Who lacks and who benefits from diet diversity: evidence from (impact) profiling for children in Zimbabwe
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International Journal of Health Geographics Open Access
RESEARCH
Who lacks and who benefits from diet diversity: evidence from (impact) profiling for children in Zimbabwe Remco Oostendorp1* , Lia van Wesenbeeck2, Ben Sonneveld2 and Precious Zikhali3
Abstract Background: 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. Methods: 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 (nonparametric) 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 socioeconomically 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. Results: 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. Conclusions: 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. Keywords: Child malnutrition, Zimbabwe, Impact assessment, Profiling
*Correspondence: [email protected] 1 Vrije Universiteit Amsterdam, Tinbergen Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands Full list of author information is available at the end of the article
Background Zimbabwe continues to struggle with high levels of food and nutrition insecurity among its population, especially amo
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