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High levels of child malnutrition in developing countries contribute to mortality and have long-term consequences for children’s cognitive development and earnings as adults. Recent impact evaluations show that many different interventions have had an impact on children’s anthropometric outcomes (height, weight, and birth weight), but there is no simple answer to the question “What works?” to address the problem. Similar interventions have widely different results in different settings, owing to differences in local context, the causes and severity of malnutrition, and the capacity for program implementation.Impact evaluations of programs supported by the Bank, which are generally large-scale, complex inter-ventions in low-capacity settings, show equally variable results. The findings confirm that it should not be assumed that an intervention found effective in a randomized medical setting will have the same effects when implemented under field conditions. There are many robust experimental and quasi-experimental methods for assessing impact under difficult circumstances often found in field settings.The relevance and impact of nutrition impact evaluations could be enhanced by collecting data on service delivery, demand-side behavioral outcomes, and implementation processes to better understand the causal chain and what part of the chain is weak, in parallel with impact evaluations. It is also important to understand better the distribution of impacts, particularly among the poor, and to document better the costs and effectiveness of interventions.High levels of child malnutrition in developing countries are contributing to mortality and present long-term consequences for the survivors. An estimated 178 million children under age 5 in developing countries are stunted (low height for age) and 55 million are wasted (low weight for height). Malnutrition makes children more susceptible to illness and strongly affects child mortality. Beyond the mortality risk in the short run, the developmental delays caused by undernutrition affect children’s cognitive outcomes and productive potential as adults. Micronutrient deficiencies—vitamin A, iron, zinc, iodine, for example—are also common and have significant consequences. Progress in reducing malnutrition has been slow: More than half of countries are not on track to achieve the Millennium Development Goal of halving the share of children who are malnou-rished (low weight for age) by 2015. The food price and financial crises are making achievement of this goal even more elusive.

To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canada's Food Guide to Healthy Eating (CFGHE). One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

To study individual determinants of differential benefit from the Senegal Community Nutrition Project (CNP) by monitoring improvement in children's weight-for-age index (WA) or underweight status (WA < -2 Z-scores) during participation. A follow-up study using the CNP child monitoring data. Linear general models compared variations in WA according to 14 factors describing the beneficiaries and CNP services. Poor neighbourhoods of Diourbel, a large city in Senegal, West Africa. Over a 6-month period, the CNP provided underweight or nutritionally at-risk 6-35-month-old children with monthly growth monitoring and promotion and weekly food supplementation, provided that mothers attended weekly nutrition education sessions. All the children who participated in the first two years of the project (n=4084). Mean WA varied from -2.13 (standard deviation (SD) 0.82) to -1.58 (SD 0.81) Z-scores between recruitment and the end of the follow-up. The lower the child's initial WA, the greater was their increase in WA but the lower was the probability of recovery from underweight. Only 61% of underweight children recovered. Six months of CNP services may not be sufficient for catch-up growth of severely underweight children. The number of food supplement rations received was not a direct indicator of the probability of recovery. After adjustment for services received and initial WA, probability of recovery was lower in girls, in younger children, in twins and when mothers belonged to a specific ethnic group. Determinants of benefit from CNP differed from the risk factors for underweight. Identification of participants with a lower probability of recovery can help improve outcome. Moreover, an explanation for the lack of recovery could be that many underweight children are stunted but not necessarily wasted.

Background Exclusive breastfeeding (EBF) is essential for optimal infant nutrition and health, yet its uptake remains suboptimal in Nigeria. Although the Accelerating Nutrition Results in Nigeria (ANRiN) project delivers community-based nutritional interventions, there is limited evidence on how access to the intervention influenced mothers’ knowledge, attitudes, and practices (KAP) regarding EBF, particularly in Kwara State. Objectives This study assessed the KAP of EBF among mothers of infants aged 0–6 months in Kwara State and identified the sociodemographic predictors associated with these outcomes with access to ANRiN intervention as a comparator. Methods A descriptive cross-sectional study was conducted among 582 mothers of infants aged 0–6 months (with access to ANRiN intervention as a comparator into beneficiaries and non-beneficiaries), recruited using multistage sampling. Data were collected with a structured questionnaire and analyzed using chi-square tests, t-tests, and logistic regression. Results Beneficiaries demonstrated significantly higher knowledge (10.65 ± 2.49 vs. 8.98 ± 2.69, p  < 0.001) and attitude scores (5.52 ± 0.91 vs. 5.32 ± 1.13, p  = 0.024) than non-beneficiaries. The prevalence of breastfeeding in the previous 24 h was also higher among beneficiaries (56.6%) compared to non-beneficiaries (43.4%, p  = 0.012), though this does not necessarily reflect sustained EBF for six months. Predictors of good knowledge and attitudes differed between groups: for non-beneficiaries, partner education ( p  = 0.013, p  = 0.009), higher income ( p  = 0.010), and healthcare provider information ( p  = 0.002) were significant, whereas among beneficiaries, urban residence ( p  = 0.002), self-employment ( p  = 0.023), and healthcare provider information ( p  < 0.001) were strongest. Improved practices among beneficiaries were associated with higher partner education ( p  = 0.048) and employment ( p  = 0.001, p  = 0.015). Conclusions The findings show that nutritional interventions such as ANRiN not only enhance mothers’ EBF knowledge and attitudes but also shape distinct predictors of practice compared to non-beneficiaries. Tailored strategies that consider these differential predictors, such as targeting rural, less-educated households for non-beneficiaries and addressing urban-rural disparities among beneficiaries, may strengthen the effectiveness of EBF promotion programs in Nigeria.

Increasing evidence from lifetime experimental studies in animals and observational and experimental studies in human subjects suggests that pre- and postnatal nutrition programme long-term health. However, key unanswered questions remain on the extent of early-life programming in contemporary European populations, relevant nutritional exposures, critical time periods, mechanisms and the effectiveness of interventions to prevent or reverse programming effects. The EARly Nutrition programming – long-term Efficacy and Safety Trials and integrated epidemiological, genetic, animal, consumer and economic research (EARNEST) consortium brings together a multi-disciplinary team of scientists from European research institutions in an integrated programme of work that includes experimental studies in human subjects, modern prospective observational studies and mechanistic animal work including physiological studies, cell-culture models and molecular techniques. Theme 1 tests early nutritional programming of disease in human subjects, measuring disease markers in childhood and early adulthood in nineteen randomised controlled trials of nutritional interventions in pregnancy and infancy. Theme 2 examines associations between early nutrition and later outcomes in large modern European population-based prospective studies, with detailed measures of diet in pregnancy and early life. Theme 3 uses animal, cellular and molecular techniques to study lifetime effects of early nutrition. Biomedical studies are complemented by studies of the social and economic importance of programming (themes 4 and 5), and themes encouraging integration, communication, training and wealth creation. The project aims to: help formulate policies on the composition and testing of infant foods; improve the nutritional value of infant formulas; identify interventions to prevent and reverse adverse early nutritional programming. In addition, it has the potential to develop new products through industrial partnerships, generate information on the social and economic cost of programming in Europe and help maintain Europe's lead in this critical area of research.

This dissertation is an evaluation of an educational programme that took place within the context of a nutrition improvement project. The goal of the project was to effect dietary modification and diversification for the purpose of increasing vitamin A, iron and zinc status in children. The project itself provides a model for dietary change projects because it demonstrated the effectiveness of mobilizing community resources, including local knowledge, existing leadership and indigenous foods. Furthermore, this evaluation has particular significance because of its depth in exploring the behavioural change process. The lack of such descriptions has previously left undetermined the value of similar nutrition education projects. Thus, this thesis gives credibility to programmes that focus on building self-reliance in communities, revisiting caring roles within the family, and changing behaviour related to food and diet. The dissertation emphasizes that by exploring and changing social practices related to the family nutrition system, the problem of malnutrition may be addressed more effectively than by exclusively medical means. The project, called Tulimbe Nutrition Project, took place from 1995–1997 in two rural communities in Southern Malawi. Five Malawian home economists were hired as facilitators for the four-month dietary intervention. Three hundred families with children from three to seven years old participated. Various programmes were introduced to the parents of these children: food processing, meal planning and preparation, agricultural activities, and appropriate technologies. The success of the intervention was evaluated by analyzing data collected during cooking demonstrations, home visits, interviews and focus group discussions. The data is organized into three major themes reflecting the changes which occurred as a result of the intervention: community involvement, gender relations, and dietary change. As a result of the project's approaches to community development, community members, individually and collectively, had a new understanding of their identities, attitudes and capabilities. By involving men in the project, along with women, people noted positive changes in families, because both husbands and wives became better caregivers. Finally, as a result of the momentum of project activity over the intervention period, there was a significant increase in the adoption rates of new food processing and preparation methods. Although the issues of targeting, leadership and incentives were problematic ones, the intervention strategies continue to be practiced and enhanced by new initiatives. The project gained national attention for both its dietary strategies and its approaches to community involvement. Local agencies in Malawi have taken on the challenge of replicating the project in other areas. However, in order for dietary diversification and modification programmes to have a more widespread effect, political commitment and mass mobilization campaigns are required.