INTERGENERATIONAL, ENVIRONMENTAL, AND HEALTH IMPACTS OF NUTRITIONAL INTERVENTIONS IN LOW- AND MIDDLE-INCOME POPULATIONS

Abstract

The last several decades have seen significant progress to promote maternal and child health. Still, the burden of maternal and child undernutrition in low-income and middle-income countries (LMICs) remains unacceptably high. Malnutrition, especially during the first 1,000 days of life, is the main underlying factor for half of all child deaths. Food consumption has implications both for the health of an individual and the health of the planet. Improving early life nutrition for mother and child can result in lasting effects not only throughout the lives of the same generation but also of future generations and can help break the cycle of poverty. This dissertation focuses on the various cross-disciplinary impacts of nutritional interventions among vulnerable populations to help guide investments in nutrition. The three papers collectively employ a range of quantitative methods to explore three specific dimensions of nutrition sensitive and specific interventions. Paper 1 evaluates the impact of a cluster-randomized home gardening trial in rural Tanzania on women’s dietary diversity, using linear probability models with inverse probability weights, and finds significant improvements in dietary quality. Paper 2 evaluates the joint impact of plant and animal protein on human and environmental health in Addis Ababa, Ethiopia and finds that adults could benefit from increased consumption of plant sources of protein, whilst children would gain from increased animal protein intake with substantially different environmental impacts. Lastly, Paper 3 uses comparative risk assessment to quantify the intergenerational impacts of maternal prenatal supplementation on chronic disease in the adult offspring and finds a significant impact in reducing adult disease. Together these three papers show the importance of multisectoral approaches to improving nutrition in the first 1,000 days. This thesis presents innovative perspectives on approaches to curbing the double burden of malnutrition while safeguarding planetary health in low and middle-income countries.