| Summary: | Globally, more than two billion people suffer from deficiencies in micronutrients that are essential for human health. Low-income populations in low- and middle-income countries are especially vulnerable to these deficiencies. There are three priority interventions used to reduce micronutrient deficiencies and improve overall nutrition status — supplementation, fortification, and diet diversity. As the share of food purchases made by low-income households has been increasing, there is increasing interest in the role the private sector can play in these interventions. Currently, there is little known about the potential for a market-based approach to contribute to improvements in diet diversity. Proven to be one of the most effective ways of improving nutritional status, increasing diet diversification among low-income populations will be essential for reducing micronutrient deficiencies in the long-term. The purpose of this research is to contribute evidence on the potential for a market-based approach to increase diet diversity among low-income households in Mozambique. This research starts by examining the extent to which low-income consumers in
Nampula, Mozambique make diverse food purchases and the amount they are willing to pay for such diversity. Since diet diversification is intended to improve health, the connections between individual-level health constructs and diversity of food purchases is subsequently investigated. These studies are then used as the basis for a participatory community-based intervention that explores if health constructs influence modifications in food purchases and the barriers and enabling factors that exist to using the market to increase household diet diversity. The findings of this work reveal that there is potential for markets to contribute to the diversity of foods consumed by low-income households; however, concerted efforts between the private, public, and civil sectors will likely be required for the success and longevity of market-based approaches. === Doctor of Philosophy === Though we usually think of hunger in terms of not getting enough to eat, there is another form, known as 'hidden hunger', which refers to not eating enough of the right types of foods. This results in not getting enough of the nutrients, such as iron or vitamin A, that are essential for human health and development. People living in low- and middle-income countries (LMICs) are especially vulnerable to this type of hunger, as their diet typically is comprised of calorie-rich but nutrient-deficient foods. One of the most effective ways to reduce hidden hunger, is to eat a variety of foods that are rich in micronutrients (e.g., fruits, vegetables, legumes, meat). In LMICs, governmental and non-governmental organizations (NGOs) have created programs to encourage this so-called 'diet diversity' by encouraging households to produce different types of food crops or plant kitchen gardens. These programs have been successful in increasing diet diversity, however, significant portions of the population in LMICs still lack diversity in their diets. We now know that an increasing number of low-income households in LMICs are purchasing at least some of their foods from markets. Thus, there is increasing interest in the role that businesses and food purchases
can play in increasing the diversity of the diet among households that may be suffering from hidden hunger. The purpose of this research was to explore this possibility. First, I investigated if low-income consumers are already purchasing diverse foods from the market in Mozambique, and, if they are, how much are they willing to pay for this diversity. Second, I explored how the diversity of these purchases are related to what individuals believe about the connection between diet diversity and health. Then I conducted a community-based intervention, where low-income households participated in a nutrition and food-purchasing education and worked with facilitators to find ways that worked for them to increase the diversity of the foods they purchased from the market. The findings of this study show that it may be possible to use the market and food purchases to increase the diet diversity of low-income households, but that support from governments and NGOs will likely be required in order to be successful in reducing hidden hunger in the long-term.
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