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"Pearson, Ruth"
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Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis
Background
Sustainable Development Goal (SDG) 2.2 calls for an end to all forms of malnutrition, with 2025 targets of a 40% reduction in stunting (relative to 2012), for wasting to occur in less than 5% of children, and for a 50% reduction in anaemia in women (15–49 years). We assessed the likelihood of countries reaching these targets by scaling up proven interventions and identified priority interventions, based on cost-effectiveness.
Methods
For 129 countries, the Optima Nutrition model was used to compare 2019–2030 nutrition outcomes between a status quo (maintained intervention coverage) scenario and a scenario where outcome-specific interventions were scaled up to 95% coverage over 5 years. The average cost-effectiveness of each intervention was calculated as it was added to an expanding package of interventions.
Results
Of the 129 countries modelled, 46 (36%), 66 (51%) and 0 (0%) were on track to achieve the stunting, wasting and anaemia targets respectively. Scaling up 18 nutrition interventions increased the number of countries reaching the SDG 2.2 targets to 50 (39%), 83 (64%) and 7 (5%) respectively. Intermittent preventative treatment of malaria during pregnancy (IPTp), infant and young child feeding education, vitamin A supplementation and lipid-based nutrition supplements for children produced 88% of the total impact on stunting, with average costs per case averted of US$103, US$267, US$556 and US$1795 when interventions were consecutively scaled up, respectively. Vitamin A supplementation and cash transfers produced 100% of the total global impact on
prevention
of wasting, with average costs per case averted of US$1989 and US$19,427, respectively. IPTp, iron and folic acid supplementation for non-pregnant women, and multiple micronutrient supplementation for pregnant women produced 85% of the total impact on anaemia prevalence, with average costs per case averted of US$9, US$35 and US$47, respectively.
Conclusions
Prioritising nutrition investment to the most cost-effective interventions within the country context can maximise the impact of funding. A greater focus on complementing nutrition-specific interventions with nutrition-sensitive ones that address the social determinants of health is critical to reach the SDG targets.
Journal Article
A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children’s consumption of fruit: a cluster randomised trial
Background
Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria.
Methods
Four primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children’s (
N
= 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake.
Results
Significant increases were recorded in the intervention schools for children’s consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition.
Conclusions
These results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools.
Trial registration
AsPredicted: 3943 05/02/2017. URL:
https://aspredicted.org/see_one.php?a_id=3943
Journal Article
Thailand's hidden workforce
Millions of Burmese women migrate into Thailand each year to form the basis of the Thai agricultural and manufacturing workforce. Un-documented and unregulated, this army of migrant workers constitutes the ultimate 'disposable' labour force, enduring grueling working conditions and much aggression from the Thai police and immigration authorities. This insightful book ventures into a part of the global economy rarely witnessed by Western observers. Based on unique empirical research, it provides the reader with a gendered account of the role of women migrant workers in Thailand's factories and interrogates the ways in which they manage their families and their futures.
eBook
Optima Nutrition: an allocative efficiency tool to reduce childhood stunting by better targeting of nutrition-related interventions
Background
Child stunting due to chronic malnutrition is a major problem in low- and middle-income countries due, in part, to inadequate nutrition-related practices and insufficient access to services. Limited budgets for nutritional interventions mean that available resources must be targeted in the most cost-effective manner to have the greatest impact. Quantitative tools can help guide budget allocation decisions.
Methods
The Optima approach is an established framework to conduct resource allocation optimization analyses. We applied this approach to develop a new tool, ‘
Optima Nutrition’,
for conducting allocative efficiency analyses that address childhood stunting. At the core of the Optima approach is an epidemiological model for assessing the burden of disease; we use an adapted version of the
Lives Saved Tool
(LiST). Six nutritional interventions have been included in the first release of the tool: antenatal micronutrient supplementation, balanced energy-protein supplementation, exclusive breastfeeding promotion, promotion of improved infant and young child feeding (IYCF) practices, public provision of complementary foods, and vitamin A supplementation. To demonstrate the use of this tool, we applied it to evaluate the optimal allocation of resources in 7 districts in Bangladesh, using both publicly available data (such as through DHS) and data from a complementary costing study.
Results
Optima Nutrition can be used to estimate how to target resources to improve nutrition outcomes. Specifically, for the Bangladesh example, despite only limited nutrition-related funding available (an estimated $0.75 per person in need per year), even without any extra resources, better targeting of investments in nutrition programming could increase the cumulative number of children living without stunting by 1.3 million (an extra 5%) by 2030 compared to the current resource allocation. To minimize stunting, priority interventions should include promotion of improved IYCF practices as well as vitamin A supplementation. Once these programs are adequately funded, the public provision of complementary foods should be funded as the next priority. Programmatic efforts should give greatest emphasis to the regions of Dhaka and Chittagong, which have the greatest number of stunted children.
Conclusions
A resource optimization tool can provide important guidance for targeting nutrition investments to achieve greater impact.
Journal Article
Maximizing the impact of malaria funding through allocative efficiency: using the right interventions in the right locations
Background
The high burden of malaria and limited funding means there is a necessity to maximize the allocative efficiency of malaria control programmes. Quantitative tools are urgently needed to guide budget allocation decisions.
Methods
A geospatial epidemic model was coupled with costing data and an optimization algorithm to estimate the optimal allocation of budgeted and projected funds across all malaria intervention approaches. Interventions included long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), intermittent presumptive treatment during pregnancy (IPTp), seasonal mass chemoprevention in children (SMC), larval source management (LSM), mass drug administration (MDA), and behavioural change communication (BCC). The model was applied to six geopolitical regions of Nigeria in isolation and also the nation as a whole to minimize incidence and malaria-attributable mortality.
Results
Allocative efficiency gains could avert approximately 84,000 deaths or 15.7 million cases of malaria in Nigeria over 5 years. With an additional US$300 million available, approximately 134,000 deaths or 37.3 million cases of malaria could be prevented over 5 years. Priority funding should go to LLINs, IPTp and BCC programmes, and SMC should be expanded in seasonal areas. To minimize mortality, treatment expansion is critical and prioritized over some LLIN funding, while to minimize incidence, LLIN funding remained a priority. For areas with lower rainfall, LSM is prioritized over IRS but MDA is not recommended unless all other programmes are established.
Conclusions
Substantial reductions in malaria morbidity and mortality can be made by optimal targeting of investments to the right malaria interventions in the right areas.
Journal Article
Participants’ Roles in Bullying Among 7–11 Year Olds: Results from a UK-Wide Randomized Control Trial of the KiVa School-Based Program
This paper describes the social architecture model of school-based bullying behavior. The model proposes that the behavior of all students affects rates of bullying. Alongside self-reported victims and bullies, the model identified four bystander roles: assistant, reinforcer, outsider, and defender. The level of support for bullies varies based on school policies that address bullying and promote school connectedness. The universal components of the KiVa school-based anti-bullying program designed to teach pupils to stand against bullying are described. The Stand Together trial, a UK-based randomized controlled trial, recruited 11,000+ students from 118 schools across the UK, half of whom received the KiVa program whilst the remainder delivered usual practice to address bullying. The main trial results reported a significant reduction in victimization in favor of KiVa. This paper examines data collected on the pupil-reported Participant Role Questionnaire (PRQ), one of the secondary measures used to explore whether significant reductions in victimization were accompanied by changes in bystander behavior. The results showed reductions in the student response rates of self-identified roles as bullies, assistants, and reinforcers in favor of KiVa, but outsider roles increased, and defender roles reduced. This provides tentative support for the social architecture model as taught in the Stand Together KiVa trial but also suggests that further work needs to be conducted to support the development of defender behaviors and address this important public health challenge.
Journal Article
transcending the impact of the financial crisis in the United Kingdom: towards plan F—a feminist economic strategy
This paper sets out a framework for understanding the impacts of the financial crisis and its aftermath that is based on the idea of three interacting spheres: finance, production and reproduction. All of these spheres are gendered and globalised. The gendered impact of the current crisis is discussed in terms of the impact on unemployment, employment protection and security, public sector services, social security benefits, pensions, and the real value of wages and living standards. Drawing on the analysis of the UK Women's Budget Group, the paper demonstrates that the biggest falls in disposable income as the result of austerity policies by the Conservative-led government since 2010 have been borne by the most vulnerable women—lone mothers, single women pensioners and single women without children. Working-age couples without children have been least affected. The paper then goes on to discuss what an alternative economic strategy, based on feminist political economy, might look like. It utilises the notion of the 'reproductive bargain', first developed to understand the transition in Cuba in the 1990s. It sets out a possible feminist economic strategy that insists on the incorporation of reproductive and care work into the analysis of alternative economic policies and links employment, wages and social security payments to public provisioning of transgenerational reproductive services. It suggests feasible strategies to finance the proposed Plan F—a feminist economic strategy.
Journal Article
Host Genetics and Environmental Factors Regulate Ecological Succession of the Mouse Colon Tissue-Associated Microbiota
The integration of host genetics, environmental triggers and the microbiota is a recognised factor in the pathogenesis of barrier function diseases such as IBD. In order to determine how these factors interact to regulate the host immune response and ecological succession of the colon tissue-associated microbiota, we investigated the temporal interaction between the microbiota and the host following disruption of the colonic epithelial barrier.
Oral administration of DSS was applied as a mechanistic model of environmental damage of the colon and the resulting inflammation characterized for various parameters over time in WT and Nod2 KO mice.
In WT mice, DSS damage exposed the host to the commensal flora and led to a migration of the tissue-associated bacteria from the epithelium to mucosal and submucosal layers correlating with changes in proinflammatory cytokine profiles and a progressive transition from acute to chronic inflammation of the colon. Tissue-associated bacteria levels peaked at day 21 post-DSS and declined thereafter, correlating with recruitment of innate immune cells and development of the adaptive immune response. Histological parameters, immune cell infiltration and cytokine biomarkers of inflammation were indistinguishable between Nod2 and WT littermates following DSS, however, Nod2 KO mice demonstrated significantly higher tissue-associated bacterial levels in the colon. DSS damage and Nod2 genotype independently regulated the community structure of the colon microbiota.
The results of these experiments demonstrate the integration of environmental and genetic factors in the ecological succession of the commensal flora in mammalian tissue. The association of Nod2 genotype (and other host polymorphisms) and environmental factors likely combine to influence the ecological succession of the tissue-associated microflora accounting in part for their association with the pathogenesis of inflammatory bowel diseases.
Journal Article
Corporate Responsibility and Labour Rights
The emergence of voluntary corporate codes of conduct since the early 1990s is both a manifestation of and a response to the process of globalization. They have been part of a more general shift away from state regulation of transnational corporations towards corporate self-regulation in the areas of labour and environmental standards and human rights. This work provides a critical perspective on the growth and significance of corporate codes with a particular focus on working conditions and labour rights. It brings together work by academics, practitioners and activists.
eBook