiliation(s)
- Sylvester Ogutu
- International Center for Tropical Agriculture (CIAT), Kampala, Uganda
| | | | | | - Thea Ritter
- International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Ricardo Labarta
- Previously with the International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Diego Alvarez
- International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Swamikannu Nedumaran
- The International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Hyderabad, India
| | - Carolina Gonzalez
- International Center for Tropical Agriculture (CIAT), Cali, Colombia
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Martin SL, Zongrone AA, Craig HC, Litvin K, Fort P, Cooper S, Haller M, Dickin KL. Measuring the intangible resources caregivers need to provide nurturing care during the complementary feeding period: a scoping review in low- and lower-middle-income countries. Public Health Nutr 2024; 27:e78. [PMID: 38223942 DOI: 10.1017/s1368980024000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries. DESIGN We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age. RESULTS We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures. CONCLUSIONS Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.
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Affiliation(s)
- Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, CB 7461, Chapel Hill, NC, 27599-7461, USA
| | | | - Hope C Craig
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, Virginia, USA
| | - Peyton Fort
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Stephanie Cooper
- Global Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mia Haller
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine L Dickin
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Quisumbing A, Cole S, Elias M, Faas S, Galiè A, Malapit H, Meinzen-Dick R, Myers E, Seymour G, Twyman J. Measuring Women's Empowerment in Agriculture: Innovations and evidence. GLOBAL FOOD SECURITY 2023; 38:100707. [PMID: 37752898 PMCID: PMC10518460 DOI: 10.1016/j.gfs.2023.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/23/2023] [Accepted: 07/04/2023] [Indexed: 09/28/2023]
Abstract
This paper addresses women's empowerment in agriculture, innovations in its measurement, and emerging evidence. We discuss the evolution of the conceptualization and measurement of women's empowerment and gender equality since 2010. Using a gender and food systems framework and a standardized measure of women's empowerment, the Women's Empowerment in Agriculture Index (WEAI), we review the evidence on "what works" to empower women based on impact evaluations of a portfolio of 11 agricultural development projects with empowerment objectives and a scoping review of livestock interventions. We then review the evidence on associations between empowering women and societal benefits--agricultural productivity, incomes, and food security and nutrition. We conclude with recommendations for measurement and policy.
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Affiliation(s)
- Agnes Quisumbing
- International Food Policy Research Institute, Washington DC, USA
| | - Steven Cole
- International Institute of Tropical Agriculture, Dar es Salaam, Tanzania
| | - Marlène Elias
- Alliance of Bioversity International and the International Center for Tropical Agriculture (CIAT), Rome, Italy
| | - Simone Faas
- International Food Policy Research Institute, Washington DC, USA
| | | | - Hazel Malapit
- International Food Policy Research Institute, Washington DC, USA
| | | | - Emily Myers
- International Food Policy Research Institute, Washington DC, USA
| | - Greg Seymour
- International Food Policy Research Institute, Washington DC, USA
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Leight J, Pedehombga A, Ganaba R, Gelli A. Women's empowerment, maternal depression, and stress: Evidence from rural Burkina Faso. SSM - MENTAL HEALTH 2022; 2:100160. [PMID: 36688233 PMCID: PMC9792374 DOI: 10.1016/j.ssmmh.2022.100160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Though there is a wide array of evidence that women's empowerment is associated with more positive health and nutritional outcomes for women and children, evidence around the relationship with mental health or subjective well-being remains relatively limited. The objective of this paper is to explore this relationship in longitudinal data from rural Burkina Faso. Methods We analyze the association between empowerment measured using the project-level Women's Empowerment in Agriculture Index (pro-WEAI), and two additional outcomes of interest: stress (measured using the SRQ-20) and maternal depression (measured using the Edinburgh scale for post-partum depression). The analysis employs both cross-sectional specifications and panel specifications conditional on individual fixed effects. Results We find evidence of substantial negative correlations between the empowerment score and maternal stress and depression measured using both continuous and binary variables. This relationship seems to be particularly driven by self-efficacy and respect among household members, where higher scores have negative associations with depression and stress that are both large in magnitude and precisely estimated. Conclusion Enhanced mental health may be another channel for a positive effect of empowerment on women's welfare.
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Affiliation(s)
- Jessica Leight
- International Food Policy Research Institute (IFPRI), USA
| | | | | | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), USA
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The role of multi-dimensional women's empowerment in agriculture to improve the nutritional status of under-five children in rural cash crop producing, resource-limited settings of Ethiopia. J Nutr Sci 2022; 11:e92. [PMID: 36337985 PMCID: PMC9607879 DOI: 10.1017/jns.2022.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6-59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P > 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.
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Komakech JJ, Walters CN, Rakotomanana H, Hildebrand DA, Stoecker BJ. The associations between women's empowerment measures, child growth and dietary diversity: Findings from an analysis of demographic and health surveys of seven countries in Eastern Africa. MATERNAL & CHILD NUTRITION 2022; 18:e13421. [PMID: 35999703 PMCID: PMC9480916 DOI: 10.1111/mcn.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
Evidence on the efficacy of women's empowerment to improve child growth and minimum dietary diversity (MDD) in the Eastern Africa (EA) region is limited. This cross‐sectional study used recent Demographic and Health Survey data of mother–child dyads from seven countries in EA to examine the associations between women's empowerment measures, child growth and MDD. Length‐for‐age z‐scores, weight‐for‐length z‐scores and weight‐for‐age z‐scores were used to categorize growth indicators of 6–23 months old children. Multivariable logistic regression was used to identify significant associations. Among all countries, 32%–59% of children experienced growth failure. Children meeting MDD were 18%–45%. Women having self‐esteem were associated with lower odds of stunting (adjusted odds ratio [AOR] = 0.62 in Rwanda), wasting (AOR = 0.38 in Uganda), underweight (AORs = 0.60 and 0.57 in Tanzania and Uganda, respectively) and growth failure (AOR = 0.64 in Rwanda). Having health decision control in Burundi was associated with lower odds of stunting (AOR = 0.49) and child growth failure (AOR = 0.52) and higher odds of meeting MDD (AOR = 2.50). Having Legal empowerment among women increased the odds of stunting (AOR = 1.79 in Burundi), underweight (AOR = 1.77 in Uganda) and growth failure (AOR = 1.87 in Burundi). Economic empowerment showed mixed associations with child growth and MDD among some countries. Women's self‐esteem and health decision control were associated with better child growth and MDD for some countries in EA. Nutrition‐sensitive interventions aimed at improving child growth and MDD should consider local contexts when addressing women's empowerment. Understanding the associations between women's empowerment, child growth and child dietary diversity is important for most nutrition‐sensitive interventions seeking to improve child feeding practices and growth by targeting mothers. In this study, for women to have self‐esteem and health decision control was consistently beneficial for child growth and minimum dietary diversity (MDD). Mixed associations existed among other women's empowerment measures, child growth and MDD across the seven East African countries investigated. For improved child growth and better child dietary diversity, targeting specific women's empowerment measures based on local context may be beneficial in the East African region.
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Affiliation(s)
- Joel J. Komakech
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Christine N. Walters
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Hasina Rakotomanana
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Deana A. Hildebrand
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
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Waid JL, Wendt AS, Sinharoy SS, Kader A, Gabrysch S. Impact of a homestead food production program on women's empowerment: Pro-WEAI results from the FAARM trial in Bangladesh. WORLD DEVELOPMENT 2022; 158:106001. [PMID: 36193041 PMCID: PMC9351289 DOI: 10.1016/j.worlddev.2022.106001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Nutrition-sensitive agricultural programs have the potential to improve women's and children's nutrition, along with women's empowerment. The project-level Women's Empowerment in Agriculture Index (pro-WEAI) aims to standardize the measurement of women's agency and enable the assessment of impact over typical project timelines. Within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Habiganj, Sylhet, Bangladesh, we examined quantitative pro-WEAI data collected from a subsample of trial participants and their husbands (n = 885) approximately four months after the end of the intervention. We evaluated the impact of a three-year homestead food production program on men's and women's agency separately by pro-WEAI domain and indicator, using multilevel logistic and linear regression. We show that women in the FAARM intervention group had levels of agency similar to men and much higher than women in the control group (Odds Ratio [OR] 7.7, p < 0.001), corresponding to better gender equity in intervention areas (OR 3.5, p < 0.001). The higher levels of agency among intervention women were driven by greater intrinsic and collective agency but not by instrumental agency. Compared to controls, more women in the intervention group found intimate partner violence unacceptable (OR 3.5, p < 0.001), had greater ownership of assets (OR 2.6, p = 0.001), better control of income (OR 1.8, p = 0.042), higher levels of group membership (OR 14.0, p < 0.001), and membership in groups they considered influential (OR 166.8, p < 0.001). Self-efficacy was greater in intervention areas for both women (OR 3.2, p < 0.001) and men (OR 2.3, p = 0.002). Our results contribute to the development of benchmarks for interpreting pro-WEAI scores across programs. Our assessment of the impact of a homestead food production program on women's agency provides additional rationale for women-led agricultural projects. We plan to build on these findings by examining the role of improved women's agency on the pathway from the intervention to nutritional impacts.
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Key Words
- 3DE, Three domains of empowerment
- Agency
- Agriculture
- DHS, Demographic and Health Survey
- FAARM, Food and Agricultural Approaches to Reducing Malnutrition
- GAAP2, Gender, Agriculture, and Assets Project–Phase 2
- GPI, Gender Parity Index
- Gender equity
- Homestead food production
- IFPRI, International Food Policy Research Institute
- ODK, Open Data Kit
- OR, Odds Ratio
- RCT, Randomized controlled trial
- SDG, Sustainable Development Goal
- Self-efficacy
- WEAI, Women's Empowerment in Agriculture Index
- Women’s groups
- pro-WEAI, project-level Women's Empowerment in Agriculture Index
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Affiliation(s)
- Jillian L. Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Amanda S. Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sheela S. Sinharoy
- Hubert Department of Global Health and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Acharya A, Chang CL, Chen M, Weissman A. Facilitators and barriers to participation in health mothers' groups in improving maternal and child health and nutrition in Nepal : A mixed-methods study. BMC Public Health 2022; 22:1660. [PMID: 36050671 PMCID: PMC9438323 DOI: 10.1186/s12889-022-13859-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background In Nepal, Health Mother’s Groups (HMG) are women’s group-based programmes for improving maternal and child health. However, they remain underutilised with only 27% of reproductive-aged women participating in an HMG meeting in 2016. This study aimed to understand the facilitators and barriers to HMG meeting participation. Methods We conducted a convergent mixed-methods study using cross-sectional quantitative data from the 2016 Nepal Demographic and Health Survey and primary data collected via 35 in-depth interviews and eight focus group discussions with 1000-day women and their family members, female community health volunteers (FCHVs) and health facility staff in two geographies of Nepal, Kaligandaki and Chapakot. Quantitative data were analysed using logistic regression and qualitative data using deductive coding. The results were triangulated and thematically organised according to the socio-ecological model (SEM). Results Facilitators and barriers emerged across individual, interpersonal and community levels of the SEM. In the survey, women with more children under five years of age, living in a male-headed household, or in rural areas had increased odds of HMG participation (p < 0.05) while belonging to the Janajati caste was associated with lower odds of participation (p < 0.05). Qualitative data helped to explain the findings. For instance, the quantitative analysis found women’s education level associated with HMG participation (p < 0.05) while the qualitative analysis showed different ways women’s education level could facilitate or hinder participation. Qualitative interviews further revealed that participation was facilitated by women’s interest in acquiring new knowledge, having advanced awareness of the meeting schedule and venue, and engagement with health workers or non-government organisation staff. Participation was hindered by the lack of meeting structure and work obligations during the agricultural season. Conclusions To improve women’s participation in HMGs in Nepal, it is necessary to address factors at the SEM’s individual, interpersonal, and community levels, such as enhancing FCHV literacy, providing advance notice of the meeting schedule, upgrading the meeting venues and reducing women’s workload through family support, particularly during agricultural season. These improvements are essential for strengthening effective implementation of HMG meetings and similar women’s group-based platforms, and for ultimately improving maternal and child health in Nepal.
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Affiliation(s)
- Ajay Acharya
- Family Health International (FHI 360), Anamika Galli Ward-4 Baluwatar, Kathmandu, Nepal.
| | | | - Mario Chen
- FHI 360, Global Health, Population and Nutrition, NC, Durham, US
| | - Amy Weissman
- FHI 360, Asia Pacific Regional office, Bangkok, Thailand
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Atreya K, Rimal NS, Makai P, Baidya M, Karki J, Pohl G, Bhattarai S. Dalit's livelihoods in Nepal: income sources and determinants. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 25:1-29. [PMID: 35909425 PMCID: PMC9325665 DOI: 10.1007/s10668-022-02582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
This paper focuses on the lack of income opportunities for Dalits in Nepal, as they are the most affected group in any disaster. The presence of vulnerable family members in Dalit households may further increase their income deprivation. We therefore studied Dalit households' income sources and identified income determinants in Gandaki Rural Municipality in Gorkha District-the epicentre of the 2015 earthquake. We observed a higher dependency of Dalit households on daily wages, livestock sales, social security allowances, and vegetables sales; however, remittance and seasonal job earnings represented the largest share of household incomes. We observed a significant difference in per capita income between farm (US$46) and non-farm (US$273) income sources, with the difference smallest in the lowest income quantile and the largest in the highest quantile. When the household head was a single woman, we observed a reduction in non-farm (by 29%) and total incomes (by 23%). Likewise, when the household head had a chronic health problem, or the household included an elderly family member, there was a reduction in the household's income. We suggest economic interventions for Dalit households to prevent increased social exclusion in the development process, specifically focusing on vulnerable individuals and households in the lowest income quantile.
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Affiliation(s)
- Kishor Atreya
- School of Forestry and Natural Resource Management, Institute of Forestry, Tribhuvan University, Kathmandu, Nepal
- Department of Watershed Management and Environmental Science, Institute of Forestry, Pokhara Campus, Tribhuvan University, Pokhara, Nepal
| | | | | | | | - Jiban Karki
- PHASE Nepal, GPO Box 12888, Kathmandu, Nepal
| | - Gerda Pohl
- PHASE Nepal, GPO Box 12888, Kathmandu, Nepal
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Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116684. [PMID: 35682268 PMCID: PMC9180902 DOI: 10.3390/ijerph19116684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022]
Abstract
Young children in low- and middle-income countries (LMICs) are vulnerable to adverse effects of household microenvironments. The UN Sustainable Development Goals (SDGs)-specifically SDG 3 through 7-urge for a comprehensive multi-sector approach to achieve the 2030 goals. This study addresses gaps in understanding the health effects of household microenvironments in resource-poor settings. It studies associations of household microenvironment variables with episodes of acute respiratory infection (ARI) and diarrhoea as well as with stunting among under-fives using logistic regression. Comprehensive data from a nationally representative, cross-sectional demographic and health survey (DHS) in Uganda were analysed. We constructed and applied the multidimensional energy poverty index (MEPI) and the three-dimensional women empowerment index in multi-variate regressions. The multidimensional energy poverty was associated with higher risk of ARI (OR = 1.32, 95% CI 1.10 to 1.58). Social independence of women was associated with lower risk of ARI (OR= 0.91, 95% CI 0.84 to 0.98), diarrhoea (OR = 0.93, 95% CI 0.88 to 0.99), and stunting (OR = 0.83, 95% CI 0.75 to 0.92). Women's attitude against domestic violence was also significantly associated with episodes of ARI (OR = 0.88, 95% CI 0.82 to 0.93) and diarrhoea (OR = 0.89, 95% CI 0.84 to 0.93) in children. Access to sanitation facilities was associated with lower risk of ARI (OR = 0.55, 95% CI 0.45 to 0.68), diarrhoea (OR = 0.83, 95% CI 0.71 to 0.96), and stunting (OR = 0.64, 95% CI 0.49 to 0.86). Investments targeting synergies in integrated energy and water, sanitation and hygiene, and women empowerment programmes are likely to contribute to the reduction of the burden from early childhood illnesses. Research and development actions in LMICs should address and include multi-sector synergies.
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Environmental and Socioeconomic Impacts of Shrimp Farming in the Philippines: A Critical Analysis Using PRISMA. SUSTAINABILITY 2022. [DOI: 10.3390/su14052977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shrimp aquaculture is under pressure to increase its production to meet the growing demand for food from a growing population. In the Philippines, aquaculture has experienced the shift from milkfish to prawn, with its attractive marketable price. This intensification has led to negative and positive impacts, which have raised a range of environmental and socioeconomic problems. This paper reviews the environmental and socioeconomic challenges that the shrimp aquaculture industry faces using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. We examine the gaps and the changes that are required to revitalize the industry. We examine and assess the impacts of shrimp culture on the environment, e.g., shrimp farm management, marine pollution, disease outbreaks, and the social, economic, and climate change impacts. The presence of viral diseases, such as White Spot Syndrome Virus (WSSV), Monodon Baculovirus (MBV), Infectious Hypodermal and Hematopoietic Necrosis Virus (IHHNV), Hepatopancreatic Parvovirus (HPV), and Yellow Head Virus (YHV), have caused approximate losses in the industry of 40,080 mt in 1997, and 51,000 mt in 2014. Recommended strategies and policy changes are considered for the improvement of shrimp aquaculture, including disease management, the adoption of good aquaculture practices, proper environmental monitoring, sustainable practices at the farm level, and priorities for cooperation among the concerned government agencies and local governments, as well as the involvement of state universities and colleges, for better management practices.
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Wei N, Zhou L, Huang W. Does an upward intergenerational educational spillover effect exist? The effect of children's education on Chinese parents' health. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:69-89. [PMID: 34415455 DOI: 10.1007/s10754-021-09308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research on the presence of an upward spillover effect of children's education on parental health is rapidly developing. However, there are certain differences in the conclusions of relevant studies, and no consistent viewpoint has been reached. METHODS Using the exogenous differences in education generated by the expansion of higher education enrollment that China implemented as a reform in 1999, we analyze this issue by studying the effect of children's higher education on their parents' health. RESULTS The instrumental variable (IV) estimation results show that children who received higher education have a significant and positive effect on the physical health of their parents. Compared with the ordinary least squares (OLS) estimation results, the coefficient of the effect of children receiving higher education is larger in the IV estimation. CONCLUSIONS Children's education can generate a significant active effect on parental health, affecting parental physical health via its effect on parental health cognition and health behaviors. Based on heterogeneity analyses, the effect of a son's education on parental health is more significant than the effect of a daughter's education, and among rural children, higher education has a more significant effect on parental health.
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Affiliation(s)
- Ning Wei
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Lülin Zhou
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Wenhao Huang
- School of Management, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu Province, China.
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Dupuis S, Hennink M, Wendt AS, Waid JL, Kalam MA, Gabrysch S, Sinharoy SS. Women's empowerment through homestead food production in rural Bangladesh. BMC Public Health 2022; 22:134. [PMID: 35045859 PMCID: PMC8772198 DOI: 10.1186/s12889-022-12524-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Women in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial. METHODS We conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants. RESULTS The analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household. CONCLUSIONS This study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study. TRIAL REGISTRATION FAARM is registered with ClinicalTrials.gov ( NCT02505711 ).
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Affiliation(s)
- Sarah Dupuis
- Hubert Department of Global Health, Rollins School of Public Health, Mailstop 1518-002-7BB, Emory University, Atlanta, GA, 30322, USA
| | - Monique Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Mailstop 1518-002-7BB, Emory University, Atlanta, GA, 30322, USA
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Mailstop 1518-002-7BB, Emory University, Atlanta, GA, 30322, USA.
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Boedecker J, Lachat C, Hawwash D, Van Damme P, Nowicki M, Termote C. Pathways to Diverse Diets-a Retrospective Analysis of a Participatory Nutrition-Sensitive Project in Kenya. Curr Dev Nutr 2021; 5:nzab140. [PMID: 35024542 PMCID: PMC8737113 DOI: 10.1093/cdn/nzab140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a current need for better understanding the impact of nutrition-sensitive agriculture interventions. This study is based on a community-based participatory project that diversified diets of women and children by making use of local food biodiversity. This retrospective impact pathway analysis aims at explaining why and how impact was reached. OBJECTIVES This study aimed to understand how a nutrition-sensitive agriculture project improved people's diets by analyzing the pathways from agriculture to nutrition. It also aimed to test theoretical pathways by comparing the documented pathways with those from a widely used framework from the literature. METHODS A qualitative study was conducted in 2019 through 10 semistructured focus group discussions with community members engaging in the project and 5 key informant interviews with local authorities that worked with these communities during the project. Summative content analysis was used to identify pathways through which the project affected diets of beneficiaries. The defined pathways were compared with the pathways of the widely used Tackling the Agriculture-Nutrition Disconnect in India (TANDI) framework from the literature. RESULTS Out of the agriculture-nutrition pathways that are presented in the literature, 3 were found in the responses: 1) food from own production; 2) income from sale of foods produced; and 3) women's empowerment through access to and control over resources. In addition, 5 other pathways were identified and indicated spillover effects from the intervention to the control participants, increased nutrition knowledge, improved health, savings, and empowerment and harmony in the household. CONCLUSIONS Pathway analysis in nutrition-sensitive agriculture can provide valuable understanding on how and why dietary improvements have been achieved in an intervention. The approach can hence be instrumental in addressing the current demand within the field on understanding the progress and impact of interventions. Pathway analysis also helps to address knowledge gaps regarding theoretical frameworks, as in the present study, concerning women empowerment pathways.
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Affiliation(s)
- Julia Boedecker
- Food Environment and Consumer Behaviour Lever, The Alliance of Bioversity International and International Center for Tropical Agriculture (CIAT) , Nairobi, Kenya
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Department of Plants and Crops, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Dana Hawwash
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | | | - Marisa Nowicki
- Food Environment and Consumer Behaviour Lever, The Alliance of Bioversity International and International Center for Tropical Agriculture (CIAT) , Nairobi, Kenya
| | - Céline Termote
- Food Environment and Consumer Behaviour Lever, The Alliance of Bioversity International and International Center for Tropical Agriculture (CIAT) , Nairobi, Kenya
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Kumar N, Raghunathan K, Arrieta A, Jilani A, Pandey S. The power of the collective empowers women: Evidence from self-help groups in India. WORLD DEVELOPMENT 2021; 146:105579. [PMID: 34602708 PMCID: PMC8350313 DOI: 10.1016/j.worlddev.2021.105579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Women's groups are important rural social and financial institutions in South Asia. In India, a large majority of women's groups programs are implemented through self-help groups (SHGs). Originally designed as savings and credit groups, the role of SHGs has expanded to include creating health and nutrition awareness, improving governance, and addressing social issues related to gender- and caste-based discrimination. This paper uses panel data from 1470 rural Indian women from five states to study the impact of SHG membership on women's empowerment in agriculture, using the project-level Women's Empowerment in Agriculture Index (pro-WEAI) and the abbreviated Women's Empowerment in Agriculture Index (A-WEAI). Because SHG membership was not randomized and women who self-select to be SHG members may be systematically different from non-members, we employ nearest neighbor matching methods to attribute the impact of SHG membership on women's empowerment in agriculture and intrahousehold inequality. Our findings suggest that SHG membership has a significant positive impact on aggregate measures of women's empowerment and reduces the gap between men's and women's empowerment scores. This improvement in aggregate empowerment is driven by improvements in women's scores, not a deterioration in men's. Greater control over income, greater decisionmaking over credit, and (somewhat mechanistically, given the treatment) greater and more active involvement in groups within the community lead to improvements in women's scores. However, impacts on other areas of empowerment are limited. The insignificant impacts on attitudes towards domestic violence and respect within the household suggest that women's groups alone may be insufficient to change deep-seated gender norms that disempower women. Our results have implications for the design and scale-up of women's group-based programs in South Asia, including the possibility that involving men is needed to change gender norms.
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Affiliation(s)
- Neha Kumar
- International Food Policy Research Institute, Washington, DC, United States
| | | | - Alejandra Arrieta
- University of Washington, Department of Health Metrics Sciences, United States
| | | | - Shinjini Pandey
- Department of Agricultural, Environmental, and Development Economics, Ohio State University, Columbus, Ohio, United States
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Sampson D, Cely-Santos M, Gemmill-Herren B, Babin N, Bernhart A, Bezner Kerr R, Blesh J, Bowness E, Feldman M, Gonçalves AL, James D, Kerssen T, Klassen S, Wezel A, Wittman H. Food Sovereignty and Rights-Based Approaches Strengthen Food Security and Nutrition Across the Globe: A Systematic Review. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.686492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This systematic review assembles evidence for rights-based approaches–the right to food and food sovereignty–for achieving food security and adequate nutrition (FSN). We evaluated peer-reviewed and gray literature produced between 1992 and 2018 that documents empirical relationships between the right to food or food sovereignty and FSN. We classified studies by literature type, study region, policy approach (food sovereignty or right to food) and impact (positive, negative, neutral, and reverse-positive) on FSN. To operationalize the concepts of food sovereignty and the right to food and connect them to the tangible interventions and practices observed in each reviewed study, we also classified studies according to 11 action types theorized to have an impact on FSN; these included “Addressing inequities in land access and confronting the process of land concentration” and “Promoting gender equity,” among others. We found strong evidence from across the globe indicating that food sovereignty and the right to food positively influence FSN outcomes. A small number of documented cases suggest that narrow rights-based policies or interventions are insufficient to overcome larger structural barriers to realizing FSN, such as inequitable land policy or discrimination based on race, gender or class.
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Mobarok MH, Skevas T, Thompson W. Women's empowerment in agriculture and productivity change: The case of Bangladesh rice farms. PLoS One 2021; 16:e0255589. [PMID: 34347833 PMCID: PMC8336850 DOI: 10.1371/journal.pone.0255589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Using productivity change as a measure of farm economic performance, we analyze the relationship between women's empowerment in agriculture and farm productivity change and its components, which include efficiency change, technological change, and scale efficiency change. A non-parametric Malmquist approach is used to measure farm specific productivity change and its decomposition. We use a bootstrap regression to analyze factors that cause differences in productivity change and its components, testing, in particular, the role women's empowerment plays. The empirical application focuses on a sample of Bangladesh rice farms over the crop cultivation period 2011 and 2014. Results suggest that improvements in women's empowerment in agriculture were associated with higher levels of productivity change, efficiency change, and technical change, while they had no impact on scale efficiency change. We find that empowering women, specifically, improving their ability to make independent choices regarding agricultural production had a statistically significant positive association with productivity change, efficiency change, and technical change. We also find that lowering the gender parity gap is positively related with improving productivity of the sample farms.
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Affiliation(s)
- Mohammad Hasan Mobarok
- Division of Applied Social Sciences, University of Missouri, Columbia, MO, United States of America
- * E-mail:
| | - Theodoros Skevas
- Division of Applied Social Sciences, University of Missouri, Columbia, MO, United States of America
| | - Wyatt Thompson
- Division of Applied Social Sciences, University of Missouri, Columbia, MO, United States of America
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Two decades of theorising and measuring women's empowerment: Literature review and future research agenda. WOMENS STUDIES INTERNATIONAL FORUM 2021. [DOI: 10.1016/j.wsif.2021.102495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Usman MA, Kornher L, Sakketa TG. Do non-maternal adult female household members influence child nutrition? Empirical evidence from Ethiopia. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13123. [PMID: 34241954 PMCID: PMC8269146 DOI: 10.1111/mcn.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
Child malnutrition is an enormous public health problem in low- and middle-income countries (LMICs). In this paper, we study the relationship between non-maternal adult female household members (AFHMs) and under-5 child nutritional outcomes using nationally representative Ethiopian Demographic and Health Survey data, 2016. Because most of the primary inputs that go into the production of child health are intensive in maternal time, having additional AFHMs may ease the time constraints of the child's mother. We use anthropometric measures such as height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) to measure stunting and underweight, respectively, as objective indicators of child nutritional status. Among our sampled households, we find that 40% of the children are stunted, 18% severely stunted, 27% underweight and 8% severely underweight. Furthermore, about 20% of the sampled children live with at least one extra non-maternal AFHM. The multivariate regression results suggest that an additional AFHM is associated with significantly higher HAZ and WAZ scores and less likelihood of severe stunting compared with children living with fewer AFHMs. Finally, the paper discusses the potential pathways through which non-maternal AFHMs can influence child nutritional status.
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Affiliation(s)
| | - Lukas Kornher
- Center for Development Research (ZEF), University of Bonn, Bonn, Germany
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Onah MN, Horton S, Hoddinott J. What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries. PLoS One 2021; 16:e0250014. [PMID: 33882089 PMCID: PMC8059862 DOI: 10.1371/journal.pone.0250014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/29/2021] [Indexed: 01/13/2023] Open
Abstract
This paper draws on data from five sub-Sahara African countries; Uganda, Rwanda, Malawi, Zambia, and Mozambique consisting of 10,041 married women who were cohabitating with a male spouse. The study aim was to investigate the relationship between women's empowerment and women's dietary diversity and consumption of different food items. Women's empowerment was measured using the indicators in the five domains of Women's Empowerment in Agriculture index (WEAI) and women's dietary diversity and food consumption was examined using the women's dietary diversity score (WDDS) measure. OLS and LPM regressions were used and analyses were confirmed using marginal effects from Poisson and logistic regressions. Results suggest that three out of the 10 WEAI indicators of empowerment showed different magnitude and direction in significant associations with improved WDDS and varied associations were found in three out of the five countries examined. In addition, the three significant empowerment indicators were associated with the consumption of different food groups in three out of the five countries examined suggesting that diverse food groups account for the association between the WEAI and WDDS. Improved autonomy, and input in production were associated with improved likelihoods of consumption of dairy products, and fruits and vegetables including vitamin A-rich produce. Empowerment in public speaking was associated with improved consumption of other fruits and vegetables including vitamin A-rich produce. The varied nature of empowerment indicators towards improving women's dietary diversity and food consumption suggests that different empowerment strategies might confer different benefits towards the consumption of different food groups. Further, findings imply that interventions that seek to empower women should tailor their strategies on existing contextual factors that impact on women.
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Affiliation(s)
- Michael Nnachebe Onah
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Ontario, Canada
- Institute of Public Policy and Administration, Graduate School of Development, University of Central Asia, Bishkek, Kyrgyzstan
| | - Sue Horton
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Ontario, Canada
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell Institute of Public Affairs, Cornell University, Ithaca, New York, United States of America
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21
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal. J Nutr 2021; 151:1018-1024. [PMID: 33693922 DOI: 10.1093/jn/nxaa399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: -0.0503, P = 0.014) and in the model with women's and men's domains (β: -0.056, P = 0.008). Household decision making for women (β: -0.0631, P = 0.007) and for men (β: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.
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Affiliation(s)
- Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kenda Cunningham
- Hellen Keller International, Kathmandu, Nepal.,London School of Hygiene and Tropical Medicine, Department of Population Health, Faculty of Epidemiology, London, United Kingdom
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Tome J, Mbuya MNN, Makasi RR, Ntozini R, Prendergast AJ, Dickin KL, Pelto GH, Constas MA, Moulton LH, Stoltzfus RJ, Humphrey JH, Matare CR. Maternal caregiving capabilities are associated with child linear growth in rural Zimbabwe. MATERNAL & CHILD NUTRITION 2021; 17:e13122. [PMID: 33350100 PMCID: PMC7988870 DOI: 10.1111/mcn.13122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
Between birth and 2 years, children's well-being depends on the quality of care they receive from caregivers, primarily their mothers. We developed a quantitative survey instrument to assess seven psychosocial characteristics of women that determine their caregiving ability ('maternal capabilities': physical health, mental health, decision-making autonomy, social support, mothering self-efficacy, workload and time stress, and gender norm attitudes). We measured maternal capabilities in 4,025 mothers and growth in their 4,073 children participating in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. We used generalized estimating equation models with exchangeable correlation structure to test the association between each maternal capability during pregnancy, and infant length-for-age Z (LAZ) at 18 months, accounting only for within-cluster correlation and intervention arms in unadjusted analyses and for potential confounders in adjusted analyses to examine the association between each capability, assessed during pregnancy, with child LAZ at 18 months of age. In adjusted models, each unit increase in gender norm attitudes score (reflecting more equitable gender norm attitudes) was associated with +0.09 LAZ (95% CI: 0.02, 0.16) and a decreased odds of stunting (adjusted odds ratio [AOR]: 0.86; 95% CI: 0.74, 1.01); each unit increase in social support score was associated with +0.11 LAZ (95% CI: 0.05, 0.17, p < 0.010) and decreased odds of stunting (AOR: 0.83; 95% CI: 0.73, 0.96). Each unit increase in decision-making autonomy was associated with a 6% reduced odds of stunting (AOR: 0.94; 95% CI: 0.89, 0.996, p = 0.04). Interventions and social programming that strengthen these maternal capabilities may improve child nutritional status.
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Affiliation(s)
- Joice Tome
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Mduduzi N. N. Mbuya
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Global Alliance for Improved NutritionWashingtonDistrict of ColumbiaUSA
| | - Rachel R. Makasi
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Blizard InstituteQueen Mary University of LondonLondonUK
| | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Gretel H. Pelto
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Mark A. Constas
- Charles H. Dyson School of Applied Economics and ManagementCornell UniversityIthacaNew YorkUSA
| | - Lawrence H. Moulton
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rebecca J. Stoltzfus
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Ickes SB, Oddo VM, Sanders HK, Nduati R, Denno DM, Myhre JA, Kinyua J, Iannotti LL, Singa B, Farquhar C, Walson JL. Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya. Am J Clin Nutr 2021; 113:562-573. [PMID: 33515015 PMCID: PMC7948888 DOI: 10.1093/ajcn/nqaa351] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF. OBJECTIVES We evaluated associations between maternal employment and breastfeeding (BF) status. We compared formally and non-formally employed mothers in Naivasha, Kenya, where commercial floriculture and hospitality industries employ many women. METHODS We conducted a cross-sectional survey among mothers (n = 1186) from September 2018 to October 2019 at 4 postpartum time points: at hospital discharge (n = 296) and at 6 wk (n = 298), 14 wk (n = 295), and 36 wk (to estimate BF at 24 wk; n = 297) postpartum. Mothers reported their BF status and reasons for EBF cessation. We used multivariable logistic regression models to test the association between formal maternal employment and 3 outcomes: early BF initiation (within 1 h of birth), EBF at each time point, and continued BF at 9 mo. Models were informed by a directed acyclic graph: a causal diagram used to characterize the relationship among variables that influence the independent (employment) and dependent (BF status) variables. RESULTS EBF did not differ by employment status at hospital discharge or at 6 wk postpartum. However, formally employed mothers were less likely than those not formally employed to report EBF at 14 wk (59.0% compared with 95.4%, respectively; AOR: 0.19; 95% CI: 0.10, 0.34) and at 24 wk (19.0% compared with 49.6%, respectively; AOR: 0.25; 95% CI: 0.14, 0.44). The prevalence of continued BF at 36 wk did not differ by group (98.1% for formally employed compared with 98.5% for non-formally employed women; AOR: 0.80; 95% CI: 0.10, 6.08). The primary reasons reported for early EBF cessation were returning to work (46.5%), introducing other foods based on the child's age (33.5%), or perceived milk insufficiency (13.7%). CONCLUSIONS As more women engage in formal employment in low- and middle-income countries, additional supports to help prolong the period of EBF may be beneficial for formally employed mothers and their children.
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Affiliation(s)
- S B Ickes
- Address correspondence to SBI (e-mail: )
| | - V M Oddo
- University of Washington Department of Health Services, Seattle, WA, USA,University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, USA
| | - H K Sanders
- Wheaton College Department of Applied Health Science, Wheaton, IL, USA
| | - R Nduati
- University of Nairobi Department of Pediatrics and Child Health, Nairobi, Kenya
| | - D M Denno
- University of Washington Department of Health Services, Seattle, WA, USA,University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Pediatrics, Seattle, WA, USA,Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
| | - J A Myhre
- Naivasha Sub-County Referral Hospital and Serge East Africa, Naivasha, Kenya
| | - J Kinyua
- Kenya Medical Research Institute, Nairobi, Kenya
| | - L L Iannotti
- Washington University in St. Louis Brown School, St. Louis, MO, USA
| | - B Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - C Farquhar
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Medicine (Allergy and Infectious Disease), Seattle, WA, USA,University of Washington Department of Epidemiology, Seattle, WA, USA
| | - J L Walson
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Department of Pediatrics, Seattle, WA, USA,Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya,University of Washington Department of Medicine (Allergy and Infectious Disease), Seattle, WA, USA,University of Washington Department of Epidemiology, Seattle, WA, USA
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Conway K, Akseer N, Subedi RK, Brar S, Bhattarai B, Dhungana RR, Islam M, Mainali A, Pradhan N, Tasic H, Thakur DN, Wigle J, Maskey M, Bhutta ZA. Drivers of stunting reduction in Nepal: a country case study. Am J Clin Nutr 2020; 112:844S-859S. [PMID: 32889522 PMCID: PMC7487432 DOI: 10.1093/ajcn/nqaa218] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting - a physical manifestation of chronic malnutrition - despite only modest economic growth and significant political instability. OBJECTIVE This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country. METHODS Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses. RESULTS Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction. CONCLUSIONS Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.
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Affiliation(s)
- Kaitlin Conway
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Samanpreet Brar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Jannah Wigle
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Alam A, Khatun W, Khanam M, Ara G, Bokshi A, Li M, Dibley MJ. "In the Past, the Seeds I Planted often Didn't Grow." A Mixed-Methods Feasibility Assessment of Integrating Agriculture and Nutrition Behaviour Change Interventions with Cash Transfers in Rural Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114153. [PMID: 32532096 PMCID: PMC7312022 DOI: 10.3390/ijerph17114153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Combining agriculture with behaviour change communication and other nutrition-sensitive interventions could improve feeding practices to reduce maternal and child undernutrition. Such integrated intervention requires rigorous design and an appropriate implementation strategy to generate an impact. We assessed feasibility and acceptability of an intervention package that combines nutrition counselling, counselling and support for home-gardening, and unconditional cash transfers delivered to women on a mobile platform for improving maternal and child nutrition behaviours among low-income families in rural Bangladesh. We used mixed-methods including in-depth interviews with women (20), key-informant interviews with project workers (6), and a cross sectional survey of women (60). Women well-accepted the intervention and reported to be benefited by acquiring new skills and information on home gardening and nutrition. They established homestead gardens of seasonal vegetables successfully and were able to find a solution for major challenges. All women received the cash transfer. Ninety-one percent of women spent the cash for buying foods, 20% spent it on purchasing seeds or fertilizers and 57% used it for medical and livelihood purchases. Project staff and mobile banking agent reported no difficulty in cash transfer. Combining nutrition-specific and -sensitive interventions is a feasible and acceptable approach. Using mobile technologies can provide additional benefits for the intervention to reach the disadvantage families in rural settings.
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Affiliation(s)
- Ashraful Alam
- School of Public Health, The University of Sydney, Edward Ford Building, Sydney 2006, Australia; (W.K.); (M.L.); (M.J.D.)
- Correspondence: ; Tel.: +61-2-9351-8925
| | - Wajiha Khatun
- School of Public Health, The University of Sydney, Edward Ford Building, Sydney 2006, Australia; (W.K.); (M.L.); (M.J.D.)
| | - Mansura Khanam
- International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.K.); (G.A.)
| | - Gulshan Ara
- International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.K.); (G.A.)
| | - Anowarul Bokshi
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia;
| | - Mu Li
- School of Public Health, The University of Sydney, Edward Ford Building, Sydney 2006, Australia; (W.K.); (M.L.); (M.J.D.)
| | - Michael J. Dibley
- School of Public Health, The University of Sydney, Edward Ford Building, Sydney 2006, Australia; (W.K.); (M.L.); (M.J.D.)
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Hoke MK. A biocultural examination of home food production and child growth in highland Peru. Am J Hum Biol 2020; 32:e23438. [PMID: 32459029 DOI: 10.1002/ajhb.23438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Chronic malnutrition remains a persistent global health issue. This mixed methods investigation in rural Peru examines the role of home food production (HFP) in reducing child malnutrition by testing the following hypotheses: (a) higher HFP will be associated with higher infant z-scores than those with less HFP and (b) infants with higher HFP will exhibit improved longitudinal growth outcomes across 6 months. METHODS Ethnographic methods include semi-structured interviews and participant observation. A household survey and anthropometric data were collected twice, from 86 infants under of 24 months old. A HFP index (HFI) was generated based on reports of animals for meat consumption, eggs, milk, and agricultural products for home consumption. Kruskal-Wallis tests were used to examine patterns of HFI and infant anthropometrics. Multivariate regressions were used to examine the relationships between HFP and infant height for age (HAZ), weight for age (WAZ), and triceps skinfold for age (TSAZ) in both rounds and 6-month change between rounds (6MΔ). RESULTS There were no relationships between HFI and infant z-scores in round one, however, HFI was significantly positively related to HAZ (B = 0.091, P < .039) in round two and with 6MΔ in HAZ (B = 0.09, P < .047). HFI did not predict WAZ or TSAZ in either round. CONCLUSIONS HFP represents an important influence of infant growth in Nuñoa, likely through nutritional improvement due to increased availability of animal-sourced foods and through contribution to household economy and maternal empowerment.
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Affiliation(s)
- Morgan K Hoke
- Department of Anthropology & Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Broaddus-Shea ET, Shrestha BT, Rana PP, Winch PJ, Underwood CR. Navigating structural barriers to the implementation of agriculture-nutrition programs in Nepal. Food Secur 2020. [DOI: 10.1007/s12571-020-01031-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yapo YV. Breastfeeding and child survival from 0 to 5 years in Côte d'Ivoire. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:5. [PMID: 32228697 PMCID: PMC7106562 DOI: 10.1186/s41043-020-0210-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND One of the main objectives of health policy-makers is to promote children's growth, development, and survival. The current research evaluates the impact of breastfeeding on infant survival and highlights the major socio-economic determinants of child survival from 0 to 5 years old in Côte d'Ivoire. METHODS This study uses Probit estimation to evaluate the impact of the type of breastfeeding on the survival of children aged from 0 to 5 years old. The main socio-economic determinants of child survival were identified and analyzed. The sample of the study covers 7776 children under 5 years old drawn from the Côte d'Ivoire Demographic Health Surveys and the Multiple Indicators cluster survey of 2012. RESULTS A child is more likely to survive when immediate exclusive breastfeeding was practiced for up to 6 months. The probability of survival increases significantly when the mother lives in a healthy environment, when she has at least a primary school education, and when she plays a leading role in caring for the children. Likewise, when she better controls the market of some breast milk supplement and she chooses the best milk formula to complete feeding for her baby, the child's chances of survival increase significantly. CONCLUSION Health policy-makers must strengthen programs to promote exclusive breastfeeding up to 6 months through social campaigns. It should also strengthen the capacity of health workers (midwives, nurses, doctors, etc.) to better guide and provide training to mothers and young women about childbearing age to allow them to practice exclusive breastfeeding for up to 6 months. It is only after 6 months that they have to complete infant feeding by providing some semi-solid food rich in vitamins, proteins, and minerals. Taking into account the time constraint when they are engaged in economic activity, they must choose the best formula milk to supplement breastfeeding. It is also important to educate women to improve hygiene in their housing, in their neighborhood and in their community in order to promote the welfare and health of their children.
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Affiliation(s)
- Yomin Virginie Yapo
- Department of Economics and Management, Félix Houphouët Boigny University, 01 BP V43 Abidjan 01, Abidjan-Cocody, Côte d'Ivoire.
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Bogale B, Gutema BT, Chisha Y. Prevalence of Stunting and Its Associated Factors among Children of 6-59 Months in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia: A Community-Based Cross-Sectional Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:9520973. [PMID: 32280353 PMCID: PMC7115144 DOI: 10.1155/2020/9520973] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
Methods The community-based cross sectional study was conducted in the Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. The simple random sampling method was used to recruit 656 mother-child pairs. Height for age Z score was computed using WHO Anthro version 3.2.2 software. Multivariable logistic regression model was fitted, and adjusted odds ratio (AOR) at p value <0.05 was used to determine statistically significant association between predictors and outcome variable. Result The prevalence of stunting among children of 6-59 months in the study area was 47.9% (95% CI; 44.0-51.7). The likelihood of stunting was significantly higher among children who live in households with medium (AOR 2.20, 95% CI: 1.43-3.37) and poor (AOR 2.87, 95% CI: 1.72-4.81) wealth status. In addition, children who were not exclusively breast fed (AOR 1.55, 95% CI: 1.07-2.24), whose mothers had not participated in decision of major household purchases (AOR 2.27, 95% CI: 1.21-4.26), and whose mothers lacked decision on freedom of mobility (AOR 1.96, 95% CI: 1.05-3.66) were significantly stunted compared with counterparts. Conclusion Stunting is a severe public health problem in the area. Therefore, efforts should be taken to enhance maternal empowerment, household wealth, and infant and young child feeding practice for reducing stunting among children.
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Affiliation(s)
- Biruk Bogale
- Department of Public Health, Mizan Tepi University, Mizan Aman, Ethiopia
| | | | - Yilma Chisha
- Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
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To sell or consume? Gendered household decision-making on crop production, consumption, and sale in Malawi. Food Secur 2020. [DOI: 10.1007/s12571-020-01021-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choufani J, Jamaluddine Z, Cunningham K. A Multisectoral Nutrition Program in Nepal Improves Knowledge of Dietary Diversity, Sick Child Feeding, and Handwashing, but Not All Practices: a Program Impact Pathways Mediation Analysis. Curr Dev Nutr 2020; 4:nzz135. [PMID: 32258988 PMCID: PMC7101495 DOI: 10.1093/cdn/nzz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few intervention studies have focused on how inputs link with outcomes. OBJECTIVES This study tested whether Suaahara I program inputs translated into intended outcomes and identified gaps along the theorized program impact pathway to improved nutrition, care, and water, sanitation, and hygiene behaviors. METHODS We used household-level, cross-sectional survey data from a process evaluation of Suaahara I conducted in 2014. A total of 480 households with a pregnant woman or child aged <2 y were selected with an equal split between intervention and comparison arms. We used regression models to test associations between exposure to Suaahara I and 3 primary outcomes and 3 parallel knowledge mediators: child minimum dietary diversity, child feeding during illness, and proper handwashing during child care. We used generalized structural equation modeling using full information maximum likelihood to test whether knowledge mediated associations between exposure and outcomes. RESULTS In the adjusted regression models between maternal exposure to Suaahara I and 3 behavioral outcomes, we found a small positive association for handwashing (β: 0.21; 95% CI: 0.10, 0.31), but no association with the other 2 outcomes. In the mediation analysis, maternal exposure to Suaahara I, however, was associated with the mediator (knowledge) for all 3 outcomes: handwashing with soap and water (β: 0.05 ± 0.02), child minimum dietary diversity (logit = 0.06; P = 0.03), and child feeding during illness (logit = 0.09 ± 0.02). We found a positive, significant association for the full indirect pathway of program input to output via knowledge for child feeding during illness (logit = 0.07 ± 0.03) only. CONCLUSIONS Exposure to Suaahara I behavior change interventions improved knowledge, but this did not always translate into improved practices. It is important to address barriers to optimal practices beyond knowledge in future nutrition programs in Nepal.
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Affiliation(s)
- Jowel Choufani
- International Food Policy Research Institute, Washington, DC, USA
| | - Zeina Jamaluddine
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Women's bargaining power and child feeding in Nepal: Linkages through nutrition information. MATERNAL & CHILD NUTRITION 2020; 16:e12883. [PMID: 31386796 PMCID: PMC7038888 DOI: 10.1111/mcn.12883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/05/2022]
Abstract
Women's intra-household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross-sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0-23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision-making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision-making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender-related issues that underlie child nutrition outcomes.
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Affiliation(s)
- Shibani Kulkarni
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Edward A. Frongillo
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | | | - Spencer Moore
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Christine E. Blake
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
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ATEŞ-ŞAHİNKAYA N, ACAR-TEK N, DIGÜZEL E. The association between maternal features and nutritional problems in children with autism spectrum disorder. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective In the literature, there is almost no data on the relationship between autistic children’s nutritional problems and their mothers’ demographic and nutritional characteristics. Therefore, this study aimed to evaluate whether there was a relationship between maternal features and nutritional problems in autistic children. Methods This study was conducted with the participation of 58 autistic children (6-19 years) and their mothers. Descriptive data were obtained with a general questionnaire. For the evaluation of children’s nutritional status, anthropometric measurements and 24-hour dietary recall were used. Also, the Brief Autism Mealtime Behavior Inventory and ORTO-15 questionnaires were used to evaluate the meal behavior of children and orthorexia tendency of mothers, respectively. Results No significant correlation was found between the Brief Autism Mealtime Behavior Inventory scores in children of mothers with high and low orthorexia tendency. There were also no statistically significant differences between the children of mothers with high and low educational level in terms of Brief Autism Mealtime Behavior Inventory scores. Only the dietary vitamin B6 intake was significantly higher in the children of mothers with high educational level. Maternal age was associated with the dietary energy and protein intake, unlike, maternal orthorexia tendency was not associated with the nutritional status and meal behavior of children. The abdominal pain experience in the last one month was found to be significantly higher in the children of employed mothers than children of unemployed mothers. Conclusion It is thought that the maternal characteristics are not effective on meal behavior in children and also maternal age and educational status have a very limited effect on the nutritional status of children.
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Gupta S, Vemireddy V, Singh D, Pingali P. Adapting the Women's empowerment in agriculture index to specific country context: Insights and critiques from fieldwork in India. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2019; 23:245-255. [PMID: 31799111 PMCID: PMC6853022 DOI: 10.1016/j.gfs.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Abstract
The Women's Empowerment in Agriculture Index (WEAI) is a direct, multi-dimensional measure of women's access to resources and decision-making in various domains of agriculture. However, several challenges characterize its use: adaptation of questionnaires to local agricultural contexts, modifications to index construction once underlying activities and adequacy thresholds are modified, and sensitivity analysis. In this paper, we address such challenges based on our experience of adapting and using the WEAI across 3600 households in India. In doing so we contribute to the methodological and technical base underlying the index, expand the WEAI evidence base for South Asia, and highlight the importance of tailoring the index to specific agricultural contexts in order to impact public policies in a meaningful way. The Abbreviated Women’s Empowerment in Agriculture Index (AWEAI) is contextually adapted for 3600 households in India. We find that on average women in all four of our locations are disempowered in agriculture. Disempowered women lack membership to agriculture-related Self- Help Groups, ownership of land and control over incomes. There are significant differences between the original and our India- specific version of the AWEAI in each district.
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Affiliation(s)
- Soumya Gupta
- Tata- Cornell Institute for Agriculture and Nutrition, Cornell University, United States
| | | | - Dhiraj Singh
- Tata- Cornell Institute for Agriculture and Nutrition, India
| | - Prabhu Pingali
- Tata- Cornell Institute for Agriculture and Nutrition, Cornell University, United States
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Santoso MV, Kerr RB, Hoddinott J, Garigipati P, Olmos S, Young SL. Role of Women's Empowerment in Child Nutrition Outcomes: A Systematic Review. Adv Nutr 2019; 10:1138-1151. [PMID: 31298299 PMCID: PMC6855975 DOI: 10.1093/advances/nmz056] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/26/2019] [Indexed: 01/20/2023] Open
Abstract
Women's empowerment has gained attention as critical for child nutrition during the first 1000 days of life. However, the ways in which various women's empowerment measures are applied and the evidence for how they are differentially related to child nutrition is unclear. In this systematic review, therefore, we 1) systematically parse the many ways in which women's empowerment has been quantitatively measured in the context of child nutrition through the use of a theoretically driven application of dimensions and domains of empowerment; 2) summarize evidence for each of the various pathways between women's empowerment and child nutrition, based on dimensions and domains of empowerment; and 3) offer suggestions for future research to better articulate the relationship between women's empowerment and child nutrition. A search of evidence yielded 62 quantitative studies that used 200 unique indicators of women's empowerment, tested in 1316 associations with various child nutrition outcomes. Despite the large number of unique indicators, indicators for time resource allocation and reproductive decisions and indicators for men's engagement in child care and nutrition, all pertinent to child nutrition, were missing. Overall, the findings indicated an inconclusive relationship between women's empowerment and child nutrition: 379 out of 461 (82% weighted) and 217 out of 258 (84% weighted) associations found with stunting and wasting outcomes, respectively, were not significant. The current lack of evidence is likely not due to the absence of an underlying relationship between women's empowerment and child nutrition, but rather limitations in study design. Future research should carefully select women's empowerment indicators in context-specific ways, aggregate them meaningfully, and use a longitudinal study design to conduct pathway and lifecycle analysis in appropriate populations to clarify the relationship between women's empowerment and child nutrition.
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Affiliation(s)
| | - Rachel Bezner Kerr
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Priya Garigipati
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Sophia Olmos
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA,Institute of Policy Research, Northwestern University, Evanston, IL, USA,Address correspondence to SLY (e-mail: )
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Malapit H, Quisumbing A, Meinzen-Dick R, Seymour G, Martinez EM, Heckert J, Rubin D, Vaz A, Yount KM. Development of the project-level Women's Empowerment in Agriculture Index (pro-WEAI). WORLD DEVELOPMENT 2019; 122:675-692. [PMID: 31582871 PMCID: PMC6694750 DOI: 10.1016/j.worlddev.2019.06.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
With growing commitment to women's empowerment by agricultural development agencies, sound methods and indicators to measure women's empowerment are needed to learn which types of projects or project-implementation strategies do and do not work to empower women. The Women's Empowerment in Agriculture Index (WEAI), which has been widely used, requires adaptation to meet the need for monitoring projects and assessing their impacts. In this paper, the authors describe the adaptation and validation of a project-level WEAI (or pro-WEAI) that agricultural development projects can use to identify key areas of women's (and men's) disempowerment, design appropriate strategies to address identified deficiencies, and monitor project outcomes related to women's empowerment. The 12 pro-WEAI indicators are mapped to three domains: intrinsic agency (power within), instrumental agency (power to), and collective agency (power with). A gender parity index compares the empowerment scores of men and women in the same household. The authors describe the development of pro-WEAI, including: (1) pro-WEAI's distinctiveness from other versions of the WEAI; (2) the process of piloting pro-WEAI in 13 agricultural development projects during the Gender, Agriculture, and Assets Project, phase 2 (GAAP2); (3) analysis of quantitative data from the GAAP2 projects, including intrahousehold patterns of empowerment/disempowerment; and (4) a summary of the findings from the qualitative work exploring concepts of women's empowerment in the project sites. The paper concludes with a discussion of lessons learned from pro-WEAI and possibilities for further development of empowerment metrics.
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Affiliation(s)
- Hazel Malapit
- International Food Policy Research Institute, Washington, DC, USA
| | - Agnes Quisumbing
- International Food Policy Research Institute, Washington, DC, USA
| | | | - Greg Seymour
- International Food Policy Research Institute, Washington, DC, USA
| | | | - Jessica Heckert
- International Food Policy Research Institute, Washington, DC, USA
| | | | - Ana Vaz
- Oxford Poverty and Human Development Initiative, United Kingdom
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Seymour G, Masuda YJ, Williams J, Schneider K. Household and child nutrition outcomes among the time and income poor in rural Bangladesh. GLOBAL FOOD SECURITY 2019. [DOI: 10.1016/j.gfs.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Heys M, Gibbons F, Haworth E, Medeiros E, Tumbahangphe KM, Wickenden M, Shrestha M, Costello A, Manandhar D, Pellicano E. The Estimated Prevalence of Autism in School-Aged Children Living in Rural Nepal Using a Population-Based Screening Tool. J Autism Dev Disord 2018; 48:3483-3498. [PMID: 29855757 PMCID: PMC6153945 DOI: 10.1007/s10803-018-3610-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Few data exist on the prevalence of autism in low-income countries. We translated, adapted and tested the acceptability of a Nepali-language version of a screening tool for autism (Autism Quotient-10). Using this tool, we estimated autism prevalence in 4098 rural Nepali children aged 9-13 years. Fourteen children scored > 6 out of 10, indicative of elevated autistic symptomatology, of which 13 also screened positive for disability. If the AQ-10 screening tool is as sensitive and specific in the Nepali population as it is in the UK, this would yield an estimated true prevalence of 3 in 1000 (95% confidence interval 2-5 in 1000). Future research is required to validate this tool through in-depth assessments of high-scoring children.
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Affiliation(s)
- Michelle Heys
- UCL Institute for Global Health, University College London, London, UK.
- Great Ormond Street Institute of Child Global Health, University College London, London, UK.
| | | | - Ed Haworth
- Great Ormond Street Institute of Child Global Health, University College London, London, UK
| | - Emilie Medeiros
- UCL Institute for Global Health, University College London, London, UK
| | | | - Mary Wickenden
- UCL Institute for Global Health, University College London, London, UK
| | - Merina Shrestha
- Autism Care Society, Kathmandu, Nepal
- Tribhuvan University Teaching Hospital, Department of Child Health, Kathmandu, Nepal
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | | | - Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, London, UK
- Department of Educational Studies, Macquarie University, Sydney, Australia
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Cunningham K, Ferguson E, Ruel M, Uauy R, Kadiyala S, Menon P, Ploubidis G. Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal. MATERNAL AND CHILD NUTRITION 2018; 15:e12638. [PMID: 30047247 DOI: 10.1111/mcn.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
Abstract
In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes.
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Affiliation(s)
| | - Elaine Ferguson
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Ruel
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA
| | - Ricardo Uauy
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Food Nutrition and Food Technology, Santiago, Chile
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA.,Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - George Ploubidis
- Department of Quantitative Social Science, Centre for Longitudinal Studies; Institute of Education, London, UK
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40
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Wong JT, Bagnol B, Grieve H, da Costa Jong JB, Li M, Alders RG. Factors influencing animal-source food consumption in Timor-Leste. Food Secur 2018. [DOI: 10.1007/s12571-018-0804-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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41
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Kjeldsberg C, Shrestha N, Patel M, Davis D, Mundy G, Cunningham K. Nutrition-sensitive agricultural interventions and gender dynamics: A qualitative study in Nepal. MATERNAL AND CHILD NUTRITION 2018; 14:e12593. [PMID: 29573370 DOI: 10.1111/mcn.12593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/18/2017] [Accepted: 01/07/2018] [Indexed: 01/01/2023]
Abstract
Undernutrition and low women's status persist as major development obstacles in South Asia and specifically, Nepal. Multi-sectoral approaches, including nutrition-sensitive agriculture, are potential avenues for further reductions in undernutrition. Although evidence is growing, many questions remain regarding how gender mediates the translation of agricultural production activities into nutritional benefit. In this study, we examined how gender influences the pathway from agricultural production to improved income and control of income, with a focus on five domains of empowerment: decision-making power, freedom of mobility, social support, workload and time, and self-efficacy. For this, we conducted a qualitative retrospective assessment (N = 10 FGDs) among 73 beneficiary women of a nutrition-sensitive agriculture programme implemented from 2008 to 2012 in two districts of Nepal-Baitadi and Kailali. We found that women reported increased decision-making power, new knowledge and skills, increased recognition by their family members of their new knowledge and contributions, and self-efficacy as farmers and sellers, whereas workload and time were the most consistent constraints noted. We also found that each empowerment domain operated differently at different stages of the pathway, sometimes representing barriers and at other times, opportunities and that the interconnectedness of the domains made them difficult to disentangle in practice. Finally, there were major contextual differences for some domains (e.g., freedom of mobility) between the two districts. Future policies and programmes need to include in-depth formative research to ensure that interventions address context-specific gender and social norms to maximise programmatic opportunities to achieve desired results.
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Affiliation(s)
| | | | - Miti Patel
- Helen Keller International-Nepal, Kathmandu, Nepal
| | - Dale Davis
- Helen Keller International-Nepal, Kathmandu, Nepal
| | - Gary Mundy
- Helen Keller International-Asia Pacific Regional Office, Phnom Penh, Cambodia
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43
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Ickes SB, Wu M, Mandel MP, Roberts AC. Associations between social support, psychological well-being, decision making, empowerment, infant and young child feeding, and nutritional status in Ugandan children ages 0 to 24 months. MATERNAL & CHILD NUTRITION 2018; 14:e12483. [PMID: 28782300 PMCID: PMC6866247 DOI: 10.1111/mcn.12483] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/15/2017] [Accepted: 06/04/2017] [Indexed: 01/21/2023]
Abstract
Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey (n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context.
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Affiliation(s)
- Scott B. Ickes
- Departments of Health Services and Global Health, and Program in Nutritional SciencesUniversity of WashingtonSeattleWashingtonUSA
- Department of Kinesiology and Health SciencesThe College of William and MaryWilliamsburgVirginiaUSA
| | - Michael Wu
- Master Program of Global Health and DevelopmentTaipei Medical UniversityTaipeiTaiwan
| | - Maia P. Mandel
- Department of Kinesiology and Health SciencesThe College of William and MaryWilliamsburgVirginiaUSA
| | - Alison C. Roberts
- Department of Kinesiology and Health SciencesThe College of William and MaryWilliamsburgVirginiaUSA
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Sinharoy SS, Waid JL, Haardörfer R, Wendt A, Gabrysch S, Yount KM. Women's dietary diversity in rural Bangladesh: Pathways through women's empowerment. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28766878 DOI: 10.1111/mcn.12489] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/26/2022]
Abstract
The relationship between women's empowerment and women's nutrition is understudied. We aimed to elucidate this relationship by quantifying possible pathways between empowerment and dietary diversity among women in rural Bangladesh. In 2015, we conducted a cross-sectional survey of 2,599 married women ages 15-40 (median: 25) living in 96 settlements of Habiganj District, Bangladesh, as a baseline for the Food and Agricultural Approaches to Reducing Malnutrition trial. We collected data on women's empowerment (highest completed grade of schooling and agency), dietary diversity, and demographic factors, including household wealth. We used exploratory factor analysis and confirmatory factor analysis on random split-half samples, followed by structural equation modelling, to test pathways from schooling, through domains of women's agency, to dietary diversity. Factor analysis revealed 3 latent domains of women's agency: social solidarity, decision-making, and voice with husband. In the adjusted mediation model, having any postprimary schooling was positively associated with voice with husband (β41 = .051, p = .010), which was positively associated with dietary diversity (β54 = .39, p = .002). Schooling also had a direct positive association with women's dietary diversity (β51 = .22, p < .001). Neither women's social solidarity nor decision-making mediated the relationship between schooling and dietary diversity. The link between schooling and dietary diversity was direct and indirect, through women's voice with husband but not through women's social solidarity or decision-making. In this population, women with postprimary schooling seem to be better able to negotiate improved diets for themselves.
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Affiliation(s)
- Sheela S Sinharoy
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jillian L Waid
- Helen Keller International, Dhaka, Bangladesh.,Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Regine Haardörfer
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, USA
| | - Amanda Wendt
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Kathryn M Yount
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Karmacharya C, Cunningham K, Choufani J, Kadiyala S. Grandmothers' knowledge positively influences maternal knowledge and infant and young child feeding practices. Public Health Nutr 2017; 20:2114-2123. [PMID: 28578753 PMCID: PMC10261267 DOI: 10.1017/s1368980017000969] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 03/31/2017] [Accepted: 04/18/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine associations between grandmothers' knowledge and infant and young child feeding (IYCF) practices and to test whether the associations are independent of or operate via maternal knowledge. DESIGN Cross-sectional household survey data from households with a child under 5 years (n 4080). We used multivariate regression analyses, adjusted for child, maternal, grandmother and household characteristics, and district-level clustering, to test associations between grandmothers' knowledge and IYCF practices for children aged 6-24 months living with a grandmother. We used causal mediation to formally test the direct effect of grandmothers' knowledge on IYCF practices v. maternal knowledge mediating these associations. SETTING Two hundred and forty rural communities, sixteen districts of Nepal. SUBJECTS Children aged 6-24 months (n1399), including those living with grandmothers (n 748). RESULTS We found that the odds of optimal breast-feeding practices were higher (early breast-feeding initiation: 2·2 times, P=0·002; colostrum feeding: 4·2 times, P<0·001) in households where grandmothers had correct knowledge v. those with incorrect knowledge. The same pattern was found for correct timing of introduction of water (2·6), milk (2·4), semi-solids (3·2), solids (2·9), eggs (2·6) and meat (2·5 times; all P<0·001). For the two pathways we were able to test, mothers' correct knowledge mediated these associations between grandmothers' knowledge and IYCF practices: colostrum feeding (b=10·91, P<0·001) and the introduction of complementary foods (b=5·18, P<0·001). CONCLUSIONS Grandmothers' correct knowledge translated into mothers' correct knowledge and, therefore, optimal IYCF practices. Given grandmothers' influence in childcare, engagement of grandmothers in health and nutrition interventions could improve mothers' knowledge and facilitate better child feeding.
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Affiliation(s)
- Chandni Karmacharya
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jowel Choufani
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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47
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Du Y, Zhao LJ, Xu Q, Wu KH, Deng HW. Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study. Osteoporos Int 2017; 28:1699-1709. [PMID: 28236128 DOI: 10.1007/s00198-017-3951-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Low bone mineral density (BMD) and osteoporosis have become a public health problem. We found that non-Hispanic white, black, and Asian adults with extremely low education and personal income are more likely to have lower BMD. This relationship is gender-specific. These findings are valuable to guide bone health interventions. INTRODUCTION The evidence is limited regarding the relationship between socioeconomic status (SES) and bone mineral density (BMD) for minority populations in the USA, as well as the relationship between SES and BMD for men. This study explored and examined the relationship between SES and BMD by race/ethnicity and gender. METHODS Data (n = 6568) from the Louisiana Osteoporosis Study (LOS) was examined, including data for non-Hispanic whites (n = 4153), non-Hispanic blacks (n = 1907), and non-Hispanic Asians (n = 508). General linear models were used to estimate the relationship of SES and BMD (total hip and lumbar spine) stratified by race/ethnicity and gender. Adjustments were made for physiological and behavioral factors. RESULTS After adjusting for covariates, men with education levels below high school graduate experienced relatively low hip BMD than their counterparts with college or graduate education (p < 0.05). In addition, women reporting a personal annual income under $20,000 had relatively low hip and spine BMD than their counterparts with higher income level(s) (p < 0.05). CONCLUSIONS Establishing a conclusive positive or negative association between BMD and SES proved to be difficult. However, individuals who are at an extreme SES disadvantage are the most vulnerable to have relatively low BMD in the study population. Efforts to promote bone health may benefit from focusing on men with low education levels and women with low individual income.
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Affiliation(s)
- Y Du
- Center for Aging, School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - L-J Zhao
- Center for Bioinformatics and Genomics, Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St. Ste. 2001, New Orleans, LA, 70112, USA
| | - Q Xu
- Silver School of Social Work, New York University, New York, NY, 10003, USA
| | - K-H Wu
- Center for Bioinformatics and Genomics, Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St. Ste. 2001, New Orleans, LA, 70112, USA
| | - H-W Deng
- Center for Bioinformatics and Genomics, Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St. Ste. 2001, New Orleans, LA, 70112, USA.
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Alaofè H, Zhu M, Burney J, Naylor R, Douglas T. Association Between Women's Empowerment and Maternal and Child Nutrition in Kalalé District of Northern Benin. Food Nutr Bull 2017; 38:302-318. [PMID: 28443373 DOI: 10.1177/0379572117704318] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence on effectiveness of women's empowerment (WE) to reduce undernutrition is limited in sub-Sahara Africa, and few studies incorporate multidimensional measures of WE. OBJECTIVE To examine whether a WE status, in sum and across leadership, decision-making, mobility, economic security, male involvement in housework, and nonfamily group domains, is associated with women and their children nutritional status in Kalalé district of northern Benin. METHODS Data were obtained from the 2014 Solar Market Garden baseline study: 767 paired reproductive-age women aged 15 to 49 years and children 6 to 59 months old. Exploratory principal component (cross-validate with confirmatory) factor analysis was first conducted to identify the structure of empowerment. Then, using a new survey-based index, regression analysis was conducted to examine associations between WE measures and maternal dietary diversity score (DDS) and body mass index (BMI), as well as their child's DDS, height-for-age z score (HAZ), weight-for-height z score (WHZ), and weight-for-age z score (WAZ). RESULTS Positive associations were observed between women's composite empowerment, leadership, maternal DDS and BMI, and female child's DDS. However, opposite signs were found between economic security and child's DDS. Mobility was positively associated with female children's WHZ and male children's HAZ and WAZ, while decision-making was correlated with male child's WHZ and female children's WAZ. CONCLUSIONS Women's empowerment can be associated with undernutrition. Efforts to improve nutrition may benefit from empowerment initiatives that promote women's self-confidence and decision-making in Benin. However, additional qualitative and longitudinal research may enhance understanding of WE in the present area.
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Affiliation(s)
- Halimatou Alaofè
- 1 Health Promotion Sciences Department, University of Arizona, Tucson, AZ, USA
| | - Min Zhu
- 2 Epidemiology and Biostatistics Department, University of Arizona, Tucson, AZ, USA
| | - Jennifer Burney
- 3 School of Global Policy and Strategy, University of California, San Diego, San Diego, CA, USA
| | - Rosamond Naylor
- 4 School of Earth, Energy & Environmental Sciences, Stanford University, Stanford, CA, USA
| | - Taren Douglas
- 1 Health Promotion Sciences Department, University of Arizona, Tucson, AZ, USA
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Rajaram R, Perkins JM, Joe W, Subramanian SV. Individual and community levels of maternal autonomy and child undernutrition in India. Int J Public Health 2016; 62:327-335. [PMID: 27392731 DOI: 10.1007/s00038-016-0850-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 04/19/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Investigate the relationship between maternal autonomy at multiple levels and the risk of child stunting, underweight, and wasting in India. METHODS Data were from a 2005-2006 nationally representative, cross-sectional sample of 51,555 children under 5 years from 29 states in India. Multilevel, multivariable, logistic regression analyses were used to estimate the odds of child stunting, underweight, and wasting in relation to maternal autonomy in healthcare, movement, and money at the individual level and community level, while adjusting for several child, maternal, and household factors. RESULTS When only adjusting for child age and sex, children in communities with a high proportion of women with autonomy in healthcare, or movement, or money, separately, had a lower risk of being stunted, underweight, or wasted, separately. However, adjusting for other explanatory factors attenuated these relationships and made them statistically insignificant. Individual maternal autonomy in any of the three domains was not associated with any of the outcomes. CONCLUSIONS The results suggest that caution should be taken when interpreting the direct relevance of maternal autonomy at both individual and community levels to measures of child undernutrition.
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Affiliation(s)
- Ramaprasad Rajaram
- Lead Economist and Associate Director, Athena Infonomics, Chennai, India.
| | - Jessica M Perkins
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - William Joe
- Institute of Economic Growth (IEG), University of Delhi Enclave, North Campus, Delhi, 110007, India
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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