Journal Articles

× Child undernutrition disproportionally affects children in low- and middle-income countries. In Ethiopia, both wasting and stunting are serious public health concerns, with high human and economic costs. Understanding the dynamics in ponderal and linear growth faltering is critical to inform the design of innovative interventions that can prevent both wasting and stunting in poor and complex settings. Using two longitudinal studies conducted in 2017 and 2019 in four highland regions of Ethiopia, we evaluated the dynamics and drivers of child growth faltering in children 6–23 months of age (N = 5003). Child wasting prevalence peaked during the first 6 months of life, whereas stunting increased significantly after 6 months of age. Male sex, child illnesses (i.e., diarrhoea or fever) and low consumption of fruits and vegetables were associated with higher odds of acute undernutrition (P < 0.05). The consumption of animal source foods (ASF) was associated with increases (β: 95% CI) in weight-for-length Z-score (WLZ; 0.12: 0.0002; 0.242), whereas fruit or vegetables consumption was associated with increases in midupper arm circumference (MUAC; 0.11 cm: 0.003; 0.209). Only consumption of ASF was the statistically significant predictor of future linear growth (0.14: 0.029; 0.251). Distinct trends in WLZ and MUAC were observed by child sex and age. Improving diet quality through improved nutrition knowledge and increased access and affordability of ASFs, along with effective infection prevention/control measures could prevent both child wasting and stunting concurrently.

× Age-appropriate breastfeeding and introduction to complementary foods can shape child feeding practices, ensure adequate energy and nutrient intake and prevent linear growth faltering. This study aimed to assess mothers' and health workers' knowledge of timely introduction to complementary foods and evaluate the relationship between delays in complementary feeding and subsequent linear growth. We conducted two rounds of surveys (March/August 2017) among 249 health workers (n = 249) and caregivers (n = 2635) of children 6–23 months of age. We collected information about socio-demographic characteristics, knowledge and practice related to timely introduction to complementary foods. The study was conducted in households from the Productive Safety Net Programme (PSNP) districts, in four highland regions of Ethiopia. Delays in the introduction to complementary feeding were widespread with 53% of children 6–8 months of age not consuming solid, semisolid or soft foods in the past 24 h. After controlling for child, caregiver and household characteristics, children not introduced to complementary foods by 6–8 months had a 0.48 SD lower length-for-age z-score at 12–15 months. Caregivers' knowledge was strongly and inversely correlated with untimely introduction of complementary foods in logistic regressions (OR = 0.55, p < 0.01). In turn, local health extension worker's knowledge was strongly correlated with caregiver's knowledge. Consequently, frequent and timely visits by health extension workers emphasising not only on what to feed but also when and how to feed a child are needed. Innovative ways of increasing reach, intensity and frequency of nutrition messaging by using the PSNP interactions as an additional point of contact would need to be explored further.

× Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0–5 months. In children aged 6–59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting.

× The objective of our study was to reanalyse the Ethiopia STEPwise approach to Surveillance Noncommunicable Disease Risk Factors survey (NCD STEPS), using causal path diagrams constructed using expert subject matter knowledge in conjunction with graphical model theory to map the underlying causal network of modifiable factors associated with prediabetes/diabetes and hypertension. We used data from the 2015 Ethiopia NCD STEPS representative cross-sectional survey (males; n = 3977 and females; n = 5823 aged 15–69 years) and performed directed acyclic graph-informed logistic regression analyses. In both sexes, a 1-unit higher in body mass index (BMI) and waist circumference (WC) were positively associated with prediabetes/diabetes (BMI: males: adjusted odds ratio [aOR]: 1.07 [95% confidence interval: 1.0, 1.1], females aOR: 1.03 [1.0, 1.1]; WC: males: aOR: 1.1 [0.9, 1.2], females: aOR: 1.2 [1.1, 1.3]) and hypertension (BMI: males: aOR: 1.2 [1.1, 1.2], females aOR: 1.1 [1.0, 1.1]; WC: males: aOR: 1.6 [1.4, 1.8], females: aOR: 1.3 [1.2, 1.5]). Although residing in urban settings was associated with higher odds of hypertension in both males (aOR: 1.79 [1.49, 2.16]) and females (aOR: 1.70 [1.49, 1.95]), it was only associated with prediabetes/diabetes in males (aOR: 1.56 [1.25, 1.96]). Males and females in pastoralist areas had lower odds of prediabetes/diabetes compared with their agrarian counterparts (males: aOR: 0.27 [0.14, 0.52], females: aOR: 0.31 [0.16, 0.58]). Physical activity was associated with lower odds of prediabetes/diabetes among females (aOR: 0.75 [0.58, 0.97]). Other diet-related modifiable factors such as consumption of fruit and vegetable, alcohol or salt were not associated with either prediabetes/diabetes or hypertension. Our findings highlight the need to implement interventions that prevent overweight/obesity and nutrition-related NCDs, particularly in urban areas.

× The prevention of wasting should be a public health priority as the global burden of acute malnutrition is still high. Gaps still exist in our understanding of context-specific risk factors and interventions that can be implemented to prevent acute malnutrition. We used data from the four rounds of the Ethiopia Demographic and Health Survey (2000–2016) to identify risk factors that have contributed to the change in weight-for-height z-score (WHZ) among children under 5 years of age. We performed a pooled linear regression analysis followed by a decomposition analysis to identify relevant risk factors and their relative contribution to the change in WHZ. Modest improvements in WHZ were seen between 2000 and 2016. The sharpest decrease in mean WHZ occurred from birth to 6 months of age. Perceived low weight at birth and recent diarrhoea predicted a decline in WHZ among children aged 0–5, 6–23 and 23–59 months. Less than 50% of the change in WHZ was accounted for by the change in risk factors included in our regression decomposition analysis. This finding highlights data gaps to identify context-specific wasting risk factors. The decline in the prevalence of recent diarrhoea (15% of the improvement), decline in low birth size (7%–9%), and an increase in wealth (15%–30%) were the main risk factors that accounted for the explained change in WHZ. Our findings emphasize the importance of interventions to reduce low birthweight, diarrhoea and interventions that address income inequities to prevent acute malnutrition.

× The quality of complementary feeding can have both short- and long-term health impacts by delaying or promoting child growth and establishing taste preferences and feeding behaviours. We aimed to assess the healthy and unhealthy feeding practices of infants and young children in rural Ethiopia. We conducted two rounds of surveys in December 2017/18 in Habru district, North Wello, rural Ethiopia among caregivers of infants and young children (N = 574). We characterised the consumption of infants and young children using non-quantitative 24 h recall and the World Health Organization infant and young child feeding indicators. Sociodemographic characteristics, anthropometry and haemoglobin concentrations were assessed. Breastfeeding was a norm as 82% and 67% were breastfed in the first and second rounds. Between the two rounds, dietary diversity increased from 5% to 17% (p < 0.05), but more pronounced increases were observed in the consumption of ultra-processed food (UPFs). Up to one-in-five (22%) of the children consumed UFPs. With an average of only three food groups consumed, the consumption of nutrient-dense foods like animal source foods, fruits and vegetables was very low particularly among younger children. UPFs are an additional risk factor that contributes to poor quality diets. Behavioural Change Communication interventions, including those in rural areas, should explicitly discourage the consumption of UPFs. Future studies should aim to quantify the amount of UPFs consumed and evaluate how this is associated with diet adequacy and nutritional outcomes.

× Seasonal price variability for cereals is two to three times higher in Africa than on the international reference market. Seasonality is even more pronounced when access to appropriate storage and opportunities for price arbitrage are limited. As smallholder farmers typically sell their production after harvest, when prices are low, this leads to lower incomes as well as higher food insecurity during the lean season, when prices are high. One solution to reduce seasonal stress is the use of improved storage technologies. Using data from a randomised controlled trial, in a major maize-growing region of Western Ethiopia, we study the impact of hermetic bags, a technology that protects stored grain against insect pests, so that the grain can be stored longer. Despite considerable price seasonality—maize prices in the lean season are 36% higher than after harvesting—we find no evidence that hermetic bags improve welfare, except that access to these bags allowed for a marginally longer storage period of maize intended for sale by 2 weeks. But this did not translate into measurable welfare gains as we found no changes in any of our welfare outcome indicators. This ‘near-null’ effect is due to the fact that maize storage losses in our study region are relatively lower than previous studies suggested—around 10% of the quantity stored—likely because of the widespread use of an alternative to protect maize during storage, for example a cheap but highly toxic fumigant. These findings are important for policies that seek to promote improved storage technologies in these settings.

× Monitoring smallholder agricultural productivity growth, one of the targets of the Sustainable Development Goals, rests on accurate measures of crop production and land area. Existing methods and protocols for measuring smallholder production and plot size are prone to various sources and forms of mismeasurement. Inaccuracies in production and land area measurement are likely to distort descriptive and predictive inferences. We examine the sensitivity of empirical assessments of the relationship between agricultural productivity and land area to alternative measurement protocols. We implement six production and six land area measurement protocols, and show that most of these protocols differ systematically in their accuracy. We find that an apparent inverse size–productivity relationship in our data is fully explained by measurement error in both production and plot size. Moreover, we show that some of the previously used “gold standard” measures are themselves prone to nonclassical measurement error, and hence can generate spurious inverse size–productivity findings. Our results also show that slight improvements in the precision of objective measures significantly reduce the inferential bias associated with the size–productivity relationship.

× Little is known about the effects of urbanization on women’s attitudes toward intimate partner violence (IPV). The scarcity of empirical studies on this relationship can be partly attributed to the lack of an objective measure of urbanization levels. In this study, we investigate the effects of urbanization on Ethiopian women’s attitudes toward IPV using four continuous measures of urbanization: nightlight intensity, distance to urban areas, total urban area within a 10-km radius, and an urbanization index. These measures are defined from satellite-based nighttime light intensity and multispectral sensor data. We find that despite a generally strong positive association between urbanization and progressive attitudes among women toward IPV, some stages of urbanization show a more significant association than others. The heterogeneities in the effect of all urbanization measures on women’s attitudes toward intimate partner violence further show that the effects of urbanization measures are sharply heterogeneous across wealth indicator terciles. While we find that urbanization measures are associated with an overall decrease in the justification of IPV, the effects are higher and stronger for women in the upper and middle wealth terciles compared to the lowest wealth tercile. Initially less-privileged women gain little from urbanization in the attitudes toward IPV, resulting in increased inequality in women’s empowerment in the short and medium term.

× Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents) and grandmothers (23 respondents) of children aged 6–23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notes before qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuits and lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored.

× Consumption of milk is linked to improved nutrient intake and reduced risk of child malnutrition in low and middle-income countries. However, these benefits are contingent on the safety and quality of the milk. Milk consumption may alleviate the widespread risk of malnutrition in rural Ethiopia, but milk-borne contaminants may also compromise child health. We aimed to: i) identify the types of dairy feeds used, their storage conditions, and potential risk of aflatoxin contamination; ii) assess stakeholders' knowledge about aflatoxin contamination along the value chain; and iii) assess parental practices on feeding milk to infants and young children. This qualitative study was conducted in the Sidama region, southern Ethiopia. In-depth interviews (n = 12) and key-informant interviews (n = 18) were conducted with actors along the dairy value chain. Focus-group discussions were conducted with farmers (9FGD/n = 129) and child caregivers (9FGD/n = 122). Study participants were selected to represent a rural-urban gradient, as well as low- and high- dairy cow holdings. We found that while animal-feed processors and their distribution agents had relatively good knowledge about aflatoxin, farmers and retailers did not. Feed storage conditions were poor. Many respondents linked moldy feeds to animal health but not to human health. Farmers' feed choice was influenced by cost, seasonality, and herd size. Small-holding farmers had limited access to commercial feed. Children's consumption of milk was limited to skim milk, as butter was extracted and sold for income. The high cost of dairy products also led some parents to dilute skim milk with water before feeding children, compromising the nutritional value and safety of the milk. Our findings underscore the need to address the gaps in aflatoxin and food safety knowledge, improve storage conditions, and ensure the availability of quality feed to increase the sector's productivity, but most importantly to protect consumers' health and well-being, especially infants and young children.

× As one of the agglomeration models targeting cluster-based rural development, cluster farming has been promoted in Ethiopia and it is already reported to have significant welfare implications, but participation rates are not as high as expected. This study examines the role of land as a constraint to the development of cluster-based development in Ethiopia both using extensive and intensive measures of cluster farming. The study further disaggregates farm households based on their farm size to better understand potential heterogeneities in the relationship between farm size and cluster farming. The paper also documents other household socio-economic and network characteristics that may matter in cluster farming.
Methods
We use a large-scale farm household data from 3,969 households coupled with some expert insights on cluster farming in Ethiopia. Households in the study areas grow major staples such as maize, wheat, teff, malt barley, and sesame in four main regions of Ethiopia. We employ a double hurdle model to examine both the decision to participate and the extent to which households participate in cluster farming. By extent of participation, we refer to the amount of land and share of land farm households contribute to cluster farming. For robustness purposes, we also estimate the Tobit and Linear Probability Models.
Results
We show a positive association between farm size and cluster farming both at the extensive and intensive margins. This relationship turns negative for large amounts of land. This shows that cluster farming increases with farm size up to a threshold beyond which it declines. We also find suggestive evidence that participation rates are lower for small-scale farms, but also declines for large-scale farms. In addition, we show that access to information and network characteristics also matter in enabling cluster farming.
Conclusion
The findings of this study are relevant in the framework of plans to upscale the cluster-based development initiative in Ethiopia. Attention to landholding issues is key and may be an important area where policy action can be geared to boost cluster farming. Moreover, our results inform potential targeting plans that aim to increase the participation of small-scale farmers who are usually the intended targets of such programs.

× We analyze rural households’ purchases of food (cereals and non-cereals) in Sub-Saharan Africa using nationally representative data with 65,000 observations covering 7 countries over a decade. We distinguish between three strata of countries: lower stratum in income and urbanization, middle stratum, and upper stratum. The paper breaks ground by the breadth and time length of the sample. We find that purchases form the majority of rural food consumption whether in favorable or unfavorable agroecological zones and over country and income strata and for most food products. Rural nonfarm employment (as a cash source) plays an important role in household food purchases across all study countries and food products. Policy implications include the importance of food purchase markets and supply chains to and in rural areas as well as nonfarm employment.

× There is an international consensus that Africans consume less fruits and vegetables (FV), and animal products (AP) than they need for adequate nutrition, and that production and supply chains of these products are constrained. Yet, in this paper, we show that despite these problems, there is a lot of dynamism in demand and supply of these nutrient-dense products in Africa: (1) macro evidence of “domestic supply booms"—with supply growing as fast as or faster than in Asia and Latin America; (2) only 2–4% of FV, and 10% of AP consumption in Africa is imported, and only about 1–2% of the output of FV and AP is exported: the supply booms have thus been overwhelming domestically sourced, not imported; (3) micro evidence of substantial shares of consumption of FV and AP in total food consumption, similar to Asia's; (4) evidence of rapid development of spontaneous clusters of farms and off-farm SMEs (output wholesalers, logistics, processors, and agro-dealers supporting farmers). These clusters are important in fueling the supply booms. Illustrative cases from Ethiopia, Nigeria, Tanzania, and Zambia are presented. We recommend that African governments and international partners: (1) internalize the fact that these spontaneous clusters are forming and already fueling supply booms; (2) note that important drivers of the booms have been government investments in wholesale markets, roads, and other infrastructure like electrification, and agricultural research/extension; (3) leverage and support existing spontaneous clusters and help new ones to form by greatly increasing those three types of public investments.

× The main objective of this study is to understand the interlinkages between different irrigation technologies and management systems and environmental outcomes. We use a unique and comprehensive household and plot-level dataset covering ten districts of Ethiopia complemented with remotely sensed data and qualitative information collected from the study sites. The econometric results show that compared to open-access plots equipped with pump irrigation, other irrigated configurations, and especially private groundwater-based systems, have higher vegetation cover and show less susceptibility to the most common environmental concerns mentioned in the survey regions: water logging, soil salinity, and erosion externalities.

× Graduation model interventions seek to address multiple barriers constraining households’ exit from poverty, however, few explicitly target restrictive gender norms. Using a randomized controlled trial design, combined with three rounds of data, we investigate the impacts on gender equitable attitudes and behaviors of a graduation program that seeks to address multiple constraints for those in poverty and improve restrictive gender norms in Ethiopia. We find that at 1-year follow-up all treatment arms lead to improvements in men’s gender equitable attitudes and their engagement in household domestic tasks as reported by both men and women; but at 3-year follow-up, impacts are only sustained in the treatment arms that introduced men’s engagement groups after the 1-year follow-up survey to further promote improvements in equitable gender norms.

× The global nutrition and food security crisis, characterised by troubling trends in various forms of malnutrition ranging from hunger to obesity, has significantly worsened [1,2]. In 2021 and 2022, nearly one-third of the global population faced moderate to severe food insecurity, underscoring a persistent challenge in accessing healthy and sustainable diets [1,3]. This decline in diet quality has led to a surge in malnutrition, with obesity and diet-related noncommunicable diseases (NCDs) reaching epidemic proportions [4–6].

Despite the implementation of numerous nutrition policies and interventions, many low- and middle-income countries (LMICs) continue to grapple with food and nutrition security issues, posing a significant threat to vulnerable populations [3,7]. Food insecurity is particularly evident among the poor, with women and children in rural areas being the most affected [1,2,8]. In 2022 alone, an alarming 230 million children under the age of five experienced some form of malnutrition. Specifically, 148 million (22.3%) were stunted, 45 million (6.8%) were wasted, and 37 million (5.6%) were overweight [1,9,10]. Stunting and wasting were more prevalent in rural areas, while overweight was somewhat more common in urban settings. In Ethiopia, the latest national survey showed that 37% of children under five were stunted, 11% were wasted, and 22% were underweight [11].

× Governments and development agencies increasingly promote agro-clusters as a pathway to improving smallholder incomes and ensuring inclusive rural development through mitigating production and market risks. However, there is very limited empirical evidence to support this promise. We use a large farm household survey of about 4000 smallholder farmers in Ethiopia growing cereals like teff, maize, wheat, maltbarley and sesame to examine the relationship between agro-clusters and smallholder welfare and poverty. Using instrumental variable estimators, we establish a positive association between agro-clusters, household income and per capita income. Agro-clusters are also shown to reduce poverty and poverty gaps. Our results are robust over different agro-cluster proxies and alternative estimators, such as the augmented inverse probability weighting estimator. We also show that our findings are unlikely to be driven by omitted variable bias. Moving beyond average effects and in the interest of understanding heterogeneous effects, we use quantile regressions at different income levels. We find that agro-clusters are associated with welfare gains for all households. However, the most significant gains are observed for the wealthier households. Despite this regressive association, our findings suggest that agro-clusters may be useful in making farming more profitable with significant welfare implications.

× Despite enthusiasm around applications of information and communications technologies (ICTs) to smallholder agriculture in many lower-income countries, there are still many questions on the effectiveness of ICT-based approaches. This study assesses the impacts of video-mediated agricultural extension service provision on farmers’ adoption of improved agricultural technologies and practices in Ethiopia using data from a two-year randomized experiment. Our results show that the video-mediated extension approach significantly increases uptake of recommended technologies and practices by improving extension access and farmer knowledge. Specifically, we find that video-mediated extension reaches a wider audience than the government’s conventional extension approach and leads to higher levels of farmer understanding and uptake of the subject technologies in those locations randomly assigned to the program. While our results also point to greater extension access and greater knowledge among female spouses in locations where both male and female spouses were targeted by the program, we do not find clear evidence that a more inclusive approach translates into higher uptake of the subject technologies. Finally, we find that the video-mediated approach becomes less costly as the scale of operation increases.

× Livestock markets influence income generation for producers, but also accessibility and affordability of highly nutritious animal-sourced foods for consumers. Despite their importance, the functioning of livestock markets in lower-income countries is poorly understood and rarely studied compared to more developed countries. This study analyzes wholesale cattle markets in Ethiopia using a uniquely rich large-scale dataset covering both prices and cattle characteristics in 39 markets (in both highland and lowland areas) over a 10-year period, and hedonic regression models structured to understand both cattle price formation and seasonal and secular price dynamics. We show that cattle prices are influenced by a wide range of factors, including proxies for meat quality, religious fasting practices, climate-based seasonality but also climate shocks and availability of grazing land, competition from animal traction services, and rising consumer incomes. However, the implied effects of these factors are often significantly different in highland mixed crop-livestock areas compared to agro-pastoralist lowland areas, emphasizing the dualistic nature of cattle markets in Ethiopia. The analyses help inform the systemic challenges that Ethiopia will need to overcome to meet rising demand for beef products in the face of sustained income and population growth, as well as the adverse effects of climate change.

× The paucity of reliable, timely household consumption data in many low- and middle-income countries have made it difficult to assess how global poverty has evolved during the COVID-19 pandemic. Standard poverty measurement requires collecting household consumption data, which is rarely collected by phone. To test the feasibility of collecting consumption data over the phone, we conducted a survey experiment in urban Ethiopia, randomly assigning households to either phone or in-person interviews. In the phone survey, average per capita consumption is 23 percent lower and the estimated poverty headcount is twice as high than in the in-person survey. We observe evidence of survey fatigue occurring early in phone interviews but not in in-person interviews; the bias is correlated with household characteristics. While the phone survey mode provides comparable estimates when measuring diet-based food security, it is not amenable to measuring consumption using the ‘best practice’ approach originally devised for in-person surveys.

× Acid soils are a major constraint to agricultural productivity in many parts of sub-Saharan Africa, including Ethiopia. Restoring soil pH to optimal ranges for agriculture can have a significant impact on yields, particularly for acid intolerant crops like wheat and barley. The application of agricultural lime is the standard corrective, although the large application requirements, lack of farmer awareness, and weak or non-existent lime supply chains make this a complex problem to address at scale. To date, no large-scale farmer trials of lime application have been undertaken in Ethiopia. This leaves open the question to local policy makers as to the economic benefits given the enormous capital and logistics investments required. To help address this we leverage existing spatial edaphic data and longitudinal crop surveys to simulate the productivity impact of varying lime and fertilizer applications. Our estimates find the impact of moving pH from 5.5 to 6.5, modeled as a lime soil remediation strategy, increases yields by 22% and 19% for wheat and barley, respectively. In addition, at lower pH levels our models indicate that commonly used nitrogen-based fertilizers are less cost-effective. For wheat in highly acidic soils, we find that fertilizers cost over two times as much as a single application of lime over a five-year period. The cost savings of the use of lime reaches as high as 121% of average one-year agricultural household income for wheat; with barley these savings are lower but still substantial at 24%. In general, we advocate for an integrated soil fertility management strategy that applies appropriate levels of fertilizer on pH balanced soil. If successful, Ethiopia’s acid soil reclamation could become a modest version of Brazil’s successful “cerrado miracle” and serve as an example for Africa.

× Ethiopia’s agriculture-based economy generates highly seasonal outputs, with most production occurring during the long-rains Meher season and a lesser amount during the short-rains Belg season. Despite numerous studies detailing the economic impacts of Meher precipitation, there is relatively little consideration of other seasonal or subseasonal climate impacts in Ethiopia, with most economic models only considering aggregated annual-scale production to simulate the Ethiopian economy. This paper serves to address both seasonal and subseasonal effects of climate using a partial equilibrium agroeconomic model of Ethiopia. First, an annual-scale model is disaggregated into a seasonal time step, corresponding to the two major cropping seasons in Ethiopia. Second, the effect of yield gains from a subseasonal forecast–based planting strategy is considered in the updated model. We found that crop yields and corresponding economic indicators varied widely by season and location, and that subseasonal forecast–based management strategies can, on average, increase gross domestic product (GDP), per capita calorie consumption, and lead toward reduced poverty, warranting the inclusion of seasonal and subseasonal processes in economic models and agricultural planning.

× This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.

× Local value-addition in developing countries is often aimed at for upgrading of agricultural value chains, since it is assumed that doing so will make farmers better off. However, transmission of the added value through the value chain and constraints to adoption of value-adding activities by farmers are not well understood. We look at this issue in the case of coffee in Ethiopia–the country’s most important export product–and value-addition in the coffee value-chain through ‘washing’ coffee, which is done in wet mills. Washed coffee is sold internationally with a significant premium compared to ‘natural’ coffee but the share of washed coffee in Ethiopia’s coffee exports has stagnated. Relying on a unique primary large-scale dataset and a combination of qualitative and quantitative methods, we examine the reasons for this puzzle. The reasons seemingly are twofold. First, labor productivity in producing red cherries, which wet mills require, is lower than for natural coffee, reducing incentives for adoption, especially for those farmers with higher opportunity costs of labor. Second, only impatient, often smaller, farmers sell red cherries, as more patient farmers use the storable dried coffee cherries as a rewarding savings instrument, given the negative real deposit rates in formal savings institutions.

× Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning and performance at work. The objective of this article is to identify whether antenatal care-seeking was associated with the uptake of iron supplementation among pregnant women, adjusting for a range of covariates. This article used data from the cross-sectional recent Demographic and Health Surveys (DHS) of 12 countries in Asia, Africa and Latin America & the Caribbean regions. The individual-level data from 273,144 women of reproductive age (15−49 years) were analysed from multi-country DHS. Multiple Logistic regression analyses were conducted using Predictive Analytics Software for Windows (PASW), Release 18.0. Receiving at least four antenatal care visits was significantly associated with the consumption of 90 or more iron-containing supplements in 12 low and middle income countries across three regions after adjusting for different household and respondent characteristics, while mass media exposure was found to be a significant predictor in India and Indonesia. Antenatal care seems to be the most important predictor of adherence to iron intake in the selected countries across Africa, Asia, Latin America and Caribbean regions.

× Modern marketing arrangements are increasingly being implemented to assure improved food quality and safety. However, it is not well known how these modern marketing arrangements perform in early stages of roll-out. We study this issue in the case of rural–urban milk value chains in Ethiopia, where modern processing companies—selling branded pasteurized milk—and modern retail have expanded rapidly in recent years. We find overall that the adoption levels of hygienic practices and practices leading to safer milk by dairy producers in Ethiopia are low and that there are no significant improvements in the incipient modern milk value chains compared to traditional ones. While suppliers to modern processing companies are associated with more formal milk testing, they do not obtain price premiums for the adoption of improved practices, nor do they obtain higher prices overall. At the urban retail level, we find there are only small price differences between pasteurized and raw milk and that modern retailers sell pasteurized milk at lower prices, ceteris paribus. Modern value chains to better reward hygiene and food safety in these settings are therefore called for.

× Ethiopia announced its first food-based dietary guidelines (FBDGs) on 15 March 2022. The present study aims to develop and evaluate the Ethiopian Healthy Eating Index (Et-HEI) based on the FBDG. Data were collected from 494 Ethiopian women of reproductive age sampled from households in five different regions. The Et-HEI consists of eleven components, and each component was scored between 0 and 10 points, the total score ranging from 0 to 110, with maximum adherence to the FBDG. The Et-HEI score was evaluated against the Minimum Dietary Diversity for Women (MDD-W) and the probability of nutrient adequacy. The average Et-HEI score for women of reproductive age was 49 out of 110. Adherence to the recommendations for grains, vegetables, legumes, fat and oils, salt, sugar and alcohol contributed the most to this score. Most women had low scores for fruits, nuts and seeds, and animal-sourced foods, indicating low intake. The Cronbach's alpha coefficient, indicating the reliability of the Et-HEI to assess its diet quality, was 0⋅53. The low mean Et-HEI score agreed with a low mean score of the MDD-W (3⋅5 out of 10). Also, low nutrient adequacies confirmed poor adherence to nutrient-dense components of the FBDG. The Et-HEI was not associated with the intake of vitamin B12, vitamin C and calcium in this study population. Women who completed secondary school and above had relatively lower Et-HEI scores. The newly developed Et-HEI is able to estimate nutrient adequacy while also assessing adherence to the Ethiopian FBDG though there is room for improvement.

× Index insurance has been promoted as an innovative strategy for enhancing long-term resilience to climate-related shocks and providing financial inclusion, particularly to poor women farmers in developing countries. In this paper, we evaluate the gendered impact of an index-based livestock insurance product on food consumption among pastoral households in southern Ethiopia. We exploit intertemporal variation in household risk exposure and insurance payouts to evaluate the ex ante and ex post insurance impacts and use randomly distributed discount coupons to instrument the insurance purchase variables. We find that during the pre-drought period, a previous season insurance purchase and the intensity of insurance coverage significantly and equally reduces food expenditure in male- and female-headed households. In the post-drought period, we find that an insurance payout significantly increases food expenditure per adult equivalent among female-headed households.

× Background: Nutrition-sensitive agriculture is an efective multi-sectoral approach to address the underlying causes of malnutrition. However, successful implementation requires the involvement of diferent sectors to jointly plan, monitor, and evaluate key activities, which is often challenged by contextual barriers. Previous studies in Ethiopia have not adequately explored these contextual barriers. Hence, the current study aimed to qualitatively explore the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture among sectors in Ethiopia.
Methods: A qualitative exploratory study was conducted in Tigray and Southern Nations, Nationalities, and Peoples (SNNP) of Ethiopia regional states in 2017. Ninety-four key informants were purposively selected from government agencies primarily in health and agriculture, from local (kebele) to national levels, and ranging from academic organizations, research institutions, and implementing partners. Researchers developed a semi-structured guide and conducted key informant interviews which were audiotaped, transcribed verbatim in local language, and translated to English. All transcriptions were imported into ATLAS.ti Version 7.5 software for coding and analysis. The data analysis followed an inductive approach. Transcriptions were coded line by line; then similar codes were grouped into categories. Subsequently, non-repetitive themes were identifed from the categories using thematic analysis methodology.
Results: The following themes were identifed as challenges that hinder joint planning, monitoring, and evaluation to link nutrition to agriculture: (1) limited capacity, (2) workload in home sector (agriculture or nutrition), (3) lack of attention to nutrition interventions, (4) inadequate supportive supervision, (5) problematic reporting system, and (6) weak technical coordinating committees.
Conclusions and recommendations: Gaps in human and technical resources, limited attention from diferent sectors, and absence of routine monitoring data hindered joint planning, monitoring, and evaluation activities for nutrition-sensitive agriculture in Ethiopia. Short-term and long-term training for experts and intensifcation of supportive supervision may address gaps in capacity. Future studies should address whether routine monitoring and surveillance in nutrition-sensitive multi-sectoral activities provides long-term improvement in outcomes.

× Restoration of degraded land is key to enhancing land productivity and farmers' wellbeing in sub-Saharan Africa. Evidence shows that the benefits of land restoration are tremendous, ranging from biophysical benefits in soil health, agricultural productivity, ecosystem services, to socio-economic dimensions such as improving farmers’ income and livelihoods. Yet one issue that is rarely considered is how the outcomes of restoration initiatives affect different social groups, specifically women, men, and the marginalized. Our study aims to understand the extent of gender and social inclusion in land restoration studies in Ethiopia. Through analyzing 314 peer-reviewed scientific articles on land restoration initiatives and studies for Ethiopia published between 1985 and 2020, we aimed to: i) develop a novel approach that would allow for the semi-automatization of analyzing gender aspects in a large set of scientific documents using machine learning techniques, ii) assessed the current evidence on gender integration in peer-reviewed studies related to RDL, and iii) identified what gender issues are discussed in RDL literature. We employed text mining techniques to analyze the literature for keywords and to classify articles into three main classes: gender blind, gender sensitive, and gender transformative, based on the extent to which gender and social inclusion keywords appeared in the studies. Our analysis showed that gender and social inclusion are rarely considered in landscape restoration studies in Ethiopia, as most studies and interventions are heavily focused on the biophysical and environmental aspects of restoration. Despite an exponential increase in the use of gender and social inclusion keywords after 2005, most of the research (58 percent of articles) remains gender blind. The most frequently used related terms remained generic, e.g. community, access, participatory, and tenure. Only 38% of the studies could be classified as gender sensitive to a certain degree, and a strikingly low number of articles (4 percent) ― which consider the systematic challenges women face ― could be defined as gender transformative. This implies that scientific evidence about how land restoration has benefited men and women, and to what extent it could transform gender and power dynamics, is lacking. Our findings demonstrate the urgent need to consider gender and social inclusion to ensure associated benefits of land restoration practices.

× Soil erosion and subsequent land degradation undermine efforts to ensure food security and environmental sustainability in Ethiopia. The government of Ethiopia has implemented extensive soil and water conservation (SWC) programs in severely degraded and food-insecure areas of the country, in some cases integrated with subsequent or parallel irrigation development. However, the effectiveness of these interventions has not been extensively evaluated. This study, therefore, evaluates the performance and impacts of SWC practices in terms of improving vegetation greenness and reducing soil erosion in Feresmay watershed in Ethiopia. Long-term Landsat-based Normalised Difference Vegetation Index (NDVI), Revised Universal Soil Loss Equation (RUSLE), and Soil and Water Assessment Tool (SWAT) were used for change-detection analysis before and after the implementation of various SWC interventions. The results revealed the positive impacts of SWC interventions in improving the vegetation greenness and soil erosion reduction although the outcome varied by intervention. Increased vegetation greenness was observed largely in areas where area closure with catchment treatment (ACCT) and impacts of irrigation (IRR) interventions are dominant, while relatively little impact was observed at the watershed level analysis. Although these interventions helped to reduce soil loss, the results highlighted the need for more SWC interventions to minimise further soil loss.

× Objectives: Intimate partner violence (IPV) is a public health challenge but there is evidence that cash and cash ‘plus’ interventions reduce IPV. An increasingly popular design feature of these kind of interventions is the group-based modality for delivering plus activities, however, evidence of the mechanisms through which this modality of delivery impacts IPV is limited. We explore how the group-based modality of delivering plus activities that complemented the Government of Ethiopia’s Productive Safety Net Programme contributed to modifying intermediate outcomes on the pathway to IPV. Design: Qualitative study using in-depth interviews and focus group discussions between February and March 2020. Data were analysed using a thematic content and gender lens approach. Findings were interpreted, refined and drafted in collaboration with our local research partners. Setting: Amhara and Oromia regions in Ethiopia. Participants: In total 115 men and women beneficiaries from the Strengthen PSNP4 Institutions and Resilience (SPIR) programme took part in the study. Fifty-eight were interviewed and 57 took part in 7 focus group discussions. Results: We found that Village Economic and Social Associations—through which SPIR activities were delivered—improved financial security and increased economic resilience against income shocks. The group-based delivery of plus activities to couples appeared to enhance individual agency, collective power and social networks, which in turn strengthened social support, gender relations and joint decision-making. Critical reflective dialogues provided a reference group to support the shift away from social norms that condone IPV. Finally, there appeared to be gender differences, with men highlighting the financial benefits and enhanced social status afforded by the groups, whereas women’s accounts focused primarily on strengthened social networks and social capital. Conclusion: Our study offers important insights into the mechanisms by which the group-based delivery of plus activities affects intermediate outcomes on the pathway to IPV. It underscores the importance of the modality of delivery in such programmes, and suggests that policy-makers should consider gender-specific needs as men and women might differentially benefit from interventions that enhance social capital to generate gender transformative impacts.

× Consumption of animal source foods, through livestock production, improves children's growth and micronutrient status. However, research on the relationship between livestock ownership and childhood anemia has produced conflicting results. The current study used robust analytical approaches to examine the effect of household livestock ownership on children's anemia using the most recent secondary data from the national demographic and health survey. We followed a 1:1 closest neighborhood propensity score matching analysis. A propensity score was generated using the binary logistic regression model to compute the probability of owning livestock. From a total of 18,008 households enrolled in the latest Ethiopian Demographic and Health Survey (EDHS 2016), data of 721 index children aged 6–59 months from households owning livestock were matched with a comparable number (721) of children from households without livestock. The paired and independent t-test, matched relative risk (RR), and standardized mean differences were used to compare the distributions of hemoglobin concentration and anemia risks between treatment and control groups. Anemia was found in more than half (54.1% and 58.8%) of children aged 6–59 months from livestock-owning and nonowning families, respectively (p > .05). Aggregate ownership of livestock was not associated with hemoglobin concentration or anemia status (RR = 0.95, 95% confidence interval [95% CI] [0.87–1.04]). Species-wise, poultry was associated with a lower (RR = 0.88, 95% CI [0.84–0.95]) anemia risk, while ownership of goat/sheep was associated with higher (RR = 1.10, 95% CI [1.03–1.17]) risk. In conclusion, ownership of small livestock species (sheep/goats and poultry), but not aggregate livestock ownership, was associated with the risk of anemia among children in Ethiopia. Therefore, agriculture-sensitive nutrition, with a One Health lens approach, is recommended to mitigate the high burden of anemia among children in Ethiopia. In the future, a well-controlled interventional study with more extended periods may be required to fully understand the effects of livestock production and highlight the differences seen across livestock species.

× Poor diet quality has been identified as a primary driver of malnutrition and increasing burden of noncommunicable diseases in low- and middle-income countries. Low fruit and vegetable consumption contributes to poor diet quality. We experimentally assess whether videos embedded messages about increasing fruit and vegetable consumption affect consumption. Four months after viewing either a basic video or a video that explains why fruits and vegetables can improve health and nutrition outcomes, average household consumption of fruits and vegetables increased by about 9% in both treatment groups relative to the control group, both in kilocalorie and consumption expenditure terms.

× Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30–90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50–150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15–35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200–300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200–300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

× The lack of timely, high-resolution data on agricultural production is a major challenge in developing countries where such information can guide the allocation of scarce resources for food security, agricultural investment and other objectives. While much research has suggested that remote sensing can potentially help to address these gaps, few studies have indicated the immediate potential for large-scale estimations over both time and space. In this study we described a machine learning approach to estimate smallholder maize yield in Ethiopia, using well-measured and broadly distributed ground truth data and freely available spatiotemporal covariates from remote sensing. A neural networks model outperforms other algorithms in our study. Importantly, our work indicates that a model developed and calibrated on a previous year’s data can be used to reasonably estimate maize yield in the subsequent year. Our study suggests the feasibility of developing national programs for the routine generation of broad-scale, high-resolution estimates of smallholder maize yield, including seasonal forecasts, on the basis of machine learning algorithms and well-measured ground control data and currently existing time series satellite data.

× Objective To determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia.

Design A community-based cross-sectional study.

Setting Bishoftu town, Ethiopia, January–February 2022.

Participants A total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected.

Outcome The response variable was diarrhoeal disease among children under 5 years.

Results The 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother’s age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child’s age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease.

Conclusion In this study, diarrhoea among children is a significant health issue. Child’s age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.

× Objective:
To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference.

Design:
Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet.

Settings:
Five regions are included in the urban and rural areas of Ethiopia.

Participants:
Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019.

Results:
Women’s mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet’s cost.

Conclusion:
The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.

× Cluster farming is increasingly recognized as a viable means of improving smallholder economic integration and commercialization in many developing countries. However, little is known about its impact on smallholder welfare and livelihoods. We examine the relationship between cluster farming and smallholder commercialization using a large-scale survey of 3969 farm households in Ethiopia cultivating high-acreage crops such as teff, wheat, maize, barley, and sesame. Using switching regressions and instrumental variable estimators, we show that cluster farming is associated with commercialization measured as commercialization index, market surplus value, and market price. To further deal with endogeneity concerns, we also employ some pseudo-panel models where we observe similar insights. Beyond this, we account for heterogeneities by disaggregating households based on farm scales and crops cultivated. Our findings show that cluster farming is positively associated with commercialization for all farms and crop types despite this disaggregation. However, the related gains are higher among medium and large farms and vary per crop type. These findings imply that cluster farming is crucial in improving smallholder commercialization and may be a critical entry and leveraging point for policy. We thus lend support to initiatives and plans that seek to upscale cluster farming as they can potentially improve smallholder commercialization with ensuing impacts on rural livelihoods and welfare.

× Several countries across the developing world have designed and implemented agricultural export incentives. However, little is known about the effects of these policies on various aspects of domestic food security. This study utilizes economywide models linked top-down with microsimulation modules to analyze the impacts of increased agricultural export promotion on the four dimensions of food security – availability, access, utilization, and stability – in three structurally food-insecure economies of Ethiopia, Kenya, and Uganda. We find that agro-export promotion adversely affects all four aspects of food security in urban areas and at the national level due to significant increases in food prices domestically. However, it generally benefits households in rural areas. The food security effects are stronger in Ethiopia and Kenya. We also find that risks associated with the volatility in international markets and declines in domestic productivity can lead to further deterioration in access to food when countries implement outward-oriented agricultural policies

× Background
Adolescence is a critical period of physical and psychological development, especially for girls, because poor nutrition can affect their wellbeing as well as that of their children. We aimed to assess the feasibility and impact of a package of nutrition education interventions delivered through public primary schools on the diets of adolescent girls in Ethiopia.
Methods
In this non-masked, cluster-randomised, controlled trial, primary schools (clusters) in the Southern Nations, Nationalities, and People's Region and Somali region of Ethiopia were randomly allocated to the intervention group (nutrition information provided during flag ceremonies, classroom lessons, school club meetings, peer group mentoring, BMI measurement and counselling, and parent–teacher meetings) or the control group (standard academic curriculum on health and nutrition) by use of computer-generated pseudo-random numbers. Duration of the school-based interventions was 4 months, and the key messages were related to dietary diversity (eating a variety of foods), energy adequacy (eating breakfast and healthy snacks), and healthy food choices (avoiding junk foods). Adolescent girls were eligible for participation if aged 10–14 years and enrolled in grades 4–8 in a study school. Data were collected with two independent cross-sectional surveys: baseline before the start of implementation and endline 1·5 years later. The primary outcome of impact was dietary diversity score, defined as the number of food groups (out of ten) consumed over the previous 24 h using a list-based method, and minimum dietary diversity, defined as the proportion of girls who consumed foods from at least five of the ten food groups, in the intention-to-treat population. We also assessed intervention exposure as a measure of feasibility. We estimated intervention effects using linear regression models for mean differences at endline, with SEs clustered at the school level, and controlled for adolescent age, region, household food security, and wealth. The trial is registered with ClinicalTrials.Gov, NCT04121559, and is complete.
Findings
27 primary schools were randomly allocated to the intervention group and 27 to the control group. Between March 22 and April 29, 2021, 536 adolescent girls participated in the endline survey (270 in the intervention group and 266 in the control group), with median age of 13·3 years (IQR 12·1–14·0). At endline, the dietary diversity score was 5·37 (SD 1·66) food groups in the intervention group and 3·98 (1·43) food groups in the control group (adjusted mean difference 1·33, 95% CI 0·90–1·75, p<0·0001). Increased minimum dietary diversity was also associated with the intervention (182 [67%] of 270 in the intervention group vs 76 [29%] of 266 in the control group; adjusted odds ratio 5·37 [95% CI 3·04–9·50], p<0·0001). 256 (95%) of 270 adolescent girls in the intervention group were exposed to at least one of the five in-school intervention components. Interpretation Integrating nutrition interventions into primary schools in Ethiopia was feasible and increased dietary diversity incrementally among adolescent girls, but could be limited in changing other food choice behaviours, such as junk food consumption, based on nutrition education alone.

× Ethiopia recently experienced a large-scale war that lasted for more than two years. Using unique High-Frequency Phone Survey (HFPS) data, which span several months before and after the outbreak of the war, this paper provides evidence on the immediate impacts of the conflict on households’ food security. We also assess potential mechanisms and evaluate impacts on proximate outcomes, including on livelihood activities and access to food markets. We use difference-in-differences and two-way fixed effects estimation to compare trends across affected and unaffected regions (households) and before and after the outbreak of the war. Seven months into the conflict, we find that the war was associated with a 37 percentage points increase in the probability of moderate to severe food insecurity. Using the Armed Conflict Location and Event Data (ACLED), we show that exposure to an additional battle leads to a 1 percentage point increase in the probability of moderate or severe food insecurity. The conflict was associated with significant reduction in access to food through supply chain disruptions and by curtailing non-farm livelihood activities. Non-farm and wage related activities were affected the most, whereas farming activities were relatively more resilient. Our estimates, which likely underestimate the true average effects on the population, constitute novel evidence on the near-real-time impacts of large-scale conflict. Our work highlights the potential of HFPS to monitor active and large-scale conflicts, especially in contexts where conventional data sources are not immediately available.

× Background and Aims
Access to safe drinking water, sanitation, and hygiene is a fundamental human right and essential to control infectious diseases. However, many countries, including Ethiopia, do not have adequate data to report on basic water, sanitation, and hygiene (WASH) services. Although contaminated drinking water spreads diseases like cholera, diarrhea, typhoid, and dysentery, studies on drinking water contamination risk levels in households are limited in Ethiopia. Therefore, closing this gap needs investigation.
Methods
A community-based cross-sectional study was conducted. A total of 5350 households were included. A systematic, simple random sampling technique was used to select the participants. The information was gathered through in-person interviews using a standardized questionnaire. Furthermore, 1070 drinking water samples were collected from household water storage.
Results
This investigation revealed that 9.8%, 83.9%, and 4.9% of households used limited, basic, and safely managed drinking water services, respectively. Besides, 10.2%, 15.7% and 59.3% of households used safely managed, basic and limited sanitation services, respectively. Yet, 10.6% and 4.2% of households used unimproved sanitation facilities and open defecation practices. Also, 40.5% and 19.4% of households used limited and basic hygiene services. On the other hand, 40.1% of households lacked functional handwashing facilities. In this study, 12.1%, 26.3%, and 42% of households’ drinking water samples were positive for Escherichia coli, fecal coliforms, and total coliforms, respectively. Also, 5.1% and 4.5% of households’ drinking water samples had very high and high contamination risk levels for E. coli, respectively. We found that 2.5% and 11.5% of households and water distributors had unacceptable fluoride concentrations, respectively.
Conclusion
The majority of households in Bishoftu town lack access to safely managed sanitation, drinking water, and basic hygiene services. Many households’ water samples had very high and high health risk levels. Hence, the government and partner organizations should implement water and sanitation safety plans.

× Background
Despite remarkable gains over the past decade, mounting evidence suggests that Ethiopia’s rural health extension program (HEP) is facing serious implementation challenges. We investigated the current and potential future program design and implementation challenges of Ethiopia’s rural HEP based on the lived experiences of health extension workers (HEW) implementing the program at the grassroots level.

Methods
We employed a longitudinal qualitative exploration linked to a larger cluster-randomized trial (RCT) which was implemented in 282 villages randomly selected from 18 Kebeles of the Gedeo zone, southern Ethiopia. Data were collected using in-depth interviews with key informants, focus group discussion, and passive observation of program implementation. The data were analyzed manually using a thematic framework analysis approach. Themes and sub-themes were generated by condensing, summarizing, and synthesizing data collected in the field in the form of extended notes and field observation checklists.

Findings
Despite considerable gains in availing basic health services to the rural population, HEP seems to suffer serious design and implementation flaws that demand thoughtful and immediate adjustment. The design constraints span from the number and type of intervention packages to the means of dissemination (vehicle) as well as the target population emphasized. As such, some low-cost high-impact interventions that were strongly desired by the community were overlooked, while others were inappropriately packed. The means of distribution - female health extension workers trained with basic prevention skills, were lacking essential skills. They also had high burnout rates and with little engagement with men, were repeatedly mentioned flaws of the program demanding revitalization. Furthermore, the sheer structure of HEP precluded adult and adolescent men, non-reproductive women, and the elderly.

Conclusion
Despite significant gains over the last couple of months, Ethiopia’s rural HEP appears to have reached a tipping point that requires a comprehensive revamp of the program package, means of distribution, and target beneficiaries rather than the “usual” tweaks to reap maximum benefits.

× Irrigation, and especially farmer-led irrigation, is considered to be a promising option for enhancing agricultural productivity in Sub-Saharan Africa. However, there is a lack of thorough understanding of the impacts of irrigation development on environment. Past discussions are mainly limited to the water depletion and hydrological regime change effect of irrigation. This paper presents a study to narrow the knowledge gap by assessing nutrient water pollution risk induced by the expansion of farmer-led irrigation in Ethiopia. Using household survey data collected from four woredas in Ethiopia where irrigated crop production currently concentrates, we first evaluate the impact of irrigation on cropping intensity and annual consumption level of fertilizers and then use the findings of the household survey data analysis to support conceptualization of a modeling framework for assessing agricultural nutrient water pollution risk from farmer-led irrigation development in Ethiopia at national scale. We project that overall farmer-led irrigation development in Ethiopia will lead to a gentle increase in national total of agricultural nutrient loadings. This result helps justify the endeavor of promoting farmer-led irrigation in Ethiopia. On the other hand, the projected nutrient flow and nutrient loading growth rate related to the farmer-led irrigation expansion are highly heterogeneous spatially, and risk of local water quality deterioration exists. There is still need to make investment to ensure the environmental sustainability of farmer-led irrigation development.

× Background
The Diet Quality Questionnaire (DQQ) is a rapid dietary assessment tool designed to enable feasible measuring and monitoring of diet quality at population level in the general public.

Objectives
To evaluate validity of the DQQ for collecting population-level food group consumption data required for calculating diet quality indicators by comparing them with a multipass 24-h dietary recall (24hR) as the reference.

Methods
Cross-sectional data were collected among female participants aged 15–49 y in Ethiopia (n = 488), 18–49 y in Vietnam (n = 200), and 19–69 y in Solomon Islands (n = 65) to compare DQQ and 24hR data in proportional differences in food group consumption prevalence, percentage of participants achieving Minimum Dietary Diversity for Women (MDD-W), percent agreement, percentage misreporting food group consumption, and diet quality scores of Food Group Diversity Score (FGDS), noncommunicable disease (NCD)-Protect, NCD-Risk, and the Global Dietary Recommendation (GDR) score using a nonparametric analysis.

Results
The mean (standard deviation) percentage point difference between DQQ and 24hR in population prevalence of food group consumption was 0.6 (0.7), 2.4 (2.0), and 2.5 (2.7) in Ethiopia, Vietnam, and Solomon Islands, respectively. Percent agreement of food group consumption data ranged from 88.6% (10.1) in Solomon Islands to 96.3% (4.9) in Ethiopia. There was no significant difference between DQQ and 24hR in population prevalence of achieving MDD-W except for Ethiopia (DQQ 6.1 percentage points higher, P < 0.01). Median (25th–75th percentiles) scores of FGDS, NCD-Protect, NCD-Risk, and GDR score were comparable between the tools.

× Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence-based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self-efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress.

× Lack of accurate information about soil nutrient deficiencies coupled with limited access to appropriate fertilizers could lead to mismatch between soil nutrient deficiencies (requirements) and fertilizer applications. Such anomalies and mismatches are likely to have important implications for agricultural productivity. In this article we use experimental (spectral soil analysis) data from Ethiopia to examine farmers’ response to soil nutrient deficiencies and its implications for yield responses. We find that farmers’ response to macronutrient (nitrogen and phosphorus) deficiencies is not always consistent with agronomic recommendations. For example, we find that farmers in our sample are applying nitrogen fertilizers to soils lacking phosphorus, potentially due to lack of information on soil nutrient deficiencies or lack of access to appropriate fertilizers in rural markets. On the other hand, farmers respond to perceivably poor-quality and acidic soils by applying higher amount of nitrogen and phosphorus fertilizers. We further show that such mismatches between fertilizer applications and soil macronutrient deficiencies are potentially yield-reducing. Those farmers matching their soil nutrient deficiencies (requirements) and fertilizer application are likely to enjoy additional yield gains. Marginal yield response associated with nitrogen (phosphorus) application increases with nitrogen (phosphorus) deficiency in soils. Similarly, we find that farmers’ response to acidic soils is not yield-enhancing. These findings suggest that such mismatches may explain heterogeneities in marginal returns to chemical fertilizers and the observed low adoption rates of chemical fertilizers in sub-Saharan Africa.

× Some agricultural practices, such as irrigation, have the potential to buffer seasonal dietary gaps and through increased production and consumption improve diets, particularly of the rural poor relying on subsistence farming but also for rural and urban households purchasing irrigated produce on local markets. The study aimed to evaluate the effect of seasonality and irrigation on women's diet in rural Ethiopia. Using a longitudinal study design, three rounds of surveys were conducted among women of reproductive age (15–49 years). Data on socioeconomic status, food consumption and haemoglobin concentration was collected. Energy and nutrient intakes were estimated using an interviewer-administered multiple-pass 24-h recall. Women's dietary diversity score (WDDS), the proportion of women meeting the minimum dietary diversity for women (MDDW), haemoglobin concentration, the prevalence of anaemia and energy and nutrients intakes were compared between irrigators and nonirrigators and by season. Associations between MDDW/WDDS and irrigation status were assessed using fixed-effect models, after adjusting for covariates. WDDS was low (3–4 out of 10 food groups) and exhibited high seasonal variability (p < 0.05). Diets were predominantly cereal-based, with little consumption of nutrient-dense foods like fruits and animal source foods. High seasonal variability in energy, protein, vitamin C, calcium, iron and zinc intakes were observed (p < 0.01). Irrigators were more likely to meet the MDDW than women from non-irrigating households (p < 0.05). No cases of malaria were reported from the three rounds of screening. There is a high seasonal variation in women's diet, but this could be partly offset by irrigation practices.

× Poultry has gained renewed attention as a promising value chain for women because it is an asset that is widely accessible to women, has low start-up costs, and provides a good source of nutritious animal-sourced foods for children in chicken meat and, especially, eggs. The current study presents evidence from an experimental intervention that randomly provided women either a poultry package transfer of vaccinated, improved-breed chickens and related inputs, or a cash grant of equivalent value within a sample of households participating in a social safety net program. These transfers were embedded in a set of intensive livelihood and enhanced nutrition interventions as part of a broader experiment in rural Ethiopia. We assess the impact of the poultry package transfer as well as the enhanced nutrition intervention on the consumption of eggs by both children and adult women. We find that the poultry transfer increased the frequency of egg consumption as well as the sale of eggs, falling between the extreme of an autarkic household and one in which production decisions are fully separable from consumption choices.

× There is evidence that cash transfers reduce intimate partner violence (IPV), but less is known about the impacts of public works and complementary programmes on IPV. Using mixed-methods we examined whether and how the Ethiopian government's public works programme (that includes cash and/or food for work) alongside complementary activities that engage women and men affected IPV. We analysed midline data collected in July–October 2019 from a randomised controlled trial (RCT) designed to measure the added impacts of the complementary programming in the Amhara and Oromia regions. Eligible households for this analysis had at least one child aged 0–35 months and a primary female caregiver who was married, and under 50 years-old (n = 2604). A nested qualitative study was conducted with a sub-sample of RCT participants from February–March 2020; data included seven focus group discussions and 58 in-depth interviews. Male partners of women who reported experiencing IPV were purposively sampled. Ordinary Least Squares regression analyses were used to estimate the average treatment effect of the complementary programming, and sub-analyses were conducted on the poorest ten households from each village who received additional livelihood transfers. Qualitative data were analysed using thematic content analysis. We found no impacts of the complementary programming on IPV in the full sample, but some impacts among the poorest sample. Evidence on pathways found that both the public works and complementary programming decreased poverty-related stress and arguments within relationships and increased emotional wellbeing. There were some impacts on women's empowerment from the complementary programming. However, men's reactions to women's empowerment were mixed. There was strong evidence that engaging men in nutrition behaviour change communication contributed to improving gender relations. Our findings indicate that social protection and complementary programmes have the potential to be gender transformative and prevent the drivers of IPV.

× The transition of farmers from subsistence to market-oriented agriculture is meant to reduce hunger, increase wellbeing and accelerate rural economic progress. While an impressive extant literature has analysed agricultural commercialisation effects on welfare from an income, expenditure and consumption perspective, authors place less attention on the implications on asset holdings, which is a more robust long-term measure of welfare. Using chickpea production in Ethiopia as a case, we assess the effects of chickpea commercialisation on household asset ownership and livestock holdings of smallholder farmers. We employ a household fixed-effects estimator to control for time-invariant unobserved heterogeneity and account for possible endogeneity using an instrumental variable approach. For comparison purposes, we also evaluate the income effects of chickpea and examine impact heterogeneity using quantile regressions. Our results indicate a positive impact of agricultural commercialisation on assets, livestock ownership and income. We found commercialisation to benefit all farmers in terms of impact heterogeneity, though with higher gains for asset-rich households. Despite this rising asset inequality, we conclude that increased agricultural commercialisation can contribute to economic development of households and reduce rural poverty.

× As development and humanitarian agencies increasingly advance the objective of ‘building resilience’, three resilience measurement methods have come into especially widespread use: the Resilience Indicators for Measurement and Analysis approach developed by FAO, the multi-dimensional index approach developed by TANGO International, and the probabilistic approach of Cissé and Barrett. We compare performance across those three methods using nationally representative panel data from Ethiopia and Niger. We find that the three measures exhibit significantly different distributions and orderings among households, and they vary significantly in the households they identify as resilient or least resilient. All three measures exhibit only modest out-of-sample predictive accuracy, generating many false negatives and false positives relative to the food security outcome measure whose resilience they are meant to reflect. It remains unclear what these measures capture and what value they add beyond more established wellbeing measures such as the food consumption score or real expenditures. Significant room exists for improvement in resilience measurement to better guide and evaluate development resilience interventions.

× Multistakeholder platforms (MSPs) are the subject of increasing attention and investment in the domain of collaborative natural resource governance, yet evidence-based guidance is slim on policy and investment priorities to leverage the MSP approach. We provide a comparative analysis of eight landscape-level MSPs spanning seven countries (Peru, Brazil, India, Tanzania, Ethiopia, and a cross-border case from Kenya and Somalia), representing a diversity of resource systems covering forests, rangelands, and multiuse agricultural landscapes. Applying an adapted social-ecological systems framework, our synthesis identifies the influence of these MSPs on patterns of stakeholder interaction and draws implications for the design and organization of MSPs that are both appropriate and effective. From the cases, we distill lessons addressing: (1) how to design an MSP in relation to the governance context, including the fit between institutional and ecological dimensions of the system and with attention to cross-scale linkages; (2) how to implement inclusive processes that address power inequities, including through capacity building and procedural rules; and (3) how to support adaptive learning to expand the MSP’s influence over time, including monitoring outcomes, adapting the scope of stakeholder engagement, and investing in MSP durability.

× Irrigation has significant potential to enhance productivity, resilience to climatic risks and nutrition security in Sub-Saharan Africa. While the focus has historically been on large-scale dam-based schemes, farmer-managed small-scale irrigation (SSI) has gained increased attention in recent years. Using data from Ethiopia, Tanzania and Ghana, we first examine patterns of adoption of different SSI technologies. Next, we employ hierarchical modelling to examine which variables are associated with observed adoption patterns and cluster effects that explain variation in irrigation adoption. We document significant cross-country variation in adoption patterns and find a positive association between plot-level use of SSI and the intensity of agricultural labor and inorganic fertilizers applied on the plot. Community-level intra-cluster correlation (ICC) is the highest in Tanzania, where gravity-fed irrigation is most common while farm-level ICC is the highest in Ethiopia where motorized technologies are more common. These results suggest the need for localized investments to ease locale-specific potential constraints. For example, easing possible liquidity constraints to acquiring motorized technologies can be more effective in Ethiopia while the construction of dams and improved conveyance systems, as well as the strengthening of community-based irrigation management (e.g., through Water User Associations (WUAs)) can be more effective in Tanzania. Further research is needed to understand pathways for selected plot-level characteristics that affect use of SSI including status of plot ownership and the gender of the plot manager.

× Integrating nutrition interventions into antenatal care (ANC) requires adapting global recommendations to fit existing health systems and local contexts, but the evidence is limited on the process of tailoring nutrition interventions for health programmes. We developed and integrated maternal nutrition interventions into ANC programmes in Bangladesh, Burkina Faso, Ethiopia and India by conducting studies and assessments, developing new tools and processes and field testing integrated programme models. This paper elucidates how we used information and data to contextualize a package of globally recommended maternal nutrition interventions (micronutrient supplementation, weight gain monitoring, dietary counselling and counselling on breastfeeding) and describes four country-specific health service delivery models. We developed a Theory of Change to illustrate common barriers and strategies for strengthening nutrition interventions during ANC. We used multiple information sources including situational assessments, formative research, piloting and pretesting results, supply assessments, stakeholder meetings, household and service provider surveys and monitoring data to design models of maternal nutrition interventions. We developed detailed protocols for implementing maternal nutrition interventions; reinforced staff capacity, nutrition counselling, monitoring systems and community engagement processes; and addressed micronutrient supplement supply bottlenecks. Community-level activities were essential for complementing facility-based services. Routine monitoring data, rapid assessments and information from intensified supervision were important during the early stages of implementation to improve the feasibility and scalability of models. The lessons from addressing maternal nutrition in ANC may serve as a guide for tackling missed opportunities for nutrition within health services in other contexts.

× Differences in world market participation and access to value chain technologies have resulted in uneven experiences across countries. In this paper, we explore their impact on prices in the value chain, using the example of Ethiopia and Uganda. We develop a conceptual framework, then validate the model using primary price data collected at several levels in the dairy value chains in both countries. We find that prices are lower in Uganda than Ethiopia, reflecting their respective net trade status. Moreover, despite shorter value chains, we find much more significant effects of distances from the capital on milk prices in Ethiopia than in Uganda. This is linked to the presence of milk chilling centers in Uganda. While such technology is important for milk quality, we find here that they also have the added benefit to reduce the impact of farmer's remoteness on prices and allow for more geographically extended value chains.

× More than one billion people worldwide receive cash or in-kind transfers from social protection programs. In low-income countries, these transfers are often conditioned on participation in labor-intensive public works to rehabilitate local infrastructure or natural resources. Despite their popularity, the environmental impacts of public works programs remain largely undocumented. We quantify the impact on tree cover of Ethiopia’s Productive Safety Net Program (PSNP), one of the world’s largest and longest-running public works programs, using satellite-based data of tree cover combined with difference-in-differences and inverse probability treatment weighting methodologies. We find that the PSNP increased tree cover by 3.8% between 2005 and 2019, with larger increases in less densely populated areas and on steep-sloped terrain. As increasing tree cover is considered an important strategy to mitigate global warming, our results suggest a win–win potential for social safety net programs with an environmental component.

× Evidence on the potential for agricultural intensification to improve nutrition has grown considerably. While small-scale irrigation is a key factor driving agricultural intensification in sub-Saharan Africa, its impact on nutrition has not yet been thoroughly explored. In this study, we assess the impact of adoption of small-scale irrigation in Ethiopia and Tanzania on household and women's dietary diversity, as well as children's nutrition. We use two rounds of primary data collected from irrigators and nonirrigators in Ethiopia and Tanzania. We used a panel fixed effects econometric approach to control for observed household, women and children specific characteristics as well as observed and unobserved time-invariant confounding factors. The results show that among Ethiopian households who reported having faced drought, women in irrigating households have higher Women's Dietary Diversity Score (WDDS) compared to women in nonirrigating households. In Tanzania, women in irrigating households have higher WDDS compared to nonirrigators and the impact of irrigation on WDDS more than doubles among households facing drought. In addition, among Tanzanian households who reported having faced a drought shock, irrigating households have higher Household Dietary Diversity Score compared to nonirrigators. Children in irrigating households in Ethiopia have weight-for-height z-scores (WHZ) that are 0.87 SDs higher, on average, than WHZ of children in nonirrigating households. In Tanzania, irrigation leads to higher WHZ-scores in children under-five among households who reported having experienced a drought in the 5 years preceding the survey. The study shows small-scale irrigation has a strong effect on households' economic access to food and on nutritional outcomes of women and children.

× We use plant level census data to identify spillovers from FDI in Ethiopia's manufacturing sector. Spillovers are identified by comparing changes in total factor productivity (TFP) among domestic plants in districts where a large greenfield foreign plant produces and districts where FDI in the same industry was licensed but not yet operational. Over the four years starting with the year of the FDI opening, the TFP of domestic plants is 11 percent higher in treated districts, employment in domestic plants increases and more domestic plants open. We describe mechanisms for knowledge diffusion using a plant level technology transfer survey. One third of Ethiopian plants are linked to FDI through labor sharing, supply chains and competition. Technology upgrading is most common as a reaction to competition in output markets and observation and imitation of FDI in the same line of business. Other benefits include enhanced managerial practices and knowledge about exporting.

× While social protection programmes have multiplied over the last two decades across sub-Saharan Africa, these coexist alongside humanitarian assistance in many places, calling for better integration of assistance delivered through the two channels. Progress on this front is hampered by limited evidence of whether and how these historically siloed sectors can work together. Using quantitative and qualitative data from districts covered by Ethiopia’s Productive Safety Net Programme (PSNP) and where humanitarian food assistance (HFA) was delivered, we assess differences in targeting and transfer values. We find that the PSNP and HFA were targeted to households with different characteristics. PSNP transfers did, on average, reach those households that were chronically food insecure. HFA, while delivered through the PSNP systems, was targeted to households that were acutely vulnerable. These are promising findings as they suggest that social protection systems are able to effectively deliver a continuum of support in response to different types of vulnerability and risk. On transfer values, we find that the value of PSNP transfers is greater than those for HFA. One reason for this may be due to the social pressure on local officials to distribute support more widely across a drought-affected population when faced with acute needs.

× Credit constraint is often considered as one of the key barriers to the adoption of modern agricultural technologies and low agricultural productivity in low- and middle-income countries. Past research and much of the policy discourse associate agricultural credit constraints with supply-side factors, such as limited access to credit sources or high costs of borrowing. However, demand-side factors, such as risk-aversion and financial illiteracy among borrowers could also affect credit-rationing of smallholder agricultural households. This study investigates the nature of credit constraints, factors affecting credit constraint status, and the effects of credit constraints on adoption and intensity of use of three modern agricultural technologies – small-scale irrigation, chemical fertilizer, and improved seeds. The paper also assesses whether credit constraints are gender-differentiated. Primary survey data were collected from sample farmers in Ethiopia and Tanzania, and Tobit and two-step hurdle econometric models were used to analyze these data. Results show that demand-side credit constraints are as important as supply-side factors in conditioning smallholders’ access to credit in both countries. We also find that credit is a binding constraint for the decision to adopt technologies and input use intensity in Tanzania but not statistically significant in Ethiopia. Results suggest that women are more likely to be credit constrained (from both the supply and demand sides) than men in both study countries. Based on these findings, we suggest that policies should focus on addressing both supply- and demand-side credit constraints to credit access, including through targeted interventions to reduce risk, such as crop insurance, and to strengthen the gender sensitivity of credit policies.

× Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food nvironments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks.

× CONTEXT: On-farm water application in Ethiopia, as in much of Sub-Saharan Africa, is dominated by furrow irrigation, which resulted in inefficient water uses and related economic and environmental problems. A recent project introduced two on-farm water management tools, called wetting front detectors and Chameleon sensors, to some farmers in Koga irrigation scheme and facilitated for other farmers in the quaternary canal, who did not receive the technology, to learn from farmers who installed the tools on their plots.
OBJECTIVES: The objective of this study is to investigate the role of different social ties on information exchanges among farmers when some farmers have the signal on how long to irrigate a field during an irrigation event from on-farm water management tools. The study explored the relative importance of being neighbors, friends, spatial proximity of farms, and project induced pairings.
METHODS: The study used a household survey data from all members of quaternary canals in the project that were in the technology, information, and control groups, as well as detailed network modules on how farmers with plots in the quaternary canal are associated with each other. A fixed effects econometric approach is used to control for time invariant household level and quaternary canal characteristics, while teasing out how the different social ties affect the information flow.
RESULTS AND CONCLUSIONS: The results show that being in purposeful friendships as indicated by knowing each other's decision on the use of agricultural inputs and its outcome, as well as being spatially proximate as indicated by having farm plots next to each other or usually passing by each other's plots play a significant role in determining whether information-recipient farmers received information from the technology-recipient farmers as expected. Being relatives or neighbors played a minor role to facilitate information exchanges on how long to irrigate. In addition, ad-hoc pairs of farmers between technology-recipient and information-recipient created through the project within the quaternary canal did not play a significant role above and beyond the existing social ties of friendships and spatial proximity.
SIGNIFICANCE: The findings have implications for effective ways of targeting in future scale up of such technologies as it informs that the roll out of such type of technologies and the extension services around it can better help technology diffusion and learning if they use friends and spatial proximates as anchors of information. That is, at times of over-subscription to such on-farm water management tools, information about the technology and the recommended duration of one irrigation turn can diffuse faster if the limited number of tools are distributed in such a way that friends and spatial proximates have access to a tool, rather than distributing the tools based on being neighbors or relatives.

× Telescoping errors occur if survey respondents misdate events from outside the reference period and include them in their recall. Concern about telescoping influenced the design of early Living Standards Measurement Study (LSMS) surveys, which used a two-visit interview format to bound food consumption recall. This design fell out of favor although not for evidence-based reasons. To measure the extent of telescoping bias on food consumption measures, a survey experiment was conducted in Addis Ababa, Ethiopia, randomly assigning households to either a two-visit bounded recall or a single visit unbounded recall. The average value of reported food consumption is 16 percent higher (95 percent CI: 7.4–25.9) in the unbounded single visit recall relative to the two-visit bounded recall. Most of the error is explained by difference in reported spending on less frequently consumed, protein-rich foods, so apparent food security indicators based on household diet diversity are likely overstated with unbounded recall.

× Improving household resilience is becoming one of the key focus and target of social protection programs in Africa. However, there is surprisingly little direct evidence of the impacts of social protection programs on household resilience measures. We use five rounds of panel data to examine rural households’ resilience outcomes associated with participation in Ethiopia’s Productive Safety Nets Program (PSNP). Following Cissé and Barrett (2018), we employ a probabilistic moment-based approach for measuring resilience and evaluate the role of PSNP transfers and duration of participation on households’ resilience. We document four important findings. First, although PSNP transfers are positively associated with resilience, PSNP transfers below the median are less likely to generate meaningful improvements in resilience. Second, continuous participation in the PSNP is associated with higher resilience. Third, combining safety nets with income generating or asset building initiatives may be particularly efficacious at building poor households’ resilience. Fourth, our evaluation of both short-term welfare (consumption) and longer-term outcomes (resilience) suggests that these outcomes are likely to be driven by different factors, suggesting that optimizing intervention designs for improving short term welfare impacts may not necessarily improve households’ resilience, and vice versa. Together, our findings imply that effectively boosting household resilience may require significant transfers over multiple years. National safety nets programs that transfer small amounts to beneficiaries over limited time horizons may not be very effective.

× Civil conflict began in Ethiopia in November 2020 and has reportedly caused major disrup tions in access to health services, food, and related critical services, in addition to the direct impacts of the conflict on health and well-being. However, the population-level impacts of
the conflict have not yet been systematically quantified. We analyze high frequency phone surveys conducted by the World Bank, which included measures of access to basic ser vices, to estimate the impact of the first phase of the war (November 2020 to May 2021) on households in Tigray. After controlling for sample selection, a difference-in-differences approach is used to estimate causal effects of the conflict on population access to health services, food, and water and sanitation. Inverse probability weighting is used to adjust for sample attrition. The conflict has increased the share of respondents who report that they were unable to access needed health services by 35 percentage points (95% CI: 14–55 pp)
and medicine by 8 pp (95% CI:2–15 pp). It has also increased the share of households unable to purchase staple foods by 26 pp (95% CI:7–45 pp). The share of households unable to access water did not increase, although the percentage able to purchase soap declined by 17 pp (95% CI: 1–32 pp). We document significant heterogeneity across popula tion groups, with disproportionate effects on the poor, on rural populations, on households with undernourished children, and those living in communities without health facilities. These significant disruptions in access to basic services likely underestimate the true bur den of conflict in the affected population, given that the conflict has continued beyond the
survey period, and that worse-affected households may have higher rates of non-response. Documented spatial and household-level heterogeneity in the impact of the conflict may help guide rapid post-conflict responses.

× Economists often default to the assumption that cash is always preferable to an in-kind transfer. Do beneficiaries feel the same way? This paper addresses this issue using longitudinal household data from Ethiopia, where a large-scale social safety net intervention (PSNP) operates. Even though most payments are made in cash, and even though the (temporal) transaction costs associated with food payments are higher than payments received as cash, most beneficiaries stated that they prefer their payments only or partly in food. Higher food prices induce shifts in stated preferences toward in-kind transfers. More food-secure households, those closer to food markets and to financial services are more likely to prefer cash. Though shifts occur, the stated preference for food is dominant: In no year do more than 17 percent of households prefer only cash. There is suggestive evidence that stated preferences for food are also driven by self-control concerns.

× We study post-harvest losses (PHL) in important and rapidly growing rural–urban value chains in Ethiopia. We analyze self-reported PHL from different value chain agents – farmers, wholesale traders, processors, and retailers – based on unique large-scale data sets for two major commercial commodities, the storable staple teff and the perishable liquid milk. Aggregate PHL over all segments of the value chain (farmer to retailer) in the most prevalent marketing channel for teff and milk amount to between 2.2 and 3.3 percent and 2.1 and 4.3 percent of total produced quantities, respectively. Estimates of PHL from this research are found to be lower than is commonly assumed. We complement these findings with primary data from urban food retailers for more than 4,000 commodities. We find that the emerging modern retail sector in Ethiopia is characterized on average by half the level of PHL than is observed in the traditional retail sector. This is likely due to more stringent quality requirements in procurement systems, to sales of more packaged – and therefore better protected – commodities, and to better refrigeration, storage, and sales facilities. The further expected expansion of modern retail in these settings should therefore likely lead to a lowering of PHL in food value chains, at least at the retail level.

× Sub-Saharan Africa has long been beset with food insecurity. Investment in small-scale irrigation may provide a solution to address the challenge by extending crop production into the dry season. We present an agent-based modeling system to assess the potential of dry-season small-irrigation development in Sub-Saharan Africa with an application to Ethiopia. We identify significant potential for investing in dry-season small-scale irrigation in Ethiopia and map geographic domains with highest investment opportunities.

× The mechanism(s) that generate measurement error matter for inference. Survey measurement error is typically thought to represent simple misreporting correctable through improved measurement. But errors might also or alternatively reflect respondent misperceptions that materially affect the respondent decisions under study. We show analytically that these alternate data generating processes imply different appropriate regression specifications and have distinct effects on the bias in parameter estimates. We introduce a simple empirical technique to generate unbiased estimates under more general conditions and to apportion measurement error between misreporting and misperceptions in measurement error when one has both self‐reported and objectively measured observations of the same explanatory variable. We then apply these techniques to the longstanding question of agricultural intensification: Do farmers increase input application rates per unit area as the size of the plots they cultivate decreases? Using nationally representative data from four sub‐Saharan African countries, we find evidence that measurement error in plot size reflects a mixture of farmer misreporting and misperceptions. The results matter for inference around the intensification hypothesis and call into question whether more objective, precise measures are always preferable when estimating behavioral parameters.

× Exchange rate policies can have important implications on incentives for export agriculture. However, their effects are often not well understood. We study the issue of foreign exchange controls and pricing in the value chain for Ethiopia's coffee—its most important export crop. Relying on unique pricing and cost data, we find that coffee exporters are willing to incur losses during exporting by offering high prices for coffee locally in order to access scarce foreign exchange. We further find that the consequent high wholesale prices for coffee are transmitted to producers, so that coffee farmers are unintended beneficiaries of this rent.

× Background: Intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes. We analysed the spillover effects of Unite for a Better Life (UBL), an intervention evaluated in a cluster randomised controlled trial using a double-randomised design; previous evidence suggests UBL reduced IPV in rural Ethiopia among direct beneficiaries.
Methods: Villages (n=64) were randomly allocated to control, or to receive UBL delivered to men, women or couples. Each cluster comprised 106 surveyed households, including 21 randomly selected indirect beneficiary households who were not included in the intervention. Primary and secondary IPV outcomes included women’s experience and men’s perpetration of past-year physical or sexual IPV 24 months postintervention. An intention-to-treat analysis was conducted comparing indirect beneficiaries to sampled households in control communities. The analysis includes 2516 households surveyed at baseline in 2014–2015 (1680 households in the control arm, 258 indirect beneficiary households in the couples’ arm, 287 indirect beneficiary households in the women’s arm and 291 indirect beneficiary households in the men’s arm). Follow-up data were available from 88% of baseline respondents and 86% of baseline spouses surveyed in 2017–2018, a total of 4379 individuals.
Results: Among indirect beneficiaries, there was no statistically significant intervention effect on women’s past-year experience of physical or sexual IPV, while men’s UBL significantly reduced reported perpetration of past-year sexual IPV (Adjusted Odds Ratio: 0.55; 95% CI 0.38 to 0.80, p=0.002). The intervention effects among indirect beneficiaries were statistically similar to those reported for the direct beneficiaries. In general, the hypothesis of equal effects cannot be rejected.
Conclusion: A gender-transformative intervention delivered to men was effective in reducing reported IPV even among indirect beneficiaries, suggesting that the programme had positive spillover effects in diffusing information and changing behaviours within the broader community.

× International humanitarian organizations have expressed substantial concern about the potential for increases in food insecurity resulting from the COVID‐19 pandemic. We use a unique panel survey of a representative sample households in Addis Ababa to study both food security and food consumption during the pandemic. In contrast to some other countries in the region, Ethiopia never went into a full lockdown severely restricting movement. Despite subjective income measures suggesting a large proportion of households have been exposed to job loss or reduced incomes, we find that relative to a survey conducted in August and September of 2019, food consumption and household dietary diversity are largely unchanged or slightly increased by August 2020. We find some changes in the composition of food consumption, but they are not related to shocks found in previous phone surveys conducted with the same households. The results therefore suggest the types of subjective questions about income typically being asked in COVID‐19 phone surveys may not appropriately reflect the magnitude of such shocks. They also imply, at least indirectly, that in the aggregate food value chains have been resilient to the shock associated with the pandemic.

× Objectives: Experience of intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes for women. However, rigorous economic evaluations of interventions targeting IPV prevention are rare. This paper analyses the cost-effectiveness of Unite for a Better Life (UBL), a gender-transformative intervention designed to prevent IPV and HIV risk behaviours among men, women and couples. Design: We use an economic evaluation nested within a large-scale cluster randomised controlled trial, analysing financial and economic costs tracked contemporaneously. Setting: UBL was implemented in rural southern Ethiopia between 2013 and 2015. Participants: The randomised controlled trial included 6770 households in 64 villages. Interventions: UBL is an intervention delivered within the context of the Ethiopian coffee ceremony, a culturally established forum for community discussion, and designed to assist participants to build skills for healthy, non-violent, equitable relationships. Primary and secondary outcome measures: This paper reports on the unit cost and cost-effectiveness of the interventions implemented. Cost-effectiveness is measured as the cost per case of past-year physical and/or sexual IPV averted. Results: The estimated annualised cost of developing and implementing UBL was 2015 US$296 772, or approximately 2015 US$74 per individual directly participating in the intervention and 2015 US$5 per person annually for each community-level beneficiary (woman of reproductive age in intervention communities). The estimated cost per case of past-year physical and/or sexual IPV averted was 2015 US$2726 for the sample of direct beneficiaries, and 2015 US$194 for the sample of all community-level beneficiaries. Conclusions: UBL is an effective and cost-effective intervention for the prevention of IPV in a low and middle-income country setting. Further research should explore strategies to quantify the positive effects of the intervention across other domains.

× The COVID‐19 impact on the global economy combined with partial lockdown measures in Ethiopia represents a large, unprecedented shock to the country's economy. The social accounting matrix (SAM) multiplier model, built on the most up‐to‐date SAM (2017) for Ethiopia, shows that the country suffered a 14.3% loss in GDP (Birr 43.5 billion or US$1.9 billion) during the lockdown period compared to the no‐COVID case during the same period. Nearly two‐thirds of the losses come from the services sector. Although no direct restrictions were imposed on the agriculture sector, which is the primary means of livelihood for most, the sector faces a 4.7% loss in output due to its linkages with the rest of the economy. We find dissimilar income and poverty effects across households by income quintile and level of urbanization. The study also considers two recovery scenarios and generates relevant insights on the potential impacts of COVID‐19 by the end of 2020. The earmarked relief and recovery plan resources can only help the economy to recover if targeted in an efficient way towards sectors most affected by COVID‐19, and further resources are mobilized to support strategic sectors—those with the highest economywide multiplier effects—and vulnerable communities.

× It is widely feared that the shock of the COVID‐19 pandemic will lead to a significant worsening of the food security situation in low and middle‐income countries. One reason for this is the disruption of food marketing systems and subsequent changes in farm and consumer prices. Based on primary data in Ethiopia collected just before the start and a few months into the pandemic, we assess changes in farm and consumer prices of four major vegetables and the contribution of different segments of the rural‐urban value chain in urban retail price formation. We find large, but heterogeneous, price changes for different vegetables with relatively larger changes seen at the farm level, compared to the consumer level, leading to winners and losers among local vegetable farmers due to pandemic‐related trade disruptions. We further note that despite substantial hurdles in domestic trade reported by most value chain agents, increases in marketing—and especially transportation—costs have not been the major contributor to overall changes in retail prices. Marketing margins even declined for half of the vegetables studied. The relatively small changes in marketing margins overall indicate the resilience of these domestic value chains during the pandemic in Ethiopia.

× This article analyzes how urban proximity introduces spatial heterogeneity in farm productivity within the high-value dairy sector in one of the poorest countries in Africa, Ethiopia. We look at how urban proximity—measured as travel time—affects the decisions and productivity of milk farmers located in rural production zones serving fresh milk to the capital Addis Ababa. Using an instrumental variable approach, we find that with each additional hour of travel time, farmers’ milk productivity per cow is reduced, on average, by almost 1 L per day or by 26%. When trying to disentangle the underlying mechanisms (and controlling for transaction costs), we find that farmers’ inclusion in “modern” value chains and their access to commercial milk buyers and milk processing companies drive the urban proximity effect. As only a limited number of farmers have access to such value chains in developing countries, measures to make dairy value chains more inclusive to remote—often poorer—farmers can, therefore, have important benefits for them, for the performance of the dairy sector in Ethiopia, and for the process of agricultural transformation as a whole.

× Increased deployment of agricultural extension agents (EAs) in rural areas is recommended to spur agricultural productivity and mitigate spatial imbalances in welfare. However, high turnover and low motivation levels of EAs in remote areas pose challenges for equitable service provision and, in some cases, exacerbate geographical welfare disparities. We assess the effectiveness of selected potential policy interventions to incentivise and retain EAs in remote areas of Ethiopia. To this end, we conducted a choice experiment to elicit the preferences of 761 EAs for job attributes. We apply a random parameters logit model to estimate parameters of interest and to simulate the impact of possible policy interventions. Our results show that offering education opportunities is by far the most powerful instrument to attract and retain EAs. It increases uptake of the extension job in remote locations by 77 percentage points, which is significantly higher than the effect from doubling current salary levels. EAs also expressed a strong preference for work environments with basic amenities, housing, transportation services, and well-equipped Farmer Training Centres (FTCs). Furthermore, the results from sub-sample analyses show that female EAs are less responsive to pecuniary incentives and are more concerned with the availability of infrastructure and amenities. Current salary levels, years of employment, and location of work are also important sources of heterogeneity in the response of EAs to potential policy changes.

× Agricultural statistics and applied analyses have benefitted from moving from farmer estimates of yield to crop cut based estimates, now regarded as a gold standard. However, in practice, crop cuts and other sample-based protocols vary widely in the details of their implementations and little empirical work has documented how alternative yield estimation methods perform. Here, we undertake a well-measured experiment of multiple yield estimation methods on 237 smallholder maize plots in Amhara region, Ethiopia. We compare yield from a full plot harvest with farmer assessments and with estimates from a variety of field sampling protocols: W-walk, transect, random quadrant, random octant, center quadrant, and 3 diagonal quadrants. We find that protocol choices are important: alternative protocols vary considerably in their accuracy relative to the whole plot, with absolute mean errors ranging from 23 (farmer estimates) to 10.6 (random octant). Furthermore, while most methods approximate the sample mean reasonably well, the divergence of individual measures from true plot-level values can be considerable. We find that randomly positioned quadrants outperform systematic sampling schemes: the random octant had the best accuracy and was the most cost-effective. The nature of bias is non-classical: bias is correlated with plot size as well as with plot management characteristics. In summary, our results advocate that even “gold standard” crop cut measures should be interpreted cautiously, and more empirical work should be carried out to validate and extend our conclusions.

× Using a household and plot-level survey conducted in Ethiopia, this study analyzes the difference in farmers’ adoption of sustainable land management (SLM) practices between their rainfed and irrigated plots. The paper also investigates the varying influence of different types of irrigation water management systems and associated irrigation technologies on the adoption of SLM practices in irrigated plots. After controlling for heterogeneity among different irrigation water management systems and technologies, we found that access to irrigation play major role in enhancing farmers’ motivation to adopt more SLM practices. Furthermore, the combined effect of irrigation water management system and irrigation technology on type and number of SLM practices adopted is quite varied and very significant. The evidence highlights that farmers adopt more SLM practices in their plots with pump irrigation compared to those plots where gravity irrigation is applied because pump irrigation systems enhance complementarities with SLM practices. Finally, the findings underscore that the type of irrigation water management and the irrigation technology applied play an important role in restoring degraded lands and maintaining soil fertility, even when farmers’ adoption of irrigation was not explicitly triggered by concerns for soil health.

× The impact of food taboos–often because of religion–is understudied. In Ethiopia, religious fasting by Orthodox Christians is assumed to be an important impediment for the sustainable development of a competitive dairy sector and desired higher milk consumption, especially by children. However, evidence is limited. Relying on unique data, we shed light on three major issues. First, we observe that the average annual number of fasting days that Orthodox adults are effectively adhering to is 140, less than commonly cited averages. Using this as an estimate for extrapolation, fasting is estimated to reduce annual dairy consumption by approximately 12 percent nationally. Second, farms adapt to declining milk demand during fasting by increased processing of milk into storable products–fasting contributes to larger price swings for these products. We further note continued sales of milk by non-remote farmers and reduced production–by adjusting lactation times for dairy animals–for remote farmers. Third, fasting is mostly associated with increased milk consumption by the children of dairy farmers, seemingly because of excess milk availability during fasting periods. Our results suggest that fasting habits are not a major explanation for the observed poor performance of Ethiopia’s dairy sector nor low milk consumption by children. To reduce the impact of fasting on the dairy sector in Ethiopia further, investment is called for in improved milk processing, storage, and infrastructure facilities.

× Background
Social and behavior change communication interventions are integral to improving dietary and care practices, but evidence on the impact of the combination and intensity of these interventions in different contexts is scarce.
Objective
We examined the extent of and factors associated with intervention exposure: interpersonal communication (IPC) alone or with other interventions (i.e., mass media, community mobilization, or nutrition-sensitive agricultural activities); number of and factors associated with IPC contacts; and combinations of intervention components and number of contacts associated with infant and young child feeding (IYCF) practices.

× We provide new evidence on the impact of social protection interventions on household size and the factors that cause the household size to change: fertility, child fosterage, and in and out migration related to work and marriage. Using data from an intervention delivered at scale, Ethiopia’s Productive Safety Net Program (PSNP), we find that participation in the PSNP leads to an increase in household size of 0.3 members. We find no evidence that PSNP participation increases fertility and some evidence that fertility is reduced, specifically it reduces the likelihood that an adult female member gives birth by 8.1 percentage points. We reconcile this seemingly divergent findings by showing that the increase in household size arises from an increase in the number of girls aged 12 to 18 years. We present evidence that this occurs because the PSNP causes households to delay marrying out adolescent females.

× Limited evidence exists on the complex relationship among interventions, early initiation of breastfeeding (EIBF), prelacteal feeding and exclusive breastfeeding (EBF). We examined whether early breastfeeding practices are associated with EBF and how much improving EIBF and non‐prelacteal feeding contributes to increased prevalence of EBF. Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia. Multivariable logistic regression analyses were used to examine effects of interventions and early breastfeeding practices on EBF. Structural equation modelling quantified the direct and indirect effects of interventions (via improving EIBF and non‐prelacteal feeding) on EBF. Although breastfeeding is nearly universal in all three countries (≥98%), delayed initiation of breastfeeding is prevalent (>60%) and prelacteal feeding is common. EIBF alone was not associated with EBF, whereas non‐prelacteal feeding was associated with 1.6–3.5 higher odds of EBF. Intervention exposure affected breastfeeding practices in all three countries; these impacts were amplified among those who practiced EIBF or non‐prelacteal feeding [odds ratio (OR) = 11 and 27.5 in Bangladesh and 6.5 and 11.5 in Vietnam, respectively]. The paths through EIBF and non‐prelacteal feeding explained 13%–18% of the effect of the interventions on EBF. Early breastfeeding practices influence EBF, but interventions aimed only at the initiation and early days of breastfeeding will be inadequate to promote EBF. Social and behaviour change interventions should simultaneously target EIBF, non‐prelacteal feeding and EBF to support optimal breastfeeding practices.

× This paper develops a regional TIMES modelling framework for the electricity sector of the Eastern Nile Basin region, including Egypt, Ethiopia and Sudan, to assess the potential of energy trading for cross-border collaboration in this rapidly growing sector. Four alternative scenarios are developed for the 2014–2050 period to assess national and regional benefits of alternative energy development strategies. The study finds that electricity trading scenarios out-perform a reference scenario that assumes no energy trading, lowering systems cost by 4.5–7.2%. Total systems costs are lower, even when transmission costs for trade are considered. Costs are also lower with increased generation from renewables compared to investments without regional trade. Investing in renewables has important co-benefits, such as improved energy security and reduced greenhouse gas emissions. Supporting energy trade not only reduces systems costs, but can also strengthen cooperation in the region, as reflected in the energy trading efforts of the East African Power Pool and the transboundary collaboration efforts of the Nile Basin Initiative.

× Child stunting and linear growth faltering have declined over the past few decades and several countries have made exemplary progress.

× Intimate partner violence (IPV) is linked to substance use by male perpetrators and is associated with an increased risk of depression for women who experience violence. Unite for a Better Life (UBL) is a gender-transformative intervention delivered to men, women, and couples in Ethiopia; previous evidence demonstrated the intervention significantly reduced experience of and perpetration of IPV when delivered to men and led to more equitable household task-sharing when delivered to men and couples. The aim of this analysis is to assess engagement in the UBL intervention and to examine the relationship between random assignment to the intervention and men’s past-year substance use and women’s reported depressive symptoms as measured at the individual level.

× Intimate partner violence (IPV) is associated with increased HIV risk and other adverse health and psychosocial outcomes. We assessed the impact of Unite for a Better Life (UBL), a gender-transformative, participatory intervention delivered to men, women, and couples in Ethiopia in the context of the coffee ceremony, a traditional community-based discussion forum. Villages (n = 64) in 4 Ethiopian districts were randomly allocated to control, men’s UBL, women’s UBL, or couples’ UBL, and approximately 106 households per village were randomly selected for inclusion in the trial. The intervention included 14 sessions delivered twice weekly by trained facilitators; control arm households were offered a short IPV educational session. Primary outcomes were women’s experience of past-year physical or sexual IPV 24 months postintervention. Secondary outcomes included male perpetration of past-year physical or sexual IPV, comprehensive HIV knowledge, and condom use at last intercourse. Additional prespecified outcomes included experience and perpetration of past-year physical and/or sexual IPV and emotional IPV, HIV/AIDs knowledge and behaviors, decision-making, and gender norms. An intention-to-treat (ITT) analysis was conducted, evaluating 6,770 households surveyed at baseline in 2014–2015 (1,680 households, 16 clusters in control; 1,692 households, 16 clusters in couples’ UBL; 1,707 households, 16 clusters in women’s UBL; 1,691 households, 16 clusters in men’s UBL). Follow-up data were available from 88% of baseline respondents and 87% of baseline spouses surveyed in 2017–2018. Results from both unadjusted and adjusted specifications are reported, the latter adjusting for age, education level, marriage length, polygamy, socioeconomic status, and months between intervention and endline. For primary outcomes, there was no effect of any UBL intervention compared to control on women’s past-year experience of physical (couples’ UBL arm adjusted odds ratio [AOR] = 1.00, 95% confidence interval [CI]: 0.77–1.30, p = 0.973; women’s UBL arm AOR = 1.11, 95% CI 0.87–1.42, p = 0.414; men’s UBL arm AOR = 1.02, 95% CI: 0.81–1.28, p = 0.865) or sexual IPV (couples’ UBL arm AOR = 0.86, 95% CI: 0.62–1.20, p = 0.378; women’s UBL arm AOR = 1.15, 95% CI: 0.89–1.50; p = 0.291; men’s UBL arm AOR = 0.80, 95% CI: 0.63–1.01, p = 0.062). For the secondary outcomes, only the men’s UBL intervention significantly reduced male perpetration of past-year sexual IPV (AOR: 0.73; 95% CI: 0.56–0.94, p = 0.014), and no intervention reduced perpetration of past-year physical IPV. Among women, the couples’ UBL intervention significantly improved comprehensive HIV knowledge, and both couples’ and women’s UBL significantly increased reported condom use at last intercourse. Among additional outcomes of interest, the men’s UBL intervention was associated with a significant reduction in women’s experience of past-year physical and/or sexual IPV (AOR = 0.81, 95% CI: 0.66–0.99, p = 0.036) and men’s perpetration of physical and/or sexual IPV (AOR = 0.78; 95% CI: 0.62–0.98, p = 0.037). UBL delivered to men and couples was associated with a significant reduction in HIV risk behaviors and more equitable intrahousehold decision-making and household task-sharing. The primary limitation is reliance on self-reported data. A gender-transformative intervention delivered to men was effective in reducing self-reported perpetration of sexual IPV but did not reduce IPV when delivered to couples or women. We found evidence of decreased sexual IPV with men’s UBL across men’s and women’s reports and of increased HIV knowledge and condom use at last intercourse among women. The men’s UBL intervention could help accelerate progress towards gender equality and combating HIV/AIDS.

× Driven by the fast spread of private irrigation pumps, there has been a rapid expansion of intensive vegetable cultivation in the central Rift Valley in Ethiopia, making it the most important commercial vegetable production cluster in the country. Supporting that “quiet revolution” has been an inflow of migrant laborers—paid through daily, monthly, or piecemeal contracts, with few employment benefits attached to them—and a gig economy as widely used contractors organize, among others, mechanized land preparation, the digging of wells and ponds, seedling propagation, and loading of trucks. Almost 60% of the irrigated area is cultivated by medium-scale tenant farmers relying on short-term rental contracts. It seems that gig economies characterized by flexible contract arrangements implemented by outside contractors, which are increasingly fueling sophisticated sectors in developed countries, are important in these commercial agrarian settings in Africa as well. We further find that the COVID-19 pandemic has led to significant disruptions of this model, as seen by more limited access to services and the unavailability or high price increases in factor markets, especially for labor, and large but heterogenous price changes in output markets.