Peer support groups are implemented globally, and viewed as cost-effective, scalable platforms for delivering health and nutrition programming. Quality is important for participation and achieving social and behavior change goals. This manuscript describes community-based implementation research, and associated findings, which was conducted to learn how participants of a nutrition and health program define quality peer groups and how they suggest improving peer groups.

This collection of 14 manuscripts published between 2023 - 2024 highlights research from USAID Advancing Nutrition that provides evidence and learning about dietary assessment, adolescent nutrition, feeding sick children, the potential of large-scale food fortification to address micronutrient needs, the integration of responsive care and early learning counseling, and other aspects of multi-sectoral nutrition programs in different contexts.

This comprehensive review summarizes influential norms and intervention approaches, an important step toward enhancing the effectiveness of social and behavioral change interventions by addressing nutrition-relevant norms.

Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries.

his study describes the anemia prevalence among young hospitalized children and their mothers in Northern Lao PDR, and explores possible nutritional causes and risk factors for anemia.

This report presents the findings from a series of case studies conducted in Nigeria, Senegal, and Uganda to complement the WHO's new guidance on the prevention and treatment of wasting in infants and children under five. The emphasis this guidance places on the use of local foods for moderate wasting management.

These four papers together outline the new ecological approach to reducing anemia. Understanding the ecology of anemia—the biology of nutrients interacting with physical, economic, social, behavioral, demographic, and environmental factors—is key to implementing context-specific interventions to reduce anemia.

This report presents the findings from a qualitative, formative research study on the food preferences of and cultural/religious prohibitions for women of reproductive age, children 6–23 months, and adolescent girls in selected regions of mainland Tanzania.

Ready-to-use therapeutic food (RUTF), is the product used to treat severly wasted children in outpatient care. As part of efforts to understand and document the last mile delivery of this lifesaving product to health facilities in the Democratic Republic of Congo, USAID Advancing Nutrition studied four USAID-supported RUTF pipelines. 

Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization/UNICEF implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI). Skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. This qualitative case study describes the Kyrgyz Republic's experience with health professional competency building related to breastfeeding counselling and support.

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Diet quality influences maternal health and nutrition from preconception through pregnancy and lactation, as well as infant health and nutrition. Minimum diet diversity among women, a good predictor of adequate micronutrient intake, is often used as a proxy for diet quality. This secondary analysis assessed factors associated with the quality of maternal diets in winter when micronutrient-rich foods may be more difficult to access due to scarcity and price.

This paper presents analysis of biomarker data from 24 nationally- representative, population-based surveys to estimate prevalence of micronutrient deficiencies and provide a transparent methodology for future estimates. 

The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalizing the Ten Steps through nine national responsibilities for universal coverage and sustainability. In the Kyrgyz Republic, the case study explored responsibility, development and implementation of incentives and/or sanctions, and responsibility in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring communication and advocacy and financing) as they relate to the universal coverage of the targeted responsibilities were also explored.

To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0–5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large-scale cross-sectional surveys.

Nutrition modeling tools have wide-ranging influence across policy and program cycles and contexts, but the impact depends on the tool application process, accompanying advocacy, and the expertise, capabilities, and resources of local teams. This study provides understanding about how practitioners have successfully used such tools and the policy questions these tools can answer. 

This research documents global health professionals’ experiences engaging family members in nutrition activities, as well as their perceived barriers, facilitators, and recommendations for nutrition activities that promote family member engagement.

Household Consumption and Expenditure Surveys (HCESs) can contribute a unique source of nationally representative food acquisition data that are regularly collected in low- and lower-middle income countries. This study analyzes past use of HCES data to estimate nutrient supply and evaluate adequacy and overviews future implications for building models using HCES data.

Despite the efficacy of double-fortified salt (DFS) in improving hemoglobin, ferritin, anemia, and iron deficiency anemia, there has been limited experience with its production and distribution at scale within programs. Across the world, program managers, researchers, and salt production companies have jointly attempted to introduce DFS in various settings and circumstances. However, many of these experiences were/are limited in scope and reach, and most have failed to launch a large-scale DFS program after exploratory discussions. This study shares evidence from India, the only country that has reported large-scale DFS implementation experience.

Undernutrition remains a serious threat to the health and wellbeing of women and children in low- and middle-income countries (LMICs). This peer-reviewed publication describes a study supported by USAID Advancing Nutrition to compare costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda.

Improving dietary quality requires changes across food and agriculture systems to improve access to affordable nutritious foods, especially for women and young children. Local, national, and global leaders need reliable data to inform policies that strengthen the food systems families depend on. This study explores how household consumption and expenditure surveys could be used to identify nutrient gaps and provide policy-makers with reliable data that support food-based recommendations for children 12-23 months old.

This peer-reviewed publication describes a study identifies assessments (methods, tools, and metrics) suitable for evaluating market food environments in low- and middle-income countries (LMICs). Findings highlight suitable assessments and recommended adaptations to existing assessments to strengthen market food environment evaluation in LMICs.

Large-scale food fortification has the potential to increase micronutrient supplies in the food system but more information is needed to understand whether current strategies are equitably benefiting populations with the greatest micronutrient needs. This study applied a mathematical modeling framework to compare fortification scenarios across different contexts, using oil, sugar, and wheat flour fortification in Malawi through secondary data analyses of a Household Consumption and Expenditure Survey. 

This systematic review describes program approaches designed to achieve nutrition social and behavior change by increasing family support. 

This article summarizes the current literature on the role of social norms relevant to complementary feeding and suggests that addressing social norms through effective, multifaceted, and culturally relevant interventions is a feasible and effective component of programs to improve complementary feeding practices.

Anemia is a condition that can arise from a number of factors including inadequate nutrition, infection, chronic disease, and genetic-related etiologiesis. It's one of the world's most common public health problems. This meta-review suggests the importance of nutrition-specific interventions for anemia and highlights the lack of evidence to understand the influence of nutrition-sensitive and multifaceted interventions on the condition.

This research design found quantitative and qualitative evidence of positive impacts on nutrition practices, including breastfeeding, family members’ knowledge and awareness of recommended practices, and provision of support to mothers.

USAID created USAID Advancing Nutrition to support the implementation of USAID’s Multi-Sectoral Nutrition Strategy 2014–2025, by— improving coordination and collaboration across sectors and disciplines to improve nutrition building and translating research, learning, and experience to programs and policies for improved implementation and scale strengthening the capacity of Missions and partners in achieving sustainable, scalable outcomes for nutrition across humanitarian and development contexts enhancing the quality and measurement of nutrition programming. This executive summary provide a snapshot of key contributions and lessons learned for USAID and its implementing partners.

Guided by the Global Action Plan (GAP) on Wasting framework, this desk review presents evidence for effectiveness of health system approaches, documented considerations for implementation of the approaches, and areas for further research. 

The Kenya Ministry of Health Division of Family Health, Wellness, and Nutrition; implementing partners; and USAID Advancing Nutrition co-created a breastfeeding counseling mentorship program to reinforce and build the competencies required by health workers to implement the Ten Steps at health facilities offering maternal and newborn services. Key learning is included in this brief. 

This compendium documents the collaborating, learning, and adapting (CLA) approaches implemented by USAID Advancing Nutrition. It also compiles internal resources and templates that we developed to support CLA implementation across the project (annex 1) and the project’s CLA plan (annex 2). 

Access these resources for inspiration and techniques to solve a challenge or “level up” for greater effectiveness in your nutrition program or services. The resources included here range from case studies, guides, and briefs to job aids, data analyses, and research insights.

This report for USAID Resilience Food Security Activity implementing partners presents 1) common approaches currently used for engaging men in maternal, infant, and young child nutrition programming, 2) findings from the literature and key informant interviews about barriers, and 3) the key considerations for the design, implementation, monitoring, and sustainability of male engagement activities to minimize the risk of engagement while ensuring women’s agency and safety.

This learning agenda synthesizes learning across over 50 activities related to women’s diets from 2018–2023 through 12 learning questions across five areas of inquiry—improving women’s diets through market food environments, demand creation, family diets, counseling and other health service delivery, and policies and policy implementation to inform future USAID and implementing partner work.

This report presents the findings from a series of case studies conducted in Nigeria, Senegal, and Uganda to complement the WHO's new guidance on the prevention and treatment of wasting in infants and children under five. The emphasis this guidance places on the use of local foods for moderate wasting management.

This learning agenda informs research and learning investments that will help guide programming and policies to strengthen growth monitoring and promotion globally. 

Counseling is an essential service to support and improve maternal, infant, and young child nutrition and child development outcomes. USAID Advancing Nutrition has developed a series of counseling-related resources to help strengthen the effectiveness of nutrition counseling in nutrition programming. 

Ready-to-use therapeutic food (RUTF), is the product used to treat severly wasted children in outpatient care. As part of efforts to understand and document the last mile delivery of this lifesaving product to health facilities in the Democratic Republic of Congo, USAID Advancing Nutrition studied four USAID-supported RUTF pipelines. 

This framework was implemented in partnership with the Government of Kenya in Marsabit, Isiolo, Samburu, and Turkana Counties, the USAID Nawiri program is a five-year initiative funded by the USAID Bureau for Humanitarian Assistance (BHA) to sustainably reduce persistent acute malnutrition in Kenya’s arid and semi-arid lands (ASALs). USAID Nawiri aims to help resolve the underlying causes of acute malnutrition through this integrated, multi-sectoral resilience-strengthening program that leverages ongoing emergency and development activities.

The 2020 UNICEF report titled "Improving Young Children’s Diets during the Complementary Feeding Period" provides an Action Framework to improve the diets of children 6–23 months of age. This report is one of four case studies that use the Action Framework as a tool to examine the efforts in emergency contexts to support complementary feeding. Lessons from this case study provide examples, for both country-level practitioners and global-level decision makers, of program interventions and policies to support complementary feeding in emergencies.

The 2020 UNICEF report titled "Improving Young Children’s Diets during the Complementary Feeding Period" provides an Action Framework to improve the diets of children 6–23 months of age. This report is one of four case studies that use the Action Framework as a tool to examine the efforts in emergency contexts to support complementary feeding. Lessons from this case study provide examples, for both country-level practitioners and global-level decision makers, of program interventions and policies to support complementary feeding in emergencies.

The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges to public health and disrupted nutrition programs globally. USAID Advancing Nutrition conducted a learning activity to document COVID-19-related adaptations within USAID-funded nutrition investments to identify practices we can share to mitigate current and future challenges to nutrition program implementation.

This case study explores implementation of growth monitoring and promotion in Ghana and Nepal. It includes important considerations for strengthening growth monitoring and promotion through service delivery and demand generation efforts.

This report identifies tools available to support programming for complementary feeding in emergencies and helps teams assess gaps and additional needs. 

This learning brief details how purposeful co-location of nutrition partners in four provinces in the Democratic Republic of the Congo contributed to collaboration in delivering the continuum of care for wasting and includes recommendations to strengthen coordination and collaboration. Also available in French. 

This brief describes the factors that promoted or hindered successful implementation of small-quantity lipid-based nutrient supplements programs in highly food insecure contexts (i.e. Somalia, Niger, and Honduras) and presents considerations for scale-up. 

This report describes where nutrition-sensitive agriculture activities are appropriate in emergency contexts and how they can be designed to improve nutrition outcomes based on research in Cameroon and South Sudan. 

In South Sudan, a protracted crisis context, a secondary data analysis of a representative sample of households helped explore the association between short-term agricultural inputs and women’s dietary diversity and found that these inputs improved women’s dietary diversity.  

In northern Cameroon, a complex emergency context,  a mixed method study design helped explore the association between agriculture inputs and women’s dietary diversity and found that short-term agricultural support contributed to improving women’s dietary diversity. 

This brief describes implementing partners’ experience with different resource transfer modalities (cash, voucher, and in-kind) to inform the design of nutrition programs in rapid-onset and protracted emergency settings.

This brief describes three primary actions stakeholders should consider to support ongoing coordination and collaboration of co-located partners, based on experience from programming to address wasting in the Democratic Republic of Congo.