29 results found
Azupogo F, Abizari A-R, Aurino E, et al., 2021, Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data., Public Health Nutrition, Vol: 25, Pages: 1-16, ISSN: 1368-9800
OBJECTIVE: We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. DESIGN: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. SETTING: Countrywide, covering rural and urban areas in Ghana. PARTICIPANTS: Non-pregnant adolescent girls aged 15-19 years. RESULTS: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. CONCLUSIONS: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.
Aurino E, Giunti S, 2021, Social protection for child development in crisis: A review of evidence and knowledge gaps, World Bank Research Observer, Vol: 37, ISSN: 0257-3032
Globally, humanitarian needs have reached an historically unprecedented scale, undermining the ability of affected children to survive, grow and thrive. Social protection holds the promise of addressing acute needs and risks faced by children in crisis-contexts, while allowing for human capital investments. We review evidence of the impact of emergency cash, food and other in-kind transfers implemented by governments or humanitarian actors on child development in different contexts. Compared with development settings, rigorous evidence for crises is limited. Most existing studies focus on either schooling or acute malnutrition, highlighting that transfers can mitigate the detrimental effects of crises on these outcomes, while evidence on linear growth, micronutrient deficiencies, health, labor, learning, psycho-social outcomes and child protection is scarce. Also, most studies are set in contexts characterized by high institutional fragility in which emergency social protection is undertaken by international organizations, while evidence from settings where institutional capacity for shock-responsive social protection exists is scarce. Further gaps relate to the cost-effectiveness of alternative program designs and delivery modalities; heterogeneity by child and household backgrounds; and longer-term effects of interventions. Filling these gaps is critical to support child-sensitive approaches to social protection in crises to effectively pursue Sustainable Development Goal 1.
Segal AB, Huerta MC, Aurino E, et al., 2021, The impact of childhood obesity on human capital in high-income countries: A systematic review, Obesity Reviews, Vol: 22, Pages: 1-15, ISSN: 1467-7881
Current evidence of the impact of childhood obesity on human capital development does not point in a consistent direction, and its interpretation is challenging. We carried out a systematic review of studies from high‐income countries that used robust causal inference approaches to assess the impact of childhood overweight and obesity on outcomes typically linked to human capital development in economics. Global Health, Medline and EconLit were used to search for peer‐reviewed papers. Three reviewers independently assessed study quality using the Newcastle‐Ottawa Scale. Nineteen papers representing 22 studies met the inclusion criteria. Included studies were categorized based on three components of human capital: cognitive performance (n = 18), measured through test scores; educational attainment (n = 3), through grade progression and college completion; and labour market outcomes (n = 1), through wages. We find that childhood overweight and obesity hinder education outcomes, with effects mostly observed at older ages of exposure measurement (12+ years). Girls with overweight and obesity experienced larger negative effects and more often than boys. Future research should elucidate the pathways through which childhood obesity impacts human capital development, to support policies that may mitigate those impacts, thus averting social costs that are currently widespread, increasing and unaccounted for.
Aurino E, Gelli A, Adamba C, et al., 2020, Food for thought? Experimental evidence on the learning impacts of a large-scale school feeding program, The Journal of Human Resources, Vol: 2020, Pages: 1-75, ISSN: 0022-166X
There is limited experimental evidence on the effects of large-scale, government-led interventions on human capital in resource-constrained settings. We report results from a randomized trial of the government of Ghana’s school feeding. After two years, the program led to moderate average increases in math and literacy standardized scores among pupils in treatment communities, and to larger achievement gains for girls and disadvantaged children and regions. Improvements in child schooling, cognition, and nutrition constituted suggestive impact mechanisms, especially for educationally-disadvantaged groups. The program combined equitable human capital accumulation with social protection, contributing to the “learning for all” sustainable development agenda.
Azupogo F, Abizari A-R, Aurino E, et al., 2020, Malnutrition, hypertension risk, and correlates: an analysis of the 2014 Ghana demographic and health survey data for 15-19 years adolescent boys and girls, Nutrients, Vol: 12, ISSN: 2072-6643
The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15-19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.
Aurino E, Olney J, Miraldo M, et al., 2020, Chronic Syndemic meets Viral pandemic, Publisher: BMJ Opinion
Schott W, Aurino E, Penny ME, et al., 2020, Time use and sexual maturity-related indicators differentially predict youth body mass indices, Peruvian girls versus boys, Annals of the New York Academy of Sciences, Vol: 1468, Pages: 55-73, ISSN: 0077-8923
Rapid development in Latin America has been accompanied by lifestyle shifts, including changes in time use and social environments. Overweight/obesity has also emerged as a public health challenge. We examined whether lifestyle changes and sexual maturity-related indicators (early pubertal development and having a child) predict increases in adiposity among Peruvian youth. Using longitudinal data from Young Lives, we examined changes in adiposity between ages 8 and 15 years old for the younger cohort and ages 15 and 22 years old for the older cohort. Boys and girls in both cohorts demonstrated substantial increases in age-adjusted adiposity measures, but predictors were different for boys versus girls. For boys, increases in time spent in work and domestic chores predicted increases in adiposity body mass index and BMI-for-age Z-score and increases in time spent sleeping were associated with decreases in adiposity (waist circumference and waist-to-height ratio). For girls, sexual maturity-related indicators (early menarche and childbearing) predicted increases in adiposity, regardless of time use. Potential mechanisms for these results may include diet, physical activity, wealth, and urban-rural residence. Time use among youth was associated with diet quality and physical activity, but in different ways for boys versus girls. Strategies for dealing with rising overweight and obesity should incorporate sex-based specificities.
Aurino E, Wolf S, Tsinigo E, 2020, Household food insecurity and early childhood development: Longitudinal evidence from Ghana, PLoS One, Vol: 15, Pages: 1-19, ISSN: 1932-6203
The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years. Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves. Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy and short-term memory. When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009). No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African coun
Aurino E, Tranchant J-P, Gelli A, et al., 2019, School feeding or general food distribution? Quasi-experimental evidence on the educational impacts of emergency food assistance during conflict in Mali, Journal of Development Studies, Vol: 55, Pages: 7-28, ISSN: 0022-0388
This study relies on a unique precrisis baseline and five-year follow-up to investigate the effects of emergency school feeding and generalised food distribution (GFD) on children’s schooling during conflict in Mali. It estimates programme impact on child enrolment, absenteeism, and attainment by using a difference in differences weighted estimator. School feeding led to increases in enrolment by 10 percentage points and to around an additional half-year of completed schooling. Attendance among boys in households receiving GFD, however, declined by about 20 per cent relative to the comparison group. Disaggregating by conflict intensity showed that receipt of any food assistance led to a rise in enrolment mostly in high-intensity conflict areas and that the negative effects of GFD on attendance were also concentrated in the most affected areas. School feeding mostly raised attainment among children in areas not in the immediate vicinity of conflict. Programme receipt triggered adjustments in child labour. School feeding led to lower participation and time spent in work among girls, while GFD raised children’s labour, particularly among boys. The educational implications of food assistance should be considered in planning humanitarian responses to bridge the gap between emergency assistance and development by promoting children’s education.
Aurino E, Schott W, Behrman JR, et al., 2019, Nutritional Status from 1 to 15 years and Adolescent Learning for Boys and Girls in Ethiopia, India, Peru and Vietnam, Population Research and Policy Review, Vol: 38, Pages: 899-931, ISSN: 0167-5923
There has been little examination of: (1) associations of early-life nutrition and adolescent cognitive skills, (2) if they vary by gender, (3) if they differ by diverse contexts, and (4) contributions of post-infancy growth to adolescent cognitive attainment. We use Young Lives data on 7687 children from Ethiopia, India, Peru, and Vietnam to undertake ordinary least squares estimates of associations between age-1 height-for-age z-score (HAZ) and age-15 cognitive outcomes (math, reading, vocabulary), controlling for child and household factors. Age-1 HAZ is positively associated with cognitive scores in all countries. Child gender-specific estimates for these coefficients either do not differ (math, reading) or favor girls (vocabulary). Augmenting models to include growth in HAZ between ages 1 and 15 years that was not predicted by HAZ at age 1 reveals that such improvements are associated with higher cognitive scores, but that sex-specific coefficients for this predictor favor boys in India and Peru. The results suggest that nutritional indicators at age 1 have gender-neutral associations with math and reading and favor girls for vocabulary achievement at age 15, but unpredicted improvements in HAZ by adolescence are associated with higher cognitive scores for boys than for girls. This evidence enriches our understanding of relationships between children’s nutritional trajectories during childhood and adolescent cognitive development, and how these associations vary by gender in some contexts to the possible disadvantage of girls.
Gelli A, Aurino E, Folson G, et al., 2019, A school meals program implemented at scale in Ghana increases height-for-age during midchildhood in girls and in children from poor households: a cluster randomized trial, The Journal of Nutrition, Vol: 149, Pages: 1434-1442, ISSN: 0022-3166
BACKGROUND: Attention to nutrition during all phases of child and adolescent development is necessary to ensure healthy physical growth and to protect investments made earlier in life. Leveraging school meals programs as platforms to scale-up nutrition interventions is relevant as programs function in nearly every country in the world. OBJECTIVE: The aim of this study was to evaluate the impact of a large-scale school meals program in Ghana on school-age children's anthropometry indicators. METHODS: A longitudinal cluster randomized control trial was implemented across the 10 regions of Ghana, covering 2869 school-age children (aged 5-15 y). Communities were randomly assigned to 1) control group without intervention or 2) treatment group providing the reformed national school feeding program, providing 1 hot meal/d in public primary schools. Primary outcomes included height-for-age (HAZ) and BMI-for-age (BAZ) z scores. The analysis followed an intention-to-treat approach as per the published protocol for the study population and subgroup analysis by age (i.e., midchildhood for children 5-8 y and early adolescence for children 9-15 y), gender, poverty, and region of residence. We used single-difference ANCOVA with mixed-effect regression models to assess program impacts. RESULTS: School meals had no effect on HAZ and BAZ in children aged 5-15 y. However, in per-protocol subgroup analysis, the school feeding intervention improved HAZ in 5- to 8-y-old children (effect size: 0.12 SDs), in girls (effect size: 0.12 SDs)-particularly girls aged 5-8 y living in the northern regions, and in children aged 5-8 y in households living below the poverty line (effect size: 0.22 SDs). There was also evidence that the intervention influenced food allocation and sharing at the household level. CONCLUSION: School meals can provide a platform to scale-up nutrition interventions in the early primary school years, with important benefits accruing for more disadvantaged children. This tri
Schott W, Aurino E, Penny ME, et al., 2019, The double burden of malnutrition among youth: trajectories and inequalities in four emerging economies, Economics and Human Biology, Vol: 34, Pages: 80-91, ISSN: 1570-677X
As part of the nutritional transition, undernutrition is globally declining while changes brought by economic development have ushered in increases in overweight and its related economic costs and health consequences around the world. We examine trajectories in stunting and overweight from age one year to mid-adolescence and from mid-childhood to early adulthood among two cohorts from Ethiopia, India, Peru and Vietnam using data from the Young Lives study. We examine descriptive data and then model trajectories in stunting and overweight status over age. Group-based trajectory analysis with five ages of overweight and stunting for each country-cohort reveals (1) trajectories of catch-up growth for a subset of study children between the ages of 12 and 19 in the older cohort in Ethiopia (20.1% of the cohort), India (20.5%), Peru (16.9%), and Vietnam (14.0%); (2) trajectories of increasing probabilities of stunting as children age from 12 to 22 in the older cohort in India (22.2%) and Peru (30.7%); (3) trajectories of early (childhood) increases in overweight probabilities (younger cohort: India, 3.4%, Peru, 19.4%, and Vietnam, 8.1%), and of later (adolescence) increases in overweight probabilities (older cohort: Ethiopia, 0.5%, India, 6.3%, Peru, 40.9%, and Vietnam, 9.4%). Multinomial logit prediction of membership in trajectory categories reveals that higher wealth quartiles and maternal schooling are protective against high stunting probability trajectory group membership, but higher wealth and urban residence predict high overweight probability trajectory group membership. This evidence suggests a window of opportunity for interventions to reduce stunting and to avert overweight development in adolescence, in addition to the often-emphasized first 1,000 days after conception. A life-course approach to policies and programs to target both undernutrition and overweight should be considered.
Tranchant JP, Gelli A, Bliznashka L, et al., 2019, The impact of food assistance on food insecure populations during conflict: evidence from a quasi-experiment in Mali, World Development, Vol: 119, Pages: 185-202, ISSN: 0305-750X
Mali, a vast landlocked country at the heart of West Africa in the Sahel region, is one of the least developed and most food insecure countries in the world. Mali suffered from a series of political, constitutional and military crises since January 2012, including the loss of government control of northern territories from April 2012 until January 2013. A range of humanitarian aid interventions were scaled up in response to these complex crises. In this study, we exploit data from a unique pre-crisis baseline to evaluate the impact of humanitarian aid on the food security of rural populations. We design a quasi-experimental study based on two survey rounds, five years apart, in the Mopti region in Northern Mali. Data was collected from 66 communities randomly selected from within food-insecure districts. Study outcomes include household expenditures and food consumption and a proxy for child nutritional status (height measurements). We estimate program impact by combining propensity score matching and difference-in-difference. Food assistance was found to increase household non-food and food expenditures and micro-nutrient availability. Disaggregating by degree of conflict exposure showed that the effects on children’s height and caloric and micro-nutrient consumption were mostly concentrated in areas not in the immediate vicinity of the conflict, unlike the increase in food expenditures that were driven by households located in close proximity to armed groups. The effects were also concentrated on households receiving at least two forms of food assistance. In villages where armed groups were present, food assistance improved household zinc consumption and also appeared to support food expenditures. Food transfers are thus found to exert a protective effect among food insecure population in conflict context.
Aurino E, Fledderjohann J, Vellakkal S, 2019, Inequalities in adolescent learning: Does the timing and persistence of food insecurity at home matter?, Economics of Education Review, Vol: 70, Pages: 94-108, ISSN: 0272-7757
We investigated inequalities in learning achievements at 12 years by household food insecurity trajectories at ages 5, 8 and 12 years in a longitudinal sample of 1,911 Indian children. Estimates included extensive child and household controls and lagged cognitive scores to address unobserved individual heterogeneity in ability and early investments. Overall, household food insecurity at any age predicted lower vocabulary, reading, maths and English scores in early adolescence. Adolescents from households that transitioned out from food insecurity at age 5 to later food security, and adolescents from chronically food insecure households had the lowest scores across all outcomes. There was heterogeneity in the relationship between temporal occurrence of food insecurity and cognitive skills, based on developmental and curriculum-specific timing of skill formation. Results were robust to additional explanations of the “household food insecurity gap”, i.e. education and health investments, parental and child education aspirations, and child psychosocial skills.KeywordsCognitive skillsLearningAdolescentFood insecurityIndiaEducation inequalityHuman capitalLongitudinalEducationLifecourseJEL classificationI24, I29, I39, H52
Azupogo F, Aurino E, Gelli A, et al., 2019, Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana, Maternal and Child Nutrition, Vol: 15, Pages: 1-11, ISSN: 1740-8695
Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6–9 years; n = 323) and adolescents (10–17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.
Aurino E, Morrow V, 2018, “Food prices were high, and the dal became watery”. Mixed-method evidence on household food insecurity and children’s diets in India, World Development, Vol: 111, Pages: 211-224, ISSN: 0305-750X
Food insecurity and malnutrition are key policy priorities in India. Evidence on children’s experiences of household food insecurity and how food insecurity influences their dietary quality is limited for India and other low- and middle-income countries. Evidence on mid-childhood and adolescence is even scarcer. We present longitudinal evidence on household food insecurity and child diets by drawing on a mixed methods study with two cohorts of children from Andhra Pradesh and Telangana (India).Analysis of survey data shows that children living in food insecure households had lower dietary diversity and probability of consumption of micronutrient- and protein-rich foods, which are critical for their healthy development. Inequalities in child dietary quality by household food security status were most pronounced at preschool age.Children identified dietary quality as a critical dimension of their well-being. From an early age, children were able to describe and explain the food security challenges of their families and recognize the negative consequences of household food insecurity on their diets, health and education. Children were not only cognizant of household responses to food insecurity, but they were also actively involved in such strategies through limiting the quantity and quality of food purchased and consumed, reducing dietary diversity, and/or engaging in work or social protection. The latter were often mentioned as critical safety nets in face of economic, demographic or climate shocks, although children expressed criticism about implementation.Longitudinal mixed methods can enhance our understanding of children’s experiences of household food insecurity and its repercussion on their health and broader well-being. Child-focused evidence is key to shaping social protection implementation to context-specific needs at critical human development stages
Picchioni F, Aurino E, Aleksandrowicz L, et al., 2018, Roads to interdisciplinarity - working at the nexus among food systems, nutrition and health (vol 9, pg 181, 2017), FOOD SECURITY, Vol: 10, Pages: 1141-1141, ISSN: 1876-4517
Drake L, Fernades M, Aurino E, et al., 2017, School feeding programs in middle childhood and adolescence, Child and Adolescent Health and Development, Editors: Bundy, de Silva, Horton, Jamison, Patton, Publisher: International Bank for Reconstruction and Development / The World Bank, Pages: 147-164, ISBN: 978-1-4648-0423-6
Almost every country in the world has a national school feeding program to provide daily snacks or meals to school-attending children and adolescents. The interven-tions reach an estimated 368 million children and ado-lescents globally. The total investment in the intervention is projected to be as much as US$75 billion annually (WFP 2013), largely from government budgets. School feeding may contribute to multiple objectives, including social safety nets, education, nutrition, health, and local agriculture. Its contribution to education objectives is well recognized and documented, while its role as a social safety net was underscored following the food and fuel crises of 2007 and 2008 (Bundy and others 2009). In terms of health and nutrition, school feeding contributes to the continuum of development by build-ing on investments made earlier in the life course, including maternal and infant health interventions and early child development interventions (see chapter 7 in this volume, Alderman and others 2017). School feeding may also help leverage global efforts to enhance the inclusiveness of education for out-of-school children, adolescent girls, and disabled persons, as called for in the Sustainable Development Goals (see chapter 17 in this volume, Graham and others 2017). Although the Disease Control Priorities series focuses on low- and middle-income countries (LMICs), evidence from high-income countries (HICs) is included because of the near universality of school feeding and the insights that inclusion can provide as economies develop.For example, the design of school feeding in countries under-going the nutrition transition1may provide some lessons on how to shift from providing access to sufficient calo-ries to promoting healthful diets and dietary behaviors for children and adolescents (WFP 2013).Agricultural development has increasingly
Fernandes M, Aurino E, 2017, Identifying an essential package for school-age child health: economic analysis, Child and Adolescent Health and Development, Editors: Bundy, De Silva, Horton, Jamison, Patton, Publisher: The World Bank, Pages: 355-368, ISBN: 978-1-4648-0423-6
his chapter presents the investment case for providing an integrated package of essential health services for children attending primary schools in low- and middle- income countries (LMICs). In doing so, it builds on chapter 20 in this volume (Bundy, Schultz, and others 2017), which presents a range of relevant health services for the school-age population and the economic rationale for adminis-tering them through educational systems. This chapter identifies a package of essential health services that low- and middle-income countries (LMICs) can aspire to implement through the primary and secondary school platforms. In addition, the chapter considers the design of such programs, including targeting strategies. Upper-middle-income countries and high-income countries (HICs) typically aim to implement such interventions on a larger scale and to include and promote additional health services relevant to their populations. Studies have docu-mented the contribution of school health interventions to a range of child health and educational outcomes, partic-ularly in the United States (Durlak and others 2011; Murray and others 2007; Shackleton and others 2016). Health services selected for the essential package are those that have demonstrated benefits and relevance for children in LMICs. The estimated costs of implementation are drawn from the academic literature. The concept of a package of essential school health interventions and its justification through a cost-benefit perspective was pioneered by Jamison and Leslie (1990). As chapter 20 notes, health services for school-age children can promote educational outcomes, including access, attendance, and academic achievement, by mitigat-ing earlier nutrition and health deprivations and by addressing current infections and nutritional deficiencies (Bundy, Schultz, and
Bundy DAP, De Silva N, Horton S, et al., 2017, Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition, The Lancet, ISSN: 0140-6736
The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5–9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10–14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15–19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.
Schott W, Aurino E, Penny ME, et al., 2017, Adolescent mothers’ anthropometrics and grandmothers’ schooling predict infant anthropometrics in Ethiopia, India, Peru, Vietnam, Annals of the New York Academy of Sciences, Vol: 1416, Pages: 86-106, ISSN: 1749-6632
We investigated intergenerational associations of adolescent mothers’ and grandmothers’ anthropometrics and schooling with adolescent mothers’ offspring's anthropometrics in Ethiopia, India, Peru, and Vietnam. We examined birthweight (n = 283), birthweight Z‐score (BWZ), conditional growth in weight‐for‐age Z‐score (cWAZ, residuals from a regression of WAZ at last survey round on BWZ, sex, and age), and height‐for‐age Z‐score (HAZ) of children born to older cohort adolescent girls in the Young Lives study. Our key independent variables were adolescent mothers’ body size: HAZ and body‐mass‐index‐for‐age Z‐score (BMIZ) at age 8, conditional HAZ (cHAZ, residuals from a regression of HAZ at the end of a growth period on prior HAZ, age, and sex), conditional BMIZ growth (cBMIZ, calculated analogously), and grandmaternal BMIZ, HAZ, and schooling. We adjusted for child, maternal, and household characteristics. Adolescent mothers’ cHAZ (ages 8–15) predicted birthweight (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0001 = 130 g, 95% confidence interval (CI) 31–228), BWZ (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0002 = 0.31, CI 0.09–0.53), and cWAZ (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0003 = 0.28, CI 0.04–0.51). Adolescent mothers’ BMIZ at age 8 predicted birthweight (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0004 = 79 g, CI 16–43) and BWZ (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0005 = 0.22, CI 0.08–0.36). Adolescent mothers’ cBMIZ (ages 12–15) predicted child cWAZ and HAZ. Grandmothers’ schooling predicted grandchild birthweight (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0006 = 22 g, CI 1–44) and BWZ (urn:x-wiley:00778923:media:nyas13455:nyas13455-math-0007 = 0.05, CI 0.01–0.10).
Fernandes M, Folson G, Aurino E, et al., 2017, A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana, Food Security, Vol: 9, Pages: 1073-1090, ISSN: 1876-4517
Food environments can play important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.
Aurino E, Schott W, Penny ME, et al., 2017, Birthweight and prepubertal body size predict menarcheal age in India, Peru and Vietnam, Annals of the New York Academy of Sciences, Vol: 1416, Pages: 107-116, ISSN: 1749-6632
Evidence on the associations of birthweight and prepubertal nutritional status with menarcheal age for low- and middle-income countries is limited. We investigated these relations using the Young Lives younger cohort for 2001 Indian, Peruvian and Vietnamese girls born 2001-2002. Girls were followed at approximately ages 1, 5, 8 and 12 years. Weibull survival models estimated hazards of earlier menarche based on birthweight z-scores (BWZ), and age 8-years BMI-for-age z-scores (BMIZ) and height-for-age z-scores (HAZ). Estimates controlled for potential individual-, mother- and household-level confounders, and for changes in anthropometry between 1 and 8 years. In adjusted models, BWZ predicted later age at menarche (Hazard Ratio, HR=0.90, 95%CI: 0.83 - 0.97). Conversely, HAZ (HR=1.66 95%CI 1.5 - 1.83) and BMIZ at 8 years (HR=1.28, 95% CI: 1.18 - 1.38) predicted earlier menarche. Changes in HAZ and BMIZ between 1 and 8 years were not associated with earlier menarche. Associations were consistent across countries, though with variation in estimated magnitudes. Maternal height and age were associated with later menarche. This evidence points to consistently robust and opposite associations of birthweight versus prepubertal attained height and BMI with menarcheal age in three diverse settings in terms of nutrition, ethnicity and socio-economic status.
Aurino E, Burchi F, 2017, Children's multidimensional health and medium-term cognitive skills in low- and middle-income countries, The European Journal of Development Research, Vol: 29, Pages: 289-311, ISSN: 0957-8811
This article engages in the debate on the effects of early childhood health and children’s cognition at preschool and school ages in low- and middle-income countries. On the basis of three rounds of the ‘Young Lives’ panel, it endorses a multidimensional approach to health. A ‘suite of indicators’ of malnutrition and morbidity, and a composite Multidimensional Health Poverty Index (MHPI) are used to measure health. Expanding the informational basis for measuring health helped to capture variations in children’s medium-term cognitive outcomes more effectively. Beyond stunting, our empirical analysis shows that acute malnutrition is an important predictor of children’s lifecourse learning in India, while it has minor or no effects in the other countries. The composite MHPI is also significantly associated with later cognition; however, it is substantially less informative than the suite of indicators. Finally, the article explores some potential channels through which the relationship between early health and mid-term cognitive abilities operates.
Picchioni F, Aurino E, Aleksandrowicz L, 2017, Roads to interdisciplinarity – working at the nexus among food systems, nutrition and health, Food Security, Vol: 9, Pages: 181-189, ISSN: 1876-4525
Aurino E, 2016, Do boys eat better than girls in India? Longitudinal evidence on dietary diversity and food consumption disparities among children and adolescents, Economics & Human Biology, Vol: 25, Pages: 99-111, ISSN: 1570-677X
This paper examines the dynamics of gender-based disparities in the intra-household allocation of food during childhood and adolescence in Andhra Pradesh and Telangana by using three rounds of longitudinal data from two cohorts. While boys are advantaged at all ages (except for the Younger Cohort at 12 years old), the pro-boy gap widens markedly at 15 years old. Specifically, mid-adolescent girls tend to consume fewer protein- and vitamin-rich foods such as eggs, legumes, root vegetables and fruit. This result is robust to gender differences between adolescents in terms of puberty onset, school enrolment, time use and dietary behaviours. Finally, gender disparities in dietary diversity during early and mid-adolescence do not vary by maternal education, poverty or place of residence, whilst they are moderated by levels of caregiver's educational aspirations at 15 years old.
Aurino E, Fernandes M, Penny ME, 2016, The nutrition transition and adolescents’ diets in low- and middle-income countries: a cross-cohort comparison, Public Health Nutrition, Vol: 20, Pages: 72-81, ISSN: 1475-2727
To investigate changes in dietary diversity and dietary composition among adolescents in four developing countries.We analysed dietary diversity and consumption of seven food groups and foods with added sugars as reported by adolescents from two cohorts growing up 8 years apart, when they were aged about 12 years.Ethiopia, India (Andhra Pradesh), Peru and Vietnam in 2006 and 2013.Adolescents (n 3659) from the older cohort (OC) born in 1995/96 and adolescents (n 7422) from the younger cohort (YC) born in 2001/02 (N 11 081).Controlling for other factors, dietary diversity increased in Peru (OC=4·89, YC=5·34, P<0·001) and Ethiopia (OC=3·52, YC=3·94, P=0·001). Dietary diversity was stable in India (OC=4·28, YC=4·29, P=0·982) and Vietnam (OC=4·71, YC=4·73, P=0·814); however, changes in dietary composition were observed. YC adolescents were more likely to consume eggs (India: +32 %, P=0·038; Vietnam: +50 %, P<0·001) and milk and dairy (India: +12 %, P=0·029; Vietnam: +46 %, P<0·001). Other notable shifts included meat consumption in Peru (+72 %, P<0·001) and consumption of fruit and vegetables in Ethiopia (+36 %, P<0·001). Compared with OC, the prevalence of added sugar consumption was greater among the YC in Ethiopia (+35 %, P=0·001) and Vietnam (+44 % P<0·001). Between 2006 and 2013, disparities in dietary diversity associated with household wealth and place of residence declined, although this varied by country. No marked gender disparities in dietary diversity were evident.We found significant changes over time in dietary diversity among adolescents in four countries consistent with the hypothesis of the nutrition transition.
Fernandes M, Galloway R, Gelli A, et al., 2016, Enhancing linkages between healthy diets, local agriculture, and sustainable food systems: the school meals planner package in Ghana, Food and Nutrition Bulletin, Vol: 37, Pages: 571-584, ISSN: 1564-8265
BACKGROUND: Interventions that enhance linkages between healthy diets and local agriculture can promote sustainable food systems. Home-grown school feeding programs present a promising entry point for such interventions, through the delivery of nutritious menus and meals. OBJECTIVE: To describe the adaptation of the School Meals Planner Package to the programmatic and environmental reality in Ghana during the 2014 to 2015 school year. METHODS: Guided by a conceptual framework highlighting key considerations and trade-offs in menu design, an open-source software was developed that could be easily understood by program implementers. Readily available containers from markets were calibrated into "handy measures" to support the provision of adequate quantities of food indicated by menus. Schools and communities were sensitized to the benefits of locally sourced, nutrient-rich diets. A behavior change communication campaign including posters and songs promoting healthy diets was designed and disseminated in schools and communities. RESULTS: The School Meals Planner Package was introduced in 42 districts in Ghana, reaching more than 320 000 children. Monitoring reports and feedback on its use were positive, demonstrating how the tool can be used by planners and implementers alike to deliver nutritious, locally-sourced meals to schoolchildren. The value of the tool has been recognized at the highest levels by Ghana's government who have adopted it as official policy. CONCLUSIONS: The School Meals Planner Package supported the design of nutritious, locally sourced menus for the school feeding program in Ghana. The tool can be similarly adapted for other countries to meet context-specific needs.
Gelli A, Masset E, Folson G, et al., 2016, Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data, Trials, Vol: 17, ISSN: 1745-6215
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