Lilia Bliznashka

Objective: Household Consumption and Expenditure Surveys (HCES) are increasingly used to assess diets in low- and middle-income countries, but their validity compared to individual-level dietary data remains uncertain. We assessed the strengths and limitations of HCES data for informing strategies to improve diets and nutrition in Tanzania. Design: Exploratory analysis of food group consumption from HCES (individualised using the adult female equivalent approach) and 24-h dietary recall (24hR). We examined concordance and trends by socioeconomic characteristics between methods for 10 food groups and fortifiable food vehicles. Setting: Rural Arusha and Kilimanjaro regions, and national data from the Tanzania National Panel Survey Wave 5. Participants: The analysis included 2599 adult women who completed a 24hR and lived in 2604 households contributing to HCES data in Arusha and Kilimanjaro. Nationally, 4469 households were included, with a regional subsample of 370 households from Arusha and Kilimanjaro. Results: Dietary patterns were similar using HCES and 24hR data, including low consumption of nutrient-dense foods, while HCES were effective at capturing usual intake of food items eaten episodically. However, compared to 24hR data, energy intakes were substantially lower using HCES data, particularly in large households (42% difference), while there was poor concordance between methods for fruit and meat consumption and for wealth-related trends in cereal and vegetable intake. Conclusion: HCES data can provide valuable insights for nutrition policy and planning; however, careful communication and interpretation of evidence is required, given limitations such as assumptions on within-household allocation of foods. Methods development could reduce measurement error.

Globally, 75% of adolescents do not meet recommendations for fruits and vegetables (F&V) consumption. This study investigated drivers of F&V choices among adolescents in Benin and identified barriers and facilitators to modifying F&V consumption. We conducted 16 focus group discussions (FGDs) with 126 adolescents and 5 semi-structured school observations in December 2024. FGDs were purposively chosen to explore variation by region (north/south), school location (urban/rural), adolescent age (12–15 years/16-18 years) and gender (boys/girls). Inductive and deductive thematic content analysis was performed using Atlas.ti . Findings showed that adolescents perceived a healthy diet as one composed of meals providing nutrients and strength, and including F&V. At home, adolescents mentioned eating staples and other vegetables more than other food groups. The foods adolescents reported typically eating at school varied by age, gender, and location. The primary categories of factors that influenced adolescent F&V choices were: intrapersonal (knowledge related to healthy eating and the nutrition and health benefits of F&V, taste preferences, and health prioritisation), socio-cultural (family and peer influences), and food environment (low availability, low affordability, convenience, and desirability). DFC factors were consistent across adolescent age, gender, and location. Multiple, dynamic, and multilevel factors influence adolescent F&V choices. Interventions that simultaneously address multiple barriers and involve family and peers are likely to be more successful in promoting F&V consumption and healthy diets than interventions only addressing individual barriers. Key messages: According to adolescents in Benin, a healthy diet was one composed of meals providing nutrients and strength and including fruits and vegetables (F&V). Intrapersonal, socio-cultural, and food environment factors influenced adolescent F&V choices regardless of adolescent gender, age, and location. Adolescent F&V choices are influenced by a dynamic interplay of multiple factors. Thus, interventions to improve adolescent diets should likely address several critical barriers in an integrated and holistic manner.

Maternal depression affects one in five women in Malawi. Integrated interventions simultaneously addressing multiple risks are a promising strategy to improve mental health. This study evaluated the impact of a nutrition-sensitive social behaviour change (SBC) intervention (agriculture and livelihoods, male engagement and Caring for the Caregiver) with or without cash transfers on maternal perinatal depression during the lean season in rural Malawi. A midline survey for a cluster-randomised controlled trial was conducted, where 156 clusters were randomly assigned to four arms (39 clusters/arm): (1) standard of care (SoC), (2) SBC, (3) SBC+low cash (US$17 per month) and (4) SBC+high cash (US$43 per month). Pregnant women and mothers of children <2 years of age (n=2677) were enrolled at baseline (May–June 2022). A subsample of 1303 women was followed-up at midline (November–December 2023). Maternal perinatal depression was assessed using the Self-Reporting Questionnaire with a score of ≥8 indicating symptoms consistent with depression. Intervention effects were estimated using linear mixed effects models. At midline, SBC+high cash reduced depression scores relative to SoC (mean difference −1.13 (95% CI −1.96 to –0.31)) but had no impact on the proportion of women with depressive symptoms. Relative to SoC, SBC+low cash and SBC alone had no impact on depression scores or the proportion of women with depressive symptoms. Relative to SBC alone, adding cash to SBC reduced depression scores and the proportion of women with depressive symptoms regardless of the size of the cash transfer. Cash transfers integrated with SBC can benefit maternal perinatal mental health in rural Malawi during the lean season. Trial registration number ISRCTN53055824 .

: We know little about how women in Africa perceive and manage food safety risks for fruits and vegetables, and how these perceptions and practices influence their food choices. To investigate this, we employed a sequential mixed-methods analysis using data from 33 villages across the Arusha and Kilimanjaro regions of Northern Tanzania. Quantitative household surveys were conducted with 2,577 women to document their perceptions of food safety risks associated with fresh fruits and vegetables. Additionally, quantitative surveys assessing food safety facilities and practices were conducted in 14 markets and 108 retail outlets. These data informed the creation of food safety scores for women’s risk perceptions and village-level vendor characteristics. We used the scores to analyse their relationship with household-level consumption and expenditure on fruits and vegetables using mixed-effects regression models. Subsequently, ethnographic research involved in-depth exploration with women from three communities to investigate the factors shaping food safety risk perceptions and their connections to household practices and food choices. Our quantitative findings indicated that women’s perceptions of food safety were associated with household-level consumption and expenditure, while vendor safety characteristics were not. The qualitative insights revealed that social relations, community interactions, and trust were pivotal for women in managing food safety risks. Women used these to assess and address food safety risks. Women were also assisted in minimising risk through their roles as producers, sellers, and household managers. Our analysis highlights the importance of understanding consumer perceptions and their socio-cultural contexts in designing interventions that enhance food safety and promote healthier diets.

Adequate amounts of fruit and vegetables (F&V) are an important part of a healthy diet, yet intake is suboptimal in most population groups worldwide. To better understand the evidence of strategies aiming to improve F&V intake, we conducted a scoping review of interventions assessing the impact on F&V intake, including those aiming to improve F&V intake explicitly and those targeting diet, health, lifestyle, or food environment generally. Among all eligible interventions reviewed, most of which were implemented in high-income countries, about half reported a significant positive impact on fruit and/or vegetable intake. Interventions that used a multicomponent strategy (61%) and those that focused on F&V specifically (72%) were most likely to find a significant increase in fruit and/or vegetable intake. Detailed summaries are provided in 2 accompanying articles. In the present article, we put these findings into perspective. Specifically, we considered the evidence for 4 target countries of the Fruit and Vegetables for Sustainable Healthy Diets Initiative: Benin, the Philippines, Sri Lanka, and Tanzania. When considering available evidence at the national level, there is a paucity of information from intervention trials despite evidence of inadequate F&V intakes in each of these countries. When considering available evidence at the global level, and especially for low-and-middle income countries, there is a critical need to strengthen the evidence across various intervention strategies, particularly related to targeting, timing, intensity, duration, frequency, and other key characteristics, to better understand how to enhance their impact on F&V intake in various population groups and contexts.