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PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; 5 Strengthening Institutions and Governance; DCA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Looking back at the development of successful enabling environments for nutrition may inform policymakers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, from a peak at 45% in 1998/99 to 25% in 2018, we analyzed through a stories of change approach the actors, ideas, initiatives, policies and capacities which enabled wide-scale nutrition progress. We triangulated findings from policy analysis, stakeholder mapping, and national-level semi-structured interviews (n = 20). We found that since 2002, nutrition has been anchored in the Ministry of Health, where leadership advocated for the creation of coordination bodies, enabling a coherent defining of nutrition and laying groundwork for better integration of nutrition into and prioritization of nutrition by the health and tangential ministries. Under the leadership of the Ministry of Health and its partners, horizontal and vertical coherence in nutrition action increased, through effective cooperation between nutrition actors; increasing intersectoral collaboration, particularly with the influential agriculture sector; and increasing funding to support nutrition-sensitive programming and build the capacity of nutrition staff. Nevertheless, sustainably organizing funding and human resources at the decentralized level remained challenging, in a context of emerging threats such as climate change and insecurity. Burkina Faso’s health sector’s success in creating an enabling environment for nutrition may have contributed to improvements in child nutrition alongside other sectoral improvements. Enhancing accountability of the Health, Agriculture, WASH, Education and Social Protection sectors and empowering decentralized bodies to take nutrition-relevant decisions may help accelerating progress in nutrition.

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; CRP4; DCA, Development Strategies and Governance (DSG); Transformation Strategies; Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, PHND, The current study aimed to understand why child stunting and anemia (CS&A) rates declined in Ghana between 2009 and 2018, and which priority policies and programs will further improve nutrition outcomes. Trends and potential drivers of stunting (height-for-age z-score < -2.0 SD) and anemia (hemoglobin < 11.0 g/dL), and decomposition analysis of DHS data (2003 to 2014) were conducted. The quantitative evidence was triangulated with Net-Map analysis of nutrition stakeholder relationships and influence, desk review of policies and programs 2009–2019, and in-depth interviews with 25 stakeholders who provided additional insights to explain CS&A trends. Declines in stunting (29.6%) and anemia (14.1%) in children were observed at the national level, but with important subgroup variations. Decomposition analyses identified changes in the household, maternal, and child characteristics (including wealth, use of antenatal services, maternal education, and immunization) as correlates of anemia reduction. Stunting reduction was linked with changes in bed-net utilization, household wealth, and pregnancy care service utilization. Additionally, multiple policies and programs initiated/implemented across multiple sectors were considered potentially relevant to CS&A reduction over time, including those focused on infant and young child feeding, water and sanitation, social protection, and health care access. Initiation/strengthening of these interventions was stimulated by awareness creation and subsequently increased prioritization of stunting. However, program delivery was limited by deficits in government funding, perceived low priority of child anemia, low implementation capacity and coverage, and weak coherence across sectors. Reduced CS&A resulted from improved access to services implemented across multiple sectors, albeit limited by implementation scale and capacity. Further reduction in CS&A requires enhanced multi-sectorally coordinated actions and capacity.

PR, IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; DCA; Transform Nutrition West Africa; ISI, PHND; DSGD, Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0–59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.

PR, IFPRI3; ISI; Stories of Change in Nutrition; Transform Nutrition West Africa; DCA; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND; A4NH, CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH), Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.

PR, IFPRI3; ISI; CRP4; CRP7; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH); CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), Climate change poses a growing threat to the achievement of optimal nutritional status, both directly through affecting food production and indirectly through altering social and economic influences in people's lives. These adverse nutrition outcomes are not evenly distributed across the world, and vulnerable populations are the most impacted. Understanding how different forms of inequity interact with climate change and adverse nutritional outcomes is a novel area of research in today's challenging environment of increased climate change pressures. This article presents the results of a systematic literature search undertaken to identify the connections, trends and pathways between climate change, inequity and nutrition outcomes. Forty‐six peer‐reviewed studies are identified that explore these complex interactions with a specific focus on the extent to which equity is a fundamental component of climate change and nutrition research. The pathways captured in this body of evidence are mapped to current framework thinking to identify trends and gaps. While there is a trend for studies to acknowledge an unfair distribution of vulnerability to adverse nutrition outcomes, there is less attention given to the (lack of) recognition of the social situations which increase these groups' vulnerability and the absence of representation or inclusion of these groups as vital decision‐makers. Studies that do incorporate these core dimensions of equity take mixed‐method and qualitative approaches. This highlights an inherent value in stepping outside the usual scope of empirical climate change research, one that incorporates the voices of those most affected.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The COVID-19 pandemic has provoked a range of economic shocks, food systems shocks, public health crises and political upheavals across the globe, prompting a rethink of associated global systems. Prepandemic anticolonial movements that challenged hierarchies of race, space, gender and expert knowledge in global health took on new meaning in the context of the unequal impacts of the SARS-CoV-2 virus as it moved through different kinds of spaces and distinct political contexts. In light of these dynamics, and the desire of many current practitioners in global health to reimagine the future, the need for critical analyses of the recent past have become more urgent. Here we challenge linear understandings of progress in global health—with a focus on the field of nutrition—by returning to consider a previous cycle of dramatic social, political and economic change that prompted serious challenges to the dominance of Western powers and US-based philanthro-capitalists. With a ‘global’ health and nutrition audience in mind, we put forward considerations on why a better understanding of the continuities and divergences between this past and the present moment are necessary to challenge a status quo that was, and is, highly flawed.

PR, IFPRI3; Transform Nutrition West Africa; CRP4, A4NH; PHND, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), West Africa has a high burden of malnutrition and the drivers are often complex, highly context-specific, and cut across individual, social, political and environmental domains. Public health research most often considers immediate individual health and diet drivers, at the expense of wider considerations that may fall outside of a health agenda. The objective of this systematic mapping review is to map the broad drivers of malnutrition in West Africa, from public health and social science perspectives, and to evaluate the additional value of an interdisciplinary approach. Evidence was gathered from one public health (MEDLINE) and one social science (International Bibliography of Social Science) database using a detailed search syntax tailored to each disciplinary configuration. Literature was screened against pre-determined eligibility criteria and extracted from abstracts. Studies published in English or French between January 2010 and April 2018 were considered for inclusion. Driver categories (immediate, underlying and basic drivers) were coded against the UNICEF conceptual framework of malnutrition. A total of 358 studies were included; 237 were retrieved from the public health database and 124 from the social science database, 3 studies were included in both. The public health and social science literature document different drivers, with MEDLINE most often reporting immediate drivers of malnutrition and the International Bibliography of Social Science database reporting underlying and basic drivers. The combined literature offers more balanced representation across categories. An interdisciplinary approach proved successful in achieving complementarity in search results while upholding rigorous methods. We recommend that interdisciplinary approaches are utilised to bridge recognised gaps between defined disciplines.

PR, IFPRI3; ISI; POSHAN; Transform Nutrition West Africa; CRP4; Stories of Change in Nutrition, PHND; A4HN; SAR, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Malnutrition in all its forms continues to be a massive global challenge, and the past decade has seen a growing political attention to addressing malnutrition in different contexts. What has been largely missing so far, and is in growing demand from countries, is tangible, practical and rigorous insights and lessons (from other countries or contexts) on how to translate this burgeoning political momentum into effective policies and programme implementation strategies – and ultimately impact on the ground. This new climate of learning from experience and evidence led to the launch in 2015 of the Stories of Change initiative. This series presents a second wave of studies from six countries (Tanzania, Rwanda, Vietnam, Ghana, Burkina Faso, Nigeria,) and three Indian states (Chhattisgarh, Gujarat, Tamil Nadu). These provide clear evidence combined with compelling narratives on what drives success in addressing all forms of malnutrition – evidence that is necessary for turning global momentum into actual results on the ground. This introductory Opinion is published with the first set of papers. It will be followed by a thorough synthesis of papers as a conclusion of the Series. We hope that the lessons embedded in these Stories of Change will inform and inspire the deliberations and outcomes of the UN Food Systems Summit and the second Nutrition for Growth Summit to be held this year, and the actions of those in the global food and nutrition system working for positive change.

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Measures to slow down the spread of Covid-19 have had profound effects on the food and nutrition security of poor and marginalised households and communities. This article provides an overview of the effects of Covid-19 on food systems across low- and middle-income countries using resilience and political economy lenses, before proposing approaches to build back resilient and equitable food systems. First, future interventions need to target structural issues that limit people’s agency in accessing nutritious and diverse food and production capital. Second, local innovation systems and institutions require investment to create a market environment that benefits domestic (small and medium) enterprises and agri‑food supply chain workers without jeopardising the environment. Third, interventions need to be informed by a diverse set of opinions that include the voices of the most marginalised.

PR, IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all; POSHAN, PHND, Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs a

Non-PR, IFPRI1; CRP4; Stories of Change in Nutrition; Transform Nutrition West Africa; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Au cours de la dernière décennie, le Ghana a enregistré une importante baisse des cas de retard de croissance chez les enfants de moins de cinq ans. Pendant ce temps, le recul de l’anémie durant la même période n’a été que marginal, il en résulte que les taux d’anémie infantile demeurent une grave urgence de santé publique [1]. Ces changements se sont produits dans un contexte socio-économique considéré comme favorable aux résultats de la nutrition, marqués par l’expansion et la diversification de l’économie et des investissements dans les infrastructures clés, les soins de santé, l’éducation, l’eau et l’assainissement. L’étude des Histoires de changement en nutrition au Ghana a pour but de permettre une meilleure compréhension des changements observés, entre 2009 et 2018, par rapport au retard de croissance et à l’anémie, ainsique des éventuels moteurs de ces changements. Ces constatations peuvent être utilisées pour l’élaboration des programmes, la mise en œuvre des politiques existantes et les prochains exercices de planification aux niveaux national et infranational au Ghana. Les conclusions de l’étude sont importantes parce que le retard de croissance et l’anémie ont tous d’importants impacts négatifs sur la santé et le bienêtre, en particulier ceux des milieux à faibles revenus [1], et sont classés parmi les cibles mondiales de la nutrition pour 2025, approuvées par les ministères nationaux de la santé (y compris celui du Ghana) lors de l’Assemblée mondiale de la santé[2].

PR, IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; ISI, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: This paper investigates actions that combine nutrition and physical activity which hold potential for ‘double duty action’ to tackle multiple forms of malnutrition simultaneously. Expanding on previous research on single component actions, we assessed the state of the literature to map integrated interventions across the life course to analyse potential double duty effects, and identify knowledge gaps and needs for future design, implementation, evaluation and research for effective double duty action. Methods: A scoping review of peer-reviewed and grey literature was conducted to explore the pathways that extend from combined physical activity and nutrition promotion interventions, with potential synergistic effects on outcomes other than obesity. Electronic databases were searched for studies published between 1 January 2010 and 31 January 2020. Out of 359 articles retrieved, 31 peer-reviewed and 5 grey literature sources met inclusion criteria. Findings from 36 papers reporting on 34 interventions/initiatives were organised into 6 categories, based on implementation across multiple stages of the life course. Double-duty potential was assessed through a further stage of analysis. Findings: This review has identified actions that hold potential for tackling not only obesity, but healthy diets, sedentary behaviour and quality of life more generally, as well as actions that explicitly tackle multiple forms of malnutrition. Importantly, it has identified crucial gaps in current methods and praxis that call for further practice-oriented research, in order to better understand and exploit the synergistic effects of integrated interventions on outcomes other than obesity. Conclusions: Findings from across implementation settings suggest that even in situations where interventions are aimed at, or framed in terms of, obesity prevention and control, there are unexploited pathways for broader outcomes of relevance to nutrition and health and wellbeing more gener

Non-PR, IFPRI1; CRP4; Stories of Change in Nutrition; Transform Nutrition West Africa; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), In the past decade, Ghana has seen a significant reduction in stunting among children under five years of age. However, anemia only declined marginally over the same period, with the result that the rate of child anemia continues to be a severe public health emergency. These changes occurred within a socioeconomic context considered favorable for nutrition outcomes, marked by expansion and diversification of the economy, and investments in key infrastructure, healthcare, education, and water and sanitation. The Stories of Change in Nutrition study in Ghana aimed to better understand the changes in stunting and anemia between 2009 and 2018, as well as the potential drivers of these changes. Such findings can be used to inform agendasetting, implementation of existing policies, and future planning at national and subnational levels in Ghana. This study’s findings are important because both stunting and anemia are linked to significant adverse health and well-being impacts, particularly in low-income settings [1], and are listed among the global targets for nutrition for 2025 agreed by national ministers of health (including Ghana’s) at the World Health Assembly.

Non-PR, IFPRI1; CRP4, A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The overall goal of the three-year CAN program (2016–2019) was “Reducing malnutrition among children and women by facilitating efficient implementation of food and nutrition programmes, ensuring transparency, downward accountability and community participation.” The main intervention was a social audit process designed to sensitize communities to their rights and entitlements under the four primary schemes under the NFSA. The program aimed to increase knowledge and uptake of NFSA services, improve participation in community-level governance activities, especially by women, and improve institutional delivery of nutrition services and entitlements, as well as to reduce malnutrition, especially among women and children. Combining quantitative, qualitative, and process methodologies, the IDS-led evaluation looked at immediate impacts on strengthening local governance and improving service in the ICDS, Mamata, and TPDS programs, and explored contextual, design, and implementation-related factors that may have affected the effectiveness of the social audits. Communities (GPs) selected by the SPREAD program were randomly split into an Early and a Late group, which went through the audit process at different times. The quantitative analysis used differences in outcomes between groups to try to understand how change happened, how it accumulated, and whether it might be short-lived—important considerations for complex village-level governance.

Non-PR, IFPRI2; CRP4, A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This report summarises the background, design and methods, and key findings from an independent evaluation of the Collective Action for Nutrition (CAN) Social Audit programme designed and implemented by the Odisha-based non-governmental organisation (NGO) Society for Promoting Education and Rural Development (SPREAD) and supported by Azim Premji Philanthropic Initiatives (APPI). The evaluation was led by the Institute of Development Studies (IDS), UK in partnership with Development Corner Consulting (DCOR), India. Findings are intended to provide evidence on the effectiveness of the social audit model and feed into future plans for replication and scale-up.

PR, IFPRI2; CRP4, DGO; CPA; PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), This chapter first reviews the relationship between governance systems and processes (at various levels) and the nutrition sensitivity of agri-food systems, before reviewing the role of leadership in orienting such systems toward nutrition goals.

PR, IFPRI3; ISI; Transform Nutrition; CRP4; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all; DCA, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), The Transform Nutrition (Transform) research consortium (2012-2017), led by the International Food Policy Research Institute, sought to generate evidence to inform and inspire action to address undernutrition in 4 high-burden countries (India, Bangladesh, Kenya, and Ethiopia) and globally. Within the context of the literature, this synthesis article brings together core findings of Transform, highlighting priorities for future research.

PR, IFPRI3; CRP4; ISI; Stories of Change in Nutrition, PHND; SAO; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; POSHAN; Stories of Change in Nutrition, PHND; A4NH; SAO, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; DCA; Stories of Change in Nutrition, A4NH; PHND, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Transform Nutrition; Capacity Strengthening; B Promoting healthy food systems; F Strengthening institutions and governance; DCA; Stories of Change in Nutrition, A4NH; PHND; SAO, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

PR, IFPRI3; ISI; CRP4; Stories of Change in Nutrition, DGO; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Non-PR, IFPRI2; Transform Nutrition; CRP4; Stories of Change in Nutrition, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)