Field Exchange 73 Editorial
Dear readers,
A warm welcome to the 73rd issue of Field Exchange. In this issue we are excited to bring you articles on a variety of themes and contexts.
The topic of food systems has of course gained traction in recent years and remains of critical importance. In a views piece, Richardson draws attention to the intersection of food systems, climate change, and nutrition. This article builds upon recent learning from a variety of sources, drawing in particular from ENN’s recent literature review on food systems (ENN, 2024). Given each of these topics remain complex, interconnected, and codependent, the author highlights four collective actions we can all take now to address these pressing issues. By future-proofing solutions, we can address current challenges while at the same time proactively engaging with future effects, ensuring sustainability in doing so. More systematic and intentional collaboration – between climate and nutrition actors – can boost co-benefits. Fragile and conflict-affected contexts need greater attention because these populations are most vulnerable to climate change, food system failures, and undernutrition. Lastly, more stories of how positive change can happen need to be shared. This last point is true across all sectors, as we seek solutions to challenges rather than straightforward critique.
Providing a great example of this last point in action, O’Keeffe and Luundo describe a small-scale community farming project to address food insecurity in Kakuma refugee camp. The authors take us through the evolution of the Vijana Twaweza Club run by students in the camp, from a small fishpond to an internationally renowned success story. As well as generating income, which is then reinvested into the farm and additional training activities, the club provides a valuable nutrition source for over 500 families. This is even more prescient with the recent news that rations in the camp are to be reduced by 60%, on top of further cuts seen in the previous year. Beyond this success story itself, the authors also underscore the value of refugee-led development in the broader humanitarian space.
Turning our attention to India, Fracassi et al. speak to the value of improved, clean cookstoves and how scaling up this technology can improve nutrition and health in rural areas. The health and environmental benefits of cleaner cooking appliances – such as improved indoor air quality and reduced carbon emissions – have been well documented, but this article delves into the nutrition-specific benefits. Clean cookstoves can directly enhance the nutrient quality of foods and increase overall dietary diversity, as cooking becomes more efficient and people are better able to handle a diverse array of food types. These changes can have an impact on nutritional status, but such cookstoves also result in time saved when both cooking and collecting firewood. In this setting, women reported saving up to two hours per day on firewood collection and a further 50 minutes on cooking-related time. Such savings can, in turn, lead to further income-generating opportunities and the combatting of detrimental social norms.
Several articles touch on the theme of linking information to action. To do this, understanding nutritional determinants and causal pathways remains critical for the design of contextualised and targeted programmes. Existing assessment approaches are useful, and have been used successfully, but they may be time and resource intensive. Blanarova et al. describe the pilot of a rapid nutrition determinants assessment approach in Nepal, undertaken by the Moderate Wasting Initiative in partnership with Action Against Hunger. The approach was widely accepted and demonstrated value in improving local government understanding of the causal pathways to undernutrition in three municipalities. Lessons learned from the pilot highlight how, as with the introduction of any new methodology, robust training of assessment teams is crucial to ensure quality within a designated timeframe.
In Kenya, Maina et al. synthesised data from 18 independent coverage assessments to inform the scale-up of services to address wasting across Kenya’s arid and semi-arid counties. The pooled analysis highlighted where inter-county collaboration can address specific geographical issues and how poverty alleviation, stronger community systems, and gender equity are critical to increasing treatment coverage and promoting prevention.
Remaining in East Africa, Brennan et al. revisit the use of mid-upper arm circumference (MUAC) as a screening tool for at-risk infants aged under six months. This approach was first highlighted by Rana et al. in Field Exchange 64. In this new article, the authors explore operational pilots in Ethiopia, Somalia, Kenya, and South Sudan where, despite data gaps, the findings highlight important design improvements to optimise MUAC tapes for infants and pregnant and breastfeeding women. These pilots also highlight key challenges when using these multi-MUAC tapes, which bring their own learning opportunities.
Also in East Africa, we feature an article which zooms out from nutrition and speaks to social protection more broadly. Specifically, Kureishy et al. describe the development of Somalia’s first national social protection programme, Baxnaano. This account provides important lessons learned for the scaling up of government-led cash transfer programmes and the introduction of adaptations such as conditionalities, to address the challenges of low uptake of health and nutrition services. A scoping review by Ngamasana and Moxie affirms the use of conditional cash transfers to positively impact maternal and child health outcomes in sub-Saharan Africa, while a report by UNICEF provides guidance on building synergies between social protection and nutrition.
Several of this issue’s articles focus on the neglected topic of infant and child feeding and disability. An analysis by Rotenberg et al. analyses data from multiple indicator cluster surveys in 30 low-and middle-income countries. They found that children aged two to four years with disabilities were significantly more likely to be stunted, wasted, and/or underweight compared to similar aged children without disabilities. Exacerbating these inequalities, work by Rice et al. showed that households in Uganda that have children with disabilities lack access to essential nutrition and health services. A views piece by DeLacey draws our attention more specifically to institutional-based care, where one-quarter of children are disabled and one-third of them experience feeding difficulties. While global policies focus on discouraging institutionalisation, on a more immediate and practical level positive impacts can be achieved by improving caregiver training, providing appropriate feeding interventions, and with stronger government engagement. In support of addressing gaps in this area, ENN has provided an overview of resources and evidence around identifying and supporting infants under six months with feeding difficulties and disabilities.
We can’t capture every article here, with this issue featuring a wealth of additional content to explore. This includes an original article by Ibrahim et al. on mother-to-mother support groups in Yemen and research summaries on topics ranging from climate change to the effectiveness of postnatal interventions to adolescent mother experiences in Bangladesh. Happy reading!
Anne, Nicki, Phil, and Tom