AbstractObjectiveTo evaluate the impact of the US government’s Feed the Future initiative on
nutrition outcomes in children younger than 5 years in sub-Saharan
Africa.DesignDifference-in-differences quasi-experimental approach.SettingHouseholds in 33 low and lower middle income countries in sub-Saharan
Africa.Population883 309 children aged less than 5 years with weight, height, and age recorded
in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052
children were from Feed the Future countries and 495 257 were from non-Feed
the Future countries.Main outcome measuresA difference-in-differences approach was used to compare outcomes among
children in intervention countries after implementation of the initiative
with children before its introduction and children in non-intervention
countries, controlling for relevant covariates, time invariant national
differences, and time trends. The primary outcome was stunting (height for
age >2 standard deviations below a reference median), a key indicator of
undernutrition in children. Secondary outcomes were wasting (low weight for
height) and underweight (low weight for age).ResultsAcross all years and countries, 38.3% of children in the study sample were
stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six
years of Feed the Future’s implementation, children in 12 countries with the
initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to
5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1)
greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater
decline in underweight levels compared with children in 21 countries without
the initiative and compared with trends in undernutrition before Feed the
Future was launched. These decreases translate to around two million fewer
stunted and underweight children aged less than 5 years and around a half
million fewer children with wasting. For context, about 22 million children
were stunted, 11 million children were underweight, and four million
children were wasted in the Feed the Future countries at baseline.ConclusionsFeed the Future’s activities were closely linked to notable improvements in
stunting and underweight levels and moderate improvements in wasting in
children younger than 5 years. These findings highlight the effectiveness of
this large, country tailored initiative focused on agriculture and food
security and have important implications for the future of this and other
nutrition interventions worldwide.
Coping with COVID-19 in Sub-Saharan Africa: What Might the Future Hold?
