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Ryckman T, Codjia P, Nordhagen S, Arimi C, Kirogo V, Kiige L, Kamudoni P, Beal T. A subnational affordability assessment of nutritious foods for complementary feeding in Kenya. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 3:e13373. [PMID: 35666006 PMCID: PMC10782139 DOI: 10.1111/mcn.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Complementary feeding among children aged 6-23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange-fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal-source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions.
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Affiliation(s)
- Theresa Ryckman
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | - Caroline Arimi
- Division of Nutrition and DieteticsMinistry of HealthNairobiKenya
| | - Veronica Kirogo
- Division of Nutrition and DieteticsMinistry of HealthNairobiKenya
| | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDCUSA
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White JM, Drummond E, Bijalwan V, Singhkumarwong A, Betigeri A, Blankenship J. Micronutrient gaps during the complementary feeding period in seven countries in Southeast Asia: A Comprehensive Nutrient Gap Assessment. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13577. [PMID: 38092378 PMCID: PMC10719053 DOI: 10.1111/mcn.13577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023]
Abstract
The complementary feeding period is a critical stage of child development when micronutrient needs are high and challenging to meet. Understanding if specific micronutrient gaps exist during this period is critical for effective programming. A Comprehensive Nutrient Gap Assessment (CONGA) was conducted in seven countries in Southeast Asia to estimate gaps in micronutrients commonly lacking in the diets of children aged 6-23 months and to establish the certainty of available evidence for each identified gap. Sixty-eight evidence sources were identified during this analysis, and 310 micronutrient-specific data points were identified across all seven countries. Data points varied in recency, representativeness and evidence type. The CONGA methodology enabled the estimation of a gap burden rating for each micronutrient in each country, as well as a rating of their evidence certainty. Micronutrient gaps were identified in vitamin D, zinc and iron and a potential gap was identified in calcium during the complementary feeding period in the region. Evidence relevant to intake and deficiency of folate, vitamin B12 , thiamine, niacin, vitamin C and vitamin B6 was limited across the region. Proven strategies to address these gaps include increasing the availability and consumption of nutrient-dense foods, micronutrient supplementation, large-scale fortification of staple foods and condiments and point-of-use fortification through multiple micronutrient powders and fortified speciality foods. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia.
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Affiliation(s)
| | | | | | | | - Arvind Betigeri
- World Food Programme Asia and the Pacific Regional OfficeBangkokThailand
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White JM, Beal T, Arsenault JE, Okronipa H, Hinnouho GM, Chimanya K, Matji J, Garg A. Micronutrient gaps during the complementary feeding period in 6 countries in Eastern and Southern Africa: a Comprehensive Nutrient Gap Assessment. Nutr Rev 2021; 79:16-25. [PMID: 33693910 PMCID: PMC7947982 DOI: 10.1093/nutrit/nuaa142] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Insufficient quantity and inadequate quality of foods in early life are key causes of all forms of malnutrition. Identification of nutrient and dietary gaps in the diets of infants and young children is essential to inform policies and programs designed to improve child diets. A Comprehensive Nutrient Gap Assessment was used to assess the public health significance of nutrient gaps during the complementary feeding period and to identify evidence gaps in 6 countries in Eastern and Southern Africa. Important gaps were identified in iron, vitamin A, zinc, and calcium and, to a lesser extent, vitamin B12 and folate. The best whole-food sources of these micronutrients available in part or all of the countries studied include beef liver, chicken liver, small dried fish, beef, and eggs. Investment is needed in many countries to collect data on micronutrient biomarkers and dietary intake. Strategic actions to improve child diets will require engagement and intervention across relevant systems to accelerate progress on improving the diets of infants and young children.
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Affiliation(s)
- Jessica M White
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, Davis, California, USA
| | - Joanne E Arsenault
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Intake, Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Harriet Okronipa
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Helen Keller International, New York, New York, USA
| | | | - Joan Matji
- UNICEF, Regional Office for Eastern and Southern Africa, Nairobi, Kenya
| | - Aashima Garg
- United Nations Children's Fund (UNICEF), New York, New York, USA
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Beal T, White JM, Arsenault JE, Okronipa H, Hinnouho GM, Murira Z, Torlesse H, Garg A. Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment. Nutr Rev 2021; 79:26-34. [PMID: 33693912 PMCID: PMC7947968 DOI: 10.1093/nutrit/nuaa144] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Micronutrient malnutrition is a key driver of morbidity and mortality for millions of children in South Asia. Understanding the specific micronutrients lacking in the diet during the complementary feeding period is essential for addressing undernutrition caused by inadequate diets. A Comprehensive Nutrient Gap Assessment was used to synthesize diverse evidence and estimate the public health significance of complementary-feeding micronutrient gaps and identify evidence gaps in 8 countries in South Asia. There were important gaps across the region in iron, zinc, vitamin A, folate, vitamin B12, and, to a lesser extent, calcium and vitamin C. The most nutrient-dense, whole-food sources of these micronutrients include liver, small fish, eggs, ruminant meat, and dark leafy greens. Investment is needed in some countries to collect data on micronutrient biomarkers and dietary intakes. A food systems approach is essential for improving child diets and reducing malnutrition, which affects millions of children, their futures, and society at large across South Asia and beyond.
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Affiliation(s)
- Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, Davis, California, USA
| | - Jessica M White
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Joanne E Arsenault
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Intake, Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Harriet Okronipa
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Helen Keller International, New York, New York, USA
| | - Zivai Murira
- UNICEF, Regional Office for South Asia, Kathmandu, Nepal
| | | | - Aashima Garg
- United Nations Children's Fund (UNICEF), New York, New York, USA
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Morris SS, Garg A, Black RE. Nutrient gaps and affordability of complementary foods in Eastern and Southern Africa and South Asia. Nutr Rev 2021; 79:1-3. [PMID: 33693911 PMCID: PMC7947981 DOI: 10.1093/nutrit/nuaa149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Robert E Black
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ryckman T, Beal T, Nordhagen S, Chimanya K, Matji J. Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa. Nutr Rev 2021; 79:35-51. [PMID: 33693913 PMCID: PMC7948081 DOI: 10.1093/nutrit/nuaa137] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Low intake of diverse complementary foods causes critical nutrient gaps in the diets of young children. Inadequate nutrient intake in the first 2 years of life can lead to poor health, educational, and economic outcomes. In this study, the extent to which food affordability is a barrier to consumption of several nutrients critical for child growth and development was examined in Ethiopia, Mozambique, South Africa, Tanzania, Uganda, and Zambia. Drawing upon data from nutrient gap assessments, household surveys, and food composition tables, current consumption levels were assessed, the cost of purchasing key nutritious foods that could fill likely nutrient gaps was calculated, and these costs were compared with current household food expenditure. Vitamin A is affordable for most households (via dark leafy greens, orange-fleshed vegetables, and liver) but only a few foods (fish, legumes, dairy, dark leafy greens, liver) are affordable sources of iron, animal-source protein, or calcium, and only in some countries. Zinc is ubiquitously unaffordable. For unaffordable nutrients, approaches to reduce prices, enhance household production, or increase household resources for nutritious foods are needed.
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Affiliation(s)
- Theresa Ryckman
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington DC, USA
- Department of Environmental Science and Policy, University of California, Davis, Davis, California, USA
| | | | - Kudakwashe Chimanya
- United Nations Children’s Fund, Regional Office for Eastern and Southern Africa, Nairobi, Kenya
| | - Joan Matji
- United Nations Children’s Fund, Regional Office for Eastern and Southern Africa, Nairobi, Kenya
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