Abstract Climate change poses a growing threat to child health in Sub-Saharan Africa; however, the mechanisms linking extreme temperatures to child nutritional outcomes remain poorly understood. This study examined the effects of extreme heat exposure on child anthropometric outcomes across 33 Sub-Saharan African countries using data from 80 Demographic and Health Surveys (2006–2023/24) merged with satellite-derived climate measures. We found that extreme heat significantly impaired child growth: each additional 100 days with maximum temperature exceeding 100°F reduced height-for-age z-scores by 0.085 standard deviations and increased stunting probability by 1.8 percentage points. Notably, girls experienced significantly larger adverse effects than boys, with an additional 0.041 standard deviation reduction in height-for-age at the 100°F threshold. To investigate potential mechanisms, we examined the effects of heat exposure on dietary intake among children under 24 months of age. Extreme heat significantly reduces the consumption of nutrient-rich foods, including vitamin A- and iron-rich foods, and decreases dietary diversity. Furthermore, we found evidence of gender heterogeneity in dietary effects: households reduce dietary diversity for girls more than for boys during periods of temperature stress. These findings suggest that discriminatory feeding practices during environmental hardship may contribute to sex disparities in climate-nutrition effects. Our results highlight the need for nutrition-sensitive climate adaptation policies that explicitly focus on gender equity. JEL Classification : I15; J16; Q54; O15
This study addresses this evidence gap by investigating maternal determinants of child nutritional status in a predominantly rural district where no prior published study had examined these relationships. A community-based analytical cross-sectional study was conducted among 340 mother-child pairs. Systematic random sampling was employed at Child Welfare Clinics across five sub-districts of Mion District. Associations between maternal factors and nutritional outcomes were assessed via bivariate chi-square and Fisher's exact tests at p < 0.05. Prevalence of stunting (22.4%), wasting (15.8%), and underweight (18.3%) significantly exceeded national averages of 18.4%, 5.3%, and 10.4% respectively. Notably, wasting exceeded the WHO emergency threshold of 15%, indicating a critical public health situation. Significant associations were identified between household income and wasting (p = 0.03), maternal religious affiliation and underweight (p = 0.006), and maternal educational level and stunting (p < 0.001). Stunting prevalence unexpectedly increased with maternal education, likely attributable to small sample sizes in higher education tiers and uncontrolled confounding. Maternal age, marital status, and occupation were not significantly associated with any nutritional outcome. Undernutrition in Mion District has reached WHO-defined emergency levels, necessitating an immediate scale-up of Community-based Management of Acute Malnutrition (CMAM) services. Interventions must be culturally tailored, engaging religious and community leaders to address nutritional disparities linked to religious affiliation, while integrating social protection programmes, including targeted cash transfers, to mitigate the impact of low household income on acute malnutrition.
BACKGROUND: We evaluated growth outcomes in children and adolescents with HIV-1 initiating or switching to dolutegravir-based antiretroviral therapy (ART) in the single-arm trials IMPAACT P1093 (P1093) and IMPAACT 2019. METHODS: We performed descriptive post hoc analyses of body mass index-for-age (BAZ), weight-for-age (WAZ), and length/height-for-age z scores (L/HAZ) for each trial through Week 48. BAZ changes were assessed using a mixed model for repeated measures. RESULTS: We included data from 181 and 57 participants from P1093 and IMPAACT 2019, respectively (10% [23/238] were adolescents). Baseline mean BAZ was -0.1 in P1093 and - 0.7 in IMPAACT 2019. At Week 48, adjusted mean BAZ increased significantly in P1093 (0.3; 95% CI, 0.03, 0.49; p < 0.05) and non-significantly in IMPAACT 2019 (0.3; 95% CI, -0.03, 0.58; p = 0.074). Mean BAZ was in the normal range at Week 48 in both trials. Marked increases in BAZ were observed among subgroups with baseline BAZ < -2. By Week 48, 65% (117/181) of participants in P1093 and 74% (42/57) in IMPAACT 2019 remained in the same BAZ category. Improvements from severe or moderate malnutrition/thinness to normal weight occurred in 6% (10/181) and 7% (4/57) of participants in P1093 and IMPAACT 2019, respectively, while increases to overweight or obesity were observed in 9% (16/181) and 5% (3/57). Small changes were observed in overall mean WAZ and L/HAZ through Week 48 in both trials. CONCLUSIONS: Small overall increases in BAZ were observed over 1 year among pediatric participants on dolutegravir-based ART, with most participants remaining in their baseline BAZ category. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov, NCT01302847 and NCT03760458.
Michael McKenna, Zrinka Lulic, Ann M. Buchanan et al.
ABSTRACT Sub‐Saharan Africa is off track in achieving the 2025 World Health Assembly nutrition targets. A robust health system is essential to deliver interventions that protect the nutrition of pregnant women and children under 5 years of age. This study aimed to examine health and nutrition service readiness, provision, and training in Côte d'Ivoire, the Democratic Republic of Congo (DRC), Guinea, Kenya, Mali, Niger and Nigeria. Two data sources were used: national‐level commodity data and health facility data. Interviews were conducted with Ministry of Health officials to gather information on the procurement of nutrition commodities. Health facility data were collected in a survey using a two‐stage random cluster design. This integrated approach assessed the availability of essential nutrition commodities, service provision and training of health personnel. Findings revealed significant variations in health system readiness and service provision. For pregnant women, the availability of iron–folic acid at facilities ranged from 73% in Guinea to 98% in Mali, with similar variability in service provision and health worker training. Multiple micronutrient and calcium supplements showed gaps in availability and provision. For children under five, oral rehydration solution availability ranged from 32% in Côte d'Ivoire to 89% in Niger, with corresponding differences in service provision and training. Newer interventions like micronutrient powders (24% in DRC–49% in Niger) and small‐quantity lipid‐based nutrient supplements showed low service provision (16% in Guinea–47% in Mali). This study highlights the need for targeted interventions to address supply chain challenges, enhance health worker training and improve service provision.
Romance Dissieka, Djeinam Toure, Akriti Singh et al.
Malnutrition among children is a serious health problem in Rwanda, with 33 percent of children under five being stunted. Limited dietary diversity, especially fruits and vegetables, contributes to micronutrient deficiencies and growth retardation. This research examined fruit and vegetable intake trends and relationships with the nutritional status of 6-59-month-old children in Nyamagabe District, Southern Province, Rwanda. Data collection occurred between November 2025 and February 2026 using a mixed-method convergent parallel design. The quantitative element included a community survey of 513 mother-child pairs through multistage cluster sampling. Anthropometric values were recorded per WHO protocol, and dietary intake was collected through 24-hour recalls, food questionnaires, and diversity scores. Food security was measured using the Food Insecurity Access Scale. The qualitative element included 17 focus groups and 20 in-depth interviews. The stunting, wasting, and underweight prevalence were 39.2, 3.5, and 12.1, respectively. Only 28.7 percent of children had minimum dietary diversity, with daily fruit and vegetable intake at 1.6 servings (SD = 1.3). Children consuming three or more servings were less likely to be stunted (AOR = 0.38; 95% CI: 0.24-0.61; p < 0.001) and underweight (AOR = 0.47; 95% CI: 0.27-0.83; p = 0.009). Household food insecurity was strongly associated with increased stunting risk (AOR = 3.45; 95% CI: 2.18–5.47; p < 0.001), indicating that food-insecure households had nearly 3.5 times greater odds of having a stunted child compared to food-secure households. Absence of formal maternal education (AOR = 2.67; 95% CI: 1.58–4.51; p < 0.001) and belonging to the lowest wealth quintile (AOR = 2.89; 95% CI: 1.72–4.86; p < 0.001) were additional independent risk factors for stunting. Barriers included seasonal deficits, high prices, weak nutrition education, and a preference for starchy staples. Solutions require nutrition-sensitive agriculture, year-round food production, behavior change, and food security programs.
Gisubizo Fabien, Irène Médémè Mitchodigni, Evode Habimana et al.
AbstractMicronutrient deficiencies remain common among women and children in Sub‐Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home‐prepared foods with small‐quantity lipid‐based nutrient supplements (SQ‐LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ‐LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ‐LNS consumption across different settings.Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6‐mo‐old children received SQ‐LNSs were identified through electronic and manual searches.Prenatal SQ‐LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron‐plus‐folic acid supplementation. SQ‐LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ‐LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio‐emotional, and executive functions in Ghana and Malawi and on Griffiths’ developmental scores in Malawi.SQ‐LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ‐LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes.
Attaining the United Nations targets for Sustainable Development Goal 1 (No Poverty) and 2 (Zero Hunger) in less than five years from now (2030), have remained a challenging task for low-and middle-income countries, especially Africa, which hosts the largest number of people (309 million) facing hunger globally in 2025. It was reported that one out of every five people (20%) in Africa face hunger in 2025, compared to 6% of the population in Asia, 4.8% in Latin America and the Caribbean, 8% in Oceania and below 2.5% in Northern America and Europe (1).To understand the structural unity of the 19 papers in this volume, we must establish a clear Systems-Level Conceptual Framework. The interactions among conflict, hunger, poverty, and food insecurity are nonlinear, functioning as a self-reinforcing feedback system of interconnected feedback loops. The systemic complexity of these interactions is illustrated in the conceptual framework presented in Figure 1, which maps the reinforcing feedback loops that either trap households in a self-perpetuating "cycle of vulnerability" or through targeted policy interventions, shift them onto a "virtuous cycle of resilience". This conceptual framework was similar to the study of Tidball et al (2018) on Community-led reforestation. As depicted in the conceptual model, agricultural value chain paralysis and post-harvest losses do not directly translate into clinical malnutrition; rather, they must first pass through the critical intermediary stage of severe food insecurity before progressing to clinical malnutrition. Under the vicious cycle, the supply collapse of essential food supplies drives households into moderate-tosevere food insecurity, characterized by heightened anxiety over food access and an involuntary reliance on low-cost, nutrient-poor staple diets. Conversely, the resilience-oriented intervention pathway disrupts this vicious cycle by reducing systemic risks and weakening the reinforcing feedback loops that drive household vulnerability. By integrating value-added intensification with post-harvest dehydration (green-drying), the system enhances food security by ensuring sustained year-round physical and economic access to safe and nutritious foods, thereby promoting optimal dietary health, nutritional security, and community resilience. From the East African perspective, Omay et al with the title: "Insights into the determinants influencing food security in the IGAD region of Eastern Africa," examined how food security in the Intergovernmental Authority on Development (IGAD) region of East Africa was influenced by complex interaction of both climatic and non-climatic factors such as severe weather, land management, market mechanisms, and macroeconomic volatility. Authors found out that hydroclimatic (dry-wet) extremes considerably influenced food security status while unfair trade practices and inadequate agricultural funding across IGAD nations contributed to escalating food costs and undernourishment. The study emphasised the urgent need for intersectoral and geographically aligned strategies to promote food security. Evidence from Ethiopia shows how structural pressures are experienced through household diets. Jisso et al examined household food security and maternal dietary diversity in rural Gedeo, linking dietary diversity with wealth, maternal education, pregnancy status, and food-security conditions. Their contribution shifts attention from whether food is available to whether women can obtain varied, nutritious diets. Policies centred only on staple production may overlook micronutrient inadequacy and unequal access within households. Maternal literacy, women's income opportunities, nutrition education, and social protection should be central components of food-security policy. Mulatu et al deepen this maternal-nutrition perspective by assessing dietary practices among lactating mothers in Dangila District, Ethiopia. Although many women achieved adequate dietary diversity, only one-third demonstrated good dietary practices, while food insecurity affected most respondents. Poor practices were associated with daily labour, larger families, short birth intervals, and food insecurity. Nutritional knowledge alone cannot overcome economic pressure, time constraints, and competing household needs. The study supports practical dietary counselling within maternal health services, stronger family planning, improved livelihood opportunities, and coordination among health, agriculture, and socialwelfare programmes. Jambo et al explore a nutrition-sensitive pathway through the adoption of quality protein maize in southern Ethiopia. The crop can improve access to amino acids where maize is a staple, but its benefits depend on farmers' ability and willingness to cultivate it. Seed access, land size, income, education, extension contact, field-day participation, and livelihood diversification influenced adoption. The findings show that nutritionally improved crops cannot succeed through varietal development alone. Reliable seed systems, practical extension, farmer demonstrations, finance, communication, and markets are needed to make adoption feasible for smallholders. Bila et al in their study titled "Assessment of farmer's knowledge and attitudes toward fungi and mycotoxin contamination in staple crops in southern Mozambique" assessed the understanding and views of 180 smallholder farmers about fungi and mycotoxin contamination of food crops, food loss, and income in Southern Mozambique. The study revealed that almost all the farmers (98%) showed insufficient level of understanding about fungi and mycotoxins contamination in food crops and agricultural products. The study highlighted the urgent need for training, affordable drying and storage technologies, surveillance, stronger food-safety regulation, and extension services for farmers that translate knowledge into practical action. In the study of Lukwa et al titled "Impact of COVID-19 on household hunger and socio-economic inequality in South Africa: a comparative analysis using NID-CRAM (2020-2021) and NFNSS 2022" compared household hunger in the period of severe pandemic and early recovery phase and investigated how social gaps in food security evolved. Authors revealed that notable provinces in South Africa such as Northern Cape, Free State, and North West continued to be fairly food insecure during this periods. The study highlighted the need for sustained structural policy measures that promote social inclusion and fix regional and infrastructural deficits to enhance resilient food security. Cao et al in their study titled "Environmental sustainability and nutritional quality: addressing global food and nutrition security in a post-pandemic world" employed the IMPACT model, alongside climate forecasts, field trials, among others to explore international food supply. The authors emphasised the need for sustainable agriculture and climate adaptation to promote food security in an ever-evolving world dynamics. Ojo et al examine the bridge between innovation and farmers by studying extension agents' attitudes and participation in disseminating climate-smart agricultural practices in North-Central Nigeria. More than half held unfavourable attitudes, while participation in communicating water-and crop-management options was limited. Training, experience, characteristics, and attitudes influenced engagement. The study shows that innovations do not spread simply because they are technically effective. Extension personnel require training, logistical support, motivation, workloads, and recognition to improve farmers' access to climate information, water management, insurance, improved varieties, integrated pest management, and diversified production. Niu et al in their study titled "Definition of the traditional African diet: a scoping review" systematically investigated the definition of the traditional African diet (TrAfDi) through the lens of a scoping review.Authors reported that out of 45 included papers, cereals, pulses, seeds and nuts, vegetables and their products are among the food groups that defined the TrAfDi. The study presented a preliminary evidence on what formed a TrAfDi and revealed attributes of its indigenous qualities which are germane to designing public health strategies to address hunger crisis, overweight, and non-infectious diseases in Africa.• Pillar 2 (Papers 10-19): Shifts the analytical lens to micro-level consumer sensory preferences, clinical and household nutrition, economic disempowerment, climate-smart agriculture (CSA) adoptions, and regional socio-demographic disparities. The study of Tenza et al titled "Consumer sensory assessments of chicken breeds: the role of location, age, and gender in resource-poor communities for food security and sustainable livelihoods" investigated the impact of location, age, and gender of consumers on sensory attributes of 120 village chickens breeds and broiler chickens in under-resourced communities. Authors found out that the colour scale of both male and female chickens were fairly the same (5.02-5.57) and emphasised the impact of location, age, and gender of consumers in sensory qualities on the consumer sensory evaluations. To understand the macro-level drivers of agricultural disruption in West Africa, Diori et al in their study titled "Protracted violence and insecurity: a quantitative analysis of persistent drivers of rising conflict in the Sahel" deployed a robust econometric model to investigate the underlying drivers of escalating, prolonged conflict across the Sahel. By integrating geo-referenced historical conflict data from the Armed Conflict Location and Event Data (ACLED) database with micro-level socioeconomic measures, the authors mapped the causal pathways of agricultural vulnerability. Their quantitative analysis demonstrated that while climatic variability, such as climate-induced rainfall shocks and rangeland degradation, serve as threat multipliers, they are not the underlying drivers of violence. Instead, the structural drivers of conflict in the Sahel are institutional and political, marked by structural youth unemployment, perceived political and socioeconomic exclusion, fragile rule of law, insecure land tenure systems for pastoralist and cropproducing communities. This research establishes that predominantly military-oriented security approaches are insufficient in building resilient food systems in fragile settings, highlighting that policymakers must instead prioritise building resilient land-use conflict resolution institutions, strengthening rural technical and vocational education and training, and supporting youth-led agribusiness value chains to provide viable economic opportunities that reduce vulnerability to conflict participation. Operating within Mali's fragile and conflict-affected ecological and sociopolitical context, Kangas et al developed a robust "Theory of Change" (ToC) for how relapse can be reduced in Mali and propose an intervention package that is feasible for the health system to adopt with minimal external support. The researchers integrated community-based healthcare providers, mothers, and humanitarian practitioners to develop a post-intervention surveillance protocol focused on Small-Quantity Lipid-Based Nutrient Supplements (SQ-LNS). The participatory ToC systematically mapped the multidimensional operational, household, and environmental constraints that drive post-treatment relapse, confirming that the routine provision of SQ-LNS, combined with structured, community-based growth monitoring, creates a resilient post-intervention safety net that substantially lowers the likelihood of nutritional decline. This study provides a practical and adaptable framework for public health administrators, demonstrating that clinical management of malnutrition must be paired with structured, food-based post-discharge surveillance and sustainable locally sourced nutrient supplement value chains to promote long-term child survival in conflict-affected food environments. Focusing on Nigeria's agricultural Middle Belt region, Ogunfolaju et al in their study titled "Determinants of food insecurity among smallholder farmers in North Central Nigeria: policy implications" explored the household-level factors influencing food and nutrition security among smallholder farmers. The authors employed the Household Food Insecurity Access Scale (HFIAS) to measure food security status and analyzed the drivers of food insecurity using an ordered probit model regression. The econometric findings revealed the sex of the household head, marital status, level of education and other important socioeconomic factors significantly influenced food security status of the farming households. The paper emphasised the need for agricultural policies in Nigeria to promote equitable access to education and extension services as a means of improving household food security among smallholder farming households. Addressing an increasingly important public health challenge, Omokpariola et al presents an integrated, multi-country epidemiological and food systems assessment with the title: "Malnutrition and double burden of disease: African dilemma of non-communicable disease." The authors employed a narrative approach to explore the double burden of malnutrition and its relationship with non-communicable diseases (NCDs) in Africa. The study reveals a growing shift where accelerated urbanization, physically inactive lifestyle, and the proliferation of inexpensive imported ultra-processed foods in local retail markets contributed to an epidemiological transition. Consequently, cardiovascular diseases, hypertension, and type 2 diabetes are rising rapidly among populations residing in urban and peri-urban settings, while the rural households continue to struggle with chronic stunting. The study calls for fundamental shift in African food and agricultural policies, arguing that national development plans must move beyond the narrow objective of maximizing the production of starchy staple crops instead implement fiscal and regulatory incentives that promote the development of local value chains to encourage the availability and affordability of nutrient-dense, diverse, and minimally processed local foods. In exploring the ecological-security nexus in Nigeria, Edewor and Ogbe conduct a structured qualitative and quantitative review of how climate-affected environmental degradation triggers violent disputes over access to natural resource, particularly farmer-herder conflicts, thereby contributing to national food insecurity. The study demonstrates how rapid desertification, soil erosion, and drying water basins in northern Nigeria contributes to southward pastoralists migration, thereby intensifying violent conflicts over customary land-use rights with farming communities. To enhance the resilience of food value chains, the authors call for a dual-policy response that integrates climate adaptation with peacebuilding, recommending that governments invest in green security infrastructure, establish ranching systems to reduce open grazing, and strengthen community-led joint peace committees. Khumalo et al, in their paper titled "The association between climate-smart agriculture practices adoption and farm income and wealth of small-scale urban crop farmers in eThekwini municipality, with implications for food and nutrition security" investigated the association between Climate-Smart Agricultural (CSA) practices adopted by smallholder urban crop farmers and farm income and household wealth in the eThekwini Municipality. The study employed quantitative household-level survey data and applied multiple linear regression models alongside asset index decomposition analysis to evaluate changes in farm income and household wealth. The modeling results indicated that adopting number of CSA practices was positively and significantly associated with higher household farm income and wealth accumulation. The authors emphasized the need for municipal planning frameworks to formally integrate urban agriculture, secure land-use rights for urban farmers, and provide targeted technical training in climate-smart agronomy. Investigating the vicious cycle of poverty, malnutrition, and limited education attainment Ajayi and Oyekunle present a study titled: "An analysis of economic disempowerment as a fundamental barrier to food insecurity and education access in Nigeria" about household economic marginalization serves as a leading, intergenerational disadvantage to food security and access to education in Nigeria. The authors utilized household survey data of 450 respondents, exploring the impacts of insecurity and socioeconomic and political instability on food security and educational outcomes. The study analysed trade-offs that lowincome households are forced to make during periods of economic hardship, indicating that extreme income poverty compels households to adopt negative coping strategies. Farm families are compelled to prioritise low-cost, nutrient-poor starchy staples over nutritionally diverse diets to secure their basic means of subsistence, thereby exacerbating chronic micronutrient malnutrition and childhood stunting.The authors argue that sustainable food and nutrition security interventions must be integrated with comprehensive social protection frameworks, including conditional cash transfers and school feeding programmes, to improve households' socioeconomic well-being. Exploring regional agricultural transformations, Akpabio et al offer a pivotal, evidence-based assessment of the opportunities and structural barriers of expanding the adoption of Climate-Smart Agriculture (CSA) technologies to advance the achievement of SDG 2 (Zero Hunger) across the agroecological zones of West Africa. The authors conducted a systematic evidence synthesis of regional adoption data, emphasising that while CSA practices possess offer transformative for building climate resilience, their scaling up is hindered by persistent structural constraints such as high start-up costs, weak public agricultural extension systems, and limited access to weather-indexed insurance. The study emphasised that achieving SDG 2 in West Africa requires addressing institutional bottlenecks, calling for regional bodies such as ECOWAS to establish targeted green financing mechanisms to support CSA investment in the subregion. In conclusion, Kitole et al in their article titled: "Rural-urban disparities in child nutrition in Tabora, Tanzania: a socioeconomic decomposition and implications for food security policy" employed Blinder-Oaxaca and socioeconomic decomposition analyses to investigate the determinants of the child nutritional gap across rural and urban settings in Tanzania. The authors measured child nutritional status using standard anthropometric Z-scores for stunting, wasting, and underweight. The decomposition analysis indicated that the gap is almost entirely explained by inequalities in maternal education, healthcare utilization, household wealth measures, and access to clean water and sanitation (WASH) infrastructure.The collective evidence presented in this Research Topic emphasised that addressing the conflict-hungerpoverty-food insecurity nexus requires moving beyond fragmented, single-sector interventions. We must design and implement holistic, systems-level strategies that treat agriculture not merely as a subsistence farm-gate practice, but as a coordinated, high-tech, and risk-resilient Agribusiness System. In conclusion, the editorial team expresses its deepest gratitude to the contributing authors for their pioneering research, and to the dedicated peer reviewers whose rigorous, constructive evaluations ensured the scientific of this We the editorial of in and Sustainable Food for their support. It is that the frameworks presented in this serve as a practical for and agribusiness as they to and
Olutosin Ademola Otekunrin, Temitope Oluwaseun Ojo, Barbara Sawicka et al.
Background: Africa remains off-track to meet 2030 stunting targets despite relative economic growth. We aimed to quantify the “nutrition conversion gap”, the efficiency with which national resources are translated into stunting reduction, and examine factors associated with technical inefficiency across 54 African nations.<br><br>Methods: This longitudinal panel study (2000–2022; N=1,134 country-years) used Stochastic Frontier Analysis to estimate a health production frontier, defined as the maximum achievable Health Production Score (100 minus stunting prevalence). Inputs (GDP per capita, dietary adequacy, and maternal education) were modeled as 3-year weighted moving averages. Technical inefficiency was modeled as a function of lagged diarrhea incidence, electrification, urbanization, and political stability.<br><br>Findings: Significant performance heterogeneity exists across the continent. High technical inefficiency (=0·976, =6·43) accounted for 97·6% of observed nutritional disparities. Low GDP elasticity (= 0·042, p<0·001) suggests economic growth alone is an insufficient lever for stunting eradication. Senegal and Somalia emerged as “Positive Deviants” operating near the frontier, whereas Equatorial Guinea and Botswana represent a “Wealth Paradox”. Electricity access significantly reduced the conversion gap (p<0·001). A “Stability Paradox” was identified, where political stability in the absence of reform correlated with increased inefficiency (= 0·38, p<0·001).<br><br>Interpretation: Nutritional progress is profoundly decoupled from national wealth. Policy must pivot from aggregate resource accumulation toward mitigating systemic bottlenecks, specifically infection control and electrification. Strengthening health system efficiency through decentralized, community-led models represents a more potent roadmap for human capital development than simple macroeconomic expansion.
Moderate acute malnutrition (MAM) among children under five remains a challenge in Tanzania, where the fortified blended foods used to manage it are almost entirely imported, expensive and inaccessible. This study developed and evaluated a grain amaranth-based extruded instant porridge as a locally sourced alternative. Five formulations were generated from grain amaranth, pro-vitamin A maize, soybean and sesame by two-stage linear programming using regional food composition data, with crude protein maximized subject to a technological fat ceiling of 11.0 g/100 g. Formulation 1, the least-cost solution, and Formulation 5, the most nutrient-dense within fat ceiling that is more economical than the non-compliant Formulation 3, were advanced to twin-screw extrusion. Proximate composition (AOAC 2005), mineral content (microwave plasma atomic emission spectrometry) and anti-nutritional factors (colorimetric methods) were determined; functional and sensory properties were evaluated; data were analyzed by ANOVA. Protein ranged from 18.14 g/100 g in Formulation 1 to 20.53 g/100 g in Formulation 5 reaching 98.0% of the WFP/UNICEF Super Cereal Plus (CSB++) minimum of 400 kcal/100 g. Formulation 5 showed the highest fat (11.95 g/100 g) and zinc (8.98 mg/100 g), all within CSB++ ranges, with only potassium below specification (37.1%). Extrusion significantly increased water absorption capacity ( p < 0.001), shifted the flour from the fair to good flowing category, and reduced tannins, oxalates and phytate by 50.2, 64.9 and 77.6% relative to raw grain amaranth. Sensory scores showed good overall acceptability (6.2–6.9), with significant differences for aroma ( p < 0.001) and flavor ( p = 0.002); SC(F5)-777 ranked highest among extruded samples. Food-to-food fortification using grain amaranth at 40–45% produced energy- and nutrient-dense instant porridge with improved mineral content, functional properties, and sensory characteristics, demonstrating strong potential for use as locally available supplementary food for managing MAM in children under five.
Amos Steven Mwikwabe, Haikael David Martin, Benson Kusirie Mushi et al.
Maternal malnutrition remains a key driver of adverse birth outcomes in sub-Saharan Africa, yet contextual evidence on multi-level determinants in north-eastern Nigeria is scarce. This study explored how socio-cultural, environmental, and health-system factors shape maternal nutrition and child health in Balanga Local Government Area (LGA), Gombe State. An exploratory qualitative design underpinned by interpretive phenomenology was employed. Two focus-group discussions (n = 20), five in-depth interviews, and twelve key-informant interviews were conducted among pregnant women, health workers and governance actors. Data were analysed thematically using NVivo 14 and triangulated across sources. Carbohydrate dominance (97% consumed tuwo daily) was reinforced by cultural prohibitions: 70% avoided eggs due to “theft destiny” beliefs. The 2019 Balanga Dam collapse reduced irrigated area from 11 000 ha to ess-than 2 000 ha, raised dried-fish prices by 180% and cut dietary diversity from 28% to 18%. Antenatal care attendance averaged 2.9 visits; 64% of facilities lacked haemoglobinometry. Participants attributed low birth-weight, stunting and delayed vaccination to “weak blood” from maternal undernutrition. Maternal malnutrition in Balanga LGA is produced by intersecting cultural taboos, agronomic shock and health-system challenges. An integrated package of point-of-care diagnostics, conditional e-vouchers and irrigation rehabilitation could avert maternal and child death caused by low birth weight and maternal malnutrition. The findings can be adapted by other Sub-Saharan African countries experiencing similar environmental instability and gendered food allocation.
Rosemary Dickson-Nze, Paul Balogun, Laughter Amamchukwu et al.
