IFPRI Journal Articles
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Item Impact of intervention strategies on fruit and vegetable intake in low-, middle- and high-income countries: A scoping review(Journal Article, 2025) Koyratty, Nadia; Azupogo, Fusta; Smith, Taryn J.; Hinnouho, Guy-Marino; Tharaney, Manisha; Bliznashka, Lilia; Olney, Deanna K.; Hess, Sonja Y.Background: Despite well-documented health benefits, fruit and vegetable (F&V) intake remains below recommended levels globally. Objectives: This scoping review aimed to identify effective intervention strategies to increase F&V intake. Methods: We searched PubMed and Web of Science (February 2023) for intervention studies assessing impact on F&V intake. Eligibility criteria included studies published in English since 2012, a valid control group, ≥2 weeks duration, and ≥50 participants per intervention arm. Analysis was done by intervention comparison. Findings were described by summarizing proportion of intervention comparisons reporting statistically significant increases in fruit, vegetable and/or combined F&V intake across standalone (nutrition communication, social protection, agriculture or food environment restructuring) and multi-component strategies. Results: A total of 284 intervention comparisons (223 unique studies) were included. The majority of comparisons (191/284) came from high-income countries (HICs) and 93/284 from low- and middle-income countries (LMICs). Nutrition communication was the most common standalone strategy, with 121/218 comparisons reporting positive impacts on fruit, vegetable and/or combined F&V intake. Fewer studies evaluated standalone social protection (13/284), food environment restructuring (4/284), or agriculture strategies (3/284). Among the limited interventions, 7/13 social protection and 3/4 food environment restructuring comparisons reported positive impacts, while none of the three standalone agricultural interventions did. Multi-component interventions demonstrated potential with 28/46 comparisons having positive impacts. Conclusions: Some of the intervention strategies showed potential for increasing fruit and/or vegetable intake. However, given the heterogeneity of the interventions, small number of studies for some strategies and limited evidence from LMICs, more rigorous, context-specific research is needed.Item A practical guide to adjust micronutrient biomarkers for inflammation using the BRINDA method(Journal Article, 2023-04) Luo, Hanqi; Geng, Jiaxi; Zeiler, Madeleine; Nieckula, Emily; Sandalinas, Fanny; Williams, Anne; Young, Melissa F.; Suchdev, Parminder S.The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) research group was formed over a decade ago to improve the interpretation of micronutrient biomarkers in settings with inflammation. The BRINDA inflammation adjustment method uses regression correction to adjust for the confounding effects of inflammation on select micronutrient biomarkers and has provided important insights to micronutrient research, policy, and programming. However, users may face challenges when applying the BRINDA inflammation adjustment methods to their own data due to varying guidance on the adjustment approach for different biomarkers and the need to develop statistical programming to conduct these analyses. This may result in lost opportunities to have results of micronutrient data readily available during critical decision-making periods. Our research objectives are to 1) provide an all-in-one summary of the BRINDA method in adjusting multiple micronutrient biomarkers for inflammation, 2) evaluate whether malaria as a binary variable should be included in the BRINDA inflammation adjustment method, and 3) present standardized and user-friendly BRINDA adjustment R package and SAS macro. This paper serves as a practical guidebook for the BRINDA inflammation adjustment approach and aids users to use the BRINDA R package and SAS to streamline their analyses.Item Comparison of total body vitamin A stores using individual versus population 13C-natural abundance of serum retinol in preschool children and women residing in 6 diverse African countries(Journal Article, 2023-04) Gannon, Bryan M.; Sombié, Olivier O.; Zeba, Augustin N.; Nama, Gabriel Medoua; Bekele, Tesfaye Hailu; Woldeyohannes, Meseret; van Stuijvenberg, Martha E.; Dhansay, Muhammad A.; Urio, Elisaphinate M.; Kaliwile, Chisela; Chileshe, Justin; Kalungwana, Ng’Andwe; Davis, Christopher R.; Grahn, Michael; Tanumihardjo, Sherry A.Background Stable isotope techniques using 13C to assess vitamin A (VA) dietary sources, absorption, and total body VA stores (TBSs) require determination of baseline 13C abundance. 13C-natural abundance is approximately 1.1% total carbon, but varies with foods consumed, supplements taken, and food fortification with synthetic retinyl palmitate. Objectives We determined 13C variation from purified serum retinol and the resulting impact on TBSs using pooled data from preschool children in Burkina Faso, Cameroon, Ethiopia, South Africa, Tanzania, and Zambia and Zambian women. Methods Seven studies included children (n = 639; 56 ± 25 mo; 48% female) and one in women (n = 138; 29 ± 8.5 y). Serum retinol 13C-natural abundance was determined using GC-C-IRMS. TBSs were available in 7 studies that employed retinol isotope dilution (RID). Serum CRP and α1-acid-glycoprotein (AGP) were available from 6 studies in children. Multivariate mixed models assessed the impact of covariates on retinol 13C. Spearman correlations and Bland–Altman analysis compared serum and milk retinol 13C and evaluated the impact of using study- or global-retinol 13C estimates on calculated TBSs. Results 13C-natural abundance (%, median [Q1, Q3]) differed among countries (low: Zambia, 1.0744 [1.0736, 1.0753]; high: South Africa, 1.0773 [1.0769, 1.0779]) and was associated with TBSs, CRP, and AGP in children and with TBSs in women. 13C-enrichment from serum and milk retinol were correlated (r = 0.52; P = 0.0001). RID in children and women using study and global estimates had low mean bias (range, −3.7% to 2.2%), but larger 95% limits of agreement (range, −23% to 37%). Conclusions 13C-natural abundance is different among human cohorts in Africa. Collecting this information in subgroups is recommended for surveys using RID. When TBSs are needed on individuals in clinical applications, baseline 13C measures are important and should be measured in all enrolled subjects.Item Proximate composition, minerals, tannins, phytates and cooking quality of commercial cowpea cultivars(Journal Article, 2023-09) Oliveira, Adolfo M. C. de; Jean, Abdias; Damasceno-Silva, Kaesel J.; Moreira-Araújo, Regilda S. dos R.; Franco, Luis J. D.; Rocha, Maurisrael de M.Cowpea is a socioeconomically important legume in the Northeast region of Brazil, and the most grown and consumed type of bean, representing the main source of low-cost vegetable protein for rural and urban populations in this region. The objective of this work was to characterize the proximate composition, minerals, tannins, phytic acid, and cooking quality of whole grains of cowpea from the commercial cultivars BRS Aracê, BRS Inhuma, and BRS Xiquexique. Grain samples of the cultivars were ground in a zirconium ball mill and the flour was used for analysis. The proximate composition was carried out according to the AOAC methodology. The minerals were determined by nitro-perchloric digestion and reading in a flame atomic absorption spectrophotometer. The anti-nutritional factors tannins and phytic acid were determined by extraction and reading in a spectrophotometer. Cooking quality was assessed using an electric pressure cooker and then a Mattson cooker. A completely randomized experimental design was used, with three treatments (cultivars) and three replications. The data were subjected to analysis of variance and the means were compared by the Tukey's test (p<0.05). The cowpea cultivars showed significant differences (p<0.05) for most characteristics evaluated and were similar in terms of ash, lipids, total dietary fiber, and most macrominerals. The results showed that grains of the cultivars BRS Aracê and BRS Xiquexique are excellent sources of dietary fiber, proteins, and minerals and present high cooking quality, while grains of the cultivar BRS Inhuma stood out regarding carbohydrates, soluble dietary fibers, total energetic value, and low levels of factors, anti-nutritional tannins and phytic acid.Item Modeling covariance structures for genetic and non‐genetic effects in cowpea multi‐environment trials(Journal Article, 2023-05) Araújo, Maurício dos Santos; Chaves, Saulo Fabrício da Silva; Damasceno‐Silva, Kaesel Jackson; Dias, Luiz Antônio dos Santos; de Rocha, Maurisrael de MouraItem Heterosis and line-by-tester combining ability analysis for grain yield and provitamin A in maize(Journal Article, 2023-06-30) Tabu, I.; Lubobo, K.; Mbuya, K.; Kimuni, N.Developing a high-yielding and provitamin A-rich maize variety is one of the best approaches to reduce malnutrition and increase production, especially in regions where maize is a staple food, such as, the former Katanga Province in the Democratic Republic of the Congo. However, it requires a good knowledge of combining ability and heterosis for grain yield and provitamin A. Thus, evaluating grain yield, provitamin A content and other agronomic traits of eight lines, four testers, and their 32 hybrids occurred during the 2015-2016 and 2016-2017 cropping seasons. The results showed that genetic parameters related to combining ability and heterosis among various F1 hybrids influenced all the studied traits except plant height. The parental genotypes P6 and P10 were suitable for improving 100-kernel weight, grain yield, stature at ear insertion, and provitamin A content. The parental genotypes P7, P4, and P2 were promising for provitamin A content, while the parental genotype P3 was leading for grain yield. Five hybrids (P10 × P5, P10 × P6, P10 × P7, P10 × P8, and P11 × P5) showed distinction as the best specific combinations for improving productivity and provitamin A content. The F1 hybrid P10 × P6 with desirable specific combining ability revealed that it is helpful as the best combination in producing double and triple hybrids with the highest yield and provitamin A potential. Crosses P10 × P5 and P11 × P5 can serve as the best cross combinations for grain yield, while hybrids P10 × P7 and P10 × P8 showed promising for provitamin A content. The presented results could benefit future breeding programs to develop maize genotypes with high yield and provitamin A elements, alleviating food insecurity and malnutrition.Item Adapting agriculture platforms for nutrition: A case study of a participatory, video-based agricultural extension platform in India(Journal Article, 2016-10) Kadiyala, Suneetha; Morgan, Emily H.; Cyriac, Shruthi; Margolies, Amy; Roopnaraine, Terry; Shukla, DeepakSuccessful integration of nutrition interventions into large-scale development programmes from nutrition-relevant sectors, such as agriculture, can address critical underlying determinants of undernutrition and enhance the coverage and effectiveness of on-going nutrition-specific activities. However, evidence on how this can be done is limited. This study examines the feasibility of delivering maternal, infant, and young child nutrition behaviour change communication through an innovative agricultural extension programme serving nutritionally vulnerable groups in rural India. The existing agriculture programme involves participatory production of low-cost videos promoting best practices and broad dissemination through village-level women’s self-help groups. For the nutrition intervention, 10 videos promoting specific maternal, infant, and young child nutrition practices were produced and disseminated in 30 villages. A range of methods was used to collect data, including in-depth interviews with project staff, frontline health workers, and self-help group members and their families; structured observations of mediated video dissemination sessions; nutrition knowledge tests with project staff and self-help group members; and a social network questionnaire to assess diffusion of promoted nutrition messages. We found the nutrition intervention to be well-received by rural communities and viewed as complementary to existing frontline health services. However, compared to agriculture, nutrition content required more time, creativity, and technical support to develop and deliver. Experimentation with promoted nutrition behaviours was high, but sharing of information from the videos with non-viewers was limited. Key lessons learned include the benefits of and need for collaboration with existing health services; continued technical support for implementing partners; engagement with local cultural norms and beliefs; empowerment of women’s group members to champion nutrition; and enhancement of message diffusion mechanisms to reach pregnant women and mothers of young children at scale. Understanding the experience of developing and delivering this intervention will benefit the design of new nutrition interventions which seek to leverage agriculture platforms.Item Buyer-side gender discrimination in bargaining: Evidence from seed sales in Uganda(Journal Article, 2025-12) Van Campenhout, Bjorn; Nabwire, LeocardiaItem Farmers’ purchase intention and willingness to pay for certified sweetpotato seed under different disease pressure zones in Uganda(Journal Article, 2024-05) Musoke, Charles; Kyazze, Florence B.; Kibwika, Paul; Mukasa, Settumba B.Item Hybrid performance and grain yield stability for advanced provitamin A and quality protein maize hybrids evaluated in Ethiopia(Journal Article, 2024-09) Engida, Bitew Tilahun; Yadesa, Lemi; Garoma, Belay; Goben, BedluItem Genomic prediction of tocochromanols in exotic-derived maize(Journal Article, 2023-12) Tibbs-Cortes, Laura E.; Guo, Tingting; Li, Xianran; Tanaka, Ryokei; Vanous, Adam E.; Peters, David; Gardner, Candice; Magallanes-Lundback, Maria; Deason, Nicholas T.; DellaPenna, Dean; Gore, Michael A.; Yu, JianmingTocochromanols (vitamin E) are an essential part of the human diet. Plant products, including maize (Zea mays L.) grain, are the major dietary source of tocochromanols; therefore, breeding maize with higher vitamin content (biofortification) could improve human nutrition. Incorporating exotic germplasm in maize breeding for trait improvement including biofortification is a promising approach and an important research topic. However, information about genomic prediction of exotic-derived lines using available training data from adapted germplasm is limited. In this study, genomic prediction was systematically investigated for nine tocochromanol traits within both an adapted (Ames Diversity Panel [AP]) and an exotic-derived (Backcrossed Germplasm Enhancement of Maize [BGEM]) maize population. Although prediction accuracies up to 0.79 were achieved using genomic best linear unbiased prediction (gBLUP) when predicting within each population, genomic prediction of BGEM based on an AP training set resulted in low prediction accuracies. Optimal training population (OTP) design methods fast and unique representative subset selection (FURS), maximization of connectedness and diversity (MaxCD), and partitioning around medoids (PAM) were adapted for inbreds and, along with the methods mean coefficient of determination (CDmean) and mean prediction error variance (PEVmean), often improved prediction accuracies compared with random training sets of the same size. When applied to the combined population, OTP designs enabled successful prediction of the rest of the exotic-derived population. Our findings highlight the importance of leveraging genotype data in training set design to efficiently incorporate new exotic germplasm into a plant breeding program.Item A two-gene strategy increases iron and zinc concentrations in wheat flour, improving mineral bioaccessibility(Journal Article, 2023-01) Harrington, Sophie A.; Connorton, James M.; Nyangoma, Natasha I. M.; McNelly, Rose; Morgan, Yvie M. L.; Aslam, Mohamad F.; Sharp, Paul A.; Johnson, Alexander A. T.; Uauy, Cristobal; Balk, JannekeDietary deficiencies of iron and zinc cause human malnutrition that can be mitigated by biofortified staple crops. Conventional breeding approaches to increase grain mineral concentrations in wheat (Triticum aestivum L.) have had only limited success, and our understanding of the genetic and physiological barriers to altering this trait is incomplete. Here we demonstrate that a transgenic approach combining endosperm-specific expression of the wheat VACUOLAR IRON TRANSPORTER gene TaVIT2-D with constitutive expression of the rice (Oryza sativa) NICOTIANAMINE SYNTHASE gene OsNAS2 significantly increases the total concentration of zinc and relocates iron to white-flour fractions. In two distinct bread wheat cultivars, we show that the so called VIT-NAS construct led to a two-fold increase in zinc in wholemeal flour, to ∼50 µg g−1. Total iron was not significantly increased, but redistribution within the grain resulted in a three-fold increase in iron in highly pure, roller-milled white flour, to ∼25 µg g−1. Interestingly, expression of OsNAS2 partially restored iron translocation to the aleurone, which is iron depleted in grain overexpressing TaVIT2 alone. A greater than three-fold increase in the level of the natural plant metal chelator nicotianamine in the grain of VIT-NAS lines corresponded with improved iron and zinc bioaccessibility in white flour. The growth of VIT-NAS plants in the greenhouse was indistinguishable from untransformed controls. Our results provide insights into mineral translocation and distribution in wheat grain and demonstrate that the individual and combined effects of the two transgenes can enhance the nutritional quality of wheat beyond what is possible by conventional breeding.Item What adults in rural South Asia eat and when they eat it: Evidence from Bangladesh, India, and Nepal(Journal Article, 2025-07) Scott, Samuel P.; Patwardhan, Sharvari; Ruel, Marie T.; Chakrabarti, Suman; Neupane, Sumanta; Manohar, Swetha; Moursi, Mourad; Menon, PurnimaItem Assessment of Vitamin D status and association with inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project(Journal Article, 2023-01) Young, Melissa F.; Ou, Jiangda; Duong, Cam; Luo, Hanqi; Beyh, Yara S.; Meng, Jiawei; Gernand, Alison D.; Roth, Daniel E.; Suchdev, Parminder S.Background It is unclear whether 25(OH)D concentrations in children and female adults may be influenced by inflammation and thus require adjustment when estimating the population prevalence of vitamin D deficiency. Objectives We examined correlations between inflammation biomarkers, CRP or alpha-1-acid glycoprotein (AGP), and serum 25(OH)D concentrations among preschool children (PSC; 6–59 mo) and nonpregnant females of reproductive age (FRA; 15–49 y). Methods We analyzed cross-sectional data from 6 nationally representative nutrition surveys (Afghanistan, Cambodia, Pakistan, UK, USA, and Vietnam) conducted among PSC (n = 9880) and FRA (n = 14,749) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project. Rank correlations between CRP or AGP and 25(OH)D concentrations were examined while taking into account complex survey design effects. Results Among both PSC and FRA, correlations between inflammation and vitamin D biomarkers were weak and inconsistent across surveys. For PSC, correlation coefficients between CRP and 25(OH)D concentrations ranged from −0.04 to 0.08, and correlations between AGP and 25(OH)D ranged from 0.01 to 0.05. Correlation coefficients between CRP and 25(OH)D for FRA ranged from −0.11 to 0.14, and correlations between AGP and 25(OH)D concentrations ranged from −0.05 to 0.01. Conclusions Based on the weak and inconsistent correlations between CRP or AGP and 25(OH)D, there is no rationale to adjust for these inflammation biomarkers when estimating population prevalence of vitamin D deficiency in PSC or FRA.Item Characterization of cowpea cultivars for grain size, color, and biofortification(Journal Article, 2023-01) Martins, Maria do P. S. C.; Lopes, Anna F. de S.; Jean, Abdias; Damasceno-Silva, Kaesel J.; e Martins, Maria do C. de C.; Rocha, Maurisrael de M.Cowpea crops have high socioeconomic importance in the Northeast region of Brazil. These crops generate employment and income; in addition, it is an excellent source of protein, minerals, vitamins, and dietary fiber, and contributes to the food security of thousands of people. Biofortification of cowpea with iron, zinc, and proteins can contribute to prevent the higher hunger. The objective of this work was to assess iron, zinc, and protein contents in cowpea grains of different cultivars and the effect of grain size and color on the contents of these nutrients. Twenty-four cultivars with variation in size and color of the seed coat were evaluated. Iron contents ranged from 7.12 to 8.60 mg 100 g-1, with an overall mean of 7.75 mg 100 g-1. Zinc contents ranged from 4.46 to 4.93 mg 100 g-1, with an overall mean of 4.71 mg 100 g-1. Protein contents ranged from 31.50 to 36.24 g 100 g-1, with an overall mean of 33.57 g 100 g-1. Grain size ranged from 13.55 to 37.88 g, with an overall mean of 21.50 g. The cultivars Caldeirão, BRS-Guariba, and Pingo-de-Ouro-1-2 have higher iron contents; BRS-Aracê and BRS-Imponente have higher zinc contents; BR-14-Mulato, BRS-Guariba, BRS-Aracê, and BRS-Inhuma, have higher protein contents; and BR-3-Tracuateua and BRS-Imponente have larger grain sizes. The size and color of the seed coat do not influence the iron, zinc and protein contents of the evaluated cowpea cultivars.Item Leveraging prior biological knowledge improves prediction of tocochromanols in maize grain(Journal Article, 2023-12) Tanaka, Ryokei; Wu, Di; Li, Xiaowei; Tibbs-Cortes, Laura E.; Wood, Joshua C.; Magallanes-Lundback, Maria; Bornowski, Nolan; Hamilton, John P.; Vaillancourt, Brieanne; Li, Xianran; Deason, Nicholas T.; Schoenbaum, Gregory R.; C. Buell, Robin; DellaPenna, Dean; Yu, Jianming; Gore, Michael A.With an essential role in human health, tocochromanols are mostly obtained by consuming seed oils; however, the vitamin E content of the most abundant tocochromanols in maize (Zea mays L.) grain is low. Several large-effect genes with cis-acting variants affecting messenger RNA (mRNA) expression are mostly responsible for tocochromanol variation in maize grain, with other relevant associated quantitative trait loci (QTL) yet to be fully resolved. Leveraging existing genomic and transcriptomic information for maize inbreds could improve prediction when selecting for higher vitamin E content. Here, we first evaluated a multikernel genomic best linear unbiased prediction (MK-GBLUP) approach for modeling known QTL in the prediction of nine tocochromanol grain phenotypes (12–21 QTL per trait) within and between two panels of 1,462 and 242 maize inbred lines. On average, MK-GBLUP models improved predictive abilities by 7.0–13.6% when compared with GBLUP. In a second approach with a subset of 545 lines from the larger panel, the highest average improvement in predictive ability relative to GBLUP was achieved with a multi-trait GBLUP model (15.4%) that had a tocochromanol phenotype and transcript abundances in developing grain for a few large-effect candidate causal genes (1–3 genes per trait) as multiple response variables. Taken together, our study illustrates the enhancement of prediction models when informed by existing biological knowledge pertaining to QTL and candidate causal genes.Item Combining ability studies of grain Fe and Zn contents of pearl millet (Pennisetum glaucum L.) in West Africa(Journal Article, 2023-01) Gaoh, Bassirou Sani Boubacar; Gangashetty, Prakash I.; Mohammed, Riyazaddin; Ango, Issoufou Kassari; Dzidzienyo, Daniel Kwadjo; Tongoona, Pangirayi; Govindaraj, MahalingamMicronutrient malnutrition is a major challenge in Africa, where half a million children die each year because of lack of micronutrients in their food. Pearl millet is an important food and fodder crop for the people living in the Semi-Arid regions of West Africa. The present study was conducted to determine the stability, combining ability, and gene action conditions of the high level of Fe and Zn content in grain and selected agronomic traits. Hence, eight genotypes were selected based on the availability of grain Fe and Zn contents and crossed in a full diallel mating design. Progenies from an 8 × 8 diallel mating along with the parents were evaluated in an alpha lattice design with three replications in three locations for two years. The parental lines Jirani, LCIC 9702 and MORO, had positive significant general combining ability (GCA) effects for grain Fe concentration, while Jirani and MORO had positive significant GCA effects for grain Zn concentration. For the specific combining ability (SCA), among the 56 hybrids evaluated, only the hybrids LCIC 9702 × Jirani and MORO × ZANGO had positive significant SCA effects for grain Fe concentration across locations, and for grain Zn concentration, the hybrids Gamoji × MORO, LCIC 9702 × Jirani, and ICMV 167006 × Jirani had positive significant SCA effects. The reciprocal effects were significant for grain Zn concentration, grain yield, flowering time, plant height, test weight, and downy mildew incidence, suggesting that the choice of a female or male parent is critical in hybrid production. Grain Fe and Zn concentration, flowering time, plant height, panicle length, panicle girth, panicle compactness, and downy mildew incidence were found to be predominantly under additive gene action, while grain yield and test weight were predominantly under non-additive gene action. A highly positive correlation was found between grain Fe and Zn concentrations, which implies that improving grain Fe trait automatically improves the grain Zn content. The stability analysis revealed that the hybrid ICMV 167006 × Jirani was the most stable and high-yielding with a high level of grain Fe and Zn micronutrients.Item Maize yield and fall armyworm damage responses to genotype and sowing date-associated variations in weather conditions(Journal Article, 2024-11) Tabu, Hugues Ilunga; Kankolongo, Amand Mbuya; Lubobo, Antoine Kanyenga; Kimuni, Luciens NyemboItem Malaria infection confounds inflammation-adjusted micronutrient biomarker concentrations in children and women in Malawi: a secondary analysis of the 2015/2016 Malawi micronutrient survey(Journal Article, 2025-05-14) Sandalinas, Fanny; Joy, Edward J. M.; Hopkins, Heidi; Likoswe, Blessings H.; Blake, Tineka; Luo, Hanqi; Young, Melissa F.; Bottomley, Christian; Suchdev, Parminder S.; Filteau, SuzanneInflammation and infections such as malaria affect concentrations of many micronutrient biomarkers and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi and examine the potential role of malarial immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell folate and vitamin B12 were estimated using multivariable linear regression. Factors related to malarial immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68 % (95 % CI 51, 86), 28 % (18, 40) and 34 % (13, 45) greater inflammation-adjusted ferritin in PSC, SAC and WRA, respectively (P < 0·001 for each). In PSC, the positive association was stronger in younger children, high altitude and children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25 % (16, 29) and + 15 % (9, 22) respectively, P < 0·001). Serum folate and erythrocyte folate were elevated in WRA with malaria (+ 18 % (3, 35) and + 11 % (1, 23), P = 0·01 and P = 0·003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations, and examining factors related to malarial immunity may be informative.Item Biofortification and fortification of wheat flour: Qualitative analysis for implementation and acceptance(Journal Article, 2025) Yasin, Rahima; Padhani, Zahra A.; Mirani, Mushtaque; Jamali, Muhammad Khan; Memon, Mahwish; Khatoon, Sana; Rai, Riya; Rahman, Areeba; Attaullahjan, Anushka; Das, Jai K.This paper comprehensively investigates various aspects of dietary behaviors relating to the usage of wheat flour and sociocultural preferences embedded within rural communities and aims to bridge health gaps resulting from zinc deficiency by introducing zinc bio-fortified and fortified flour in Pakistan. A household and a market study was conducted in Ghotki and Tando Muhammad Khan districts in Sindh, Pakistan. Various stakeholders involved in the wheat-flour industry including farmers, seed suppliers, owners of atta-chakkis and flour mills, grocers and flour merchants, bakers and hoteliers, consumers, and agronomists were interviewed to gauge their knowledge of bio-fortified and fortified wheat-flour. Wheat-flour is a staple food item in Pakistan, however, agricultural output in Pakistan varies across all provinces. Factors that hinder agricultural productivity include a shortfall of essential resources such as irrigation water, superior quality seeds and fertilizers, and machinery. Farmers use primitive methods of farming as they do not have access to modern technologies, information, or training. Wheat flour market vendors and consumers lack awareness of bio-fortified and fortified wheat flour products and believe the only way to create a customer-base is by ensuring that fortified wheat products are available to all and competitively priced compared to traditional options. Additionally, participants misconstrue the process of fermentation and perceive it as unhealthy. The lack of financial resources and awareness restricts adequate promotion of nutrient-rich food products amongst stakeholders involved in the wheat flour industry. Mass awareness campaigns, education and government incentives could bridge the gaps present and encourage wider adoption of bio-fortified and fortified wheat flour. Policy makers and communities can draw on the recommendations made in this paper to introduce and promote zinc bio-fortified and zinc-fortified flour in settings where zinc deficiency is prevalent.