Our Work in Africa: Uganda


Uganda
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The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at the frontiers of biology and policy, such as exploring the links between aflatoxins and nutrition outcomes, the role of livestock promotion in enhancing diet quality, and the links between sanitation (open defecation practices) and nutrition outcomes. Combining resources from Uganda, US institutions, and global partners the research and capacity building activities of the Nutrition Innovation Lab focus on operationally and policy-relevant work that supports both national government and USAID priorities.

Nutrition Innovation Lab’s vision of success is a set of robust empirical findings that can be quickly translated into policy and practice. We aim for our work to support enhanced outcomes globally not just locally, as new findings are adopted nationally and regionally. Furthermore, we hope our research platform can synergistically help other research entities with related goals.

Capacity Building

  • A total of 21 students will have received Masters or Doctorate degrees with partial or full funding from the Nutrition Innovation Lab.
  • 20 Ugandan students have attended the rigorous Boston to Bangalore Nutrition Collaborative (BBNC) training course in Bangalore India over the past four years with financial support from the lab.
  • Many government officials have attended workshops and District Dissemination Meetings gaining capacity for designing and implementing nutrition programming.  Our engagement with government officials have included both Local District Governments and Line Minisitries, ie. Ministry of Agriculture, Ministry of Health.
  • Forty professionals attended training on issues in public health nutrition, grant writing and research proposal development.  This is emblematic of our support for career enhancing activities for Ugandan professionals, policy makers, and academics.
  • The Nutrition Innovation Lab is working in collaboration with Makerere University to design and implement a modulated short course in Public Health Nutrition Practices and Programming aimed at filling in curricular gaps in the current set of educational offerings across Uganda. Through short courses students will be equipped to tackle nutritional issues in a multi-faceted and systematic way. These courses are being offered online with a customized version of Tufts University’s online learning system (TUSK), which is an open source platform for learning an content management.

The Nutrition Innovation Lab has undertaken the following research activities in Uganda

Relationships have been forged with partners such as Makerere University, Gulu University, SPRING (Strengthening Partners, results, and Innovations in Nutrition Globally), NASA, Heifer International (HI), UIC, IITA, UGA, International Food Policy Research Institute (IFPRI), and FHI360.  One set of Nutrition Innovation Lab’s core research revolves around the USAID Uganda Community Connector Project (UCCP), an integrated agriculture and nutrition intervention package implemented by FHI360. This includes the following activities:

  • A comprehensive, repeated panel survey assessing agriculture, nutrition, and health pathways and providing evaluation data to UCCP.  The survey was conducted at the end of 2012, and repeated at the end of 2014.
  • A prospective birth cohort study to dis-entangle the nutrition or health gains of key target groups (e.g. pregnant women and infants). The birth cohort study is a ‘platform’ which can be used to assess top-rank hypotheses, like linking Water, Sanitation, and Hygiene (WASH) and mycotoxins (aflatoxin/ mold) to nutrition, while answering key questions on how and why integrated interventions may succeed. The cohort study began enrolling women in 2014.
  • Process research to examine the implementation of multisectoral actions for good nutrition.  This has included key informant interviews with central policy makers, and district administrations.

Additional activities in Uganda include

  • The Nutrition Innovation Lab has supported a birth cohort study in Gulu which has examined food insecurity, depression, and other psycho-social factors which affect maternal and infant nutrition.  This project has been run by Barnabus Natamba of Gulu University.  Exposure to aflatoxin molds during pregnancy and early infancy is being assessed with the support of USAID/ East Africa.
  • An analysis conducted by Kabunga Nassul, Ph.D., examined the relationship of household food insecurity, and anemia in women with fruit and vegetable production.  This analysis found that fruit and vegetable production was linked to consumption and significantly less anemia in women of childbearing age.  This is an example of concrete biologically plausible agriculture to nutrition pathway.
  • The Nutrition Innovation Lab with UIC pilot validated an innovative water quality assessment test, the Aquagenx compartment bag test (ACBT).  Use of the ACBT in the prospective birth cohort study will allow the Lab and UCCP to assess WASH (Water, Sanitation, & Hygiene) relating to under-nutrition and health.
  •   A secondary analysis utilizing a NASA dataset examined agricultural land use, biomass fuel and health. It examined the role of cooking fuels from agricultural land and forests in causing respiratory illness, which are linked to poor nutrition.
  • Modeling the links of agriculture productivity to nutrition through the interaction of seasonality and climate variability with agricultural output and nutrition and how geography (agro-ecology, altitude, remoteness from markets) affects household outcomes is underway.
  • The Nutrition Innovation Lab advocates for the need to examine the role of aflatoxin exposure in maternal and infant nutrition, has lead to an Associate Award to fund further analyses in the Ugandan studies.
  • The Nutrition Innovation Lab in collaboration with the Nutrition Innovation Lab Asia facilitated a study of aflatoxin exposure and nutrition in Timor Leste partnering with the University of Jakarta (Indonesia), UNICEF in Timor Leste and the University of Georgia aflatoxin research laboratories (linked to the Peanut and Mycotoxin Innovation Lab).
  • A series of dissemination seminars have been held at the national and district level over several years.

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

Authors: Elizabeth Widen; Claire Biribawa; Daniel Acidri; Winifred Achoko; Harriet Achola; Jeffrey Griffiths; Sera Young January 2017
A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, mid upper arm circumference, triceps skin fold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body compos...
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Agricultural policy for improved nutrition in Africa and Asia: evidence to guide the US Government’s investments in food security

Authors: William Masters; Katherine Dennison; Jeff Hill; Elizabeth Jordan-Bell; Ahmed Kablan; Melanie Thurber; Lorraine Weatherspoon; James Oehmke May 2015
The roundtable process was designed to complement numerous past and ongoing efforts to assemble and disseminate rigorous evidence on how agricultural change can best help to improve international nutrition, beginning with the first Lancet Maternal and Child Nutrition series in 2008 and its follow-up in 0 comments

Assessing Progress in Implementing Uganda’s Nutrition Action Plan: District-Level Insights

Authors: Edgar Agaba; Shibani Ghosh; Jeffrey K. Griffiths December 2016
The 2011 Uganda Nutrition Action Plan (UNAP) established 2016 maternal and child nutrition targets. However, there is a lack of routine district-level data collection to assess UNAP implementation.  The Nutrition Innovation Lab collected serial household-level survey data (n = 3600) in 6 districts, including 2 UNAP implementation districts, in 2012 and 2014. Questionnaires focused on food security, nutrition, and health, among others, and included specific indicators relevant to UNAP’s target...
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Prioritizing and Funding the Uganda Nutrition Action Plan

Authors: Amanda Pomeroy-Stevens; Hannah Foehringer Merchant; Abel Muzoora; Ezekiel Mupere; Lidan Du December 2016
In 2010, Uganda began developing its first multisectoral nutrition plan, the Uganda Nutrition Action Plan (UNAP), to reduce malnutrition. While the UNAP signals high-level commitment to addressing nutrition, knowledge gaps remain about how to successfully implement such a plan. We tracked the UNAP’s influence on the process of priority setting and funding for nutrition from 2013 to 2015
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Optimizing the Multisectoral Nutrition Policy Cycle: A Systems Perspective

Authors: Sascha Lamstein; Amanda Pomeroy-Stevens; Patrick Webb; Eileen Kennedy December 2016
Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studies offer new data and new thinking on how and why governance, effective financial decentralization, and improved accountability all matter for nutrition actions in low-income countries. This introductory paper offers an overview of the current state of evidence and thinking on the multisectoral nutriti...
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The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Authors: Barnabas Natamba; Jane Achan; Rebecca Stoltzfus; Sera Young August 2016
Abstract Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the associati...
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Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

Authors: Sera Young; Flavia Luwedde; Paul Natureeba; Jane Achan ; Veronica Ades; Beth Osterbauer; Edwin Charlebois; Moses Kamya; Diane Havlir; Deborah Cohan November 2014
Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivari...
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“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

Authors: SL Young; F Luwedde; B. Okia; P Natureeba; L. Johnson; C. Michel; M. Robine; E. Charlebois; D. Havlir November 2014
We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen (35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly) were evaluated among 87 preg...
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Alcohol Use Among Pregnant Ugandan Women of Mixed HIV Status is Associated with Social Environment and Food Insecurity

Authors: Shalean Collins; Barnabas Natamba; Angela Arbach; Elizabeth Widen; Pooja Desai; Hijab Khan; Jeffrey Griffiths; Sera Young July 2015
Antenatal alcohol use (AAU) is associated with poor health outcomes in maternal-infant dyads. However, AAU prevalence and risk factors are poorly understood, particularly in low-income settings. Therefore we studied correlates of any AAU among pregnant women receiving antenatal care in Gulu, Uganda.
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Maternal Food Insecurity is Associated with Loss of Fat, but not Lean Mass during Lactation among Ugandans of Mixed-HIV Status

Authors: E. Widen; B. Natamba; S. Ghosh; J. Griffiths April 2015
HIV-infected women lose more weight during lactation than HIV-uninfected women. Whether this loss is fat-mass (FM) or fat-free mass (FFM) is unknown, but important, as lean mass loss accelerates HIV progression.
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Microbial Decontamination of Fresh Produce (Strawberry) Using Washing Solutions

Authors: Naresh Shahi; Byungjin Min; Eunice A. Bonsi March 2015
This Tuskegee University study was carried out to determine the effect of natural antimicrobial washing solutions against microbial growths on fresh produce specifically strawberries. Selected washing solutions used for strawberry washing, and treatments were sterile water (control), white vinegar (VI), crude lemon juice extract (LE), VI+Origanum oil (VIO), LE+Origanum oil (LEO), and VI+LE+Origanum oil (VILEO).
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Cover Image:Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Reliability and validity of an individually-focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

Authors: Barnabas K. Natamba; Angela Arbach; Hillary Kilama; Jane Achah; Jeffrey Griffiths; Sera Young August 2014
Food security occurs “when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life." Food insecurity (FI) exists when these conditions are not met and is a major underlying cause of undernutrition enshrined in the UNICEF conceptual framework. FI is a major risk factor for adverse health outcomes among specific vulnerable populations including persons infe...
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Cover-Brown et al 2014

Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change

Authors: Molly E. Brown; Kathryn Grace; Gerald Shively; Kiersten B. Johnson; Mark Carroll September 2014
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition...
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Cover Image: Land use change, fuel use and respiratory health in Uganda

Land use change, fuel use and respiratory health in Uganda

Authors: Pamela Jagger; Gerald Shively April 2014
This paper examines how biomass supply and consumption are affected by land use change in Uganda. We find that between 2007 and 2012 there was a 22% reduction in fuelwood sourced from proximate forests, and an 18% increase in fuelwood sourced from fallows and other areas with lower biomass availability and quality. We estimate a series of panel regression models and find that deforestation has a negative effect on total fuel consumed. We also find that access to forests, whether through ownershi...
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Cover Image: Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young November 2014
In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th. Whereas ...
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Nutrition Innovation Lab Annual Report- Year 6

Authors: Nutrition Innovation Lab November 2016
The following are the annual reports of the Feed the Future Innovation Lab for Nutrition for the fiscal year 2016 starting October 2015 through September 2016 (“Y6”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues innovative research at th...
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Uganda Baseline Report: Assessing the Linkage Between Agriculture, Food Security, Nutrition and Health Among Women and Children in Rural Ugandan Households.

Authors: Nutrition Innovation Lab October 2013
This report provides baseline and nationally representative data regarding nutritional and health issues in Uganda, particularly in terms of maternal and child health. Areas of assessment include livestock, malaria, aflatoxin exposure, water access, sanitation, and dietary information
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Nutrition Innovation Lab Annual Reports- Year 5

Authors: Nutrition Innovation Lab December 2015
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2015 starting October 2014 through September 2015 (“Y5”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues...
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Nutrition Innovation Lab Annual Reports- Year 2

Authors: Nutrition Innovation Lab October 2012
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2012 starting October 2011 through September 2012 (“Y2”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues ...
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Agricultural correlates of linear growth and key modifiers among children under two years in rural Uganda

Authors: Nilupa Gunaratna February 2014
Many sources have recently called for agricultural programs and policies to become more “nutrition-sensitive”, with the aim of harnessing agriculture to improve nutrition and health. Several researchers have described potential causal pathways through which agriculture could impact the nutrition and health of vulnerable populations. Stunting, or poor linear growth, particularly in young children is a key indicator. Reflecting chronic undernutrition, stunting can begin in utero, and studies h...
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Nutrition Innovation Lab Annual Reports- Year 3

Authors: Nutrition Innovation Lab October 2013
The following are the annual reports of the Feed the Future Innovation Lab for Collaborative Research on Nutrition for the fiscal year 2013 starting October 2012 through September 2013 (“Y3”). The Nutrition Innovation Lab seeks to discover how investments in agriculture can be enhanced to accelerate gains in nutrition, and how policy and program interventions can more effectively integrated to cost-effectively achieve improvements in maternal and child nutrition at scale. It also pursues ...
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Social support modifies the bidirectional linkages between food insercutiy and prenatal depresseive symptoms while domestic violence alters the unidirectional impact of food insecurity on prenatal depressive symptoms

Authors: Barnabas Natamba June 2015
This presentation by Barnabas Natamba examines and draws links between food security/ nutrition and social support/ mental health/ HIV status.
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Maternal HIV infection, but not food insercutity access score, predicts the rate of weight change in pregnant women attending antenatal services in northern Uganda

Authors: Barnabas Natamba April 2015
This poster examines seasonal food security/ insecurity, MUAC measurements, and HIV status in Uganda.
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Got Baby Food? Understanding the Market for Packaged Complementary Foods in Developing Countries

Authors: William Masters February 2016
This presentation was delivered by Dr. William Masters on Feb. 3, 2016 as a Friedman School Seminar, Tufts University.
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Effect of Nutrition-Sensitive Agricultural Extension Program on Nutrition Knowledge and Dietary Practices of Farming Households in Mukono District, Central Uganda

Authors: Elizabeth Asiimwe April 2016
This poster presentation discusses the outcomes of an extension program implemented in the Mukono District of Central Uganda. It was investigating the knowledge levels of nutrition among men and women, as well as factors that influenced diet diversity among farming households.
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District Presentations: Effectiveness of Integrated Agriculture, Health Livelihood and Nutrition Interventions to Improve Maternal and Child Nutrition and Health in Rural Uganda: A Birth Cohort Study.

Authors: Bernard Bashaasha; Florence Kinyata April 2016
These presentations were made in various Ugandan Districts, covering data gathered during the Uganda Birth Cohort Study specific to each of those districts. The presentations were delivered in April of 2016 by Drs. Bernard Bashaasha and Florence Kinyata. Click on the district name to see its specific presentation. ... 0 comments

Connecting the dots between human malaria, livestock, and under-nutrition: An unexpected pathway

Authors: Jeffrey Griffiths; Nassul Kabunga March 2015
Presentation given by Drs. Jeff Griffiths and Nassul Kabunga for USAID in Washington DC, March 15, 2015
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“Eat your Fruits and Vegetables and Don’t Get Malaria”: Linkages between Agriculture, Nutrition, and Health in Uganda

Authors: Jeffrey Griffiths November 2014
Presentation given by Dr. Jeff Griffiths for the Center for Global Public Health Event at Tufts University, Nov. 20, 2014
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Why Food is Not Enough-Boston University

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths at Boston University, February 27, 2015
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Why Food is Not Enough-BBNC

Authors: Jeffrey Griffiths January 2015
Presentation given by Dr. Jeff Griffiths at the Boston to Bangalore Nutrition Collaboration event, January 2015
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Malaria predicts maternal and child anemia in Uganda and is modulated by altitude and prior IRS

Authors: Jeffrey Griffiths February 2015
Presentation given by Dr. Jeff Griffiths for USAID in Kampala, Uganda, Feb. 10, 2015
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Understanding Pathways of Better Nutrition: Poster Presentation

Authors: Edgar Agaba June 2015
This poster is a result of Edgar Agaba's ALE-(Applied Learning Experience) research work that was completed last year in Uganda's 2 districts of Lira and Kisoro.  Collaborators included MPH- ALE, JSI/SPRING Project, and the Nutrition Innovation Lab.  The poster was presented at the LCIRAH Research Conference, June 03-04, 2015.  
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Africa Day: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This poster presentation was featured at the Africa Day for Food and Nutrition Security in Kampala Uganda on Oct. 28-30, 2015.
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Community Connector: Effectiveness of integrated Agriculture, health livelihood and nutrition interventions to improve maternal and child nutrition and health in rural Uganda: A birth cohort study

Authors: Nutrition Innovation Lab October 2015
This presentation was made to the Ugandan Community Connector and is an update on the Birth Cohort Study in Uganda on Oct. 20, 2015.
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Strengthening Policy Actions and Governance for Nutrition

Authors: Patrick Webb; Amanda Pomeroy May 2015
This is the joint Nutrition Lab/SPRING presentation to USAID on common research activities in Nepal and Uganda regarding policy and governance for nutrition.  It was presented May 5th, 2015 in Washington DC.
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Bernard Bashaasha, PhD

Role: Principal Investigator, 
School of Agricultural Sciences, Makerere University
College of Agricultural and Environmental Sciences

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