Small-scale egg production centres increase children's egg consumption in rural Zambia

Formulation and acceptability of local nutrient-dense foods for young children: A formative study for the Child Health, Agriculture and Integrated Nutrition (CHAIN) Trial in rural Zimbabwe

Stunting affects almost one-quarter of children globally, leading to reduced human capacity and increased long-term risk of chronic disease. Despite intensive infant and young child feeding (IYCF) interventions, many children do not meet their requirements for essential nutrients. This study aimed to assess the feasibility of implementing an IYCF intervention utilizing nutrient-dense powders from egg, biofortified sugar beans and Moringa oleifera leaf in rural Zimbabwe. A mixed-methods formative study was conducted comprising the following: (i) a recipe formulation trial, (ii) trials of improved practices to assess acceptability of the intervention, and (iii) a participatory message formulation process to develop counselling modules for the IYCF-plus intervention. Twenty-seven mother-baby pairs were recruited between November 2019 and April 2020. Key domains affecting IYCF practices that emerged were time, emotional and physical space, cultural and religious beliefs, indigenous knowledge systems and gender dynamics. Household observations and sensory evaluation indicated high acceptability of the new ingredients. Recipe formulation and participatory message formulation by participants instilled community ownership and served to demystify existing misconceptions about the new food products. Families noted the potential for intervention sustainability because the foods could be grown locally. Supplementing complementary foods with nutrient-dense local food ingredients as powders has the potential to sustainably address nutrient-gaps in the diets of young children living in rural lower- and middle-income countries. Comprehensive IYCF counselling utilizing a gender-lens approach, family support and indigenous knowledge systems or resources are key elements to support positive behaviour change in complementary feeding interventions.

Designing nutrition-sensitive agriculture (NSA) interventions with multi-criteria decision analysis (MCDA): a review

Despite the efforts to end malnutrition through intensive agriculture of caloric crops, micronutrient deficiencies and other forms of malnutrition persist in vulnerable communities worldwide. Nutrition-sensitive agriculture (NSA) interventions are recognized as chances to address the causes of malnutrition. In this work, the different types of NSA interventions were explored, as well as the pathways through which they can improve nutrition (e.g., increasing biofortified crops and income generation via agricultural sales for a positive impact on access to nutritious foods, and simultaneously involving nutrition education to improve care practices and eventually nutritional status). Some NSA interventions focus on one pathway. Well-designed interventions, however, should follow multi-pathway approaches targeting the underlying causes of undernutrition within the selected population. The circumstances in which certain indicators should be used to measure the impact of an NSA intervention in each stage of the full pathway were also explained, as well as the need of enhancing the design of such interventions. Multi-criteria decision analysis (MCDA) has been employed to solve agriculture-related issues, but it has not been used to identify the optimal types of NSA interventions, metrics, and indicators based on the context of the community, priorities and objectives of the project managers and designers, etc.

The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis

Background

Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa.

Objective

To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI).

Results

After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed.

Conclusion

Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.

The effectiveness of an egg-based intervention on improving the nutrition of poor school-age children in China: A quasi-experimental assessment

OBJECTIVES

Although egg-based interventions are effective in alleviating undernutrition for infants and toddlers, little is known regarding their effectiveness for children in remote and poor areas of China. For policy and intervention implications, the aim of this study was to examine the effects of offering one hard-boiled egg per school day to school-age children in less-developed areas of China.

METHODS

This analytical sample included 346 school-age children. Children in the treatment group received one egg per school day. Applying propensity score weighting to the difference-in-difference models, this study examined the effects of the egg intervention on child nutrition status measured in height-for-age Z score (HAZ), weight-for-age Z score (WAZ), and body-mass-index-for-age Z score (BMIZ).

RESULTS

After applying propensity score weighting, the average treatment effect (ATE) and the average treatment effects on the treated (ATT) estimations showed that the increase in HAZ scores from wave 1 to wave 3 for the program participants was 0.28 points higher compared with the increase in HAZ scores from wave 1 to wave 3 for the control group (P < 0.05). The ATE and the ATT estimations showed that the increase in WAZ scores from wave 1 to wave 3 for the program participants was 0.50 and 0.49 points higher compared with the increase in WAZ scores from wave 1 to wave 3 for the control group (P < 0.001). Regarding BMIZ score improvement from wave 1 to wave 3, the program participation had relatively larger effects by 0.57 and 0.55 points based on the ATE and ATT estimations (P < 0.001), respectively.

CONCLUSIONS

The egg intervention can be an effective intervention to improve child development in less-developed areas of China.

Identifying Predictors for Minimum Dietary Diversity and Minimum Meal Frequency in Children Aged 6-23 Months in Uganda

Adequate complementary foods contribute to good health and growth in young children. However, many countries are still off-track in achieving critical complementary feeding indicators, such as minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD). In this study, we used the 2016 Ugandan Demographic Health Survey (UDHS) data to assess child feeding practices in young children aged 6-23 months. We assess and describe complementary feeding indicators (MMF, MDD and MAD) for Uganda, considering geographic variation. We construct multivariable logistic regression models-stratified by age-to evaluate four theorized predictors of MMF and MDD: health status, vaccination status, household wealth and female empowerment. Our findings show an improvement of complementary feeding practice indicators in Uganda compared to the past, although the MAD threshold was reached by only 22% of children. Children who did not achieve 1 or more complementary feeding indicators are primarily based in the northern regions of Uganda. Cereals and roots were the foods most consumed daily by young children (80%), while eggs were rarely eaten. Consistent with our hypotheses, we found that health status, vaccination status and wealth were significantly positively associated with MDD and MMF, while female empowerment was not. Improving nutrition in infant and young children is a priority. Urgent nutritional policies and acceptable interventions are needed to guarantee nutritious and age-appropriate complementary foods to each Ugandan child in the first years of life.

Simple solutions for complex problems? What is missing in agriculture for nutrition interventions

Within the nutritionism paradigm, in this article we critically review the marketization and medicalization logics which aim to address the pressing issue of malnutrition in low- and middle-income countries. Drawing from political economy and food system transformation discourses, we are using the popular intervention types of nutrition-sensitive value chains (marketization logic) and biofortification exemplified through orange-fleshed sweet potato (medicalization logic) to assess their outcomes and underlying logics. We demonstrate that there is insufficient evidence of the positive impact of these interventions on nutritional outcomes, and that their underlying theories of change and impact logics do not deal with the inherent complexity of nutritional challenges. We show that nutrition-sensitive value chain approaches are unable to leverage or enhance the functioning of value chains to improve nutritional outcomes, especially in light of the disproportionate power of some food companies. We further demonstrate that orange-fleshed sweet potato interventions and biofortification more broadly adopt a narrow approach to malnutrition, disregarding the interactions between food components and broader value chain and food system dynamics. We argue that both intervention types focus solely on increasing the intake of specific nutrients without incorporating their embeddedness in the wider food systems and the relevant political-economic and social relations that influence the production and consumption of food. We conclude that the systemic nature of malnutrition requires to be understood and addressed as part of the food system transformation challenge in order to move towards solving it. To do so, new evaluation frameworks along with new approaches to solutions are necessary that support multiple and diverse development pathways, which are able to acknowledge the social, political-economic, and environmental factors and drivers of malnutrition and poverty.

Effect of a Child-Owned Poultry Intervention Providing Eggs on Nutrition Status and Motor Skills of Young Children in Southern Ethiopia: A Cluster Randomized and Controlled Community Trial

Eggs are highly nutritious foods, yet intake by children in Ethiopia is low. We hypothesized that a nutrition-sensitive poultry intervention improves nutritional status of children 6-18 months using a 6-month cluster randomized controlled community trial. Intervention group (IG) children received a gift of two egg-laying hens in a ceremony where children's ownership of the chickens was declared by community leaders. Parents promised to add more hens and feed the owner-child one-egg-a-day. Trained community workers reinforced egg feeding, environmental sanitation and poultry husbandry. Control group (CG) mothers received usual nutrition education on child feeding. At baseline 29.6% of children were stunted, 19.4% underweight and 8.6% wasted. Egg consumption significantly increased only in IG, at 6 months. The intervention increased weight-for-age and weight-for-height z-scores by 0.38 (95% CI = 0.13-0.63) and 0.43 (95% CI = 0.21-0.64), respectively. Binary logit model indicated IG children were 54% (Odds ratio [OR] = 0.46; 95% CI = 0.26-0.84) and 42% (OR = 0.58; 95% CI = 0.37-0.91) less likely to be underweight and stunted, respectively, compared to CG. IG children attained the milestone of running (p = 0.022; AHR = 1.43; 95% CI = 1.05-1.95), kicking a ball (p = 0.027; AHR = 1.39; 95% CI = 1.04-1.87) and throwing a ball (p = 0.045; AHR = 1.37; 95% CI = 1.01-1.86) earlier than CG. This nutrition-sensitive child-owned poultry approach should be implemented where animal-source food intake is low.

Determinants of egg consumption by infants and young children in Ethiopia

OBJECTIVE

To identify determinants of egg consumption in infants and young children aged 6-23·9 months in Ethiopia.

DESIGN AND SETTING

Data used were from the cross-sectional baseline survey of an egg campaign in Ethiopia implemented by the Global Alliance for Improved Nutrition.

PARTICIPANTS

Children aged 6-23·9 months (n 453) were sampled. Data on socio-demographic characteristics, economic resources, caregiver's behaviour, child health and feeding practices, and egg consumption in the last 7 d were collected using interviewer-administered questionnaires. Multivariable ordinal logistic regression was used to examine the association between explanatory variables and egg consumption in the last 7 d.

RESULTS

About half of children (53·4 %) did not consume eggs in the last 7 d. The odds of children consuming eggs were 4·33 (P < 0·002) times higher when their caregivers had some college education compared with no education. Wealth was positively (OR, 1·13, P = 0·029) and household food insecurity was negatively (OR, 0·96, P = 0·117) associated with child egg consumption. Purchasing eggs (OR, 9·73, P < 0·001) and caregiver's positive behavioural determinants (OR, 1·37, P = 0·005) were associated with child egg consumption. The associations of socio-demographic characteristics and economic resources with egg consumption provide evidence of partial mediation through caregiver behaviour and child health.

CONCLUSIONS

About half of children aged 6-23·9 months consumed eggs. Availability of eggs in households, mainly through purchase, was strongly associated with egg consumption. Education of caregivers and household heads and economic resources were associated with egg consumption and may operate through caregiver behaviour.

The role of nutrition-sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study

Objective

The study aimed to investigate the role of nutrition-sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia.

Methods

An adequacy evaluation study was used to see changes between the baseline and end-line data after following for 1 year. A sample of 170 mother-child pairs who had a 1-year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model.

Results

A total of 170 and 270 mother-child dyads were interviewed at baseline and end-line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length-for-age Z-score which changed from -1.18 to -0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction.

Conclusions

Sustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition-sensitive agricultural and direct nutrition interventions along with behavioral-based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.

A biocultural examination of home food production and child growth in highland Peru

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.

Small-Scale Livestock Production in Nepal Is Directly Associated with Children's Increased Intakes of Eggs and Dairy, But Not Meat

Animal source foods (ASF) provide nutrients essential to child growth and development yet remain infrequently consumed in rural Nepal. Agriculture and nutrition programs aim to increase ASF intake among children through small-scale animal husbandry projects. The relationship between livestock ownership and children's consumption of ASF, however, is not well established. This study examined associations between livestock ownership and the frequency with which Nepali children consume eggs, dairy, and meat. We analyzed longitudinal 7-day food frequency data from sentinel surveillance sites of the Policy and Science of Health, Agriculture and Nutrition (PoSHAN) study. Data consisted of surveys from 485 Nepali farming households conducted twice per year for two years (a total of 1449 surveys). We used negative binomial regression analysis to examine the association between the number of cattle, poultry, and meat animals (small livestock) owned and children's weekly dairy, egg, and meat intakes, respectively, adjusting for household expenditure on each food type, mother's education level, caste/ethnicity, agroecological region, season, and child age and sex. We calculated predicted marginal values based on model estimates. Children consumed dairy 1.4 (95% CI 1.1-2.0), 2.3 (1.7-3.0) and 3.0 (2.1-4.2) more times per week in households owning 1, 2-4 and >4 cattle, respectively, compared to children in households without cattle. Children consumed eggs 2.8 (2.1-3.7) more times per week in households owning 1 or 2 chickens compared to children in households without chickens. Child intake of meat was higher only in households owning more than seven meat animals. Children's intakes of dairy, eggs, and meat rose with household expenditure on these foods. Small-scale animal production may be an effective strategy for increasing children's consumption of eggs and dairy, but not meat. Increasing household ability to access ASF via purchasing appears to be an important approach for raising children's intakes of all three food types.

Is It Possible to Promote Egg Consumption During Pregnancy? Findings From a Study on Knowledge, Perceptions, and Practices in Kenya

Background:

Eggs are nutrient rich and have the potential to improve maternal nutrition during pregnancy and birth outcomes, but cultural beliefs may inhibit consumption during pregnancy.

Objective:

To understand knowledge, attitudes, beliefs, practices, facilitators, and barriers related to consuming eggs during pregnancy in Kenya.

Methods:

The study had 3 phases. Phase I included in-depth interviews and free-listing and pile-sorting exercises with pregnant women (n = 36), husbands (n = 12), and mothers-in-law (n = 12) of pregnant women, and health providers (n = 24). Phase II involved egg preparation exercises with pregnant women (n = 39). Phase III involved a weeklong trial of egg consumption with pregnant women (n = 24). We used thematic content analysis methods to analyze qualitative data and tabulated quantitative data.

Results:

All participants recognized eggs as nutritious for pregnant women; 25% of pregnant women consumed eggs the previous day. However, participants believed eating too many eggs during pregnancy (1 or more eggs daily) leads to a large baby and delivery complications. Unaffordability and unavailability also inhibit consumption. Health workers are the most trusted source of information on maternal nutrition. Almost all women complied with the household trial, said they would continue eating eggs and would recommend eggs to other pregnant women in moderation.

Conclusions:

Although participants believed consuming eggs during pregnancy is beneficial, cultural norms, practices, and beliefs may prevent pregnant women from eating them daily. Interpersonal communication from health workers and agricultural policies to promote affordability could lead to increased consumption.

An egg for everyone: Pathways to universal access to one of nature's most nutritious foods

Eggs are a highly nutritious food but have been shown to be infrequently consumed in many low-income countries, especially by women and children. We collate country-level data on egg production, availability, consumption, prices, industry structure, and contextual trends and use these to estimate current patterns and likely future outcomes under four alternative scenarios. These scenarios are as follows: incremental change based on expected economic growth and urbanisation (the base scenario); enhanced productivity of independent small producers; aggregated production in egg hubs; and the accelerated spread of large-scale intensive production. All scenarios are modelled out to 2030 using a mix of regression and deterministic models. We find that children's consumption of eggs is highly correlated with national availability, and both are a function of egg prices. Eggs are unavailable, expensive, and infrequently consumed by children in much of South Asia and sub-Saharan Africa. The base scenario results in modest increases in production in low-income regions. Focusing efforts on independent small producers can only boost rural consumption in a handful of countries where poultry ownership is unusually high and would be expensive and logistically challenging to scale. Aggregation of production, with minimum flock sizes of 5,000 layers per farm, is a more promising pathway to increasing availability in rural areas. To meet the needs of urban populations, large-scale intensive production is needed. Intensive production brings down prices significantly, allowing many more poor households to access and consume eggs. Recent experience in countries such as Thailand confirms that this is both feasible and impactful.

Small-scale egg production centres increase children's egg consumption in rural Zambia

Animal source foods can efficiently enhance dietary quality, but they remain inaccessible and unaffordable for many women and young children in remote, low-income communities. We piloted an intervention in which 20 groups established egg production centres (EPCs) in their rural Zambian communities to increase the availability of eggs in the local food system. In a repeated cross-sectional design over 1 year (midline [4 months after the start of egg production] and endline [11 months]), we evaluated programme impact on household egg acquisition within those communities and on egg consumption and height-for-age z score (HAZ) among young children (6-36 months) using multilevel linear, logistic, and truncated negative binomial regression techniques. At midline, households in project areas were significantly more likely to consume eggs than those in control areas (OR 2.08, 95% CI [1.56, 2.78]), particularly those located within 250 m of the EPC. Similarly, children living in project communities were significantly more likely to consume eggs at midline than those in control areas (OR 5.53, 95% CI [2.90, 10.58]). Although increased over baseline, egg acquisition and consumption decreased by endline because of depressed egg production over time. There was no impact on children's HAZ, likely because of the short follow-up time and relatively modest "dose" of egg consumption. Although productivity can be improved, the EPC programme offers a novel approach to improving access to eggs in rural communities, and optimization of the production practices and marketing is needed to ensure that egg consumption translates to improved dietary quality, growth, and health.

Family poultry: Multiple roles, systems, challenges, and options for sustainable contributions to household nutrition security through a planetary health lens

Achieving sustainable production of eggs by family poultry production systems that meet both environmental health and welfare standards is a complex endeavour. Humans have been raising different species of poultry for thousands of years across many different agroecological zones. The Food and Agriculture Organization of the United Nations has identified four different family poultry production systems: small extensive, extensive, semi‐intensive, and intensive. Each of these systems varies in terms of inputs, outputs, gender dimensions, poultry health and welfare, and environmental impacts. This paper addresses key issues associated with the production of family poultry eggs in support of both improved maternal and child nutrition and sustainable, nutrition‐sensitive agricultural practices. It provides an overview of the history of poultry raising; characteristics of the different family poultry production systems; challenges and solutions to poultry production in low‐ and middle‐income countries; poultry husbandry (including breeds, nutrition, and shelter); infectious disease prevention and control in line with national and international animal health regulations; and food safety (microbial pathogens, toxins, and egg storage). To ensure that bird, human, and environmental health can flourish, it is essential for interdisciplinary research and development teams to work in collaboration with communities to ensure the long‐term environmental and economic sustainability of family poultry production enterprises that are a good fit with local circumstances.