Nutrition International

Food systems performance evaluated against targets and benchmarks reveals urgent gaps and a path to 2050

Despite national and international commitments to food systems transformation and an increasing adoption of common indicators, no comprehensive targets have been established against which progress can be measured. Here, building on the Food Systems Countdown Initiative framework, we identify existing targets—based on internationally agreed commitments and normative goals—and establish benchmarks—based on empirically derived peer performance reference values at the global, regional and income group levels—for 44 Food Systems Countdown Initiative indicators. We also assess countries’ historical progress and the rate of change required to achieve targets and benchmarks over two different timescales. We show that current progress is insufficient to meet 2030 targets and benchmarks at global level. Comparing countries’ status to regional and income benchmarks, which are generally less ambitious, yields better performance across indicators and regions, although gaps remain. Achieving most targets and benchmarks by 2050 is possible if countries correct course and accelerate progress, but certain indicators will require considerable investment and intervention.

Modeling the association between repeated measures of hemoglobin during pregnancy and adverse birth outcomes

The impact of a continuum of care intervention from prevention to treatment on child wasting compared to usual community group activities: A cluster randomized controlled trial in Mali

Background Child wasting is associated with a high mortality risk and remains a persistent public health challenge. Objective This study aimed to evaluate the impact of an intervention strengthening the continuum of care of child wasting from prevention, screening, and referral to treatment in Mali. Methods A two-arm cluster-randomized controlled trial was conducted using two study designs to evaluate impact and pathways: i) a longitudinal study of children enrolled at 6 months (n=2,324) with monthly follow-up for 3–6 months to assess wasting prevalence (primary outcome); ii) a longitudinal study of all children 6–23 months admitted to outpatient therapeutic programs (OTP; n=7,104) assessing recovery and adherence. Additional OTP coverage surveys were conducted at the end of the study. In both study arms, nutrition activity support groups (NASG) screened children for wasting and provided caregiver behavior change communication (BCC). The intervention arm additionally received small-quantity lipid-based nutrient supplements (SQ-LNS), child-centered BCC, family-led screening, and follow-up on referred wasting cases to support OTP admission and adherence. Results The intervention did not impact wasting prevalence but reduced the incidence of wasting (relative risk (RR): 0.80, 95% confidence interval (CI): 0.64, 0.99) and severe acute malnutrition (SAM) (RR: 0.71, 95%CI: 0.57, 0.89). The intervention significantly increased wasting screening coverage by 37 pp (95%CI: 31, 44) and SAM treatment coverage by 15 pp (95%CI: 0.35, 30). No impacts of the intervention on OTP recovery or adherence were found. NASGs often replaced the monthly home visits with community gatherings to deliver the intervention. NASGs also often distributed SQ-LNS to children they identified with wasting instead of referring them to the OTP. Conclusions Strengthening the continuum of care of wasting through community groups reduced the incidence of wasting and SAM and improved screening coverage, which translated into a modest gain in SAM treatment coverage.