Publications

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et al Hirth RA. Willingness to Pay for a Quality-adjusted Life Year: In Search of a Standard. Med Decis Making [Internet]. 2000;20 :332-342. Publisher's VersionAbstract

This Cost-benefit analysis (CBA) provides a clear decision rule: undertake an intervention if the monetary value of its benefits exceeds its costs. Reluctance to 70 characterize health benefits in monetary terms means cost-utility and costeffectiveness analyses rely on arbitrary standards (e.g., < $50,000 per QALY) to deem a program "cost-effective." No consensus exists regarding the appropriate dollar value per QALY gained upon which to base resource allocation decisions. The authors imply a QALY value from studies and compare this with arbitrary cost-effectiveness thresholds in common use. Converting to US dollars, most value estimates far exceed thresholds used to determine whether an intervention produces an acceptable increase in health benefits in exchange for incremental expenditures.  This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Hirth RA. Willingness to Pay for a Quality-adjusted Life Year: In Search of a Standard. Med Decis Making. 2000;20 :332-342.Abstract

Cost-benefit analysis (CBA) provides a clear decision rule: undertake an intervention if the monetary value of its benefits exceeds its costs. Reluctance to 70 characterize health benefits in monetary terms means cost-utility and costeffectiveness analyses rely on arbitrary standards (e.g., < $50,000 per QALY) to deem a program "cost-effective." No consensus exists regarding the appropriate dollar value per QALY gained upon which to base resource allocation decisions. The authors imply a QALY value from studies and compare this with arbitrary cost-effectiveness thresholds in common use. Converting to US dollars, most value estimates far exceed thresholds used to determine whether an intervention produces an acceptable increase in health benefits in exchange for incremental expenditures. This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Leakey ADB, Bernacchi CJ, Dohleman FG, Ort DR, Long SP. Will photosynthesis of maize (Zea mays) in the US Corn Belt increase in future CO2 rich atmospheres? An analysis of diurnal courses of CO2 uptake under free-air concentration enrichment (FACE). Global Change Biology [Internet]. 2004;10 :951-962. Publisher's VersionAbstract

The C4 grass Zea mays (maize or corn) is the third most important food crop globally in terms of production and demand is predicted to increase 45% from 1997 to 2020. However, the effects of rising [CO2] upon C4 plants, and Z. mays specifically, are not sufficiently understood to allow accurate predictions of future crop production. A rainfed, field experiment utilizing free-air concentration enrichment (FACE) technology in the primary area of global corn production (US Corn Belt) was undertaken to determine the effects of elevated [CO2] on corn. FACE technology allows experimental treatments to be imposed upon a complete soil–plant–atmosphere continuum with none of the effects of experimental enclosures on plant microclimate. Crop performance was compared at ambient [CO2] (354 lmol mol1 ) and the elevated [CO2] (549 lmol mol1 ) predicted for 2050. Previous laboratory studies suggest that under favorable growing conditions C4 photosynthesis is not typically enhanced by elevated [CO2]. However, stomatal conductance and transpiration are decreased, which can indirectly increase photosynthesis in dry climates. Given the deep soils and relatively high rainfall of the US Corn Belt, it was predicted that photosynthesis would not be enhanced by elevated [CO2]. The diurnal course of gas exchange of upper canopy leaves was measured in situ across the growing season of 2002. Contrary to the prediction, growth at elevated [CO2] significantly increased leaf photosynthetic CO2 uptake rate (A) by up to 41%, and 10% on average. Greater A was associated with greater intercellular [CO2], lower stomatal conductance and lower transpiration. Summer rainfall during 2002 was very close to the 50-year average for this site, indicating that the year was not atypical or a drought year. The results call for a reassessment of the established view that C4 photosynthesis is insensitive to elevated [CO2] under favorable growing conditions and that the production potential of corn in the US Corn Belt will not be affected by the global rise in [CO2].

Rogers A, Ainsworth EA, Leakey ADB. Will elevated carbon dioxide concentration amplify the benefits of nitrogen fixation in legumes?. Plant Physiology [Internet]. 2009;151 :1009-1016. Publisher's VersionAbstract

Growth at elevated [CO2] stimulates photosynthesis and increases carbon (C) supply in all C3species. A sustained and maximal stimulation in productivity at elevated [CO2] requires an enhanced nutrient supply to match the increase in C acquisition. The ability of legumes to exchange C for nitrogen (N) with their N2-fixing symbionts has led to the hypothesis that legumes will have a competitive advantage over nonleguminous species when grown at elevated [CO2]. On balance, evidence suggests that in managed systems, legumes are more responsive to elevated [CO2] than other plants (e.g. Ainsworth and Long, 2005); however, in natural ecosystems, nutrient availability can limit the response of legumes to elevated [CO2] (Hungate et al., 2004van Groenigen et al., 2006). Here, we consider these observations, outline the mechanisms that underlie them, and examine recent work that advances our understanding of how legumes respond to growth at elevated [CO2]. First we highlight the global importance of legumes and provide a brief overview of the symbiotic relationship.

Cumming GS, Van Vuuren DP. Will climate change affect ectoparasite species ranges?. Global Ecology & Biogeography [Internet]. 2006;15 :486-497. Publisher's VersionAbstract

Aim Over the next 100 years, human-driven climate change and resulting changes in species occurrences will have global impacts on biodiversity, ecosystem function, and human health. Here we examine how climate change may affect the occurrences of tick species in Africa and alter the suitability of habitat outside Africa for African ticks. Location Africa and the world. Methods We predicted continental and global changes in habitat suitability for each of 73 African tick species, using multiple regression models in different climate change scenarios that cover a wide range of uncertainty. Results Global habitat suitability improves for nearly all tick species under each of a representative range of eight climate change scenarios. Depending on the scenario, African tick species experience an average increase in global habitat suitability of between 1 million and 9 million square kilometres between 1990 and 2100. Main conclusions The potential for successful translocations of ticks and their pathogens from Africa to the rest of the world is likely to increase over the next 100 years. Although the general trend is one of range expansion, there are winners and losers among tick species in each scenario, suggesting that tick community composition will be disrupted substantially by climate change. If this is also typical of other invertebrates, then climate change will disrupt not only the geographic location of communities but also their structure. Changes in tick communities are also likely to influence tick-borne pathogens. [ABSTRACT FROM AUTHOR]Copyright of Global Ecology & Biogeography is the property of Blackwell Publishing Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts)

Wolfe ND. Wild Primate Populations in Emerging Infectious Disease Research: The Missing Link?. Emerging Infectious Diseases [Internet]. 1998;4 :2. Publisher's VersionAbstract

Wild primate populations may hold valuable clues to the origins and evolution of important pathogens as they can act as reservoirs for human pathogens. As members of biologically diverse habitats, they serve as sentinels for surveillance of emerging pathogens. This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Garibaldi LA, Steffan-Dewenter I, Winfree R, Aizen MA, Bommarco R, Cunningham SA, Kremen C, Carvalheiro LG, Harder LD, Afik O. Wild Pollinators Enhance Fruit Set of Crops Regardless of Honey Bee Abundance. Science [Internet]. 2013;339 (6127) :1608-1611. Publisher's VersionAbstract

Diversity and abundance of wild-insect pollinators have declined in many agricultural landscapes. Whether such declines reduce crop yields, or are mitigated by managed pollinators such as honey bees, is unclear. Here we show universally positive associations of fruit set with wild-insect visits to flowers in 41 crop systems worldwide, and thus clearly demonstrate their agricultural value. In contrast, fruit set increased significantly with visitation by honey bees in only 14% of the systems surveyed. Overall, wild insects pollinated crops more effectively, because increase in their visitation enhanced fruit set by twice as much as an equivalent increase in honey bee visitation. Further, visitation by wild insects and honey bees promoted fruit set independently, so high abundance of managed honey bees supplemented, rather than substituted for, pollination by wild insects. Our results suggest that new practices for integrated management of both honey bees and diverse wild-insect assemblages will enhance global crop yields. 

Milner-Gulland EJ, Bennett EL. Wild Meat: the Bigger Picture. SCB 2002 Annual Meeting Wild Meat Group, Trends in Ecology & Evolution [Internet]. 2003;18 :351-57. Publisher's VersionAbstract

Tropical rural people often rely heavily on wild meat. In many areas this important food source is already lost or being rapidly depleted due to massive overhunting. A mosaic of hunted and no-take areas in a landscape context might balance conservation with continued subsistence use. This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Powell B, Maundu P, Kuhnlein HV, Johns T. Wild Foods from Farm and Forest in the East Usambara Mountains Tanzania. Ecology of Food and Nutrition [Internet]. 2013;52 :451-478. Publisher's VersionAbstract

This study explored the role of wild foods in the diets of children and mothers in the East Usambara Mountains (N = 274 dyads). We identified 92 wild food species. Although dietary diversity (most measures) was not different between seasons, wild foods accounted for a greater percentage of items consumed in the wet (food insecure) season. Many wild foods were obtained on farm; wild foods obtained from the forest accounted for less than 3% of food items consumed. Wild foods were used by virtually all informants but contributed only 2% of total energy in the diet. However, they con- tributed large percentages of vitamin A (RAE) (31%), vitamin C (20%), and iron (19.19%). Agricultural factors (e.g., hours spent in farm) were associated with greater wild food use. These findings suggest participation in agriculture may be important for the maintenance of wild food use, and that wild foods can play an important role in the nutritional resilience of local people.

Rouquet P, Froment J-M, Bermejo M, Kilbourn A, Karesh W, Reed P, Kumulungui B, Yaba P, Délicat Aé, Rollin PE, et al. Wild Animal Mortality Monitoring and Human Ebola Outbreaks, Gabon and Republic of Congo, 2001-2003. Emerging Infectious Diseases [Internet]. 2005;11 :283-290. Publisher's VersionAbstract

All human Ebola virus outbreaks during 2001-2003 in the forest zone between Gabon and Republic of Congo resulted from handling infected wild animal carcasses. After the first outbreak, we created an Animal Mortality Monitoring Network in collaboration with the Gabonese and Congolese Ministries of Forestry and Environment and wildlife organizations (Wildlife Conservation Society and Programme de Conservation et Utilisation Rationnelle des Ecosystemes Forestiers en Afrique Centrale) to predict and possibly prevent human Ebola outbreaks. Since August 2001, 98 wild animal carcasses have been recovered by the network, including 65 great apes. Analysis of 21 carcasses found that 10 gorillas, 3 chimpanzees, and 1 duiker tested positive for Ebola virus. Wild animal outbreaks began before each of the 5 human Ebola outbreaks. Twice we alerted the health authorities to an imminent risk for human outbreaks, weeks before they occurred.

Taub DR, Wang X. Why are nitrogen concentrations in plant tissues lower under elevated CO2? A critical examination of the hypotheses. Journal of Integrative Plant Biology [Internet]. 2008;50 :1365-1374. Publisher's VersionAbstract

Plants grown under elevated atmospheric [CO2] typically have decreased tissue concentrations of N compared with plants grown under current ambient [CO2]. The physiological mechanisms responsible for this phenomenon have not been definitely established, although a considerable number of hypotheses have been advanced to account for it. In this review we discuss and critically evaluate these hypotheses. One contributing factor to the decreases in tissue N concentrations clearly is dilution of N by increased photosynthetic assimilation of C. In addition, studies on intact plants show strong evidence for a general decrease in the specific uptake rates (uptake per unit mass or length of root) of N by roots under elevated CO2. This decreased root uptake appears likely to be the result both of decreased N demand by shoots and of decreased ability of the soil-root system to supply N. The best-supported mechanism for decreased N supply is a decrease in transpiration-driven mass flow of N in soils due to decreased stomatal conductance at elevated CO2, although some evidence suggests that altered root system architecture may also play a role. There is also limited evidence suggesting that under elevated CO2, plants may exhibit increased rates of N loss through volatilization and/or root exudation, further contributing to lowering tissue N concentrations.

Lobell, David B, Burke, Marshall B. Why are agricultural impacts of climate change so uncertain? The importance of temperature relative to precipitation. Environmental Research Letters [Internet]. 2008;3 :8. Publisher's VersionAbstract

Estimates of climate change impacts are often characterized by large uncertainties that reflect ignorance of many physical, biological, and socio-economic processes, and which hamper efforts to anticipate and adapt to climate change. A key to reducing these uncertainties is improved understanding of the relative contributions of individual factors. We evaluated uncertainties for projections of climate change impacts on crop production for 94 crop–region combinations that account for the bulk of calories consumed by malnourished populations. Specifically, we focused on the relative contributions of four factors: climate model projections of future temperature and precipitation, and the sensitivities of crops to temperature and precipitation changes. Surprisingly, uncertainties related to temperature represented a greater contribution to climate change impact uncertainty than those related to precipitation for most crops and regions, and in particular the sensitivity of crop yields to temperature was a critical source of uncertainty. These findings occurred despite rainfall's important contribution to year-to-year variability in crop yields and large disagreements among global climate models over the direction of future regional rainfall changes, and reflect the large magnitude of future warming relative to historical variability. We conclude that progress in understanding crop responses to temperature and the magnitude of regional temperature changes are two of the most important needs for climate change impact assessments and adaptation efforts for agriculture.

Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. The Lancet [Internet]. Submitted;365 :1147-1152. Publisher's VersionAbstract

BACKGROUND:

Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information.

METHODS:

WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG.

FINDINGS:

In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years.

INTERPRETATION:

Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.

 

Lewis JJ, Pattanayak SK. Who adopts improved fuels and cookstoves? A systematic review. Environ Health Perspect [Internet]. 2012;120 (5) :637-45. Publisher's VersionAbstract

Background: The global focus on improved cookstoves (ICSs) and clean fuels has increased because of their potential for delivering triple dividends: household health, local environmental quality, and regional climate benefits. However, ICS and clean fuel dissemination programs have met with low rates of adoption.

Objectives: We reviewed empirical studies on ICSs and fuel choice to describe the literature, examine determinants of fuel and stove choice, and identify knowledge gaps.

Methods: We conducted a systematic review of the literature on the adoption of ICSs or cleaner fuels by households in developing countries. Results are synthesized through a simple vote-counting meta-analysis. RESULTS: We identified 32 research studies that reported 146 separate regression analyses of ICS adoption (11 analyses) or fuel choice (135 analyses) from Asia (60%), Africa (27%), and Latin America (19%). Most studies apply multivariate regression methods to consider 7-13 determinants of choice. Income, education, and urban location were positively associated with adoption in most but not all studies. However, the influence of fuel availability and prices, household size and composition, and sex is unclear. Potentially important drivers such as credit, supply-chain strengthening, and social marketing have been ignored.

Conclusions: Adoption studies of ICSs or clean energy are scarce, scattered, and of differential quality, even though global distribution programs are quickly expanding. Future research should examine an expanded set of contextual variables to improve implementation of stove programs that can realize the "win-win-win" of health, local environmental quality, and climate associated with these technologies.

Roe D, Fancourt M, Sandbrook C, Sibanda M, Giuliani A, Gordon-Maclean A. Which components or attributes of biodiversity influence which dimensions of poverty?. Environmental Evidence [Internet]. 2014;3 (1). Publisher's VersionAbstract

Background:

There is an explicit assumption in international policy statements that biodiversity can help in efforts to tackle global poverty. This systematic map was stimulated by an interest in better understanding the evidence behind this assumption by disaggregating the terms and asking - as our review question - which components or attributes of biodiversity influence which dimensions of poverty?

Methods:

We employed a search strategy that covered peer-reviewed and grey literature. Relevant studies included in the map were those that described an interaction by poor people with biodiversity in non-OECD countries and documented some kind of contribution (positive or negative) to different aspects of their well-being.

Results:

A total of 387 studies were included in the final systematic map. Of these 248 met our additional criteria that studies should include a measure of the contribution to poverty alleviation. The studies were widely distributed geographically. Ecological distribution was less well spread, however, with the largest number of studies focussed on forests. We found studies addressing 12 different dimensions of poverty/well-being – although the most commonly studied was income. Similarly we found studies addressing all levels of biodiversity from genes to ecosystems. The largest number of studies was focussed on groups of resources – particularly non-timber forest products. In most cases, abundance was the attribute that made biodiversity important for poverty alleviation/well-being, while diversity was the least frequently noted attribute.

Conclusions:

The map highlights a number of apparent gaps in the evidence base. Very few studies documented any causal link between use of biodiversity and an impact on poverty. In the majority of the studies biodiversity was framed in terms of its value as a resource – in the form of specific goods that can be used to generate tangible benefits such as cash, food fuel. Very few studies explored the underpinning role of biodiversity in ecosystem service delivery for poverty alleviation, and fewer investigated the benefits of diversity as a form of insurance or adaptive capacity. This is where we suggest research should be prioritised.

Mearns R. When Livestock are Good for the Environment: Benefitsharing of Environmental Goods and Services, in Balancing Livestock and the Environment. World Bank/FAO Workshop, Washington DC ; 1996 :27-28. Publisher's VersionAbstract

Focusing principally on pastoral grazing and integrated crop- livestock systems, this paper examines the less widely documented case of positive environmental externalities associated with livestock production (e.g. enhancing soil fertility and nutrient cycling, supporting sustainable rangeland management, preserving wildlife and other forms of biodiversity). This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Ibarra JT, Barreau A, Campo DC, Camacho CI, Martin GJ, McCandless SR. When Formal and Market-based Conservation Mechanisms Disrupt Food Sovereignty: Impacts of Community Conservation and Payments for Environmental Services on an Indigenous Community of Oaxaca, Mexico. International Forestry Review [Internet]. 2011;13 (3) :318-337. Publisher's VersionAbstract

The impacts of Payments for Environmental Services (PES) and creation of formal Voluntary Conserved Areas (VCAs) on local diets, agricultural practices, subsistence hunting and livelihoods, were assessed in a Chinantec community of southern Mexico. The community has set aside VCAs covering 4 300 ha of its 5 928 ha of communal lands and forests, and has received over $769 245 in PES for protection of 2 822 ha of watersheds roughly overlapping the VCAs. Community members attribute decreased maize and other subsistence crop yields, reduction of area available for agriculture, and shortened fallow cycles to the new conservation policies. Meat consumption has decreased after a hunting ban, accompanied by increases in purchasing meat still consumed. By agreeing to conservation measures that restrict their use of ancestral agricul- tural land and prohibit hunting, villagers have seen local food security become less stable, leading to greater dependency on external food supplies. Continued strict preservation measures under the guise of community conservation could lead to losses of agrobiodiversity, dietary diversity, hunting skills and associated environmental knowledge. Appropriate application of the precautionary principle is essential to avoid structural displacement of local peoples and to ensure the success of community conservation initiatives. 

Fischer RA. Wheat physiology: a review of recent developments. Crop & Pasture Science [Internet]. 2011;62 :95-114. Publisher's VersionAbstract

This review focuses on recent advances in some key areas of wheat physiology, namely phasic development, determination of potential yield and water-limited potential yield, tolerance to some other abiotic stresses (aluminum, salt, heat shock), and simulation modelling. Applications of the new knowledge to breeding and crop agronomy are emphasized. The linking of relatively simple traits like time to flowering, and aluminium and salt tolerance, in each case to a small number of genes, is being greatly facilitated by the development of molecular gene markers, and there is some progress on the functional basis of these links, and likely application in breeding. However with more complex crop features like potential yield, progress at the gene level is negligible, and even that at the level of the physiology of seemingly important component traits (e.g., grain number, grain weight, soil water extraction, sensitivity to water shortage at meiosis) is patchy and generally slow although a few more heritable traits (e.g. carbon isotope discrimination, coleoptile length) are seeing application. This is despite the advent of smart tools for molecular analysis and for phenotyping, and the move to study genetic variation in soundly-constituted populations. Exploring the functional genomics of traits has a poor record of application; while trait validation in breeding appears underinvested. Simulation modeling is helping to unravel G E interaction for yield, and is beginning to explore genetic variation in traits in this context, but adequate validation is often lacking. Simulation modelling to project agronomic options over time is, however, more successful, and has become an essential tool, probably because less uncertainty surrounds the influence of variable water and climate on the performance of a given cultivar. It is the ever increasing complexity we are seeing with genetic variation which remains the greatest challenge for modelling, molecular biology, and indeed physiology, as they all seek to progress yield at a rate greater than empirical breeding is achieving.

Fernando N, Panozzo J, Tausz M, Norton RM, Fitzgerald GJ, Myers S, Walker C, Stangoulis J, Seneweera S. Wheat grain quality under increasing atmospheric CO2 concentrations in a semi-arid cropping system. Journal of Cereal Science [Internet]. 2012;56 :684-690. Publisher's VersionAbstract

We investigated wheat (Triticum aestivum) grain quality under Free Air CO2 Enrichment (FACE) of 550 ± 10% CO2 μmol mol−1. In each of two full growing seasons (2008 and 2009), two times of sowing were compared, with late sowing designed to mimic high temperature during grain filling. Grain samples were subjected to a range of physical, nutritional and rheological quality assessments. Elevated CO2 increased thousand grain weight (8%) and grain diameter (5%). Flour protein concentration was reduced by 11% at e[CO2], with the highest reduction being observed at the late time of sowing in 2009, (15%). Most of the grain mineral concentrations decreased under e[CO2] - Ca (11%), Mg (7%), P (11%) and S (7%), Fe (10%), Zn (17%), Na (19%), while total uptake of these nutrients per unit ground area increased. Rheological properties of the flour were altered by e[CO2] and bread volume reduced by 7%. Phytate concentration in grains tended to decrease (17%) at e[CO2] while grain fructan concentration remained unchanged. The data suggest that rising atmospheric [CO2] will reduce the nutritional and rheological quality of wheat grain, but at high temperature, e[CO2] effects may be moderated. Reduced phytate concentrations at e[CO2] may improve bioavailability of Fe and Zn in wheat grain.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, et al. What works? Interventions for maternal and child undernutrition and survival. The Lancet [Internet]. Submitted;371 :417-440. Publisher's VersionAbstract

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. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0·25 (95% CI 0·01–0·49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0·41 (0·05–0·76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0·45, 0·32–0·62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2·93–21·07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0·84, 0·74–0·95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.

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