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News Article | May 4, 2017
Site: www.fao.org

In the western Chad region of Kanem, the majority of men from poor rural families have migrated to areas with better economic opportunities to ensure the survival of their families. Women are often left as head of household and assume particularly heavy tasks, including cultivating the land. Agricultural production has dropped and food insecurity has risen, resulting in higher rates of chronic malnutrition among women and children than in the rest of the country. FAO has been working with vulnerable populations in the region since 2010 to help reduce malnutrition. Because the poorest rural families have limited access to fertile irrigated land in the “wadi”, they cannot cultivate vegetables that are essential for a nutritious diet. To establish support for gardening activities, small irrigation projects and education on nutrition, FAO brought together landowners and farmers without access to irrigable land in the wadi. These efforts led to greater agricultural production, improved incomes and a dramatic decrease in malnutrition. The Kanem region has experienced extremely high rates of child malnutrition for a long time. Nutrition surveys carried out since the late 1990s showed global acute-malnutrition rates exceeding 20 percent among children under five, far surpassing the internationally recognized emergency threshold of 15 percent. At the same time, various studies have highlighted the potential of Kanem to increase agricultural production through the exploitation of unused land in the shallow fertile wadi. This would improve both food availability and the purchasing power of vulnerable households. The idea for the project consisted primarily in strengthening vulnerable households in Kanem through four components to enhance food production and purchasing power: vegetable production in the wadi, goat rearing, income-generating activities and drip irrigation for vegetable production at the household level. These components were supplemented by a brief campaign on good nutrition. Arable-land loans and women’s empowerment offer solutions Land-loan agreements, lasting five years, were signed between lenders and the poorest user-groups. The project has enabled women’s groups in the region, where women have rarely been able to access agricultural land, to use irrigable and fertile ground and farm it in their own names. Women have arable plots of land, and have also trained in good agricultural practices that guarantee sustainable agricultural development in Kanem. The gardening activities implemented in the wadi have significantly increased food production for household consumption. Women are now able to carry out economically viable activities yearround. Access to arable land in the wadi not only allows households a more varied and balanced diet, but the work carried out also generates greater and steadier income. As a result of FAO’s activities, food production among beneficiary households increased, resulting in enhanced food security for the community and an increase of purchasing power for more than 50 percent of the beneficiary households. This additional income was used to improve household nutrition, with dramatic results: child malnutrition dropped to 12.6 percent in beneficiary households, compared to 31.1 among non-beneficiaries. Added reach through partnerships with WFP and UNICEF The FAO office in Mao (the capital of the Kanem region) was established within WFP offices, demonstrating the coordination and cooperation among the agencies. In partnership with WFP, FAO is implementing food-for-work programmes in response to the current food crisis in Kanem. FAO is also collaborating with UNICEF, implementing gardening programmes and providing education on nutrition. As of early 2013, a total of 211 women’s groups have benefited from the approach developed in FAO’s initial project. This approach has been replicated many times, not only by FAO but also other organizations in Chad such as Secours Islamique France, OXFAM, Action Contre la Faim and Agence d’Aide à la Coopération Technique et au Développement, as well as by the Government of Chad’s Programme National de Sécurité Alimentaire.


Guesdon B.,Harvard University | Hanson K.,Action Contre la Faim | Langendorf C.,Médecins Sans Frontières
PLoS ONE | Year: 2015

Objectives Debate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics. Methods Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC 115 mm vs. children that are admitted under current admission criteria (WHZ-3 and/or MUAC 115 mm) but would be excluded from a program that used a single MUAC 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes. Results We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program. Conclusions A single anthropometric admission criterion of MUAC 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment. Copyright: © 2015 Isanaka et al.


Grant
Agency: European Commission | Branch: H2020 | Program: CSA | Phase: GARRI-6-2014 | Award Amount: 2.65M | Year: 2015

The goal of the TRUST Project is to catalyse a global collaborative effort to improve adherence to high ethical standards around the world. Achieving equity in international research is one of the pressing concerns of the 21st century. Many international groups and organisations are working on governance frameworks and standards to guide research activities after progressive globalization. However, their efforts are disparate and lacking a guiding vision. In an interdisciplinary collaboration between multi-level ethics bodies, policy advisors, civil society organisations, funding organisations, industry and academic scholars from a range of disciplines, this project combines long-standing, highly respected efforts to build international governance structures with new exciting network opportunities between Europe, India, Sub-Saharan Africa, China and Russia. TRUST will open up new horizons in improving adherence to high ethical standards in research globally. The projects strategic output are three sets of tools based on participatory engagement covering all continents: (1) a global code of conduct for funders, (2) a fair research contracting on-line tool and (3) a compliance and ethics follow-up tool, which takes limited resources into account.


McDermott J.,International Food Policy Research Institute | Ait-Aissa M.,Action Contre La Faim | Morel J.,Action Contre La Faim | Rapando N.,Volunteer Efforts for Development Concerns Uganda
Food Security | Year: 2013

Aligning agriculture to improve household nutrition security requires agricultural research and development specialists to understand nutrition objectives and be able to contribute to integrated agriculture-health programs. This paper builds on discussions during the household nutrition security session at the second Global Conference on Agriculture Research for Development (GCARD2). To begin, there is a summary of the variety of ways essential nutrition knowledge can underpin nutrition-sensitive agriculture. Lessons for improving nutrition through agriculture, including: efficient and effective production of diversified, highly nutritious and biofortified foods, enhancing value chains to improve nutritional quality and food safety, and better policies and investments, are highlighted. Frequently missing in discussions on nutrition-sensitive agriculture are the requirements for capacity development and extension-critical requirements to scaling-out and sustaining improved nutrition outcomes through agriculture. Gender, local empowerment and other key issues are discussed, as are the opportunities for cost-effective approaches to be implemented and expanded. Finally, research gaps, approaches and priorities to improve practice and anticipate and respond to dynamic changes in biological and social systems are discussed. Four next steps are summarized: (1) align agricultural interventions with those in health services, water and sanitation and social protection; (2) implement approaches to accelerate learning for development implementation and policy and investment enabling; (3) build local and national capacity to adapt and innovate; and (4) empower women and disadvantaged communities, in which the burden and solutions to nutrition security are found. © 2013 The Author(s).


PubMed | EHESP School of Public Health, Brixton Heath, Action Contre la Faim and University of Paris Pantheon Sorbonne
Type: | Journal: Emerging themes in epidemiology | Year: 2016

Nutritional surveillance remains generally weak and early warning systems are needed in areas with high burden of acute under-nutrition. In order to enhance insight into nutritional surveillance, a community-based sentinel sites approach, known as the Listening Posts (LP) Project, was piloted in Burkina Faso by Action Contre la Faim (ACF). This paper presents ACFs experience with the LP approach and investigates potential selection and observational biases.Six primary sampling units (PSUs) were selected in each livelihood zone using the centric systematic area sampling methodology. In each PSU, 22 children aged between 6 and 24months were selected by proximity sampling. The prevalence of GAM for each month from January 2011 to December 2013 was estimated using a Bayesian normal-normal conjugate analysis followed by PROBIT estimation. To validate the LP approach in detecting changes over time, the time trends of MUAC from LP and from five cross-sectional surveys were modelled using polynomial regression and compared by using a Wald test. The differences between prevalence estimates from the two data sources were used to assess selection and observational biases.The 95% credible interval around GAM prevalence estimates using LP approach ranged between +6.5%/-6.0% on a prevalence of 36.1% and +3.5%/-2.9% on a prevalence of 10.8%. LP and cross-sectional surveys time trend models were well correlated (p=0.6337). Although LP showed a slight but significant trend for GAM to decrease over time at a rate of -0.26%/visit, the prevalence estimates from the two data sources showed good agreement over a 3-year period.The LP methodology has proved to be valid in following trends of GAM prevalence for a period of 3years without selection bias. However, a slight observational bias was observed, requiring a periodical reselection of the sentinel sites. This kind of surveillance project is suited to use in areas with high burden of acute under-nutrition where early warning systems are strongly needed. Advocacy is necessary to develop sustainable nutrition surveillance system and to support the use of surveillance data in guiding nutritional programs.


Huybregts L.,Ghent University | Huybregts L.,Antwerp Institute of Tropical Medicine | Houngbe F.,Ghent University | Salpeteur C.,Action Contre la Faim | And 5 more authors.
PLoS Medicine | Year: 2012

Background: Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. Methods and Findings: We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (-29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (-22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. Conclusions: Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity. Trial registration: ClinicalTrials.gov NCT01154595. Please see later in the article for the Editors' Summary. © 2012 Huybregts et al.


Alcoba G.,University of Geneva | Kerac M.,University College London | Breysse S.,Action Contre la Faim | Salpeteur C.,Action Contre la Faim | And 3 more authors.
PLoS ONE | Year: 2013

Background: Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation. Methods and Findings: OVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27-55%) vs 22% (IQR 17-23%) and population-weighted-means 52.9% (range 23-57%) vs 35.4% (range 6.7-42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM. Conclusions: The evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy. © 2013 Alcoba et al.


Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits.The MAMOut research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed.The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as delay in project implementation, switch to e-data collection and implementation of a supervision process.ClinicalTrials.gov, identifier: NCT01866124, registered May 7, 2013.


PubMed | Action Contre la Faim, Epicentre, Médecins Sans Frontières and Harvard University
Type: Comparative Study | Journal: PloS one | Year: 2015

Debate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics.Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes.We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program.A single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.


Elster D.,Cranfield University | Holman I.P.,Cranfield University | Parker A.,Cranfield University | Rudge L.,Action Contre La Faim
Quarterly Journal of Engineering Geology and Hydrogeology | Year: 2014

Liberia is recovering from a 14 year civil war and only 51% of the rural population has access to safe drinking water. Little hydrogeological knowledge survives in Liberia, increasing the difficulty in successfully siting new boreholes. An understanding of the local hydrogeological environment is therefore needed to improve borehole site selection and increase success rates. This research provides a semi-quantitative characterization of the hydrogeological environment of the basement aquifer in Lofa county, Liberia. Based on literature review and analysis of borehole logs, the study has developed a conceptual hydrogeological model for the local conditions, which is further characterized using 2D geoelectrical sections. Groundwater is predominantly obtained from the saprolite and underlying fractured bedrock, but specific capacities (median 281 l h-1 m-1; 25th and 75th percentile of 179 and 490 l h-1 m-1, respectively) are constrained by the limited thickness of the saturated saprolite. This study has shown that the groundwater resources in the crystalline basement in this part of Liberia conform to the general conceptual model, allowing standard techniques used elsewhere for siting and developing groundwater to be used. © 2014 The Geological Society of London.

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