Editorial

A warm welcome to the 69^th edition of Field Exchange in which we feature a varied selection of content from around the globe. After several special sections last year, this edition of Field Exchange is one of our general issues, and we highlight several articles which relate to something affecting us all: rising food prices constraining access to a healthy diet, on a global scale. In their cost of the diet analysis from Nigeria, Rana et al highlight how diverse, nutrient-rich foods may be available at local markets, but affordability is a key constraint on consuming adequate diets. Poor rural households included in the analysis had an annual shortfall equivalent to USD 1,650 in terms of being able to afford a diet that fully meets requirements for macronutrients and micronutrients within a culturally acceptable diet. Angood et al’s overview of national social assistance programmes in Tanzania, Ethiopia and Burundi highlights how social protection systems can be critical in addressing economic constraints to achieving nutrient-rich diets when the cash transfer is delivered alongside additional programmatic elements, including social behaviour change.

Access to healthy diets is also affected by the availability of diverse foods. An article regarding Malawi, by Corbett et al, describes how applying a strong nutrition lens within the Farmer Field School approach - developed almost 25 years ago in Southeast Asia - resulted in participants being three times more likely than non-participants to meet their minimum dietary diversity requirement. Strengthening the integration of nutrition education within all agricultural value chain activities, the use of context-specific resources and adaptations, addressing gender norms and embedding market analysis were found to be key components to this success.

Pursuing an economic theme, the first published costing of integrated management of acute malnutrition (IMAM) in Indonesia, by Trenouth et al provides valuable insights for the cost of scaling up IMAM services to achieve government targets by 2024. Modelling highlighted the relative cost-efficiency of focusing on scaling up treatment coverage in high-burden areas, as opposed to solely pursuing geographical coverage. This provides important programming guidance for where resources can be invested most efficiently.

As part of our regular featured content from the Global Nutrition Cluster, Basquin et al provide an update on their roll-out of emergency response preparedness (ERP) resources and support. Global challenges - climate change, which is fuelling conflict and food insecurity; the ongoing war in Ukraine, which has downstream impacts on food security, in addition to the more obvious geopolitical and humanitarian implications; and droughts, notably in the Horn of Africa and the Sahel - show that countries need to be increasingly prepared for emergencies. To date, the Global Nutrition Cluster has developed extensive ERP resources and tailored country support, yet uptake has been poor. More work is needed to understand why countries are not prioritising ERP and how to address these challenges, given the apparent and increasing need.

We follow on from our previous coverage on the topic of aggressive marketing tactics employed by commercial milk formula companies with three articles: a summary of the Lancet 2023 series on breastfeeding, and two articles from Cambodia by Gnanaraj et al. The authors highlight how improved internet access and increasing social media use have driven an exponential rise in digital marketing strategies, including for commercial milk formula products, and outline the threat this poses to optimal breastfeeding practices. In Cambodia, an update to the International Code of Marketing of Breastmilk Substitutes has been proposed to explicitly ban the digital marketing of commercial milk formula on social media and across the internet. The postscript to this article highlights the collaborative efforts between civil society and the government to progress this critical legislation.

In contrast, a field article from India by Roy et al portrays the potential impact of digital technology more positively, specifically exploring how it enabled communities to be reached with nutrition messages during the worst of the COVID-19 lockdowns. Digital counselling was shown to be a promising model to ensure messages on maternal, infant, and young child feeding and care practices reach their target audience, providing a complementary approach to critical interpersonal communication by frontline workers.

Finally, as usual, we feature an array of research snapshots, summaries and views, one of which offers us a gentle challenge to examine both the wording we use and the way we engage in calls to action for improving global health. Through this edition, we have refreshed our approach to summarising published research articles with a focus on breaking down some of the methodology and study limitations to provide more practical interpretation of findings. We hope you find this useful - do get in touch to let us know what you think and, as always, we welcome your reactions and experiences. Happy reading!

Anne Bush, Editor
Philip James, Editor

Are you interested in writing for Field Exchange? If so, we are interested in hearing from you. We are currently welcoming submissions for our next two issues of the magazine, which will be general issues. We are particularly interested in covering emergency contexts and are also eager to review submissions regarding food systems. However, we are open to article ideas from across the nutrition sector. If you have a story to tell about a nutrition challenge in your region or a programmatic insight to share with your peers, please do reach out to us at fex@ennonline.net with a brief abstract covering your idea. Please visit https://www.ennonline.net/fex/writeforus for more information.