Doctoral Degrees (Human Nutrition)

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Browsing Doctoral Degrees (Human Nutrition) by browse.metadata.advisor "Drimie, Scott"

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    Development of a roadmap for mainstreaming nutrition-sensitive interventions in Anambra and Kebbi States, Nigeria
    (Stellenbosch : Stellenbosch University, 2019-04) Ezekannagha, Oluchi; Mbhenyane, Xikombiso G.; Drimie, Scott; Von Fintel, Dieter; Maziya-Dixon, Busie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Malnutrition, though on a slight decline, has continued to be a problem in developing countries. The role of nutrition-sensitivity sectors as a linkage between immediate causes and basic causes of malnutrition has been increasingly recognised in recent years as positively associated with malnutrition reduction. Considering the accumulating evidence pointing to a strong relationship between malnutrition reduction and nutrition-sensitive sectors, including agriculture, education, water, sanitation and hygiene (WASH), and social protection, mainstreaming nutrition into these sectors has been widely discussed, designed and implemented in programmes and policies. Large-scale government programmes in nutrition-sensitive sectors are important elements of delivering nutrition-sensitive malnutrition-preventive benefits to the population. Mainstreaming nutrition into these cross-cutting sectors becomes imperative in the fight for malnutrition reduction. The Mainstreaming Nutrition Initiative Assessment (MNIA) is a framework developed for the assessment of mainstreaming nutrition (Menon et al, 2011), which measures the domains of epidemiology, operational and political commitment. However, there has been little attempt to explore its application in mainstreaming nutrition. The aim of the study was to develop a roadmap for mainstreaming nutrition-sensitivity in Anambra and Kebbi States, Nigeria. The study used a four-phased convergent parallel mixed methods design. In Phase 1, small area estimation methodology was employed to estimate local government prevalence of stunting in Nigeria. Phase 2 was carried out in two stages, first, a nutrition-sensitivity and potential checklist were used to determine the current nutrition-sensitivity and possible potential of programme execution in the various sectors in both states. Subsequently, a theory-based process evaluation that employed key informant interviews, document reviews, and site observations were used to determine the operational factors influencing the implementation of the programmes. In Phase 3, a political commitment rapid assessment test was administered in a workshop to explore the political realities regarding nutrition and nutrition-sensitivity in the states. In Phase 4, the data and information from the previous phases were employed to develop a roadmap for mainstreaming nutrition-sensitivity in both states, which was also validated by the stakeholders. Data were analysed using qualitative thematic analysis and MAXQDA software. LGA stunting prevalence estimations varied across the states. Kebbi State had high state average accompanied by very high LGA stunting estimates. Stunting prevalence in Kebbi State ranged from 54 percent to 67 percent. While in Anambra State, the stunting prevalence ranged from 17 percent to 25 percent, both states were in WHO category of medium to high stunting prevalence. The programmes assessed were averagely nutrition-sensitive but most of them had excellent potential to be highly nutrition-sensitive. The agricultural programmes have the best implementation while programmes in the WASH sector were the weakest in terms of implementation. The process evaluation showed that the programmes’ theory was validly nutrition-sensitive. The programmes had varied implementation dimensions, while the Agricultural Transformation Agenda Programme had a very high dose, the programmes reach was minimal. Programmes such as the Environmental Sanitation and Early Childhood Development Education has wide reach but lower dose and implementation. With regards to political commitment, while Kebbi had high expressed commitment, this was supported with the poor institutional commitment, unlike Anambra where strong institutional commitment existed but lacked financial support. From these findings, a roadmap for mainstreaming nutrition-sensitivity was developed and most stakeholders agreed that the roadmap was implementable and feasible. Future investigation is needed to replicate the study in other states. In addition, following-up Anambra and Kebbi states with the implementation of the roadmap may shed more light on the dynamics and role of the various domains in nutrition-sensitive mainstreaming.
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    Exploring stakeholder commitment and capacity to address infant and young child nutrition in the capital of the Breede Valley, Western Cape Province, South Africa
    (Stellenbosch : Stellenbosch University, 2015-12) Du Plessis, Lisanne Monica; McLachlan, Milla; Drimie, Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: There is experience with - and documented evidence on multi-stakeholder processes (MSPs) on a global - and national level and on how to build and assess commitment and capacity to address infant and young child nutrition (IYCN) at these levels. Little experience and documented evidence, however, exist for such processes at local level. In countries with a decentralised government system, part of the lack of experience and evidence on MSPs lies in the challenge of building commitment and capacity at various political and bureaucratic levels. There is, thus, a need to build an evidence-base of how to engage stakeholders at implementation level and to assess and advance their commitment and capacity to implement responses to address IYCN. There is also a call to better define enabling environments for successful action in this field. In this research, a qualitative study design and selected participatory research methods were used to explore a diversity of perceptions, willingness, abilities, relationships and powers of key stakeholders to address IYCN at sub-district level in the Breede Valley, Western Cape Province, South Africa. The study built on baseline research in the Community-based Nutrition Security Project (CNSP), which provided insight into maternal and child nutrition challenges in the Breede Valley. Stakeholders were identified and categorised during a focus group discussion (FGD) with individuals who knew the sub-district well. Subsequently, the researcher conducted semi-structured interviews with twenty seven key stakeholders to explore their perspectives, commitment and capacity concerning IYCN. Hereafter, they were invited to participate in a workshop to map stakeholder relationships and power related to IYCN governance. Lastly, FGDs were held to reflect on the research process and to explore elements of an enabling environment conducive to action on IYCN at implementation level. Main themes from the overall research findings include: the value of local knowledge and information; the appeal of the 1000 days message and its link to development; the urgent need for IYCN advocacy; the value of stakeholder engagement and seeing the broad IYCN stakeholder landscape; the need for multi-sectoral work, while recognising the difficulty in functioning across sectors; realising the capacity inherent in “people” as a resource, the need for a “whole of society approach” in advancing the IYCN agenda and the importance of strategic capacity in local forums, combined with national legislation, to advance action for IYCN. The study provides insight into the elusive concepts of commitment and capacity in relation to IYCN governance at local level. The personal and professional perspectives of key stakeholders involved at this level offered distinct information about the unique challenges they experienced as well as practical responses required to ensure action. The barriers to multi-sectoral work at the sub-district level hinged on narrow sector-specific focus areas, mandates and budgets leading to poor integration around the social determinants of health, lack of resources and lack of targeted advocacy. The core conclusion of the study is that a detailed exploration of initial stages of an MSP is a valuable practice - and research model to create awareness of IYCN as a development issue of crosscutting importance at implementation level. This process, though time and resource intensive, has supported the development of commitment and revealed collective capacity that could be unlocked to address IYCN at the sub-district level in the Breede Valley. Such an approach, appropriately adapted to local conditions, could be helpful in scaling-up efforts to improve IYCN at sub-district level elsewhere in the country. The next phase of the CNSP should involve joint planning and concrete action to improve IYCN in the Breede Valley. The proposed expansion of the definition of the enabling environment and adaptation of the nutrition governance framework could be introduced into international debates and agendas for continued deliberation, research and action to improve IYCN as a global, national and local priority.
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    An Institutional Understanding of the Transfer of Knowledge to Policy Processes: The Case of The Southern African Development Community’s Regional And National Vulnerability Assessment Committees.
    (Stellenbosch : Stellenbosch University, 2015-03) Landman, Annie Petronella; McLachlan, Milla; Drimie, Scott; Loots, Ilse; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : This thesis explores institutional blockages to and catalysts for the uptake of vulnerability research in vulnerability-reducing policies in southern Africa. The Southern African Development Community’s (SADC’s) Vulnerability Assessment Committee (VAC) constitutes the case study. It offers a unique empirical account of issues of research-policy transfer to reduce vulnerability in complex socio-ecological systems (SESs). Complexity theory provides insights into the research field. It conceptually draws together contextual challenges that contribute to vulnerability in the complex southern African context, the VAC, research processes, and policy processes. Southern Africa is a complex SES with a governing subsystem. The VAC forms part of this subsystem. VAC actors collect contextual information from the SES to inform governing actors of regional vulnerability. Governing actors could then apply the information to make policies reducing regional vulnerability in the SES. An institutional approach and the Policy Arrangement Approach (PAA) are useful for researching the research-policy transfer in the VAC policy arrangement. A PAA-analysis is organised from four integrated analytical dimensions: discourses, actors and coalitions, power and resources, and institutional rules. The PAA also uncovers links between the VAC and its context. Regional food emergencies strongly influenced the establishment and evolution of the VAC. The VAC was formed as a consensual platform to address challenges created by parallel-operating multi-sectoral administration structures hindering collaboration to deal with uncertainty, as well as different frameworks producing conflicting food security results. Discourse findings indicate the VAC mainly interprets vulnerability as vulnerability to food insecurity. Discursive shifts to broader vulnerability and resilience are stunted by a governing mode that does not accommodate multi-actor governance. Findings from the combined actors and power dimensions show that the process of formalising NVACs within national governments has increased government power, reducing the power of international agencies, whose participation is vital to addressing immediate regional challenges. Untransparent political processes have excluded international agencies from VAC activities and politicised vulnerably information. Institutional rules have emerged, including formalising NVACs within governments; set research frameworks; a minimum set of vulnerability indicators to report; a consultancy culture; multiagency VAC membership; volunteerism in un-formalised NVACs; and the strategic exploitation of food security information by international agencies focused primarily on food aid interventions. From these PAA dimension insights, identified catalysts for research-policy transfer include sufficient capacity and funding, technical assistance, communication strategies between research and policy processes, and high-level political support. Research process blockages include a focus on informing emergency interventions, a lack of VAC capacity, neglected communication and dissemination strategies, and politicised research. Policy process blockages include weak national policy processes and a lack of easy access to VAC outputs. The thesis also unpacks contextual factors and spin-offs from VAC processes that perpetuate blockages. Although currently experiencing challenges, the VAC is ideally positioned to house research-policy transfer initiatives. If policy continues to be a strategy to address regional vulnerability, policies need to acknowledge complex contexts and consequently continuously adapt to changes in complex SESs. Research remains a useful tool for better contextualising adaptive policies.