Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps.

Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms.

Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys.

Background: Adolescence presents an opportunity to influence diet, which impacts present and future health outcomes, yet adolescent diets globally are poorly understood.

Objective: We generate evidence on adolescent diets globally and explore patterns and trends by subpopulation.

Methods: We estimated mean frequency of consumption and prevalence of less-than-daily fruit and vegetable consumption, at-least-daily carbonated beverage consumption, and at-least-weekly fast-food consumption among school-going adolescents aged primarily 12 to 17 years from the Global School-based Student Health Surveys in Africa, Asia, Oceania, and Latin America between 2008 and 2015.

An egg for everyone: Pathways to universal access to one of nature's most nutritious foods.

Eggs are a highly nutritious food but have been shown to be infrequently consumed in many low-income countries, especially by women and children. We collate country-level data on egg production, availability, consumption, prices, industry structure, and contextual trends and use these to estimate current patterns and likely future outcomes under four alternative scenarios. These scenarios are as follows: incremental change based on expected economic growth and urbanisation (the base scenario); enhanced productivity of independent small producers; aggregated production in egg hubs; and the accelerated spread of large-scale intensive production.

Care-seeking and appropriate treatment for childhood acute respiratory illness: an analysis of Demographic and Health Survey and Multiple Indicators Cluster Survey datasets for high-mortality countries.

Background: Acute lower respiratory illness (ALRI) is a major global cause of morbidity and mortality among children under 5. Antibiotic treatment for ALRI is inexpensive and decreases case fatality, but care-seeking patterns and appropriate treatment vary widely across countries. This study sought to examine patterns of appropriate treatment and estimate the burden of cases of untreated ALRI in high mortality countries.

Scaling up access to oral rehydration solution for diarrhea: Learning from historical experience in low- and high-performing countries.

Aim: This paper aims to identify factors that systematically predict why some countries that have tried to scale up oral rehydration solution (ORS) have succeeded, and others have not.

Methods: We examined ORS coverage over time, across countries, and through case studies. We conducted expert interviews and literature and data searches to better understand the history of ORS scale-up efforts and why they failed or succeeded in nine countries.

Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis.

Background: The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010.

Methods: We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies.

What works? Interventions for maternal and child undernutrition and survival.

We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small.

Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress?

Many transnational organisations work to support efforts to eliminate maternal and child undernutrition in high-burden countries. Financial, intellectual, and personal linkages bind these organisations loosely together as components of an international nutrition system. In this paper, we argue that such a system should deliver in four functional areas: stewardship, mobilisation of financial resources, direct provision of nutrition services at times of natural disaster or conflict, and human and institutional resource strengthening.

Equitable utilisation of Indian community based health insurance scheme among its rural membership: cluster randomised controlled trial.

Objective: To evaluate alternative strategies for improving the uptake of benefits of a community based health insurance scheme by its poorest members.

Design: Prospective cluster randomised controlled trial.

Setting: Self Employed Women's Association (SEWA) community based health insurance scheme in rural India.

To retain or remove user fees?: reflections on the current debate in low- and middle-income countries.

Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings.

Measuring improved targeting of health interventions to the poor in the context of a community-randomised trial in rural India.

In spite of growing interest in socioeconomic differentials in health outcomes and access to health services, little has been written about methodologies for assessing the impact of equity-enhancing policies or programs. This paper describes three methodological challenges involved in designing a randomised trial with an equity outcome, and how these were met in a trial of alternative strategies to improving the uptake of benefits of a health insurance scheme among its poorest members. The Vimo SEWA trial is nested within a community-based insurance scheme in rural India.

CRTs--cluster randomized trials or "courting real troubles": challenges of running a CRT in rural Gujarat, India.

This paper addresses the logistical challenges of implementing public health interventions in the setting of cluster randomized trials (CRTs), drawing on the experience of carrying out a CRT within a community-based health insurance (CBHI) scheme in rural India. Our CRT is seeking to improve the equity impact--i.e.

Impact on child mortality of removing user fees: simulation model.

Objective: To estimate how many child deaths might be prevented if user fees were removed in 20 African countries

Design: Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services.

Results: Elimination of user fees could prevent approximately 233,000 (estimate range 153,000-305,000) deaths annually in children aged under 5 in 20 African countries.

Conclusion: Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.

Chile's national nutritional supplementation program for older people: lessons learned.

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people.

Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India.

How best to provide effective protection for the poorest against the financial risks of ill health remains an unanswered policy question. Community-based health insurance (CBHI) schemes, by pooling risks and resources, can in principal offer protection against the risk of medical expenses, and make accessible health care services that would otherwise be unaffordable. The purpose of this paper is to measure the distributional impact of a large CBHI scheme in Gujarat, India, which reimburses hospitalization costs, and to identify barriers to optimal distributional impact.

Gaps in policy-relevant information on burden of disease in children: a systematic review.

Background: Valid information about cause-specific child mortality and morbidity is an essential foundation for national and international health policy. We undertook a systematic review to investigate the geographical dispersion of and time trends in publication for policy-relevant information about children's health and to assess associations between the availability of reliable data and poverty.

Methods: We identified data available on Jan 1, 2001, and published since 1980, for the major causes of morbidity and mortality in young children.

Comorbidity in childhood in northern Ghana: magnitude, associated factors, and impact on mortality.

Background: It has been observed that in developing countries terminal illness in children under 5 yr of age is frequently characterized by comorbidity. This study seeks to quantify the co-occurrence of illness at the community level and investigates whether this co-occurrence increases the risk of mortality. We develop an appropriate measure of co-occurrence and investigate whether the comorbidity occurs by chance or whether it is due to shared risk factors.

Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial.

Background: Scaling-up of effective preventive interventions in child and maternal health is constrained in many developing countries by lack of demand. In Latin America, some governments have been trying to increase demand for health interventions by making direct payments to poor households contingent on them keeping up-to-date with preventive health services. We undertook a public health programme effectiveness trial in Honduras to assess this approach, contrasting it with a direct transfer of resources to local health teams.