Field Exchange 72 Editorial

Dear Readers, a warm welcome to the 72nd issue of Field Exchange. 

As we publish this issue, we are conscious of many current crises where conflict is fuelling malnutrition: in the Democratic Republic of Congo, Ethiopia, Gaza, South Sudan, Sudan, Ukraine, and Yemen, to name just some. Where conflict is present, lack of access can severely limit humanitarian assessment and response, across all sectors including nutrition, exacerbating already difficult situations. These, in turn, are continually compounded by the effects of climate change and an increasing humanitarian funding gap¹.  We greatly respect the continued efforts of all those working in such challenging circumstances to protect health and nutrition services and the lives of civilians caught up in humanitarian emergencies. Responding to such crises often necessitates innovative approaches – we welcome contributions to Field Exchange from those of you interested in sharing your programming experiences so that others can benefit from your learning. We recognise this alone cannot exact change, but we hope that in this way Field Exchange can continue to do what we can to support those experiencing crises.

In this edition, we revisit the topic of breastfeeding. Specifically, Smith et al. explore the value of human breastmilk, highlighting a triple win for health, environmental, and economic goals. As a predominantly dairy-based product, commercial formula milk has a significant impact on greenhouse emissions, which can be estimated using the ‘Green Feeding Tool’. In addition, another research-based tool, the ‘Mothers Milk Tool’, illuminates the hidden economic value that breastfeeding contributes to society through mothers’ unpaid care work. This article explores these two innovations to uncover breastfeeding’s critical contribution to sustainable health and development goals.

Two further articles focus on infant and young child feeding. Our first (Jomaa et al.) zooms in on Lebanon, where consistent efforts to improve breastfeeding and complementary feeding practices still run into challenges. Hearing from Action Against Hunger staff working in country, the authors disentangle existing knowledge gaps and cultural barriers to optimal practice and highlight how greater efforts are needed to support complementary feeding within high-risk, low-resource settings. In Zimbabwe, diet frequency and diversity of children aged 6–23 months also remains poor. Burns et al., writing about the multi-sectoral ‘Amalima Loko’ programme, show that a menu of locally available, predominantly indigenous foods can be used to develop feasible food-based recommendations for young children. The outcome? – a successful alternative to food transfers that could provide a blueprint for other settings.

On the theme of food systems, the article from Thurman et al. considers how generating consumer demand for healthier diets can drive positive change in food systems, but details how this is currently constrained by a lack of clear metrics. The authors describe their approach to developing common indicators (and trialling them in Bangladesh and Burkina Faso) and hope that these can inform longer-term efforts to develop a set of quality metrics that can measure programme efforts to generate consumer demand for nutritious diets. 

Also taking a food systems perspective, Fry and Sigh’s article  looks at changes in the food environment in urban and rural Cambodia, where traditional diets are being replaced with snack foods and sugar-sweetened beverages. Analysis of household survey data shows urban households procured more food from street vendors, markets, and mini marts. Interestingly, higher consumption of more processed unhealthy foods wasn’t necessarily replacing the consumption of healthier foods. Yet, disentangling these patterns from household economics and regional development is tricky. 

We also feature an extended piece from Somalia. In this special five-part article, Luc et al. delve into the spatial and temporal relationship between child wasting and food insecurity in Somalia. Some of the findings challenge key assumptions about that relationship. Results showing community-level clustering of wasting and food insecurity suggest the importance of capturing community-level drivers to support locally appropriate interventions and outcomes. Analysis of seasonal variation in child wasting showed two seasonal peaks that varied across livelihood zones and did not coincide with periods associated with the highest food insecurity. Results suggest that the assumption of food security as the primary causal factor of wasting might bias modelling crises and responses.

Building on the themes explored in the Somalia article, we selected three papers from the recent Acute Malnutrition in Africa’s Drylands series². Venkat et al. highlight the importance of a nuanced understanding of seasonality in the region. Contrary to popular opinion, the primary peak in wasting incidence appears to occur in line with peak temperature and not in the preharvest period. In Chad, geospatial analysis showed that the distribution of child wasting and food insecurity were clustered (Luc et al.). Significantly, communities with high wasting prevalence were not the same as those with highest food insecurity. Fracassi et al. explore efforts to prevent wasting in Africa’s Drylands through a food systems lens. They found some common strengths between the eight countries studied (multistakeholder governance, existing policy frameworks, and costed interventions on social value chains and social transfers). The weaknesses – vulnerabilities from livelihoods, environment, and seasonality – need to be better addressed in policy and programme implementation. 

Finally, three of our summaries explore the neglected topic of child feeding and disability. A scoping review by Klein et al. finds there are insufficient policies, programmes, and evidence to support children with feeding difficulties and disabilities and their families. The limited resources and promising approaches that do exist are not standardised or universally used, with limited trained staff and insufficient funding to implement them. More specifically, Hayes et al. highlight how children with disabilities are excluded from malnutrition assessment with a lack of standardised methods to identify and monitor nutritional status. In response, the authors explore the use of mid upper arm circumference as of potential value in addressing this gap. Holt International’s Child Nutrition Programme aims to enhance the nutrition and feeding practices of vulnerable children, including orphans and abandoned children, many of whom have significant disabilities. Learnings from the evaluation by DeLacey et al. identify key factors for successful programming for this group as including local government engagement, secure funding, adequate staffing, continuous training, robust support systems, and efficient supply chains. In our next edition we hope to include a couple of original articles which home in more specifically on this important topic.

As always, this is just a brief rundown of the rich content that features across the breadth of this issue. We have more original articles and summaries to explore. Happy reading!

Anne, Nicky, Phil, and Tom