Dr. Dave Ross, President and CEO, The Task Force for Global Health “Gateways to Health”
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Chytanya Kompala is currently completing a Hilton Prize Coalition Fellowship with PATH, a global health and innovation NGO based in Seattle, WA. Chytanya holds a Master of Science in Public Health degree in Nutrition from the Johns Hopkins Bloomberg School of Public Health.
In this blog post, Chytanya writes about her experience working with PATH’s Nutrition Innovation team to explore the effects of tobacco use during pregnancy on childhood stunting. She is also currently drafting a policy brief to highlight interventions that could help to reduce chronic undernutrition.
Stepping Out of the Silo: Advocating for Interdisciplinary Approaches to Undernutrition
By Chytanya Kompala
Global nutrition is my passion. In graduate school, I was trained to think about nutrition problems in the developing world from a certain perspective. My training came from nutritionists and did not emphasize collaboration with sectors outside of nutrition. My peers have been nutritionists. All of my previous work experiences have been completely focused on nutrition. As a global health nutritionist and researcher, I was eager to work with the Nutrition Innovation team at PATH and gain an insider’s perspective into one of the most reputable global health NGOs in the world. When I started my fellowship in February 2017, I was expecting something similar to my previous nutrition-centric experiences. I was anticipating joining a team that worked similarly to other organizations in this field. I was expecting to rely on my existing knowledge of nutrition. Instead, I had an entirely different experience. I found myself learning so much about new topics from a team with diverse backgrounds and next-generation ideas.
The issue of chronic undernutrition (technically known as stunting) has been at the center of my fellowship research. Chronic undernutrition among children under age five is one of the largest burdens of malnutrition and is an unavoidable topic in the developing world.
Early this spring, I attended a presentation at PATH’s headquarters by Roger Thurow, a senior fellow at the Chicago Council on Global Affairs and the author of The First 1,000 Days. “Stunted children have a life sentence to under-performance and under-achievement,” he said. As Thurow described, stunting during childhood impacts a child for the rest of his or her life. Long-term consequences of stunting include reduced educational attainment, impaired cognitive function and development, poor economic productivity, and even an increased likelihood of having stunted children. Stunting is an intergenerational condition that hinders the growth and development of individuals, families, communities, and even countries.
The Lancet 2013 Series on Maternal and Child Nutrition was a seminal set of papers that acted to coalesce the nutrition and development communities around a set of proven, “nutrition-specific” interventions to address stunting. They estimated that scaling up 10 nutrition interventions to 90 percent coverage would reduce stunting by about 20 percent. While this finding gave the community renewed focus, it also highlighted how much we still do not know about the complex determinants of stunting. What about the remaining 80 percent?
One of the aims of PATH’s Nutrition Innovation team is to help answer that question. During my six months at PATH, I worked on two projects: an ongoing systematic review and meta-analysis on the effects of tobacco use during pregnancy and its association with stunting, and drafting a corresponding policy brief on “nutrition-sensitive” risk factors that may be contributing to stunting—those that were not highlighted in The Lancet 2013 Series.
I never thought that my research would be focused on tobacco use. At first, I was skeptical about researching this topic. I have no background or experience working on tobacco, and I was unsure about how relevant tobacco would be to stunting. But through our meta-analysis, my eyes have been opened to the idea that much more cross-sectoral research still needs to be done to explore the intersection and overlap between different health and development issues and nutrition outcomes.
Working on the Nutrition Innovation team at PATH has taught me an invaluable lesson about the interdisciplinary nature of global health and nutrition. Too often, people try to do great work in silos. Echoing this message at PATH’s 40th anniversary celebration in May, a diverse panel of innovators and young leaders discussed the importance of making connections across sectors to solve the world’s problems. By working collaboratively and moving away from the “business as usual” mindset, we can achieve greater impact. Thinking about stunting outside of the “nutrition-specific” lens enables us to better understand the complex and broad, sweeping determinants of the problem. Our research on tobacco is just one example of this.
We are currently in the process of drafting our policy brief with the aim of broadening the conversation about stunting to address issues beyond the nutrition interventions highlighted in The Lancet. We are exploring sound evidence on additional determinants of stunting, such as household air pollution, tobacco use, hygiene and sanitation, education, and delaying the first birth and birth spacing.
Part of our message is to advocate for more interdisciplinary approaches among people working in different sectors—to encourage researchers, program implementers and policymakers to expand their approach to include cross-sector indicators in their research and programs. Many health and development studies and programs do not include stunting as an outcome of interest, even when evidence indicates that there may well be an effect. We hope our work can help guide the conversation out of the box and lead to new, creative, and interdisciplinary approaches to end undernutrition around the world.
I am grateful for this fellowship and exposure to the great work of the Nutrition Innovation team at PATH. My time here has greatly expanded and shaped my perceptions and approach to thinking about global nutrition.
“If you want to build partnerships and coalitions, you have to shine the light on your partners and not on yourself.” @TFGH President Dave Ross talks #HiltonPrize, partnerships, and some of the biggest global health challenges today: http://ow.ly/fixv30ae21j
May 23 is the International Day to End Obstetric Fistula, inaugurated by the United Nations in 2013. This day promotes awareness of obstetric fistula, a preventable condition that disproportionately affects women and girls in developing countries. An obstetric fistula is a hole in the birth canal that is caused by prolonged labor with no medical intervention. In addition to the excruciating pain of the injury itself, women suffering from this condition are left incontinent and often experience shame and isolation from their families and communities due to the social stigma surrounding their inability to control urination and bowel movements. In 2003, the United Nations Population Fund (UNFPA) launched the Campaign to End Fistula, an initiative aimed to increase public action towards treatment and prevention.
Several members of the Hilton Prize Coalition have dedicated programs to eradicate obstetric fistula, and collaboration is a key element in their designs. One such organization is Tostan. Working in six countries in Western Africa, Tostan was awarded the Conrad N. Hilton Humanitarian Prize in 2007. Tostan’s work focuses on the empowerment of women and girls, child protection and political and economic development. Their community engagement model operates as non-formal education that facilitates community-led development and social progress initiatives.
The organization maintains partnerships alongside local communities, religious leaders and health specialists in the region, having engaged in projects with The Fistula Foundation to provide medical care, including surgery and emotional support to women suffering from obstetric fistula in rural communities. Within the Coalition, Tostan collaborated alongside Hilton Prize Coalition members Amref and Handicap International in Senegal in 2014. The three organizations implemented the Zero Fistula Project, a holistic approach to effectively tackle the issue of obstetric fistula that involved collaboration between hospitals, governmental agencies, and other NGOs in the region. Through this partnership, Tostan reported, more than 600 women were healed and were able to take back their lives.
In Fall 2016, a Hilton Prize Coalition Collaborative Fellow will work alongside Tostan and Coalition member Operation Smile in Senegal for three months, focusing on social reintegration programs for women who have suffered from obstetric fistula. The Fellow will also participate in trainings to replicate this model for Operation Smile’s programs in the Democratic Republic of the Congo.
Collaborations in public health projects are vital to the development and humanitarian sectors. Obstetric fistula is a cross-cutting issue that intersects health care and early and child marriage, among others. The collaborative work of these Hilton Prize Coalition organizations to provide treatment and education is raising awareness of the issue at a local level, which will in turn eradicate the condition on a larger scale.
(Participants of the 2014 UNFPA Zero Fistula Project; Photo Credit Mathilde Demassiet)
Read Tostan’s latest blog post, “Nothing to Hide: Aissatou Mane’s Path to Fistula Recovery”
Ms. Nikhila (Nikki) Kalra is currently completing a Hilton Prize Coalition Fellowship through PATH, a Seattle-based global health innovation NGO and Hilton Prize Laureate. Nikki holds degrees from the University of Cambridge and the London School of Economics, and most recently received her PhD from Oxford University in International Development. In this blog post, Nikki writes about her field work experiences as a Spring 2016 Fellow in Ghana and Senegal through PATH’s Nutrition Innovation Program.
Innovation through Insects: Tackling Malnutrition with the Palm Weevil Larva
by Nikhila Kalra
At the start of my fieldwork in Ghana, I visited a rural community in the country’s Ashanti region to meet with some smallholder farmers who have been involved in an exciting new micro-farming initiative. Soon after I arrived, one of the project participants led me around to the back of her house and showed me the operation that has been helping her to feed her children and make some valuable extra income: six large buckets filled with wriggling white larvae.
They are palm weevil larvae (pictured above), known as akokono in the local Twi language. These edible insects could have big potential when it comes to addressing the issue of undernutrition in Ghana, a country that faces significant rates of childhood stunting and anemia. As an intern at PATH, I was working with the Nutrition Innovation team to explore the ways in which the palm weevil larva can be developed as an accessible, sustainable food source that will improve nutritional outcomes for mothers and children.
Considered something of a delicacy in many parts of Ghana, palm weevil larvae are packed with protein, essential fatty acids and many important minerals including iron, zinc and potassium. They’re also a great candidate for micro-farming. PATH’s partner in this project, Aspire, a Canadian social enterprise company with a focus on edible insects, has developed a low-cost set up that allows smallholders to produce the larvae in or near their homes for both consumption and sale. The low start-up costs and proximity to the household make akokono farming particularly viable as an economic activity for women. But there’s another important benefit: insects have a much smaller environmental footprint than traditional livestock, requiring significantly less land, feed and water to generate the same amount of protein. This is just the kind of triple impact that we’re looking for at PATH: positive effects on people’s health, their income, and the environment.
If the palm weevil larva are going to be a successful tool for tackling malnutrition and advancing women’s empowerment in Ghana, it’s important that we understand it as part of a complete food system, all the way from production to consumption. This is what my work as a Hilton Prize Coalition Fellow has been focused on. Thanks to this fellowship I’ve had the opportunity to travel to Ghana to conduct a value chain analysis for palm weevil larvae, which will allow us to answer some key questions: who are the actors in the value chain and what activities are they engaged in? What are the issues and challenges that they face? And, most importantly, which opportunities exist to add economic and nutritional value along this chain, and how can they be harnessed most effectively?
As well as helping us to gain these important insights, this fellowship has been a great practical training ground for me. When I first started on this project at PATH’s office in Seattle, I had no idea I’d get to contribute my own piece of fieldwork to it. The fellowship has been an invaluable learning opportunity, allowing me to take ownership of the research process from start to finish. This experience has given me a clearer understanding of the process of generating evidence for public health interventions, the skills to manage it, and a greater capacity to translate research into useful strategic insights.
This is Agnes, a project participant, and she’s holding up a bowl full of powder that she makes by drying and grinding up the larvae from her farm. She adds a pinch of this powder to the soups and stews she cooks for her family, giving them an extra nutritional boost. I think that this is illustrative of one of the most important things I’ve been afforded by the Hilton Prize Coalition Fellowship: the chance to learn first-hand from the knowledge and experience of the people involved in this initiative, and, as a result, to gain fresh ideas and explore innovative avenues for implementation that I would probably never have thought of sitting at my desk in Seattle.