Who lacks and who benefits from diet diversity: evidence from (impact) profiling for children in Zimbabwe

• Published in: International journal of health geographics Vol. 19; no. 1; p. 45
• Main Authors: Oostendorp, Remco, van Wesenbeeck, Lia, Sonneveld, Ben, Zikhali, Precious
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.11.2020; BioMed Central; BMC
• Subjects: Age; Agriculture; Child; Child malnutrition; Children; Children & youth; Cultivation; Diet; Ecological conditions; Ecological effects; Economic analysis; Economic aspects; Economic conditions; Family Characteristics; Food; Food groups; Food security; Food Supply; GDP; Gross Domestic Product; Growth Disorders; Heterogeneity; Households; Human nutrition; Humans; Impact assessment; Infant; Land reform; Nutrition; Nutritional status; Pediatric research; Poverty; Profiling; Risk factors; Rural areas; Social aspects; Socioeconomics; Zimbabwe; Zimbabwe - epidemiology; Zimbabwe; Zimbabwe; Profiling; Impact assessment; Child malnutrition
• ISSN: 1476-072X; 1476-072X
• DOI: 10.1186/s12942-020-00240-2

The impact of diet diversity-defined as the number of different foods or food groups consumed over a given reference period-on child nutrition outcomes strongly interacts with agro-ecological, institutional, and socio-economic drivers of child food and nutrition security. Yet, the literature on the impact of diet diversity typically estimates average treatment effects, largely ignoring impact heterogeneity among different groups. In this paper, we introduce a new method of profiling to identify groups of treatment units that stand to gain the most from a given intervention. We start from the 'polling approach' which provides a fully flexible (non-parametric) method to profile vulnerability patterns (patterns in 'needs') across highly heterogeneous environments [35]. Here we combine this polling methodology with matching techniques to identify 'impact profiles' showing how impact varies across non-parametric profiles. We use this method to explore the potential for improving child nutrition outcomes, in particular stunting, through targeted improvements in dietary diversity in a physically and socio-economically diverse country, namely Zimbabwe. Complex interaction effects with agro-ecological, institutional and socio-economic conditions are accounted for. Finally, we analyze whether targeting interventions at the neediest (as identified by the polling approach) will also create the largest benefits. The dominant profile for stunted children is that they are young (6-12 months), live in poorer/poorest households, in rural areas characterized by significant sloping of the terrain and with one-sided emphasis on maize cultivation and medium dry conditions. When moving from "need" to "maximal impact", we calculate both the coverage in "need" as well as the impact coverage, and find that targeting on need does not always provide the largest impact. Policy-makers need to remain alert that targeting on need is not always the same as targeting on impact. Estimation of heterogeneous treatment effects allows for more efficient targeting. It also enhances the external validity of the estimated impact findings, as the impact of child diet diversity on stunting depends on various agro-ecological variables, and policy-makers can relate these findings to areas outside our study area with similar agro-ecological conditions.