Objectives: To review the impact of agriculture interventions on nutritional status in participating households, and to analyse the characteristics of interventions that improved nutrition outcomes. Design: We identified and reviewed reports describing 30 agriculture interventions that measured impact on nutritional status. The interventions reviewed included home gardening, livestock, mixed garden and livestock, cash cropping, and irrigation. We examined the reports for the scientific quality of the research design and treatment of the data. We also assessed whether the projects invested in five types of 'capital' (physical, natural, financial, human and social) as defined in the Sustainable Livelihoods Framework, a conceptual map of major factors that affect people's livelihoods. Results: Most agriculture interventions increased food production, but did not necessarily improve nutrition or health within participating households. Nutrition was improved in 11 of 13 home gardening interventions, and in 11 of 17 other types of intervention. Of the 19 interventions that had a positive effect on nutrition, 14 of them invested in four or five types of capital in addition to the agriculture intervention. Of the nine interventions that had a negative or no effect on nutrition, only one invested in four or five types of capital. Conclusions: Those agriculture interventions that invested broadly in different types of capital were more likely to improve nutrition outcomes. Those projects which invested in human capital (especially nutrition education and consideration of gender issues), and other types of capital, had a greater likelihood of effecting positive nutritional change, but such investment is neither sufficient nor always necessary to effect change.

Repeated 24-h recalls (9-14/subject) were conducted on 52 periurban Guatemalan pregnant women aged 25 +/- 5 y (means +/- SD). Intakes of energy, protein, calcium, zinc, copper, manganese, nonstarch polysaccharide (NSP), phytate, and millimolar ratios of phytate to zinc and (calcium x phytate) to zinc were calculated from food-composition values on the basis of chemical analysis and the literature. Mean (+/- SD) daily intakes were as follows: energy 8694 +/- 1674 kJ, protein 63.0 +/- 13.3 g, calcium 727 +/- 163, zinc 11.3 +/- 2.7, copper 1.3 +/- 0.3, manganese 2.8 +/- 0.6, phytate 2254 +/- 773 mg/d, NSP 26.6 +/- 6.9 g, phytate/zinc 18.8 +/- 4.2, (calcium x phytate)/zinc 706 +/- 21 mmol/MJ. Ninety-four percent had zinc intakes below the recommendations (15 mg) of WHO and the US recommended dietary allowances, assuming 20% absorption. Tortillas were a major source of zinc (46%), copper (20%), manganese (23%), calcium (39%), phytate (68%), and NSP (50%); 19% zinc from flesh foods. Thirty-eight percent had phytate-zinc ratios > 20; 94% had millimolar ratios of (calcium x phytate) to zinc per MJ > or = 22. The high prevalence of millimolar ratios of phytate to zinc and (calcium x phytate) to zinc per MJ above 20 and 22, respectively, may compromise zinc nutriture.

In many developing countries, gender inequality contributes to the continued problem of unwanted pregnancies and unmet contraception needs. The majority of family planning programmes in Asia target only women; however, women's lack of decisionmaking power, even with regard to their own health, hinders their ability to practise family planning. This article describes successes and lessons learned in India and Vietnam from a HealthBridge programme which facilitated male involvement in reproductive health, particularly in family planning and in the use of male-centred contraception. The experience shows that, given the right role models and enabling environments, men are willing to be more fully and positively engaged in reproductive health matters.Dans de nombreux pays en de´veloppement, l'ine´galite´de genre contribue au proble`me qui persiste des grossesses non souhaite´es et des besoins de contraception non satisfaits. La majorite´des programmes de planning familial en Asie ne ciblent que les femmes ; cependant, le manque de pouvoir de prise de de´cisions parmi les femmes, y compris en ce qui concerne leur propre sante´, entrave leur aptitude a`pratiquer le planning familial. Cet article de´crit les enseignements et les succe`s obtenus en Inde et au Vietnam au moyen d'un programme de HealthBridge qui a facilite´la participation des hommes a`la sante´ge´ne´sique, en particulier en matie`re de planning familial et d'utilisation de moyens de contraception base´s sur les hommes. L'expe´rience montre qu'avec les bons mode`les et des environnements positifs, les hommes sont dispose´s à s'engager plus pleinement et positivement sur les questions relatives a`la santeǵ e´ne´sique.En muchos países en desarrollo, la desigualdad de ge´nero fomenta el persistente problema de los embarazos no deseados y de la demanda insatisfecha de anticonceptivos. En Asia, la mayoría de los programas de planeacio´n familiar es dirigida so´lo a las mujeres. Sin embargo, el hecho de que las mujeres no tengan el poder de decisio´n, aun trata´ndose de su propia salud, limita sus posibilidades de ejercer la planeacio´n familiar. Este artículo examina los e´xitos y los aprendizajes resultantes de la aplicacio´n de un programa de HealthBridge que fue implementado en India y en Vietnam, el cual facilito´la participacio´n de los hombres en la salud reproductiva, en particular, en la planeacio´n familiar y en el uso de anticonceptivos para el hombre. Estas experiencias demuestran que, de existir buenos modelos de referencia y ambientes propicios, los hombres manifiestan la voluntad de participar ma´s amplia y positivamente en los asuntos de salud reproductiva.

Background: When started early in pregnancy and continued up till childbirth, antenatal care (ANC) can be effective in reducing adverse pregnancy outcomes. While the proportion of women who attend ANC at least once in low income countries is high, most pregnant women attend their first ANC late. In Tanzania, while over 51% of pregnant women complete ≥4 visits, only 24% start within the first trimester. This study aimed to understand the factors that lead to delay in seeking ANC services among pregnant women in Tanzania. Methods: This qualitative descriptive case study was conducted in two rural districts in Iringa Region in Tanzania. A total of 40 focus group discussions (FGDs) were conducted involving both male and female participants in 20 villages. In addition, 36 semi-structured interviews were carried out with health care workers, members of health facility committees and community health workers. Initial findings were further validated during 10 stakeholders' meetings held at ward level in which 450 people participated. Data were analysed using thematic approach. Results: Key individual and social factors for late ANC attendance included lack of knowledge of the importance of early visiting ANC, previous birth with good outcome, traditional gender roles, fear of shame and stigma, and cultural beliefs about pregnancy. Main factors which inhibit early ANC attendance in Kilolo and Mufindi districts include spouse accompany policy, rude language of health personnel and shortage of health care providers. Conclusions: Traditional gender roles and cultural beliefs about pregnancy as well as health system factors continue to influence the timing of ANC attendance. Improving early ANC attendance, therefore, requires integrated interventions that address both community and health systems barriers. Health education on the timing and importance of early antenatal care should also be strengthened in the communities. Additionally, while spouse accompany policy is important, the implementation of this policy should not infringe women's rights to access ANC services.

This review examined existing evidence to investigate the link between tobacco and poverty in Vietnam, to assess the impact of tobacco control policies on employment related to tobacco consumption and to identify information gaps that require further research for the purposes of advocating stronger tobacco control policies. A Medline, PubMed and Google Scholar search identified studies addressing the tobacco and poverty association in Vietnam using extensive criteria. In all, 22 articles related either to tobacco and health or economics, or to the potential impact of tobacco control policies, were identified from titles, abstracts or the full text. 28 additional publications were identified by other means. PHA, LTT and LTTH reviewed the publications and prepared the initial literature review. There is extensive evidence that tobacco use contributes to poverty and inequality in Vietnam and that tobacco control policies would not have a negative impact on overall employment. Tobacco use wastes household and national financial resources and widens social inequality. The implementation and enforcement of a range of tobacco control measures could prove beneficial not only to improve public health but also to alleviate poverty.

IntroductionMale involvement has been reported to improve maternal and child health (MCH) outcomes. However, most studies in low-income and middle-income countries have reported low participation of men in MCH-related programmes. While there is a growing interest in the involvement of men in MCH, little is known on how male involvement can be effectively promoted in settings where entrenched unequal gender roles, norms and relations constrain women from effectively inviting men to participate in MCH.Methods and analysisThis paper reports participatory action research (PAR) aimed to promote male participation in pregnancy and childbirth in Iringa Region, Tanzania. As part of the Innovating for Maternal and Child Health in Africa project, PAR was conducted in 20 villages in two rural districts in Tanzania. Men and women were engaged separately to identify barriers to male involvement in antenatal care and during delivery; and then they were facilitated to design strategies to promote male participation in their communities. Along with the PAR intervention, researchers undertook a series of research activities. A thematic analysis was used to analyse the data. The common strategies designed were: engaging health facility committees; using male champions and male gatekeepers; and using female champions to sensitise and provide health education to women. These strategies were validated during stakeholders’ meetings, which were convened in each community.DiscussionThe use of participatory approach not only empowers communities to diagnose barriers to male involvement and develop culturally acceptable strategies but also increases sustainability of the interventions beyond the life span of the project. More lessons will be identified during the implementation of these strategies.

ObjectivesThis study sought to increase government, civil society and media attention to the tobacco–poverty connection in Bangladesh, particularly as it relates to bidi-dependent livelihoods.Data sourcesThis study consisted of a literature review that examined the socioeconomic impacts of tobacco farming, the working conditions of tobacco workers and the impact of tobacco on consumers, and a primary research study among bidi workers and users. The research included in-depth and semistructured interviews and focus group discussions among bidi workers and a closed-ended quantitative survey among bidi users.Data synthesisMost bidi worker families earn about $6.40 per 7-day work week, leaving them below the poverty line. The majority of bidi workers are women and children, classified as unpaid assistants, who toil long hours in toxic environments. Bidi users are primarily low-income earners who spend up to 10% of their daily income on bidis; the average proportion of income spent on bidis decreased as income increased. If bidi expenditures were reduced and spent instead on food or local transportation, many higher value jobs could be created. This could also mean better health and nutrition for those currently engaged in bidi work.ConclusionsThe results of this study illustrate the linkages between tobacco and poverty. Tobacco control is not simply about health and the environment, but also about the living conditions of the poorest of the poor. If we are to improve the lives of the poor, we must address the root causes of poverty, which include the production and use of tobacco.

Between 9 and 14 24-hour food recalls were collected from 52 Guatemalan women in their third trimester of pregnancy, living in a peri-urban community of Guatemala City. Dietary patterns were examined in terms of amount and frequency of all foods and beverages consumed, sources of energy and protein, and dietary diversity. A total of 254 different items were reported over 706 women-days; within subject number ranged from 34 to 80 in 14 days. Only seven items were reported by all women; nearly one-third of the items (N=76) were reported only once. Tortillas accounted for approximately 25% of daily energy and protein, and half of the grain product consumption. Less than 5% of the food items accounted for 75% of the daily energy and protein intakes. Dietary diversity correlated significantly with meat and dairy product consumption, but not with protein intakes. Despite the apparent high diversity of the diets, the majority of foods were consumed infrequently and contributed minimally to energy and protein intakes.