New Bank Research Findings on Nutrition

1. From Platitudes to Practice, a splendid new two-volume work on targeting nutrition and other social programs in Latin America by Margaret Grosh for Latin America and the Caribbean Department (LAC), will be available later this month. Based on 30 case studies, the volumes come to three main conclusions: Targeting works, albeit imperfectly. The median share of benefits reaching the poorest 40 percent of households is 72 percent for targeted food programs, compared to 31 percent for general food subsidies, 51 percent for primary health care and 62 percent for primary education. Administrative costs for moderately well-targeted programs are not prohibitive. Only a part of total administrative costs are due to targeting or screening devices; in cases where such costs could be separated, the median was one percent of program expenditures or $1.36 per beneficiary. And there is no correlation between the type of targeting and outcome, so it is not possible to rank targeting mechanisms. Details of circumstance and implementation contribute as much to the success and costs as the basic mechanism selected.

2. Nutrition and School Enrollment. A just-completed piece of research on Ghana by Paul Glewwe, World Bank, and Hanan Jacoby of the University of Rochester points up the economic importance of delayed primary school enrollment, and finds such delay a "consequence of nutritional deficiencies." The soon-to-be- published study, "An Economic Analysis of Delayed Primary School Enrollment and Childhood Malnutrition in a Low Income Country," finds no support for alternative explanations including family income, measured by per capita expenditures, or school fees.

3. Crediting Women. Last year's Population and Human Resources nutrition seminar by Freedom from Hunger President Christopher Dunford (on innovative community nutrition projects that require participation by women's groups in nutrition/health education activities to be eligible for credit from a revolving fund) piqued a lot of interest, but quantitative evidence was not in hand. Now, encouraging reports are in. An impact survey was conducted among a sample of randomly selected program participants and non-participants in West Africa and Central America. In Mali, for instance, 86 percent of Credit Association members reported more income (compared to 27 percent of controls), 90 percent reported more savings (compared to 27 percent), 65 percent of members were knowledgeable about specific nutrition messages presented, such as the proper age to introduce solid food to an infant (compared to 20 percent) and 85 percent of the members felt that health and nutrition of their pre-school children had improved (compared to 40 percent). Similar evidence was found in Honduras.

4. Suffer the Children. Are inadequate amounts of food the major cause of child malnutrition? A study recently completed in Zimbabwe (by Anna Ferro-Luzzi of Italy's National Institute of Nutrition and her associates), comparing the nutrition status of children and their parents in one of the poorest sections of the country, often finds parents with satisfactory weight (in many cases, overweight) but their children with poor nutrition. The conclusion: lack of food cannot be the major factor for much of the malnutrition, especially when considering the small quantities required by the very young.

5. Better Indicator. How to identify pregnant women at risk of delivering low birthweight infants? Although earlier research elsewhere had identified arm circumference and height as optimal indicators, recent research by the Institute of Nutrition for Central America and Panama (INCAP) found that, for Central America at least, calf circumference worked better than either.

6. Breastfeeding Discrimination. In rural India, "significant differences in male and female children in the extent of malnutrition pointed towards discrimination against girls, even in respect of exclusive breastfeeding," reported S. Rao and A.N. Kanade of the MACS Research Institute, in the most recent issue of The European Journal of Clinical Nutrition. The July newsletter of India's National Institute of Nutrition reports that a higher proportion of boys (51 percent) were being breastfed at the time of a survey than girls (30 percent) and that prolonged breastfeeding of boys was more common.

7. How Important Schooling? Conventional wisdom holds that mothers' schooling is critical to nutrition and health outcomes for children. Professor Jere Berhman of the University of Pennsylvania has begun to question whether education or cognitive capabilities before the schooling matters more. That question is being answered by Professor Ernesto Pollitt of University of California/Davis, using data from Guatemala. By testing cognitive capacity of girls before schooling, he shows that it may be those cognitive abilities, not just schooling, that make the difference. (The Bank's operational work in Indonesia shows that women's lack of schooling need not pose the insurmountable constraint to improving nutrition that it is widely believed to pose. Although formal education for women, of course, has many important benefits, the Indonesian experience demonstrated that education level does not define how much women are able to safeguard or improve their children's nutrition, if women receive highly specific messages, appropriately tailored and delivered.)