Field Exchange 74 Editorial

Dear readers, a warm welcome to the 74th issue of Field Exchange!

As so often happens, despite there not being a specific focus to this issue of Field Exchange, common themes still emerge. Several authors highlight how participatory approaches can enhance research uptake and foster more equitable, context-specific, and sustainable interventions to understand and address the drivers of malnutrition and improve nutrition outcomes. Participatory approaches are not new by any means, so it is interesting to see them back in the limelight and being championed again so positively.

In Guinea, Schwendler et al outline how participatory stakeholder workshops were used by researchers to disseminate community-level research findings among those in positions to enact national and sub-national change. The authors report how the approach supported cross-sectoral collaboration, as well as the prioritisation of context-specific intervention strategies for improving maternal, infant, and young child nutrition in Guinea.

Participatory processes, in this case community-level dissemination events, were also used in northern Kenya to promote a shared understanding of malnutrition drivers among research study participants and local leaders. Gargule et al report how visual aids and culturally sensitive materials helped convey complex research findings in an accessible manner, fostering inclusivity and dialogue.

In Mozambique, Photovoice was used as a participatory research method to engage adolescent girls in identifying barriers and opportunities related to their nutrition, specifically in consuming iron-rich foods. Bauler et al found the approach to be engaging, enjoyable, and efficient. There were also unexpected benefits. The rich visual data not only increased understanding of adolescent nutrition challenges but also created opportunities for the voices of adolescent girls to be shared with people with the power and influence to effect change.

It is one year on from the publication of the updated WHO 2023 guideline on the prevention and management of wasting. Several authors touch on the practical implementation of these recommendations.

Smith et al present findings from a secondary analysis of a Positive Deviance/Hearth programme in Ethiopia. After 12-months follow-up, a 46% decrease in underweight prevalence was observed, echoing the previously reported success of the approach. However, with over half of these children not achieving a normal weight-for-age, the authors emphasise the need for more intensive follow-up and/or additional nutritional interventions, especially for younger or severely underweight children. The article’s findings are timely given the WHO 2023 guideline, which recommends increasing access to local nutrient-dense diets and implementing interventions (such as Positive Deviance/Hearth) for infants and children with moderate wasting.  

Staying with the new WHO guideline, a views piece by Lelijveld et al summarises the various opinions of different researchers (including Sachdeva and Kurpad). Specifically, whether current guidance on ready-to-use therapeutic food (RUTF) dosage is appropriate. Lelijveld et al present research which argues that dosage requirements may be too high. This raises concern for later chronic disease risk. Considering that a lot of research prior to the guideline’s publication focussed on reducing or simplifying RUTF dosage regimes, the authors weigh up the complex realities faced at the household level. In doing so, they question whether detailed dosage requirements are feasible outside of clinical settings.

In a letter to the editor, Lelijveld also raises the challenge of data quality for community management of acute malnutrition programmes in contexts where there are recurrent stockouts. Effective stock management is critical in preventing stockouts. However, Lelijveld stresses the need for clarity and support for those working on the frontline to accurately reflect these issues in routine reporting.

In recent issues of Field Exchange, we have featured several articles providing greater prominence to the topic of disability and nutrition. Continuing this theme, a views piece by Delage et al underscores the importance of prioritising breastfeeding and nutritional care from birth in children born with clefts. Through the stories of Apollo and Cikuru from the Democratic Republic of Congo, current gaps in the continuum of care and an overly surgical-centric mindset are highlighted. A more comprehensive approach that includes both nutritional and surgical interventions is advocated for to prevent malnutrition and ensure optimal growth and development in children with clefts.

Also featured in this issue is a views piece from Parikh et al. This article highlights six key action areas to increase access to locally produced, nutritious complementary foods through a whole-of-systems approach. Situma et al describe the implementation, successes, and challenges of the Inter-Cluster/Sector Collaboration approach, as applied in the South Sudanese context. As always, we also include a compelling array of research snapshots and report summaries. We encourage readers to dip in and explore for yourselves!

Finally, in Field Exchange 74, we say farewell to an old friend. Since the early days, our Pandamonium cartoon has featured on the back page, bringing some lightness to the technical detail and challenging contexts featured. However, times (and pandas) move on and Pandamonium will no longer be published. As a former Field Exchange co-editor, Marie McGrath pays tribute  to Pandamonium’s creator, Jon Berkley, in a short piece following this editorial. From the whole Field Exchange team and on behalf of all readers, we echo her thanks to Jon for all his contributions to our publication over the years. We leave with fond memories of our favourite mammalian mascot.

Happy reading!

Anne, Nicki, Phil, and Tom