Background Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children's nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted appears to be a great alternative. Objectives This study aims to (1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, (2) document the reasons for adding or not adding insects to household meals, and (3) determine the nutrient contribution of community-based insects in children's food. Methods Both qualitative and quantitative research methods were concurrently applied in this exploratory study (n=392 individuals; six focus group discussions) in Northern Ghana. Results Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children's diets were unable to meet the acceptable Recommended Nutrient Intake (RNI)1 level of all nutrients under consideration, especially for zinc, vitamin B12, folate, and fat. Inclusion of community-based edible insects increased RNI levels for all 11 micronutrients considered and met children's zinc, vitamin B12, folate, and fat requirements. Conclusion Community-based insects demonstrated a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households' adoption of community-based insects as part of household meals and to make insects accessible to households.

Background: Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children’s nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted, appears to be a great alternative. Objectives: This study aimed to 1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, 2) document the reasons for adding or not adding insects to household meals, and 3) determine the nutrient contribution of community-based insects in children's food. Methods: Both qualitative and quantitative research methods were concurrently applied in this exploratory study (N = 392 individuals; 6 focus group discussions) in northern Ghana. Results: Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children’s diets were unable to meet the acceptable recommended nutrient intake (RNI; within a given age and gender group, the RNI is the amount of a nutrient ingested daily that would meet the needs of almost all healthy individuals in that group) level of all nutrients under consideration, especially for zinc, vitamin B-12, folate, and fat. Inclusion of community-based edible insects increased the RNI levels for all 11 micronutrients considered and met children’s zinc, vitamin B-12, folate, and fat requirements. Conclusions: Community-based insects demonstrate a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households’ adoption of community-based insects as part of household meals and to make insects accessible to households.

Background The coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries’ economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access, but the empirical evidence is currently limited. Objective The study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and peri-urban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country. Methods Baseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted two longitudinal telephone-surveys with the same study participants in July and September-October 2020, respectively. Results At the first follow up, the volume of milk sold by informal vendors had dropped by 30% compared to their baseline level and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed one year prior in the same season. Large reductions in the consumption of other animal-source products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow up periods, respectively compared to baseline. Conclusions The evidence therefore suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi, and a decrease in the food security of peri-urban consumers.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries’ economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access; however, the empirical evidence is currently limited. Objectives: The study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and periurban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country. Methods: Baseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted 2 longitudinal telephone surveys with the same study participants in July and September–October 2020, respectively. Results: At the first follow-up, the volume of milk sold by informal vendors had dropped by 30% compared with their baseline level, and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow-up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed 1 y prior in the same season. Large reductions in the consumption of other animal–sourced products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow-up periods, respectively, compared with baseline. Conclusions: The evidence, therefore, suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi and a decrease in the food security of periurban consumers. | PR | IFPRI3; CRP4; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all | Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH | CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Background: Recent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh—particularly, within ultrapoor and farm households—is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. Objective: Using 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. Methods: The study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. Results: In both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). Conclusions: In both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal.

Background: Recent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh—particularly, within ultrapoor and farm households—is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. Objective: Using 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. Methods: The study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. Results: In both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). Conclusions: In both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal. | PR | IFPRI3; CRP4; Agriculture, Nutrition, and Gender Linkages (ANGeL); GAAP; G Cross-cutting gender theme; 2 Promoting Healthy Diets and Nutrition for all; TMRI | Nutrition, Diets, and Health (NDH); A4NH; Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy | CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Background: Recent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh—particularly, within ultrapoor and farm households—is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. Objective: Using 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. Methods: The study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. Results: In both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). Conclusions: In both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal.

Objectives: Unsafe food contributes to 600 million cases of foodborne illness and 420,000 deaths annually. Existing methods used to evaluate food safety risks overlook consumers’ perspectives coming from their everyday experiences that influence their food choices. Our objective was to develop a cross-culturally appropriate and user-friendly scale to assess consumers’ experiences related to food safety in low- and middle-income countries. This study identified the constructs that constitute the experiences of food safety that the scale should reflect. Methods: In-depth interviews were conducted with urban households in Bangladesh (n=51), Ethiopia (n=50), and Vietnam (n=41). Eligible households had children aged 2–5 years and members serving as primary food purchasers, preparers, and caregivers. Interviews explored attitudes, perceptions, and lived experiences related to food safety. Data were analyzed using a constant comparative method. Results: Respondents expressed awareness of biological and chemical contaminants in foods. Concerns about chemical additives and food adulteration were common, fueled by beliefs that these hazards cause chronic illnesses. Personal and familial experiences with foodborne illness reinforced caution when buying foods. Religious and cultural beliefs shaped how respondents explained and responded to food safety concerns, with some attributing illness symptoms to spiritual causes. Trust in food vendors was rooted in reputation, visible cleanliness, and willingness to rectify issues (e.g., exchange items). Respondents differentiated their extent of scrutinizing safety based on food type: staples such as rice and pulses were assessed more by vendor credibility, whereas perishables such as fish and meat underwent direct, detailed inspections. Low transparency in food sourcing and how vendors prepared foods were persistent concerns. Conclusions: Trust, perceived transparency, risk perceptions, and past incidents shaped consumers’ mental representations and behaviors related to food safety. Interviews underscored the centrality of context and sensory-based quality indicators, suggesting that scenario-based assessments are more appropriate than generic risk-reduction items.

Biofortification was coined as a term to define a plant breeding strategy to increase the micronutrient content of staple food crops to reduce the burden of micronutrient deficiencies in low- and middle-income countries (LMICs). In 2003, the HarvestPlus program, based in the centers comprising the Consultative Group on International Agricultural Research (CGIAR), was initiated to implement the biofortification strategy. This paper discusses what has been achieved, what has been learned, and the key challenges to embed biofortification in food systems and to expand its impact. Cost-effectiveness is key to the biofortification strategy. Biofortification piggybacks on the agronomically-superior varieties being developed at agricultural research centers. Central plant breeding research discoveries can be spread globally. Farmers have every motivation to adopt the latest high-yielding, high profit crops. High productivity leads to lower food prices. As a consequence, consumers can increase their mineral and vitamin intakes at no additional cost by substituting biofortified staple foods one-for-one for non-biofortified staple foods. After twenty years of investment, biofortified staple food crops are being produced by farmers in over 40 countries and are eaten by hundreds of millions of people. Published nutrition trials have shown nutrient-rich crops to be efficacious. The biofortification strategy is now recognized by the international nutrition community as one effective approach among several interventions needed to reduce micronutrient deficiencies. This is a promising beginning. However, biofortification is still a newly emerging technology. A limitation of biofortification as implemented to date is that densities of single nutrients have been increased in given staple food crops. To reach a higher trajectory, the impacts of biofortification can be multiplied several-fold using genetic engineering and other advanced crop development techniques to combine multiple-nutrient densities with climate-smart traits.

Biofortification was coined as a term to define a plant breeding strategy to increase the micronutrient content of staple food crops to reduce the burden of micronutrient deficiencies in low- and middle-income countries. In 2003, the HarvestPlus program, based in the centers comprising the Consultative Group on International Agricultural Research, was initiated to implement the biofortification strategy. This article discusses what has been achieved, what has been learned, and the key challenges to embed biofortification in food systems and to expand its impact. Cost-effectiveness is key to the biofortification strategy. Biofortification piggybacks on the agronomically superior varieties being developed at agricultural research centers. Central plant breeding research discoveries can be spread globally. Farmers have every motivation to adopt the latest high-yielding, high profit crops. High productivity leads to lower food prices. As a consequence, consumers can increase their mineral and vitamin intakes at no additional cost by substituting biofortified staple foods 1-for-1 for nonbiofortified staple foods. After 20 years of investment, biofortified staple food crops are being produced by farmers in over 40 countries and are eaten by hundreds of millions of people. Published nutrition trials have shown nutrient-rich crops to be efficacious. The biofortification strategy is now recognized by the international nutrition community as one effective approach among several interventions needed to reduce micronutrient deficiencies. This is a promising beginning. However, biofortification is still a newly emerging technology. A limitation of biofortification as implemented to date is that densities of single nutrients have been increased in given staple food crops. To reach a higher trajectory, the impacts of biofortification can be multiplied several-fold using genetic engineering and other advanced crop development techniques to combine multiple-nutrient densities with climate-smart traits.

Background The double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce. Objectives This study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021. Methods Data were from 3 waves of India’s National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged &lt;5 y) combinations: mother–child (N = 328,039 across 3 waves), father–child, and parent (mother and father)–child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth. Results Nearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent–child DBM increased from 15% in 2006 to 26% in 2021. Father–child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban–rural and rich–poor inequalities in the DBM have decreased over time. Conclusions The intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India’s increasing intrahousehold DBM.

Background The double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce. Objectives This study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021. Methods Data were from 3 waves of India’s National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged <5 y) combinations: mother–child (N = 328,039 across 3 waves), father–child, and parent (mother and father)–child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth. Results Nearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent–child DBM increased from 15% in 2006 to 26% in 2021. Father–child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban–rural and rich–poor inequalities in the DBM have decreased over time. Conclusions The intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India’s increasing intrahousehold DBM. | PR | IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; G Cross-cutting gender theme; Capacity Strengthening; POSHAN | Nutrition, Diets, and Health (NDH); Food and Nutrition Policy