Field Exchange 75 Editorial
Dear readers, a warm welcome to the 75th issue of Field Exchange!
As we publish this issue, we are very aware of the broader environment of sudden, devastating funding cuts. We extend our sincere sympathies to those of you personally and professionally affected. A commentary piece by Sessions et al reflects on the implications of these cuts. It also summarises some of the opportunities arising from this ‘wake-up call’ to rethink aid models, reflected in recent articles by various actors.
Closely related is a timely views piece by Lafferty et al, conceived before the funding cuts were announced but now more relevant than ever. In this article, six nutrition experts from diverse settings reflect on two key questions: 1) What single action could most positively impact malnutrition? and 2) What bottleneck/major constraint would you remove for the provision of good preventative and treatment for malnutrition? Their responses underscore the need for political will to prioritise nutrition, sustained financing, food system reform, and empowerment of women through education, alongside access to diverse, culturally appropriate diets.
We also include two views pieces exploring issues strongly linked to child undernutrition—one emerging, the other long-standing but often under-recognised. Firstly, Jannat et al delve into the growing field of the gut microbiome and its crucial role in child health and development. Increasing evidence suggests that interventions targeting the gut microbiome may have a role to play in the management of undernutrition in young children. The authors explain key concepts such as the microbiome, probiotics, prebiotics, and microbiome-directed foods and examine their potential role in addressing undernutrition.
Secondly, Hewison et al provide a welcome refresher to us all of the critical links between tuberculosis (TB) and undernutrition, given the vicious cycle between malnutrition and infection. The authors highlight the challenges of diagnosis, treatment, and prevention of TB among children, particularly in humanitarian and resource-limited contexts. They discuss the opportunities arising from the recently updated World Health Organization recommendations to positively impact the management of TB among undernourished children. These include simplified diagnostic pathways and household food support for TB patients’ contacts.
Action is urgently needed to improve adolescent nutrition in low- and middle-income countries. Recent evidence questions the possibility of linear catch-up growth during adolescence, so there is a need to understand the wider benefits of nutrition interventions for this age group. Strout et al take a novel approach and consider the wider impact of adolescent nutrition interventions on wellbeing outcomes. Their review finds some evidence of positive impacts on cognitive function, bone health, school attendance, physical activity, behaviour, and morbidity status, while further research is needed to identify key outcomes and optimal interventions.
Several articles explore innovative ways of working to improve nutrition practices and outcomes during the first 1,000 days. In Myanmar, Kumar Das et al describe how the 2024 Nutrition Promotion Month campaign adapted to the challenges of conflict, insecurity, and natural disasters. Innovative strategies integrating digital technology were used, leveraging the rise in social media use within the country. Fostering partnerships and engaging diverse stakeholders ensured buy-in and smooth implementation, while involving prominent figures and technical experts strengthened trust, amplifying the campaign’s reach. Authors recommend future campaigns should continue to build on digital platforms while exploring innovative community-based interventions to reach the most vulnerable populations.
Bhattacharjee at al describe how leveraging existing government-led interventions with additional activities can create synergies to improve complementary feeding practices in Odisha state, India. Building on lessons learned in four pilot districts, the project was scaled up to cover the entire state. Key approaches adopted for a more sustainable model included integration with existing government schemes, strong government stewardship, and increased budgetary allocations for nutrition.
Shaikh et al describe the benefits of an integrated package of specialised nutritious foods, local diet promotion, and social and behaviour change communication during the first 1,000 days in Badakhshan province, Afghanistan. Results suggest a significant impact on reducing stunting and corresponding improvements in reported infant and young child feeding practices, adding to the growing body of evidence supporting integrated approaches in fragile contexts.
Also reporting from Afghanistan, Bongassie et al describe how mass MUAC (mid-upper arm circumference) screening can be an effective tool for assessing nutritional needs, monitoring coverage, and identifying and referring cases in resource-limited and complex settings.
Turning to the issue of relapse of acute malnutrition following recovery, evidence to date shows large variations in both relapse rates and risk factors for relapse across different contexts. We publish two original articles echoing these findings. Bollemeijer et al conducted a retrospective unmatched case-control study to look at potential risk factors for severe acute malnutrition (SAM) relapse in Sudan. Findings highlighted the protective role of individual counselling and continued breastfeeding in this context. The impact of other factors on relapse, such as agricultural land access and suboptimal care-seeking behaviour, need further exploration. Luc et al examined the impact of providing a nutrient-rich, locally produced supplementary food in preventing relapse post SAM treatment. The article also offers new evidence on the clustering of relapse in specific communities, suggesting the importance of risk factors related to livelihood systems and community-level influences. This seems to concur with the findings of King et al from their multi-country analysis that few household-level factors were associated with relapse.
Finally for our original articles, Austin & Kamazizwa describe the community outreach intervention for children with disabilities that they piloted in Harare, Zimbabwe. While the intervention had the potential to successfully address some of the children’s most immediate needs, additional holistic support is required to ensure long-term wellbeing.
We also feature our usual array of research snapshots and report summaries, so please check these out!
Finally in this issue of Field Exchange, it is with great sadness that we mark the departure of Marie McGrath from ENN. Marie has played a leading role in the vision and values of Field Exchange over the 20 odd years she has worked as subeditor/editor. She will be sorely missed. In her honour, we feature a summary of a podcast she took part in that touches on Marie’s immense contribution to the success of Field Exchange. We wish her all the very best in her new adventures.
At the same time, we welcome Astrid Klomp to the team as the new Field Exchange content coordinator. Great to have Astrid on board!
Happy reading,
Anne, Astrid, Natalie, and Phil