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Many workers in global supply chains remain nutritionally vulnerable despite the income they earn. The Seeds of Prosperity (SOP) program was implemented in Tamil Nadu and Assam, India, for tea supply chain workers (estate workers, small holder farmers, and farm workers). The aim was to enhance demand for diverse and nutritious foods and improve practices related to handwashing. The program used a behavior change communication approach wherein participants received weekly 1-hour group sessions with messaging on dietary diversity for 5 weeks and handwashing for 4 weeks. An impact evaluation was conducted to estimate changes in reported dietary and hygiene knowledge and behaviors among women. The study used a longitudinal quasi-experimental design in a subsample of program participants at baseline and post-intervention among both intervention and comparison. There was a small but significant increase in mean dietary diversity (DD) for all 4 worker groups (ranging from DD score changes of 0.3 to 0.7; P < .05) and in the proportion of women meeting the minimum dietary diversity in 2 of the 4 groups. Similarly, a significant increase in the mean number of handwashing moments was observed in 2 of the worker groups. An increase in home garden use was observed in 1 of the 4 worker groups. While the SOP program resulted in improvements in dietary diversity, most tea farming women still do not achieve minimum dietary diversity. Nutritious food access may be an important constraint to further improvement.

Using a quasi-experimental design, our study aimed to determine the effectiveness of the 'Eggs Make Kids SharpBright and StrongActive' demand-creation campaign in Nigeria. The intervention arm received emotionally compelling radio and television advertisements about eggs, and was exposed to promotional activities and advertising about eggs at points of purchase, schools and health facilities; the comparison arm received no intervention. Children 6-59 months of age (intervention: n = 1359; comparison: n = 1485) were assessed 14 months apart. Intent-to-treat analyses with analysis of covariance method assessed the impact of the intervention on caregivers' behaviour towards eggs, caregivers' willingness to pay for eggs, availability of eggs in households, and consumption of eggs by children 6-59 months of age. Analyses were adjusted for possible confounders and perceived effects of COVID-19 on finances and food consumption. Compared to the comparison arm, the intervention arm showed a greater prevalence of household egg acquisition (odds ratio = 1.34, p 0.0001), and larger improvements in caregiver self-efficacy (β = 0.242, p = 0.004) and intent to feed eggs to children (β = 0.080, p = 0.021). No effects were found on children's egg consumption or caregivers' reported willingness to pay for eggs. The lack of impact on child egg consumption despite increased acquisition of eggs and caregiver self-efficacy suggests that other barriers to child consumption may exist. Additional research should further investigate factors that may influence intrahousehold distribution of eggs and whether these may also influence other nutritious foods.

Objective:To identify determinants of egg consumption in infants and young children aged 6–23·9 months in Ethiopia.Design and setting:Data used were from the cross-sectional baseline survey of an egg campaign in Ethiopia implemented by the Global Alliance for Improved Nutrition.Participants:Children aged 6–23·9 months (n 453) were sampled. Data on socio-demographic characteristics, economic resources, caregiver’s behaviour, child health and feeding practices, and egg consumption in the last 7 d were collected using interviewer-administered questionnaires. Multivariable ordinal logistic regression was used to examine the association between explanatory variables and egg consumption in the last 7 d.Results:About half of children (53·4 %) did not consume eggs in the last 7 d. The odds of children consuming eggs were 4·33 (P < 0·002) times higher when their caregivers had some college education compared with no education. Wealth was positively (OR, 1·13, P = 0·029) and household food insecurity was negatively (OR, 0·96, P = 0·117) associated with child egg consumption. Purchasing eggs (OR, 9·73, P < 0·001) and caregiver’s positive behavioural determinants (OR, 1·37, P = 0·005) were associated with child egg consumption. The associations of socio-demographic characteristics and economic resources with egg consumption provide evidence of partial mediation through caregiver behaviour and child health.Conclusions:About half of children aged 6–23·9 months consumed eggs. Availability of eggs in households, mainly through purchase, was strongly associated with egg consumption. Education of caregivers and household heads and economic resources were associated with egg consumption and may operate through caregiver behaviour.

Background Anemia, iron deficiency, and iodine deficiency are problems of important public health concern in many parts of the world, with consequences for the health, development, and work capacity of populations. Several countries are beginning to implement double fortified salt (DFS) programs to simultaneously address iodine and iron deficiencies. Objective Our objective was to summarize the evidence for efficacy and effectiveness of DFS on the full range of status and functional outcomes and across different implementation and evaluation designs essential to successful interventions. Methods We conducted a systematic review and meta-analysis of published and gray literature examining the effects of DFS on nutritional status, cognition, work productivity, development, and morbidity of all population groups. We searched for articles in Medline, Embase, CINAHL, Cochrane Central Register, and ProQuest for randomized trials, quasi-randomized trials, and program effectiveness evaluations. Results A total of 22 studies (N individuals = 52,758) were included. Efficacy studies indicated a significant overall positive effect on hemoglobin concentration [standardized mean difference (95% CI): 0.33 (0.18, 0.48)], ferritin [0.42 (0.08, 0.76)], anemia [risk ratio (95% CI): 0.80 (0.70, 0.92)], and iron deficiency anemia [0.36 (0.24, 0.55)]. Effects on urinary iodine concentration were not significantly different between DFS and iodized salt. The impact on functional outcomes was mixed. Only 2 effectiveness studies were identified. They reported programmatic challenges including low coverage, suboptimal DFS quality, and storage constraints. Conclusions Given the biological benefits of DFS across several populations in efficacy research, additional evaluations of robust DFS programs delivered at scale, which consider effective implementation and measure appropriate biomarkers, are needed.

Objective:We estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6–59 months in Bangladesh.Design:Cross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios.Setting:The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh.Participants:Caregivers of child 6–59 months and BRAC staff members including community health workers were the participants for this study.Results:The home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis.Conclusions:The market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.

International audience; Organic farming is a way to address environmental issues. In Kenya, organic production for domestic markets based on local certification represents a solution to both economic and environmental issues. We propose to address this latter issue. Indeed, no quantitative studies have been dedicated to these systems’ impacts on the environment. However, their theoretical benefits can be weakened, first by their functioning based on internal control and indirect external control, and second by the risk of self-selection since farmers using low levels of synthetic inputs have less effort to make in order to enter in conversion process. Thanks to unique farm-level survey data along with the propensity score matching method, we assess the producer-level effects of organic certification for fruits and vegetables on agro-ecological practices. We show that conversion and certification are associated with organic farming techniques and positive perceptions of different statements about environmental values. However, we do not notice any additional effects of certification compared to conversion alone. Although economic issues are important, we focus on environmental issues that appear as important for smallholders. In a context with no public regulation, conversion-only farmers and locally certified farmers could be a lever for a more sustainable agriculture. © 2019 Canadian Agricultural Economics Society

OBJECTIVES: Double fortified salt (DFS) with iodine and iron is efficacious in improving anemia, but evidence of effectiveness in large-scale programs is limited. We evaluated a program delivering double fortified salt (DFS) over 12 mo in five districts through the public distribution system in Uttar Pradesh, India on iron status and anemia. METHODS: Only two (Etawah and Auraiya) of the five intervention districts met the evaluability threshold of 50% DFS utilization chosen as an a priori criterion for endline inclusion. We present findings on cross-sectional survey data collected from 6388 non-pregnant women of reproductive age (WRA) in Etawah and Auraiya, and their two matched adjacent boundary comparison districts. We used generalized linear models that accounted for clustering, with log link function for risk ratio (RR) and identity link function for mean difference, adjusting for matched pairs. Models were adjusted for WRA age, education of WRA and household head, religion and housing. Ferritin levels were inflammation adjusted using the BRINDA regression equation. RESULTS: There was no difference in anemia and iron deficiency anemia (IDA) prevalence or in mean hemoglobin concentration between WRA in intervention and comparison districts. However, we observed a 15% lower risk of being iron deficient in intervention areas (RR = 0.85: 95% CI, 0.75–0.98). Additionally, WRA in intervention districts who reported regular use of DFS had 23% lower risk of being iron deficient (RR = 0.77: 95% CI, 0.66–0.93), and those reporting partial use had 20% lower risk (RR = 0.80: 95% CI, 0.66–0.99). There was no difference among non-users (RR = 0.98: 95% CI, 0.88–1.22). CONCLUSIONS: DFS was effective in reducing risk of iron deficiency, but not anemia or IDA, among WRA. This modest effectiveness may have been in part due to supply chain interruptions over the course of the implementation period (slow start and earlier than planned cessation). We observed a dose responsive effect, with greater risk reductions among regular and partial users than among non-users. To maximize this potential and perhaps extend impacts to anemia or IDA, the program will require: 1) longer duration of exposure, 2) investments in addressing barriers to coverage and utilization, and 3) complementary efforts to address other causes of anemia in this context. FUNDING SOURCES: Bill & Melinda Gates Foundation.

Replication is an important tool to promote high quality research and ensure policy makers can rely on studies in making guidelines or funding programs. By ensuring influential studies are replicable we provide assurance that the policies based on these studies are well-founded and the conclusions and recommendations are robust-to different estimation models or different choices. In this paper, we argue that replication is not only useful but necessary to ensure that an author's choice in how to analyse data is not the only factor that determines whether an intervention is effective or not. We also show that while most research is done well and provides robust results, small differences can lead to different interpretations and these differences need to be acknowledged. This special issue highlights 5 such replication studies, which are replications of influential studies on biomedical, social, behavioural and structural interventions for HIV prevention and treatment. We reflect on their findings. Four out of five studies, which conduct push button replication and pure replication, were able to reproduce the results of the original studies with minor differences, mainly due to minor typographical errors or rounding differences. The analysis of the measurement and estimation analyses conducted in these five studies reveals that the original results are not very robust to alternative analytical approaches, especially when these results rely on a small number of observations. In these cases, the original results are weakened. Furthermore, in contrast to the original papers, two of the five included replication studies conducted a theory of change analysis-to explore how or why the interventions work (or do not) not just whether the intervention works or not. These two analyses indicate that the estimated impacts of the interventions are drawn from few mediators. In addition, they demonstrate that, in some cases, a lack of effect may be related to lack of adequate exposure to the intervention rather than inefficacy of the intervention per se. However, overall, the included replication studies show that the results presented in the original papers are trustworthy and robust, especially when based on larger sample sizes. Replication studies can not only verify the results of a study, they can also provide additional insights on the published results, such as how and why an intervention was effective or less effective than expected. They can thus be a tool to inform the research community and/ or policymakers about whether and how interventions could be adopted, which need to be tested further, and which should be discontinued because of their ineffectiveness. Thus, publishing these replication studies in peer-reviewed journals makes the work public and publicized. The work advances knowledge, and publication should be encouraged, as it is for other types of research.

We replicated the study ‘Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial’ using an epidemiological approach as well as an econometric approach. Bot...

Between 1996 and 2014, 30 Sub-Saharan African (SSA) countries benefited from debt relief under the Heavily Indebted Poor Countries (HIPC) initiative and the Multilateral Debt Relief Initiative (MDRI). The architects of the HIPC initiative and MDRI posited that these programs would spur growth and investment. This paper exploits the variability of participation in the HIPC initiative and MDRI across time and country, in order to identity the effect of participation on growth and investment. I find that the decision point and post-completion point periods of the enhanced HIPC initiative are associated with a 1.762 percentage point and 3.139 percentage point increase in public investment, respectively. The impact is higher in countries with low access to international capital markets. The enhanced HIPC initiative increases private investment by 1.838 percentage points during the post-completion point period in countries with low access to international capital, for approximately two years, but has no effect on growth or foreign direct investment. I find no effect of the original HIPC initiative or MDRI on growth, private investment, public investment or foreign direct investment. I find no heterogeneous impact of the enhanced HIPC initiative on growth and foreign direct investment by level of indebtedness, access to international capital markets, or institutional quality. As the measures of institutional quality have barely changed between 1996 and 2014 in HIPC countries, the results of this paper suggest that without a strong improvement in institutional quality, debt relief is unlikely to boost investment and growth in Africa. Possible future debt relief in SSA countries should be associated with a component directly aimed at improving institutional quality. If an improvement of institutional quality is not feasible in the short run, debt relief in SSA countries should aim to support public investment.

Rigorous and transparent critical appraisal is a core component of high quality systematic reviews. Well-conducted quasi-experiments have been empirically shown to estimate credible, unbiased treatment quantities. Conversely, when inappropriately designed or executed, these estimates are likely to be biased. This paper draws on recent advances in risk of bias assessment. It presents an approach to evaluating the internal validity of credible quasi-experiments. These are non-randomised studies using design-based approaches to control for unobservable sources of confounding such as difference studies, instrumental variables, interrupted time series, natural experiments and regression discontinuity designs. Our review suggests that existing risk of bias tools provide, to different degrees, incomplete transparent criteria to assess the validity of credible quasi-experiments. We argue that a tool is needed to assess risk of bias consistently across credible quasi-experiments. Drawing on existing tools, in particular Cochrane’s new tool for non-randomized studies of interventions (Sterne et al., 2014), we discuss domains of bias and suggest directions for evaluation questions.

This paper presents the statistical concepts used in power calculations for experimental design. It provides detailed definitions of parameters used to perform power calculations, useful rules of thumb and different approaches that can be used when performing power calculations. The authors draw from real-world examples to calculate statistical power for individual and cluster randomised controlled trials. This paper provides formulae for sample size determination and minimum detectable effect (MDE) associated with a given statistical power. The paper is accompanied by the sample size and MDE calculator©, a free online tool that allows users to work with the formulae presented in Section 4.

This paper examines the factors behind export diversification in oil countries. Specifically, we investigate the impact of oil booms on export diversification through an empirical framework. The paper finds that economy's export structure before the oil boom determines whether oil windfalls might affect the diversification process. Thus, an oil boom negatively affects export diversification only if countries initially exhibit low levels of diversification. In countries with a high level of diversification before the boom, an oil boom has no impact on diversification. These results are based on a large sample of 134 countries, and are robust to various sensitivity analyses. They are corroborated with data from the manufacturing sector which show that oil booms only reduce diversification in countries with a small manufacturing sector prior to the boom.

Although HIV self-testing may overcome some barriers to HIV testing, various stakeholders have expressed concerns that HIV self-testing may lead to unintended harm, including psychological, social and medical harm. Recognizing that similar concerns were raised in the past for some other self-tests, we conduct a review of the literature on a set of self-tests that share some characteristics with HIV self-tests to determine whether there is any evidence of harm. We find that although the potential for harm is discussed in the literature on self-tests, there is very little evidence that such harm occurs.

This study assesses the effect of international emigration of skilled workers on poverty in an African economy. The empirical analysis relies on three main steps: (i) an econometric analysis based on a sample of developing countries shows that skilled migration has a significant negative impact on productivity in the country of origin, while unskilled migration has a significant positive effect on the same indicator; (ii) using these estimates within a computable general equilibrium (CGE) model, calibrated on Cameroonian economy data, we simulate the impact of emigration on macroeconomic indicators and (iii) relying on the 2007 Cameroonian household survey, the CGE model maps consistent changes of commodity and factor prices across households for a micro-simulation analysis. We find that the current pattern of emigration from Cameroon has contributed to an increase in the number of the poor by 0.8 percentage points. The negative effect of skilled emigration on productivity turns out to be more important than the combined positive effects related to remittances transferred and productivity gains from unskilled emigration. This outcome strongly supports actions by developing countries to optimise contributions from their skilled workers living abroad.

Thisstudyassessestheeffectofinternationalemigrationofskilledworkerson poverty in an African economy. The empirical analysis relies on three main steps: (i) an econometric analysis based on a sample of developing countries showsthatskilledmigrationhasasignificantnegativeimpactonproductivity in the country of origin, while unskilled migration has a significant positive effect on the same indicator; (ii) using these estimates within a computable general equilibrium (CGE) model, calibrated on Cameroonian economy data, we simulate the impact of emigration on macroeconomic indicators and (iii) relying on the 2007 Cameroonian household survey, the CGE model maps consistent changes of commodity and factor prices across households for a micro-simulation analysis. We find that the current pattern of emigration from Cameroon has contributed to an increase in the number of the poor by 0.8 percentage points. The negative effect of skilled emigration on productivity turns out to be more important than the combined positive effects related to remittances transferred and productivity gains from unskilled emigration. This outcome strongly supports actions by developing countries to optimise contributions from their skilled workers living abroad.

Quasi-experimental designs are gaining popularity in epidemiology and health systems research-in particular for the evaluation of health care practice, programs, and policy-because they allow strong causal inferences without randomized controlled experiments. We describe the concepts underlying five important quasi-experimental designs: Instrumental Variables, Regression Discontinuity, Interrupted Time Series, Fixed Effects, and Difference-in-Differences designs. We illustrate each of the designs with an example from health research. We then describe the assumptions required for each of the designs to ensure valid causal inference and discuss the tests available to examine the assumptions.

Although recent evidence shows detrimental effects of armed conflict on educational attainment, coupled with the fact that 50% of children out of school live in conflict affected countries, there is a lack of studies rigorously assessing the effectiveness of different social and economic development interventions aiming to mitigate the impact of armed conflict on education outcomes. In order to fill this knowledge gap, this study assesses the impact of education investments financed by the Angola Social Action Fund from 1994 to 2001 on years of schooling. I use the Angola 2001 Multiple Indicator Cluster Survey to evaluate this impact. Using difference in differences estimation and a fixed effects model, I find that for individuals currently enrolled in schools and living in non-migrant households, an additional year of exposure to Angola Social Fund leads to an increase of years of schooling by 0.175 years. I find that Angola Social Action Fund has no impact on years of schooling for individuals currently out of school and for individuals living in migrant households. I find no heterogeneous effects of ASAF by variables considered. Interventions such as social funds can be used to mitigate the impact of civil war on education for individuals already enrolled in schools and living in non-migrant households. However, for individuals out of schools, there is great need to design innovative interventions specifically addressed to their circumstances and to test them rigorously in order to find interventions that can effectively mitigate the impacts of civil war on education.

Although recent evidence shows significant and long-lasting detrimental effects of armed conflict on child health, there is lack of studies rigorously assessing the effectiveness of different social and economic development interventions aiming to mitigate the impact of armed conflict on child health. In order to fill this knowledge gap, this study assesses the impact of health projects and water, sanitation, and waste management interventions financed by the Angola Social Action Fund (ASAF) from 1994 to 2001 on child health. I use data from Inquerito aos Agregados Familiares sobre Despesas e Receitas 2000/2001(IDR 2001), a household survey on expenditures and incomes conducted between February 2000 and February 2001 in Angola. IDR 2001 uses a stratified sampling design in which 12 households were surveyed in a random fashion in each aldeia (village) in rural areas and bairro (neighborhood) in urban areas. Using propensity score matching, a fixed effects model, and propensity-based weighted regression, I find that ASAF leads to a statistically significant increase of the height-for-age Z-scores (HAZ) by 0.335 standard deviations of children less than 5 years. This finding is robust to different implementations of the propensity score model specification and when conducting the sensitivity analysis of hidden bias. The main result that emerges from an analysis of heterogeneous effects shows that ASAF has no impact on children living in war displaced households. Despite many challenges faced by conflict affected countries, social funds which are one the key instruments of the World Bank used to promote development at the local level can be used to mitigate the impact of armed conflict on child health. For children living in war displaced households, specific interventions should be designed to mitigate the impact of armed conflict.