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Innovations in agricultural index insurance have raised expectations that the private sector can overcome shortcomings associated with more traditional indemnity-based products like multiperil crop insurance and strengthen agricultural risk management at scale across developing countries. This article updates previous reviews on agricultural insurance but differs in that it goes beyond the prognosis that recent innovations can help make insurance more commercially viable. As such, it addresses two important challenges that have received limited attention. First, it distinguishes different types of farm households and recognizes that many are excluded from the insurance market, describing additional innovations that can help make insurance more accessible to these excluded groups. Second, it acknowledges that insurance for catastrophic risks is unaffordable for most farmers and summarizes new developments in disaster assistance and safety net programs that can provide broader protection against these risks. The review concludes that cost-benefit analyses of subsidized insurance programs will be crucial for guiding public spending decisions.

Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys., The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost tool for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development, a reliable and widely used instrument.

Low-quality diets contribute to the burden of malnutrition and increase the risk of children not achieving their developmental potential. Nutrition-sensitive agriculture programs address the underlying determinants of malnutrition, though their contributions to improving diets do not factor into current nutrition impact modeling tools.To synthesize the evidence on the effectiveness of nutrition-sensitive agriculture programs in improving dietary diversity in young children (6-23.9 months and 6-60 months).A literature search was conducted for published trials through existing systematic reviews and individual database search of the ISI Web of Science. All dietary diversity measures in the studies selected to be in the analysis were extracted. Estimation of main pooled effects were conducted on outcomes of minimum diet diversity (MDD) and diet diversity score (DDS) using random-effects meta-regression models. We report pooled effect sizes as standardized mean differences (SMDs) or odds ratios (ORs).Nutrition-sensitive agricultural interventions have a significant positive impact on the diet diversity scores of children aged 6-23.9 months (SMD = 0.22, 95% confidence interval (CI) = 0.09-0.36) and on the odds of reaching minimum diet diversity (OR = 1.45, 95% CI = 1.20, 1.76). Similar impacts are found when analyses are expanded to include studies for children aged 6-60 months (DDS SMD = 0.22, 95% CI = 0.12-0.32) (MDD OR = 1.64, 95% CI: = 1.38-1.94).Nutrition-sensitive agriculture interventions consistently have a positive impact on child dietary diversity. Incorporating this evidence in nutrition modeling tools can contribute to decision-making on the relative benefits of nutrition-sensitive interventions as compared with other maternal, newborn, child health and nutrition (MNCHN) interventions.

School meal programs are credited with improving food security and encouraging primary school enrollment. Yet the role of such programs may be evolving given progress in primary school participation as well as the availability of new instruments for social protection. This study assesses whether a school meal program in Armenia that originated as a response to the global financial crisis of 2008 serves as a wide but shallow safety net. We look at both changes in poverty measures as well as the welfare effect of the program using general measures of social welfare within the context of a class of social welfare functions. We show that only for extreme poverty or for comparatively strong social aversion to inequality does the school meal program have a noticeable welfare outcome. We compare this to the welfare effect of a concurrent – and larger – family benefit program.

Background Relative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition. Objectives This study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes. Methods We converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15–49 y old and children 12–23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence. Results Most noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points. Conclusions Relative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.

The Lives Saved Tool (LiST) has been used to estimate the impact of scaling up intervention coverage on undernutrition and mortality. Evidence for the model is largely based on efficacy trials, raising concerns of applicability to large-scale contexts. We modelled the impact of scaling up health programs in India between 2006 and 2016 and compared estimates to observed changes. Demographics, intervention coverage and nutritional status were obtained from National Family and Health Survey 2005–6 (NFHS-3) for the base year and NHFS-4 2015–16 for the endline. We used the LiST to estimate the impact of changes in coverage of interventions over this decade on child mortality and undernutrition at national and subnational levels and calculated the gap between estimated and observed changes in 2016. At the national level, the LiST estimates are close to the actual values of mortality for children

Most impact evaluations of Conditional Cash Transfers (CCTs) and Unconditional Cash Transfers (UCTs) focus on the returns to increased human capital investments that will be reaped largely or exclusively in the future (e.g., when current children have increased productivities as adults). But the objectives of these programs are not only to increase human capital investments with implications for future levels and distributions of income but also to alleviate current poverty and reduce current inequality. The current distributional gains from such programs depend on the degree of inequality aversion in the social welfare function. Simulations show that, for a range of inequality aversion parameters, the welfare gains from current redistribution for the Mexican PROGRESA CCT program can be as large, or possibly much larger, than the estimated present discounted value of future earnings from human capital investments in lower and upper secondary schooling. These, moreover, are underestimates of the gains from redistribution because, in addition to current gains, such gains will be augmented in the future through the distribution of the returns on the human capital investments induced by cash transfer programs. Therefore, to fully evaluate such programs, it is critical to incorporate the distributional gains, not only the impacts on human capital investments.

Background Food for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited. Objective This study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children. Methods Through the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6–17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat. Results Adolescent girls aged 10–13 y in FFE schools experienced a significant (P

Summary Adolescence is a pivotal point in the life course, characterised by transformative physical, cognitive, and emotional growth, an openness to change, and a drive to reshape the social environment. It offers unique opportunities to adopt changes in diet and physical activity that can persist into later life. Yet pre-existing nutritional problems, including micronutrient deficiencies, food insecurity, and poor-quality diets, persist at the same time as adolescents face the rapid emergence of an obesity epidemic. Adolescent growth and nutrition has been largely overlooked in intervention and policy research. Most intervention studies have emphasised micronutrient supplementation, with few taking into account the multiple drivers of adolescent diets. This Series paper highlights that effective interventions and policies will need to cut across sectors; be supported by multifaceted and multilevel policy; and extend across education, health, food systems, social protection, and digital media. Better data standardisation and systems will be essential in coordinating and monitoring these responses. In a context of shifts in planetary ecosystems and commercial drivers, resilient food systems will need to both ensure access to healthy and affordable foods and provide the infrastructure and incentives for continuing physical activity. Intergenerational partnerships with young people will be essential in bringing about transformative change and ensuring that food policies reflect their needs and aspirations.

India has the world’s highest number of undernourished children and the largest school feeding program, the Mid-Day Meal (MDM) scheme. As school feeding programs target children outside the highest-return “first 1000-days” window, they have not been included in the global agenda to address stunting. School meals benefit education and nutrition in participants, but no studies have examined whether benefits carry over to their children. Using nationally representative data on mothers and their children spanning 1993 to 2016, we assess whether MDM supports intergenerational improvements in child linear growth. Here we report that height-for-age z-score (HAZ) among children born to mothers with full MDM exposure was greater (+0.40 SD) than that in children born to non-exposed mothers. Associations were stronger in low socioeconomic strata and likely work through women’s education, fertility, and health service utilization. MDM was associated with 13–32% of the HAZ improvement in India from 2006 to 2016., India’s national school feeding program is the largest of its kind in the world, but the long-term program benefits on nutrition are unknown. Here, the authors show intergenerational program benefits, in that women who received free meals in primary school have children with improved linear growth.

Existing empirical evidence suggests that the prevalence of undernutrition in remote and poor, rural areas is still high among Chinese children. While evidence reveals that undernutrition may detrimentally affect child development, studies focusing on rural Chinese preschoolers are sparse. Using the baseline survey of a preschool’s free nutritious lunch pilot program, this study examined the relationship between child undernutrition and developmental outcomes among a preschool-aged sample in poor, rural areas of China. We conducted the baseline survey in Hunan province in south central China in September 2018. A total of 1293 preschoolers living in two (then) nationally designated poverty counties in rural Hunan served as our study sample. Children’s nutritional statuses were measured using height-for-age z-score, weight-for-age z-score, and anemia, while their cognitive and socio-emotional skills were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Strengths and Difficulties Questionnaire (SDQ), respectively. We find that 33% of sample preschoolers were anemic, whereas the incidences of stunting and wasting were 11% and 2%, respectively. About 54% of the sample children had delay in at least one of the developmental domains measured in this study. Our findings provide suggestive evidence supporting that children from certain backgrounds tend to experience worse nutritional and developmental outcomes than their counterparts. After controlling for socioeconomic status, we observed that both anemia and stunting were negatively associated with children’s cognitive performance, however, they were not associated with socio-emotional performance. As such, this study suggests that free lunch programs have the potential to change children’s developmental trajectory in preschool. We believe that our results will contribute to the debate surrounding whether the nutritious lunch program in China should be expanded to the preschool education level.

Gender disparities in child undernutrition and mortality in India have been a topic of interest for a long time, but little is known on trends or geographic variability in recent periods. We examined the degree to which historic patterns in gender disparities in child undernutrition and mortality in India have persisted given recent progress in health and nutrition. Using two nationally representative datasets from India between 2006 and 2016, we estimated mortality rates and stunting by gender and by birth order among children under 5 years old. We then tested for differences between boys and girls within each survey round for both national and state levels using bootstrapped standard errors, controlling for cluster and sampling weights. We found striking progress in child mortality and stunting in India between 2006 and 2016 for both boys and girls. Boys were more likely to die than girls during the first year of life. Girls had a higher risk of mortality between age 1 and 5 years than boys in 2006, but the improvements in survival eliminated this gender gap in 2016. For stunting, we found no gender difference in 2006, but girls had higher height‐for‐age Z‐scores (HAZ) and lower stunting than boys in 2016. Trends in gender gaps in mortality and stunting vary substantially by birth order and between states. Our findings indicate that improvements in mortality and nutritional status among girls have started to close gender disparities. Policy efforts to close gaps must stay the course in states that have made progress and be accelerated in states where disparities are still prominent.

While taller workers are regularly observed to earn more, there is debate concerning the independent contribution of stature to labor earnings. This study investigates the degree to which the association of height and earnings in Pakistan is independent of other cognitive and socio-emotional skills. Next, the relationship between height and earnings is explored when measures of cognitive ability and an index of socio-emotional capacity are included separately. The paper finds only a modest attenuation in the contribution of height to earnings after controlling for additional dimensions of human capital, suggesting that height provides independent information on labor productivity. This result is robust to treating height as endogenous. The paper also examines non-linearities in the relationship between height and earnings. In contrast to results from relatively few other contributions to research on this non-linear relationship, height is associated with earnings only when an individual is taller than the median height. This lends some support to the role of status and confidence in the yet unresolved question as to the relative contribution of direct and indirect influence of height on earnings.

Many school feeding programs target child hunger, nutritional deficiencies, attendance, and education outcomes but often do not examine their effects on cognitive development. In this cluster-randomized controlled trial, we tested the effects of adding a morning snack to a school lunch program on the fluid intelligence of 951 children ages 4 to 6 years. While there were no significant effects on development overall, the morning snack improved short-term memory (STM) and total score on the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) among children from the lowest quartile of household expenditures (STM: 0.35SD, p = 0.020; WPPSI-IV: 0.65SD, p = 0.087), and those whose mothers completed secondary school or less (STM: 0.35SD, p = 0.002; total WPPSI-IV: 0.81SD, p = 0.011). For at risk preschoolers, school snack programs may help meet their developmental needs.

Governments and international development partners investing over $40 USD billion a year in school meals have shown interest in linking these programs with agriculture sector development, through what has become known as “Home-Grown†school feeding (HGSF). Nevertheless, evidence on the effectiveness of HGSF and agriculture is limited. This article reports on the findings of a three-year cluster randomized trial implemented in 58 districts of Ghana including a panel of 1,668 households. Communities were randomly assigned to 1) standard school meals; 2) HGSF or 3) control with no intervention. Post-intervention, the caterer-level analysis highlighted major challenges related to delayed program disbursements, resulting in a mismatch between budgeted and actual caterer outlay on food purchases per pupil equivalent to approximately 50% of the budgeted per child per day allocation. For caterers, by far the largest procurement channel was through traders, though there is evidence that HGSF may have increased the share of value purchased directly from smallholders. We find no strong evidence that the school feeding program or HGSF affected smallholders market structure, farm, non-farm and household income. When interpreting these null results, it is important to consider the findings of two parallel studies that showed positive effects of this national program on school children’s learning, cognition, and nutrition outcomes. The national program can still be considered as an effective social protection strategy with multiple objectives, even if the agriculture objectives remain aspirational.

This document is the 17th and final chapter in a book that identifies priorities for action to enhance child growth and nutrition in developing countries. The chapter seeks to establish the role of community participation as a common element in an array of nutritional interventions. The discussion of individual and household behavior agrees with the evidence that household members make rational decisions. Nutrition interventions can therefore affect needy households by: 1) changing the goals and preferences of the malnourished individual or caretaker 2) changing the power structure in the households and/or 3) alleviating existing resource constraints. While the community and household may be the focus of nutrition interventions national policies (such as food pricing strategies or breast-feeding promotion) can have strong effects on food supply and nutrition. The success of policies however depends upon local implementation and communities have an important role in diagnosing and solving nutrition problems. Because nutrition problems are location-specific their solutions must also be location-specific. Although the content of nutritional interventions is rarely generalizable across communities the process followed by successful programs may be replicated. Projects should be flexible and should be designed and monitored so that they benefit the poorest communities. The most urgent research needs include 1) applied research on the implementation of nutrition projects 2) research on the political economy and institutional issues that affect national and regional support of nutrition interventions 3) research on the nutritional effects of broader government policies 4) identification of additional successful projects and 5) development of evaluation methods. Training is needed for community residents public sector employees and those engaged in economic analysis of the nutritional effects of policies and programs.

This document is the introductory chapter to a book that identifies priorities for action to enhance child growth and nutrition in developing countries. It opens by noting that more than 1.1 billion people in developing countries currently live in poverty and the number living in poverty in sub-Saharan Africa is expected to double by the year 2000. Poverty takes a major toll on children who suffer from blindness diminished learning capacity and death from micronutrient deficiencies and from the ill effects of growth faltering. The number of children under 5 years old who are underweight is growing from 164 million in 1980 to 184 million in 1990 with 200 million expected by the year 2000. Although the largest increase is expected in sub-Saharan Africa it is predicted that almost half the children of South Asia will also be significantly underweight by the year 2000. Some 14 million preschool age children have eye damage and 250-500000 go blind each year due to vitamin A deficiency. 2/3 die within months of going blind. While the immediate causes and effects of growth faltering in children are well established less well understood are the indirect determinants which are a combination of biological and socio-economic factors specific to particular groups and places. Nutrition programs have been less effective when they ignored the complexity and specificity of the problem in the target region. Programs that try to address all the problem factors comprehensively as well as programs that focus on one or two major factors have had disappointing results. Programs that have been individually designed for specific localities with some amount of community participation have had better results.

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.

To investigate coverage and equity of India's Integrated Child Development Services programme across the continuum of care from pregnancy to early childhood, before and after the programme was expanded to provide universal access.The programme offers nutrition and health services to pregnant and lactating mothers and young children. We used data from nationally representative surveys in 2005-2006 and 2015-2016, including 36 850 mother-child pairs in 2006 and 190 804 in 2016. We assessed changes in the equity of use of programme services by socioeconomic quintile, caste, education and rural or urban residence. We used regression models to investigate the determinants of programme use.The mean proportion of respondents using programme services increased between 2006 and 2016, from 9.6% to 37.9% for supplementary food, 3.2% to 21.0% for health and nutrition education, 4.5% to 28% for health check-ups and 10.4% to 24.2% for child-specific services (e.g. immunization, growth monitoring). Wealth, maternal education and caste showed the largest positive associations with use of services. However, expansion in service use varied at the sub-national level. Although overall use had improved and reached marginalized groups such as disadvantaged castes and tribes, the poorest quintiles of the population were still left behind, especially in the largest states that carry the highest burden of undernutrition.India's policy reforms have increased coverage of the programme at the national level, including for marginalized groups. With further scaling-up, the programme needs to focus on reaching households from the lowest socioeconomic strata and women with low schooling levels.Étudier la couverture et l'équité du programme indien de services intégrés pour le développement de l'enfant (Ce programme propose des services de nutrition et de santé aux femmes enceintes, aux femmes qui allaitent et aux jeunes enfants. Nous avons utilisé des données provenant d'enquêtes nationalement représentatives, réalisées en 2005–2006 et en 2015–2016, qui ont impliqué 36 850 paires mère-enfant en 2006 et 190 804 paires mère-enfant en 2016. Nous avons évalué les changements en matière d'équité dans l'utilisation de ces services par quintile socioéconomique, caste, niveau d'éducation et résidence rurale ou urbaine. Nous avons utilisé des modèles de régression pour étudier les déterminants de l'utilisation du programme.La proportion moyenne de personnes interrogées utilisant les services du programme a augmenté entre 2006 et 2016, en passant de 9,6% à 37,9% pour la fourniture de suppléments alimentaires, de 3,2% à 21,0% pour les services d'éducation sur la santé et la nutrition, de 4,5% à 28% pour les bilans de santé et de 10,4% à 24,2% pour les services spécifiques à l'enfant (ex.: vaccination, surveillance de la croissance). Le niveau de revenus, le niveau d'éducation de la mère et la caste correspondent aux associations les plus largement positives avec l'utilisation des services. Néanmoins, l'augmentation de l'utilisation des services a varié au niveau sous-national. Même si l'utilisation générale a augmenté et que les services ont atteint des groupes marginalisés, tels que les castes et les tribus les plus défavorisées, les quintiles les plus pauvres de la population sont restés laissés pour compte, notamment dans les plus grands états, qui sont les plus lourdement frappés par la dénutrition.En Inde, les réformes des politiques ont permis d'obtenir une meilleure couverture au niveau national, y compris pour les groupes marginalisés. Pour ses prochaines extensions, le programme devra cibler les ménages appartenant aux couches socioéconomiques les plus pauvres et les femmes ayant un niveau d'éducation bas.Investigar la cobertura y la equidad del Programa de servicios integrados de desarrollo infantil de la India a través de la atención continua desde el embarazo hasta la infancia temprana, antes y después de que el programa se ampliara para proporcionar acceso universal.El programa ofrece servicios de nutrición y salud a madres embarazadas y lactantes y a niños pequeños. Se utilizaron datos de encuestas representativas a nivel nacional de 2005-2006 y 2015-2016, incluidas 36 850 parejas de madres e hijos en 2006 y 190 804 en 2016. Se evaluaron los cambios en la equidad de uso de los servicios del programa por quintil socioeconómico, casta, educación y residencia rural o urbana. Se utilizaron modelos de regresión para investigar los determinantes del uso del programa.La proporción media de encuestados que utilizan los servicios del programa aumentó entre 2006 y 2016, del 9,6 % al 37,9 % en el caso de los alimentos suplementarios, del 3,2 % al 21,0 % en el de la educación sanitaria y nutricional, del 4,5 % al 28 % en el de los reconocimientos médicos y del 10,4 % al 24,2 % en el de los servicios específicos para niños (por ejemplo, inmunización o vigilancia del crecimiento). La riqueza, la educación materna y la casta mostraron las mayores asociaciones positivas con el uso de los servicios. Sin embargo, la expansión del uso de servicios varió a nivel subnacional. Aunque el uso general ha mejorado y ha llegado a grupos marginados como las castas y tribus desfavorecidas, los quintiles más pobres de la población siguen quedando rezagados, especialmente en los estados más grandes que soportan la mayor carga de desnutrición.Las reformas políticas de la India han aumentado la cobertura del programa a nivel nacional, incluso para los grupos marginados. Con una mayor ampliación, el programa debe centrarse en llegar a los hogares de los estratos socioeconómicos más bajos y a las mujeres con bajos niveles de escolaridad.التحقق من عدالة ومدى تغطية برنامج الهند لخدمات تنمية الطفل، وذلك من خلال استمرار الرعاية من الحمل وحتى الطفولة المبكرة، قبل وبعد توسيع البرنامج لتوفير إمكانية الوصول الشامل.يقدم البرنامج خدمات التغذية والصحة للأمهات الحوامل والمرضعات والأطفال الصغار. قم باستخدام البيانات من عمليات المسح التمثيلي الوطنية في الفترة 2005 إلى 2006، والفترة 2015 إلى 2016، بما في ذلك 36850 زوجا من الأمهات والأطفال في عام 2006، و190804 في عام 2016. وقمنا بتقييم التغيرات التي طرأت على العدالة في الحصول على خدمات البرنامج من بواسطة نسبة الخمس من الفئات الاجتماعية والاقتصادية، والطبقات السكانية، والتعليم، والإقامة الريفية أو الحضرية. لقد استخدمنا نماذج التحوف لاستقصاء محددات استخدام البرنامج.ازدادت النسبة المتوسطة للمشاركين الذين يستخدمون خدمات البرنامج بين عامي 2006 و2016، من 9.6٪ إلى 37.9٪ للأغذية التكميلية، ومن 3.2٪ إلى 21٪ للتعليم الصحي والتغذية، ومن 4.5٪ إلى 28٪ للفحوصات الصحية، ومن 10.4٪ إلى 24.2% للخدمات الخاصة بالأطفال (مثل التحصين ومراقبة النمو). وأظهرت الثروة، وتعليم الأمهات، والطبقات الاجتماعية، أكبر ارتباطات إيجابية باستخدام الخدمات. ومع ذلك ، تنوع التوسع في استخدام الخدمة على المستوى دون الوطني. وعلى الرغم من أن الاستخدام الإجمالي قد تحسن ووصل إلى الفئات المهمشة مثل الطبقات والقبائل المحرومة، فإن أفقر النسبة الخمسية من السكان ما زالت منسية، وبخاصة في أكبر الولايات التي تتحمل العبء الأكبر لنقص التغذية.أدت إصلاحات السياسة في الهند إلى زيادة تغطية البرنامج على المستوى الوطني، بما في ذلك الفئات المنسية. ومع المزيد من التوسع، يحتاج البرنامج للتركيز على الوصول إلى الأسر من أدنى المستويات الاجتماعية والاقتصادية، والسيدات من المستويات التعليمية المنخفضة.旨在研究印度儿童综合发展服务项目在扩大规模、全面普及前后，在怀孕初期至幼儿期的连续护理过程中该项目的覆盖范围和公平性。.该项目为孕妇、哺乳期母亲和幼儿提供营养和健康服务。我们使用了 2005–2006 年和 2015–2016 年全国性调查的数据，其中包括 2006 年的 36，850 对母子和 2016 年的 190，804 对母子。我们通过社会经济五分位数、种姓、教育和农村或城市居民对项目服务使用的公平性变化进行了评估。我们使用回归模型来研究项目使用的决定因素。.研究表明在 2006 年至 2016 年期间，使用项目服务的受访者的平均比例有所增加，辅食方面从 9.6％ 上升至 37.9％，健康和营养教育方面从 3.2％ 上升 至 21.0％，健康检查方面从 4.5％ 上升至 28％，而且儿童特定服务（例如免疫接种、生长发育监测）由 10.4％ 上升至 24.2%。财富、孕产妇受教育程度和种姓与服务使用呈现最大程度上的正相关。然而，服务使用的扩大在地方各级间差异显著。虽然总体使用情况得以改善，且已触及边缘化群体（例如弱势种姓和部落），但最贫困的五分之一人口仍然落后，尤其是在营养不良、负担最重的各邦。.印度的政策改革扩大了该项目在国家层面的覆盖范围，同时也囊括了边缘化群体。随着规模的进一步扩大，该项目需要聚焦于触及社会经济阶层最底层的家庭和受教育程度较低的妇女。.Исследование охвата и равноправного доступа к комплексным услугам по развитию ребенка в Индии в рамках всей цепочки услуг здравоохранения: от беременности до дошкольного возраста; до и после того, как программа стала общедоступной.Программа предлагает питание и медицинское обслуживание беременным женщинам и кормящим матерям, а также маленьким детям. Авторы использовали данные национальных репрезентативных опросов, проведенных в 2005–2006 и 2015–2016 годах, в которых участвовали 36 850 пар матерей с детьми в 2006 году и 190 804 пары в 2016 году. Были оценены изменения в равенстве использования услуг программы в зависимости от социально-экономического квинтиля, кастовой принадлежности, образования и района проживания в сельской или городской местности. Для исследования детерминант использования программы использовались регрессионные модели.Средняя пропорция респондентов, пользующихся услугами программы для получения дополнительного питания, выросла с 2006 по 2016 год с 9,6 до 37,9%, с 3,2 до 21,0% возросло количество тех, кто использовал программу для получения знаний о здоровье и питании, с 4,5 до 28% возросло количество тех, кто проходил медицинский осмотр в рамках программы, с 10,4 до 24,2% — количество потребителей услуг, ориентированных на детей (прививки, контроль развития). Наибольший рост использования услуг наблюдался по показателям уровня благосостояния, образования матери и кастовой принадлежности. Однако на субнациональном уровне распространенность использования услуг варьировалась. Несмотря на то что показатели общего использования программы улучшились и она стала доступнее маргинализированным группам, таким как низшие касты и племена, беднейшие квинтили населения все еще не имеют доступа к ней, особенно в крупнейших штатах, на которые приходятся самые высокие показатели недоедания.Политика реформ, проводимая в Индии, расширила охват программой на национальном уровне, включая маргинализированные группы населения. При дальнейшем расширении масштабов программа должна стать доступной для беднейших социально-экономических слоев населения и для женщин с низким уровнем образования.

Background Children in Malawi face nutritional risks related to low-quality diets and chronic malnutrition. Objective This study evaluated the impact of a 1-y early childhood development (ECD) center–based agriculture and nutrition intervention aimed at improving household production diversity, maternal knowledge on child nutrition and feeding practices, and children's diets and anthropometric measures. Methods A longitudinal cluster-randomized controlled trial was implemented in 60 community-based childcare centers (CBCCs), covering 1248 preschool children (aged 36–72 mo) and 304 younger siblings (aged 6–24 mo). CBCCs were randomly assigned to 1) a control group providing the Save the Children's ECD program or 2) a treatment group providing a standard ECD program with additional activities to improve nutritious food production and behavior change communication to improve diets and care practices for young children. Primary outcomes were household production and production diversity, preschooler enrollment and attendance, and dietary intake measured by quantitative 24-h recall and minimum diet diversity for younger siblings. Secondary outcomes included anthropometric measures for preschoolers and younger siblings, child development scores for preschoolers, and women's asset ownership and time use (the latter 2 are not discussed in this article). We used difference-in-difference (DID) estimates to assess impacts. Results Compared with the control group, preschool children in the intervention group had greater increases in nutrient intakes and in dietary diversity. No impacts on anthropometric measures were seen in preschoolers. Younger siblings in the intervention group had greater increases in height-for-age z scores than did children in the control group (DID: 0.44; P

This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.

Marriages between blood relatives-also known as consanguineous unions-are widespread in North Africa, Central and West Asia, and South Asia. Researchers have suggested that consanguinity has adverse effects on child development, but assessing its impact is not straightforward, as the decision to marry a relative might be endogenous to other socio-economic factors. Using a unique data set collected in rural Pakistan, this paper assesses the extent to which consanguinity is linked to children's cognitive and physical development. It exploits grandfathers' land ownership (current and past) and maternal grandparent mortality to identify the effect of endogenous consanguinity on child development. Children born into consanguineous unions have lower cognitive scores, lower height-for-age, and a higher likelihood of being severely stunted. More importantly, adverse effects are greater after accounting for the endogeneity of consanguinity, suggesting that impacts on child development are substantial, and likely to be larger than suggested in previous studies.