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Nutrition is the number one health concern in Africa - and nutrition programs can be a magnet for attracting community support to the health system, especially maternal-child health programs. But nutrition is often a secondary concern of health policy, often ignored in food policy, and too often left out of training programs and work plans.
Until recently the role of women's social status in determining their children's nutritional health went largely unnoticed. That is, until researchers began to ponder the Asian Enigma- the question of why malnutrition is much more prevalent among children in South Asia than in Sub-Saharan Africa, even though South Asia surpasses Sub-Saharan Africa in most of the principal determinants of child nutrition. This report uses data from 36 countries in three developing regions to establish empirically that women's status, defined as women's power relative to men's, is an important determinant of children's nutritional status. It finds that the pathways through which status influences child nutrition and the strength of that influence differ considerably from one region to another. Where women's status is low, this research proves unequivocally that policies to eradicate gender discrimination not only benefit women but also their children.
In Sub-Saharan Africa, the scale of undernutrition is staggering; 58 million children under the age of five are too short for their age (stunted), and 14 million weigh too little for their height (wasted). Poor diets in terms of diversity, quality, and quantity, combined with illness and poor water and sanitation facilities, are linked with deficiencies of micronutrients—such as iodine, vitamin A, and iron—associated with growth, development, and immune function. In the short term, inequities in access to the determinants of nutrition increase the incidence of undernutrition and diarrheal disease. In the long term, the chronic undernutrition of children has important consequences for individuals and societies: a high risk of stunting, impaired cognitive development, lower school attendance rates, reduced human capital attainment, and a higher risk of chronic disease and health problems in adulthood. Inequities in access to services early in life contribute to the intergenerational transmission of poverty. Recent World Bank estimates suggest that the income penalty a country incurs for not having eliminated stunting when today’s workers were children is about 9†“10 percent of gross domestic product per capita in Sub-Saharan Africa. Much of the effort to date has focused on the costing, financing, and impact of nutrition-specific interventions delivered mainly through the health sector to reach the global nutrition targets for stunting, anemia, and breastfeeding, and interventions for treating wasting. However, the determinants of undernutrition are multisectoral, and the solution to undernutrition requires multisectoral approaches. An acceleration of the progress to reduce stunting in Sub-Saharan Africa requires engaging additional sectors—such as agriculture; education; social protection; and water, sanitation, and hygiene (WASH)—to improve nutrition. This book lays the groundwork for more effective multisectoral action by analyzing and generating empirical evidence to inform the joint targeting of nutrition-sensitive interventions. Using information from 33 recent Demographic and Health Surveys (DHS), measures are constructed to capture a child’s access to food security, care practices, health care, and WASH, to identify gaps in access among different socioeconomic groups; and to relate access to these nutrition drivers to nutrition outcomes. All Hands on Deck: Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africa addresses three main questions: • Do children have inadequate access to the underlying determinants of nutrition? • What is the association between stunting and inadequate food, care practices, health, and WASH access? • Can the sectors that have the greatest impact on stunting be identified? This book provides country authorities with a holistic picture of the gaps in access to the drivers of nutrition within countries to assist them in the formulation of a more informed, evidence-based, and balanced multisectoral strategy against undernutrition.
Many development programs that aim to alleviate poverty and improve investments in human capital consider womens empowerment a key pathway by which to achieve impact and often target women as their main beneficiaries. Despite this, womens empowerment dimensions are often not rigorously measured and are at times merely assumed. This paper starts by reflecting on the concept and measurement of womens empowerment and then reviews some of the structural interventions that aim to influence underlying gender norms in society and eradicate gender discrimination. It then proceeds to review the evidence of the impact of three types of interventionscash transfer programs, agricultural interventions, and microfinance programson womens empowerment, nutrition, or both. Qualitative evidence on conditional cash transfer (CCT) programs generally points to positive impacts on womens empowerment, although quantitative research findings are more heterogenous. CCT programs produce mixed results on long-term nutritional status, and very limited evidence exists of their impacts on micronutrient status. The little evidence available on unconditional cash transters (UCT) indicates mixed impacts on womens empowerment and positive impacts on nutrition; however, recent reviews comparing CCT and UCT programs have found little difference in terms of their effects on stunting and they have found that conditionality is less important than other factors, such as access to healthcare and child age and sex. Evidence of cash transfer program impacts depending on the gender of the transfer recipient or on the conditionality is also mixed, although CCTs with non-health conditionalities seem to have negative impacts on nutritional status. The impacts of programs based on the gender of the transfer recipient show mixed results, but almost no experimental evidence exists of testing gender-differentiated impacts of a single program. Agricultural interventionsspecifically home gardening and dairy projectsshow mixed impacts on womens empowerment measures such as time, workload, and control over income; but they demonstrate very little impact on nutrition. Implementation modalities are shown to determine differential impacts in terms of empowerment and nutrition outcomes. With regard to the impact of microfinance on womens empowerment, evidence is also mixed, although more recent reviews do not find any impact on womens empowerment. The impact of microfinance on nutritional status is mixed, with no evidence of impact on micronutrient status. Across all three types of programs (cash transfer programs, agricultural interventions, and microfinance programs), very little evidence exists on pathways of impact, and evidence is often biased toward a particular region. The paper ends with a discussion of the findings and remaining evidence gaps and an outline of recommendations for research.
Reducing undernutrition requires improving access to goods and services from a wide range of economic and social sectors, including agriculture, education and health. Yet despite broad agreement on the multisectoral nature of the global burden of undernutrition, relatively little research has analyzed how different dimensions of accessibility, such as urbanization and travel times to urban centers, affect child nutrition and dietary outcomes. In this paper we study these relationships in sub-Saharan Africa, a highly rural continent still severely hindered by remoteness problems. We link spatial data on travel times to 20,000 person cities to survey data from 10,900 communities in 23 countries. We document strong negative associations between nutrition indicators and rural livelihoods, but only moderately strong associations with remoteness to cities. Moreover, the harmful effects of remoteness and rural living largely disappear once education, wealth, and social/infrastructural services indicators are added to the model. This implies that the key nutritional disadvantage of rural populations stems chiefly from social and economic poverty. Combating these problems requires either an acceleration of urbanization processes, or finding innovative cost-effective mechanisms for extending basic services to isolated rural communities.
Undernutrition remains a major source of human suffering and an obstacle to national economic and human development in many African countries. This report investigates undernutrition's persistence, drawing on case studies of the public response to the problem in Ghana, Mozambique, Nigeria, and Uganda. Analyzing each nation's policymaking structures, political actors, understanding of undernutrition, and the timing of public responses, the author explains why none of these four nations has mounted an effective campaign to eliminate undernutrition. The author identifes several different causes of this shortcoming, with one underlying flaw in the various public responses standing out: a fundamental failure on the part of political leaders to see undernutrition as a grave problem that undermines development efforts in their nations. The author concludes that an effective response to undernutrition in these countries requires the formation of national advocacy coalitions that can raise public awareness of the problem, highlight policymakers' duty to ensure the nutrition of their citizens, and link proper nutrition to general national development. This report should serve as a resource for advocates, researchers, and others concerned with undernutrition in Africa.
"BACKGROUND:Undernutrition is one of the leading causes of death among children worldwide, estimated to have contributed to nearly half of under-5 deaths in 2019. Sub-Saharan Africa is the region with the highest prevalence of moderate-to-severe food insecurity at 55.6% and the highest prevalence of under-5 chronic malnutrition, or stunting, at 42.9%. Limited research has been conducted on the relationship between women's agency and women's and children's nutrition and food security status in sub-Saharan Africa. OBJECTIVES:The present thesis consists of three objectives: (I) develop context-specific models of women's agency; (II) estimate the association between women's agency and (a) women's and children's nutrition and (b) women's food insecurity status; and (III) estimate the association between women's and men's concordance on notions of women's agency and (a) women's and men's dietary diversity and (b) women's food insecurity status. METHODS:The data used for this thesis comes from a cross-sectional survey in Ethiopia, Malawi, Mozambique, and Zambia. In total, 1,261 households in Ethiopia, 708 households in Malawi, 735 households in Zambia, and 1,262 households in Mozambique were surveyed. I used confirmatory factor analysis to build country-specific measurement models for women's agency. I estimated agency scores that were used to model the association between women's agency and women's and children's nutrition and food security. For the third objective, I estimated the association between couples' agreement on domains of women's agency and women's and men's dietary diversity and women's food insecurity experience. RESULTS:The best-fitting models estimated for women's agency in Objective I were different for each country; and domains of agency were not always correlated with conventional measures of women's empowerment. The analyses conducted for Objective II yielded mixed results for the association between women's agency and women's and children's nutrition and food security outcomes. For women's nutrition, the strongest associations were found between women's decision-making and women's nutrition status, with the relationship being positive in some instances and negative in others. Decision-making was associated with an increased risk of children's malnutrition in some countries and a decreased risk in others. While agency was consistently associated with increased dietary diversity in women and children, results for the association between women's agency and women's food insecurity experience were mixed. In my third study, domestic partner concordance on gender-based attitudes improved dietary diversity for women and men in three of the four countries, but was not associated with women's food insecurity experience. Lastly, partner concordance on women's decision-making was differentially associated with women's and men's dietary diversity and women's food insecurity experience both within and between countries. CONCLUSIONS:The findings of my study support a shift away from standardized measures of women's agency towards more nuanced, context-specific and, most importantly, culturally valid alternatives. Results for the association between domains of women's agency and measures of nutrition, dietary diversity, and food insecurity were mixed. The variation of findings--between countries and between different domains of agency in a single country--supports the notion that a given construct of agency can represent distinct phenomena in different settings. Further, my results support the treatment of anthropometry, dietary diversity, and food insecurity as separate, yet interrelated facets of nutrition. Future research would benefit from a more in-depth understanding of how women internalize theoretical constructs of agency and, subsequently, how assertions of agency impact women's and children's nutrition and food security status"--
Author : Dean T. Jamison Publisher : World Bank Publications Page : 414 pages File Size : 50,90 MB Release : 2006-01-01 Category : Medical ISBN : 0821363980
Current data and trends in morbidity and mortality for the sub-Saharan Region as presented in this new edition reflect the heavy toll that HIV/AIDS has had on health indicators, leading to either a stalling or reversal of the gains made, not just for communicable disorders, but for cancers, as well as mental and neurological disorders.
While there has been substantial progress in reducing global poverty in recent years, hundreds of millions of vulnerable children remain trapped in extreme poverty. This is especially the case on the African continent, where children account for the majority and growing proportion of the population. Despite rapid economic growth in several African countries, as well as significant achievements in both development and humanitarian interventions, a staggering number of African children remain vulnerable to extreme levels of deprivation. Existing challenges notwithstanding, a number of social policies and programmes proved successful in alleviating the burden of child poverty and deprivation. In addition to being vitally important in promoting and protecting children's rights, these social policies and programmes embody the international community's commitment to achieve the Social Development Goals (SDGs) and ensuring no one is left behind. What Works for Africa's Poorest Children? From Measurement to Action identifies the social policies and programmes that are most effective in supporting Africa's poorest and most vulnerable children, and examines the key features underpinning their documented success. It provides cutting edge examples on how we can identify child poverty and deprivation, analyses innovative ultra-poor child sensitive programmes, and provides new public financing and governance rights suggestions for child poverty elimination.