Publications by authors named "Harriet Torlesse"

15 Publications

  • Page 1 of 1

A Qualitative Inquiry into the Eating Behavior and Physical Activity of Adolescent Girls and Boys in Indonesia.

Food Nutr Bull 2021 06;42(1_suppl):S122-S131

106202UNICEF Indonesia, Jakarta, Indonesia.

Background: Despite the rising double burden of malnutrition, adolescent nutrition has received little attention in Indonesia. Eating and physical activity behaviors established in adolescence are known to track into adulthood and may contribute to chronic diseases in later life. This study aimed to explore the eating behaviors and physical activity of Indonesian adolescents, and their influencing factors.

Methods: The study, designed as a qualitative study, was conducted in 2 selected districts in Indonesia: Klaten and Lombok Barat. Data were collected through immersion, open and informal discussions, and participant observations with 302 adolescent girls and boys.

Results: The eating and physical activity behaviors of adolescent boys and girls are influenced by contextual changes in their family lifestyles and environment. The adolescents in this study only conflate physical activity with participation in sport. Even when a wider view of physical activity is cast, their level of physical activity remains low, especially for adolescent girls. Adolescents and their families generally eat 3 meals a day, with schools an important source of food for adolescents. Adolescents skip breakfast at home, and breakfast and lunch are usually purchased and eaten at school. Fewer families cook and families rarely eat together due to increasingly busy lives, increased mobility, and digital connectivity.

Conclusions: The rapid contextual shifts taking place in Indonesia influence the home, school, and peer environment to shape eating behaviors and physical activity among adolescent boys and girls. Gender-responsive multicomponent school-based interventions have the potential to serve as an important entry point for influencing adolescent nutrition.
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http://dx.doi.org/10.1177/0379572121990948DOI Listing
June 2021

A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges.

Matern Child Nutr 2021 Mar 24:e13173. Epub 2021 Mar 24.

Nutrition Section, United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal.

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
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http://dx.doi.org/10.1111/mcn.13173DOI Listing
March 2021

Affordability of nutritious foods for complementary feeding in South Asia.

Nutr Rev 2021 03;79(Suppl 1):52-68

United Nations Children's Fund, Regional Office for South Asia, Kathmandu, Nepal.

The high prevalence of stunting and micronutrient deficiencies among children in South Asia has lifelong health, educational, and economic consequences. For children aged 6-23 months, undernutrition is influenced by inadequate intake of complementary foods containing nutrients critical for growth and development. The affordability of nutrients lacking in young children's diets in Bangladesh, India, and Pakistan was assessed in this study. Using data from nutrient gap assessments and household surveys, household food expenditures were compared with the cost of purchasing foods that could fill nutrient gaps. In all 3 countries, there are multiple affordable sources of vitamin A (orange-fleshed vegetables, dark leafy greens, liver), vitamin B12 (liver, fish, milk), and folate (dark leafy greens, liver, legumes, okra); few affordable sources of iron and calcium (dark leafy greens); and no affordable sources of zinc. Affordability of animal-source protein varies, with several options in Pakistan (fish, chicken, eggs, beef) and India (fish, eggs, milk) but few in Bangladesh (eggs). Approaches to reduce prices, enhance household production, or increase incomes are needed to improve affordability.
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http://dx.doi.org/10.1093/nutrit/nuaa139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948078PMC
March 2021

Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment.

Nutr Rev 2021 03;79(Suppl 1):26-34

United Nations Children's Fund (UNICEF), New York, New York, USA.

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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http://dx.doi.org/10.1093/nutrit/nuaa144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947968PMC
March 2021

Multisectoral nutrition planning in Nepal: Evidence from an organizational network analysis.

Matern Child Nutr 2021 Mar 4:e13112. Epub 2021 Mar 4.

Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal.

Multisectoral approaches are central to the global Scaling Up Nutrition (SUN) movement and the Sustainable Development Goals. Nepal joined SUN in 2011 and approved the first 5-year Multisectoral Nutrition Plan (MSNP) in 2012, covering 2013-2017. This mixed methods study draws on organizational network analysis (ONA) and qualitative interviews with a sample of 22 organizations to examine (1) levels of engagement and network dynamics among government sectors and development organizations and (2) milestones and processes in the development and implementation of Nepal's MSNP. Findings suggest that the development of the MSNP was related to the high density of organizational connections; the leadership role of the Nepal's National Planning Commission and the National Nutrition and Food Security Secretariat; and the bridging roles played by a few government ministries and UN agencies that linked organizations that did not have direct relationships with each other. Specialized roles were observed for the three types of working relationships: policy dialogue, strategic planning and implementation. Partners were less connected on MSNP implementation than for policy dialogue and strategic planning, which may have constrained collaborative scale-up efforts. The Ministry of Agricultural Development, in particular, was the conduit for connecting non-health sectors into the broader network. Our study offers insights into the structure and dynamics of multisectoral planning in Nepal. It also contributes to a small but growing literature that illustrates how ONA can be applied to measure and use network results to elucidate the processes for strengthening multisectoral planning and implementation of nutrition-specific and nutrition-sensitive interventions.
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http://dx.doi.org/10.1111/mcn.13112DOI Listing
March 2021

The quality of maternal nutrition and infant feeding counselling during antenatal care in South Asia.

Matern Child Nutr 2021 07 7;17(3):e13153. Epub 2021 Feb 7.

Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.

Antenatal care (ANC) provides a platform to counsel pregnant women on maternal nutrition and to prepare the mother to breastfeed. Recent reviews suggest that gaps in the coverage and quality of counselling during pregnancy may partly explain why services do not consistently translate to improved behavioural outcomes in South Asia. This scoping literature review collates evidence on the coverage and quality of counselling on maternal nutrition and infant feeding during ANC in five South Asian countries and the effectiveness of approaches to improve the quality of counselling. Coverage data were extracted from the most recent national surveys, and a scoping review of peer-reviewed and grey literature (1990-2019) was conducted. Only Afghanistan and Pakistan have survey data on the coverage of counselling on both maternal nutrition and breastfeeding, nine studies described the quality of counselling and three studies assessed the effectiveness of interventions to improve the quality of services. This limited body of evidence suggests that inequalities in access to services, gaps in capacity building opportunities for frontline workers and the short duration and frequency of counselling contracts constrain quality, while the format, duration, frequency and content of health worker training, together with supportive supervision, are probable approaches to improve quality. Greater attention is needed to integrate indicators into monitoring and supervision mechanisms, periodic surveys and programme evaluations to assess the status of and track progress in improving quality and to build accountability for quality counselling, while research is needed to understand how best to assess and strengthen quality in specific settings.
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http://dx.doi.org/10.1111/mcn.13153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189234PMC
July 2021

Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age.

Matern Child Nutr 2020 10 24;16 Suppl 2:e12741. Epub 2020 Aug 24.

Nutrition Section, UNICEF Regional Office for South Asia, Lekhnath Marg, Kathmandu, Nepal.

Growing evidence suggests that household sanitation is associated with child nutritional status in low- and middle-income countries. This paper examined whether household access to improved sanitation facilities and sources of drinking water was associated with stunting and anaemia amongst children aged 6-35 months of age in Indonesia. The sample for the analysis comprised 1,450 children aged 6-35 months who participated in the end-line survey of the maternal and young child nutrition security project in Asia, conducted in three selected districts in Indonesia. Logistic regression models were used to determine the association between household sanitation and water source, and stunting and anaemia. Approximately 26% and 56% of children 6-35 months of age were stunted and anaemic, respectively. Children living in a household with improved sanitation facilities had 29% reduced odds of being stunted compared with those in a household with unimproved sanitation facilities, after adjusting for potential confounders including child's age and gender, maternal education, and iron-folic acid supplementation, as well as household wealth status and source of drinking water (OR = 0.68, 95% CI:0.48-0.96). No association between household sanitation and childhood anaemia was observed. Source of drinking water was not associated with stunting or anaemia amongst children. There were no synergistic effects of household sanitation and water supply on stunting and anaemia. This suggests that efforts to improve household sanitation condition may need to be considered an essential, integral part of the programmatic responses by governments and development partners for the prevention of childhood nutritional status. Further randomised research is necessary to determine the causal link.
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http://dx.doi.org/10.1111/mcn.12741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591307PMC
October 2020

Effectiveness of programme approaches to improve the coverage of maternal nutrition interventions in South Asia.

Matern Child Nutr 2018 11;14 Suppl 4:e12699

Global Technical Services, Nutrition International, Ottawa, Canada.

The nutritional status of women before pregnancy, during pregnancy, and after delivery has far reaching consequences for maternal health and child survival, growth, and development. In South Asia, the high prevalence of short stature, thinness, and anaemia among women of reproductive age underlie the high prevalence of child undernutrition in the region, whereas overweight and obesity are rising concerns. A systematic review of evidence (2000-2017) was conducted to identify barriers and programme approaches to improving the coverage of maternal nutrition interventions in the region. The search strategy used 13 electronic bibliographic databases and 14 websites of development and technical agencies and identified 2,247 citations. Nine studies conducted in Bangladesh (n = 2), India (n = 5), Nepal (n = 1), and Pakistan (n = 1) were selected for the review, and outcomes included the receipt and consumption of iron and folic acid and calcium supplements and the receipt of information on dietary intake during pregnancy. The studies indicate that a range of barriers acting at the individual (maternal), household, and health service delivery levels affects intervention coverage during pregnancy. Programme approaches that were effective in improving intervention coverage addressed barriers at multiple levels and had several common features: use of formative research and client assessments to inform the design of programme approaches and actions; community-based delivery platforms to increase access to services; engagement of family members, as well as pregnant women, in influencing behavioural change; actions to improve the capacity, supervision, monitoring, and motivation of front-line service providers to provide information and counselling; and access to free supplements.
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http://dx.doi.org/10.1111/mcn.12699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519063PMC
November 2018

Effectiveness of programmes and interventions to support optimal breastfeeding among children 0-23 months, South Asia: A scoping review.

Matern Child Nutr 2018 11;14 Suppl 4:e12697

Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.

Most children in South Asia are breastfed at some point in their lives; however, many are not breastfed optimally, including the early initiation of breastfeeding (EIBF) within 1 hr of birth, avoidance of prelacteal feeds (APF), exclusive breastfeeding (EBF) for 6 months, and continued breastfeeding (CBF) up to 2 years of age or beyond. This review identifies and collates evidence on the effectiveness of interventions to support optimal breastfeeding in five countries in South Asia: Afghanistan, Bangladesh, India, Nepal, and Pakistan. A scoping review was conducted of peer-reviewed and grey literature. The 31 eligible studies included randomized trials and quasi-experimental designs that were conducted between 1990 and 2015. Data were collated regarding intervention design, characteristics, and effectiveness to support EIBF, APF, EBF, and CBF. Most studies reported a positive impact on breastfeeding outcomes, including 21/25 studies that examined EIBF, 15/19 studies that examined EBF, and 10/10 studies that examined APF. The only study that examined CBF reported no effect. Education, counselling, and maternal, newborn, and child health initiatives were common intervention types with positive effects on breastfeeding outcomes. Interventions were delivered in health facility, community, and home/family environments. Programmes and interventions that reached women and their families with repeated exposure and beginning during pregnancy were more likely to improve EIBF and EBF outcomes. Interventions with no impact on breastfeeding were characterized by short duration, irregular frequency, inappropriate timing, poor coverage, and targeting.
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http://dx.doi.org/10.1111/mcn.12697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519148PMC
November 2018

Trends and predictors of optimal breastfeeding among children 0-23 months, South Asia: Analysis of national survey data.

Matern Child Nutr 2018 11;14 Suppl 4:e12698

Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.

Optimal breastfeeding practices, including early initiation of breastfeeding (EIBF) within 1 hr of birth, exclusive breastfeeding (EBF) for the first 6 months of age, and continued breastfeeding (CBF) for 2 years of age or beyond with appropriate complementary foods, are essential for child survival, growth, and development. Breastfeeding norms differ within and between countries in South Asia, and evidence is needed to inform actions to protect, promote, and support optimal practices. This study examines time trends and predictors of EIBF, avoidance of prelacteal feeding (APF), EBF, and CBF to 2 years using survey data from Afghanistan, Bangladesh, India, Nepal, and Pakistan since 1990. EIBF, APF, and EBF increased in Bangladesh, India, and Nepal from 1990 to 2016. EIBF and EBF increased in Pakistan from 1990 to 2013, but both EIBF and APF decreased in recent years. In Afghanistan, EIBF, APF, and EBF decreased from 2010 to 2015. CBF remained fairly constant across the region although prevalence varied by country. Significant (p < 0.05) predictors of suboptimal practices included caesarian delivery (4-25%), home delivery, small size at birth, and low women's empowerment. Wealth, ethnic group, and caste had varied associations with breastfeeding. Progress towards optimal breastfeeding practices is uneven across the region and is of particular concern in Afghanistan and Pakistan. There are some common predictors of breastfeeding practices across the region, however country-specific predictors also exist. Policies, programs, and research should focus on improving breastfeeding in the context of women's low empowerment and strategies to support breastfeeding of infants born small or by caesarian section, in addition to country-specific actions.
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http://dx.doi.org/10.1111/mcn.12698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519202PMC
November 2018

Aiming higher for maternal and child nutrition in South Asia.

Matern Child Nutr 2018 11;14 Suppl 4:e12739

Nutrition Section, Programme Division, UNICEF, New York, New York.

The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016-2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.
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http://dx.doi.org/10.1111/mcn.12739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588023PMC
November 2018

Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction.

BMC Public Health 2016 07 29;16:669. Epub 2016 Jul 29.

UNICEF Indonesia, World Trade Center 6 (10th Floor), Jalan Jenderal Sudirman Kav. 31, Jakarta, 12920, Indonesia.

Background: Stunting in early life has considerable human and economic costs. The purpose of the study was to identify factors associated with stunting among children aged 0-23 months in Indonesia to inform the design of appropriate policy and programme responses.

Methods: Determinants of child stunting, including severe stunting, were examined in three districts in Indonesia using data from a cross-sectional survey conducted in 2011. A total of 1366 children were included. The analysis used multiple logistic regression to determine unadjusted and adjusted odds ratios.

Results: The prevalence of stunting and severe stunting was 28.4 % and 6.7 %, respectively. The multivariate analysis on determinants of stunting identified a significant interaction between household sanitary facility and household water treatment (P for interaction = 0.007) after controlling for potential covariates: in households that drank untreated water, the adjusted odds on child stunting was over three times higher if the household used a unimproved latrine (adjusted odds ratio 3.47, 95 % confidence interval 1.73-7.28, P <0.001); however, in households that drank treated water, the adjusted odds on child stunting was not significantly higher if the household used an unimproved latrine (adjusted odds ratio 1.27, 95 % confidence interval 0.99-1.63, P = 0.06). Other significant risk factors included male sex, older child age and lower wealth quintile. The risk factors for severe stunting included male sex, older child age, lower wealth quintile, no antenatal care in a health facility, and mother's participation in decisions on what food was cooked in the household.

Conclusions: The combination of unimproved latrines and untreated drinking water was associated with an increased odds on stunting in Indonesia compared with improved conditions. Policies and programmes to address child stunting in Indonesia must consider water, sanitation and hygiene interventions. Operational research is needed to determine how best to converge and integrate water, sanitation and hygiene interventions into a broader multisectoral approach to reduce stunting in Indonesia.
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http://dx.doi.org/10.1186/s12889-016-3339-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966764PMC
July 2016

Association of Safe Disposal of Child Feces and Reported Diarrhea in Indonesia: Need for Stronger Focus on a Neglected Risk.

Int J Environ Res Public Health 2016 Mar 11;13(3). Epub 2016 Mar 11.

UNICEF Indonesia, World Trade Center 6, Jalan Jenderal Sudirman Kav. 31, Jakarta 12920, Indonesia.

Indonesia still faces several challenges in the areas of water, sanitation, and hygiene (WASH). Diarrhea remains a major killer of children and it is important to understand the local diarrhea transmission pathways to prioritise appropriate WASH interventions to reduce diarrhea burden. This study used a cross-sectional data set from a recent national household survey (the 2012 Indonesia Demographic and Health Survey) to examine the associations between diarrhea in children aged less than 24 months with WASH interventions and population characteristics. Unsafe disposal of child feces was strongly associated with an increased odds of child diarrhea (OR: 1.46; 95% CI: 1.18-1.82, p = 0.001). However, other WASH practices were not found to be associated. The findings underline the dangers of unsafe disposal of child feces and highlight the need for strengthening the related policies and program strategies and their implementation.
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http://dx.doi.org/10.3390/ijerph13030310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808973PMC
March 2016

Long-term intermittent multiple micronutrient supplementation enhances hemoglobin and micronutrient status more than iron + folic acid supplementation in Bangladeshi rural adolescent girls with nutritional anemia.

J Nutr 2010 Oct 11;140(10):1879-86. Epub 2010 Aug 11.

Department of Family Sciences, College for Women, Kuwait University, Safat 13060, Kuwait.

Previous short-term supplementation studies showed no additional hematologic benefit of multiple micronutrients (MMN) compared with iron + folic acid (IFA) in adolescent girls. This study examines whether long-term once- or twice-weekly supplementation of MMN can improve hemoglobin (Hb) and micronutrient status more than twice-weekly IFA supplementation in anemic adolescent girls in Bangladesh. Anemic girls (n = 324) aged 11-17 y attending rural schools were given once- or twice-weekly MMN or twice-weekly IFA, containing 60 mg iron/dose in both supplements, for 52 wk in a randomized double-blind trial. Blood samples were collected at baseline and 26 and 52 wk. Intent to treat analysis showed no significant difference in the Hb concentration between treatments at either 26 or 52 wk. However, after excluding girls with hemoglobinopathy and adjustment for baseline Hb, a greater increase in Hb was observed with twice-weekly MMN at 26 wk (P = 0.045). Although all 3 treatments effectively reduced iron deficiency, once-weekly MMN produced significantly lower serum ferritin concentrations than the other treatments at both 26 and 52 wk. Both once- and twice-weekly MMN significantly improved riboflavin, vitamin A, and vitamin C status compared with IFA. Overall, once-weekly MMN was less efficacious than twice-weekly MMN in improving iron, riboflavin, RBC folic acid, and vitamin A levels. Micronutrient supplementation beyond 26 wk was likely important in sustaining improved micronutrient status. These findings highlight the potential usefulness of MMN intervention in this population and have implications for programming.
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http://dx.doi.org/10.3945/jn.109.119123DOI Listing
October 2010

Association of household rice expenditure with child nutritional status indicates a role for macroeconomic food policy in combating malnutrition.

J Nutr 2003 May;133(5):1320-5

Helen Keller International, Gulshan 1212, Dhaka, Bangladesh.

Macroeconomic food policies have the potential to reduce malnutrition by improving access to food, a determinant of nutritional status. However, very little is understood about the mechanisms and the magnitude of the effects of macroeconomic food policies such as food price policies on nutritional status. Data collected by the Nutritional Surveillance Project on a total of 81,337 children aged 6-59 mo in rural Bangladesh between 1992 and 2000 were used to examine how changes in rice price affect child underweight. Rice consumption per capita declined only slightly during the period but rice expenditure per capita varied widely due to fluctuations in rice price. Rice expenditure was positively correlated with the percentage of underweight children (r = 0.91, P = 0.001). Households were found to spend more on nonrice foods as their rice expenditure declined, and nonrice expenditure per capita was negatively correlated with the percentage of underweight children (r = -0.91, P = 0.001). Expenditure on nonrice foods per capita increased with the frequency with which nonrice foods were consumed (P < 0.05) and with the diversity of the diet (P < 0.001). The findings suggest that the percentage of underweight children declined when rice expenditure fell because households were able to spend more on nonrice foods and thereby increase the quantity and quality of their diet. We hypothesize that macroeconomic food policies that keep the price of food staples low can contribute toward reducing child underweight.
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http://dx.doi.org/10.1093/jn/133.5.1320DOI Listing
May 2003
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