Aga Khan Foundation

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0-2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1-1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children's ecology to provide nurturing care is needed, as is further testing of new ideas.

The effectiveness of interventions promoting healthy child growth and development depends upon the capacity of the health system to deliver a high-quality intervention. However, few health workers are trained in providing integrated early child-development services. Building capacity entails not only training the frontline worker, but also mobilizing knowledge and support to promote early child development across the health system. In this paper, we present the paradigm shift required to build effective partnerships between health workers and families in order to support children's health, growth, and development, the practical skills frontline health workers require to promote optimal caregiving, and the need for knowledge mobilization across multiple institutional levels to support frontline health workers. We present case studies illustrating challenges and success stories around capacity development. There is a need to galvanize increased commitment and resources to building capacity in health systems to deliver early child-development services.

Gijs Walraven and colleagues discuss maternal and child health programs in adjacent geographical areas in difficult environments in Afghanistan, Pakistan, and Tajikistan.

This paper reports on early soil related outcomes from conservation agriculture (CA) benchmark sites located within the marginal rainfed environment of agro-ecological zone 4 (annual rainfall: 200–250 mm) in pre-conflict central Syria. The outcomes reported are specifically those that relate to beneficial soil quality and water retention attributes relative to conventional tillage-based soil management practices applied to the fodder barley–livestock system, the dominant system in the zone. On-farm operational research was established to examine the impact of a barley (Hordeum vulgare) and vetch (Vicia sativa) rotation intercropped with atriplex (Atriplex halimus) and salsola (Salsola collina), under CA and conventional tillage agriculture, on the soil quality parameters and crop productivity. Preliminary results showed that CA had a positive effect on the soil quality parameters and crop performance. The soil moisture and hydraulic conductivity were higher under CA (p < 0.05), combined with improved productivity (grain and above-ground biomass) under specific crop mixes. The results suggest that despite the marginal nature of the zone, the use of CA is a viable option for the future of farmers’ livelihoods within similar localities and agro-climates, given the benefits for soil moisture and grain and straw productivity. In addition, it is likely to positively impact those in marginal environments where both pastoralism and agro-pastoralism production systems co-exist and compete for crop biomass as a main source of livestock feed. The increase in grain and straw yields vis-à-vis improvements in biophysical parameters in the CA system relative to tillage agriculture does suggest, however, that the competition with livestock for biomass is likely to reduce over time, and farmers would be able to return increased levels of straw (as stubble and residue) as mulch, given improved biomass yields.

Maternal self-efficacy (MSE) is associated with healthy functioning in mothers and children globally. Maternal exposure to adverse childhood experiences (ACEs) and intimate partner violence (IPV) is known to negatively impact MSE in high-income countries; however, the association has not been examined in low-and-middle-income countries, such as India, which face socioeconomic risks including poverty, illiteracy, and discrimination based on caste membership. The present study examines the mediating role of IPV in the association between ACEs (specifically-emotional, physical, and sexual abuse, neglect, household dysfunction, and discrimination) and MSE and tests caste membership as a moderator. A community-based, cross-sectional survey was performed with 316 mothers with at least one child between 0 and 24 months in a rural area in the North Indian state of Uttar Pradesh. A structural equation framework was used to test the moderated-mediation model. Results from the moderated-mediation model indicate that greater ACEs exposure was associated with lower MSE and this association was mediated by IPV exposure for low-caste but not high-caste mothers, even after controlling for wealth and literacy. These findings add to existing evidence on ACEs exposure as a significant burden for rural Indian mothers, negatively impacting parenting outcomes such as MSE. The critical role of caste membership is also highlighted, providing implications for future research.

OBJECTIVE: To explore barriers to utilization of health-facility-based delivery in Kenya, use of which is associated with reduced maternal mortality. METHODS: In April 2017, a qualitative study utilizing key informant interviews (KIIs) and focus group discussions (FGDs) was carried out in Bomachoge-Borabu and Kaloleni, Kenya. Twenty-four KIIs were performed including health service providers, community health workers, religious leaders, local government representatives, Ministry of Health representatives, and representatives of women's organizations. Sixteen FGDs were held separately with adolescent females, adult females, adult males, and Community Health Committee members. Data were transcribed, coded, and categorized thematically to illustrate supply-side and demand-side barriers to use of health-facility-based delivery services. RESULTS: Supply-side barriers included staff shortages, inadequate supplies and space, poor interpersonal relations, few trained staff, long distance to services, poor transport infrastructure, and limited service hours. Demand-side barriers included financial constraints, limited spousal support, observance of birthing traditions, limited knowledge on importance of health-facility-based delivery, and fear of health-facility procedures. CONCLUSIONS: Diverse barriers continue to influence use of health-facility-based delivery services in Kenya. Practical, integrated interventions are urgently needed to reduce barriers noted, to further reduce the maternal mortality rate.

In many parts of the world, people suffer from different micronutrient deficiencies due to the same aetiology of micronutrient deficiency and physiological interactions between the micronutrient metabolisms. To reduce and alleviate micronutrient deficiencies, supplementation programmes for different micronutrients are often implemented simultaneously. Since operational strategies and distribution systems can be similar for each micronutrient, efforts and resources are duplicated and cost-effectiveness is therefore reduced. Widespread micronutrient deficiencies in populations have a deep-rooted causality within the life cycle of people. They are strongly associated with poverty and are passed from one generation to the next. Recently, multi-micronutrient supplementation has been suggested to break this vicious circle of micronutrient deficiencies within the life cycle. However, several technical and scientific aspects have to be considered for the implementation of a multi-micronutrient supplementation programme.

Correction to: Nature Medicinehttps://doi.org/10.1038/s41591-024-03345-4, published online 6 January 2025. In the version of the article initially published, in the eighth paragraph of the Discussion, the text “Among large nations, the largest increases in SSB-related T2D burdens were in Mexico, Thailand and the United Kingdom, and in CVD burdens, Colombia, Nigeria, Thailand and Russia. These changes align with rises in SSB consumption in these nations12. Similarly, declining SSB-related cardiometabolic burdens in Brazil, the United States and the United Kingdom (for CVD) are consistent with their decreasing SSB consumption from 1990 to 202012” was incorrect and has now been updated to “Among largely populated nations, the largest increases in SSB-related T2D incidence was in Colombia, USA and Argentina; and in CVD incidence, Nigeria, Russia, Colombia and Thailand. These changes generally align with rises in SSB consumption in these nations, except in the US where slight declines in SSB consumption were offset by increased burdens of diabetes 12. Similarly, declining SSB-related cardiometabolic burdens in Turkey, Brazil, and the United States and the United Kingdom for CVD are consistent with their decreasing SSB consumption from 1990 to 202012.” Additionally, Supplementary Data 1 and 2 have been updated to remove decimals in values greater than 100. These corrections have been made to the HTML and PDF versions of the article. © The Author(s) 2025.

In Kenya, millions of children have limited access to nurturing care. With the COVID-19 pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems, economic, social and child protection, and child development and early learning. The review proposes program and policy strategies to guide the re-orientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households, and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas.

'Development evaluations in Uganda 2000–2018: A Country Evaluation Map' is a CEDIL Synthesis Working Paper. It is a report on the first of its kind country evaluation map for a single country. The map identifies 617 evaluations in multiple sectors. Nearly 60 per cent of the studies contain process evaluation evidence and over 40 per cent are impact evaluations. The map helps make visible recent development evaluations from the country, identifies potential gaps in knowledge and opportunities for evidence synthesis. Users can submit studies for inclusion in the map, thus giving the map a repository function.

The empowerment literature has tended to focus on reinforcing the capacity of local populations to act effectively in promoting change on their own behalf. Borrowing from the social capital literature, achieving greater empowerment might be linked also to the actions and aims of the already powerful. A group might endeavor to exert its ability to change a situation or relation in its favour independently, but the ease, degree and durability of any changes will be heightened if they occur with the approval of those who control the major decisive factors or, especially, if they occur in complicity with them. The ‘Quality Girls' Dormitory’ model of the USAID/ALEF Project implemented by the Academy for Educational Development in Morocco (2005–2009) demonstrates the robustness of this dynamic at a few levels. For the girls, empowerment in both their academic and personal lives emerged from their personal growth and from the contexts for success created by their respective schools and the associations operating the dormitories. The associations grew in effectiveness and influence due to both a program of institutional capacity-strengthening and the collaborative approach of the Ministry of Social Affairs, their main funding source. Subsequently, only the ministry was able to undertake the model's nationwide adoption, both generalizing and sustaining the means to empowerment for the associations and the girls.

OBJECTIVE: To describe the application and evaluation of Pneumonia Management Tool (PMT) to manage children with non-severe pneumonia (NSP) at the first level health care (FLHC) facilities according to the standard case management (SCM) guidelines for acute respiratory infections (ARI). METHOD: The ARI SCM guidelines were simplified to a PMT and used by health workers at 14 FLHC facilities to assess, manage and monitor children with NSP and to educate caretakers on home care and follow-up visits. The district supervisors provided on the job support to various cadres of health workers of both public and private facilities. RESULTS: Of 949 children with NSP, 940 (99%) were successfully treated at FLHC facilities. Caretakers found PMT useful and of 1888 follow-up visits: 1872 (99.2%) brought PMT copy; 1627 (86.2%) brought their children to the facility; 1799 (95.3%) were on time and; 1857 (98.4%) had maintained antibiotic compliance. Using PMT, health workers adherence to SCM guidelines improved from 14% at baseline to 29% after training and 65% with on the job support. The practices remained similar among various cadres of health workers. CONCLUSIONS: Health workers used PMT in managing children with NSP, counselling caretakers on home care, follow-up visits and monitoring the treatment outcome. District level supervision helped to maintain a uniform skill enhancement.

Background: Stunting, a form of chronic malnutrition, is a global health concern, especially in South Asia. Stunting remains a significant public health issue in Pakistan, particularly in remote regions like Gilgit-Baltistan and Chitral, where geographic isolation and socioeconomic challenges exacerbate malnutrition. The Aga Khan Development Network is leading the implementation of a program, Central Asia Stunting Initiative (CASI), with an aim to reduce stunting through community-driven maternal and child health interventions in the targeted areas of Gilgit Baltistan and Chitral. This study aimed to evaluate the effectiveness of CASI in improving child nutritional outcomes in Gilgit-Baltistan and Chitral. Methods: In this study, a single-group pre–post evaluation design was employed using baseline and midline cross-sectional surveys among households with children aged 0–59 months in Gilgit-Baltistan and Chitral. Data on child anthropometry, household food security, maternal education, and child feeding practices were collected from over 500 households using stratified sampling. Results: Results showed improvement in child health indicators between baseline and midline. Between baseline and midline, stunting declined from 40.9% to 35.4% in GBC (p = 0.02), with severe stunting dropping significantly (17.8% to 10.9%, p < 0.001). Wasting and underweight rates also showed marked reductions. Improvements in breastfeeding rates (71.3% to 88.3%) and dietary diversity (4.0% to 26.8%) were observed. However, food security declined sharply from 95.2% to 11.9%, underscoring persistent economic stress. Conclusions: CASI interventions yielded substantial improvements in child nutrition and maternal behaviours. However, sustained progress requires integrated strategies addressing food insecurity, economic empowerment, and long-term resilience. Future programs should adopt a multi-sectoral approach to tackle chronic malnutrition comprehensively. Despite this, results indicated an overall improvement due to CASI interventions, signifying the importance of integrated, community-based approaches in addressing stunting.

Objectives: This study aimed to assess the prevalence of malnutrition indicators such as stunting, anemia, and vitamin A deficiency (VAD) among children and reproductive-age women in the GBAO region and to identify key socioeconomic and health-related factors influencing these outcomes.

This dataset contains a comprehensive list of rock glaciers for selected regions of the Pamir and Tien Shan mountains in Central Asia.

This paper investigates the leadership practices in the Higher Education Commission projects of Punjab, Pakistan. Democratic Leadership looks the most appropriate in the world but it has not been investigated in the Pakistan Higher Education Sector projects. The research approach in this study is positive therefore it is a quantitative study. The sample size is only 86 because the target population of this paper is the higher education sector of the Punjab province. In this research, SPSS has been used for the data analysis. The reliability and regression tests were performed. The results indicate that the Democratic leadership significantly impact the project success. This research is cross sectional as data was collected one time, though in future this research will be conducted in whole Pakistan and then South Asia.

Rock Glacier Inventory for Pamir and Tien Shan. Data are not publicly available due to ongoing research.Access can be requested from the author.

Rock Glacier Inventory for Pamir and Tien Shan. Data are not publicly available due to ongoing research.Access can be requested from the author.

Introduction: Anemia is a global public health concern affecting mainly women of reproductive age (WRA) and preschoolers (PSC, 6–59 months) due to their higher demand for iron. The etiology of anemia is multifactorial, and nutritional anemia is the most common type worldwide and is predominantly due to deficiencies in iron, vitamin B12, and folate. This study aimed to assess the associated factors, etiology, and prevalence of anemia among WRA and preschoolers in the Gorno-Badakhshan Autonomous Oblast (GBAO) region in Tajikistan. Methods: We conducted a cross-sectional study in the GBAO region of Tajikistan between April 2021 and September 2021, enrolling 500 non-pregnant WRA and 500 children aged 6–59 months in pairs (mother–PSC dyads) from six districts of the GBAO region. The survey was administered through a structured questionnaire at the household level, and information was collected on sociodemographic characteristics, reproductive history, dietary intake, nutritional status, and maternal factors. Blood and stool samples were also collected for micronutrient deficiencies and helminthic infections. Data analysis began with univariate analysis, followed by multivariate logistic regression in Stata (version 18). Results: Biochemical assessment of 473 WRA and 390 preschoolers was carried out; 17.3% of WRA were anemic, and 15.4% of PSC were anemic. Anemia prevalence was 17.3% among WRA and 15.4% among PSC. Among women, low ferritin and elevated serum transferrin receptor (sTfR) levels were associated with higher odds of anemia, whereas overweight status, higher gravidity, and vitamin B12 deficiency were associated with lower odds. Among children, low maternal education, maternal anemia, age < 24 months, and low ferritin were associated with increased odds of anemia. Conclusions: Anemia prevalence in GBAO was substantially lower than reported in the 2016 national survey, potentially reflecting methodological and contextual differences. Findings highlight iron deficiency as a dominant contributor, particularly in young children, underscoring the need for context-specific maternal and child nutrition interventions.