OBJECTIVE To evaluate the impact of the US government's Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa. DESIGN Difference-in-differences quasi-experimental approach. SETTING Households in 33 low and lower middle income countries in sub-Saharan Africa. POPULATION 883 309 children aged less than 5 years with weight, height, and age recorded in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052 children were from Feed the Future countries and 495 257 were from non-Feed the Future countries. MAIN OUTCOME MEASURES A difference-in-differences approach was used to compare outcomes among children in intervention countries after implementation of the initiative with children before its introduction and children in non-intervention countries, controlling for relevant covariates, time invariant national differences, and time trends. The primary outcome was stunting (height for age >2 standard deviations below a reference median), a key indicator of undernutrition in children. Secondary outcomes were wasting (low weight for height) and underweight (low weight for age). RESULTS Across all years and countries, 38.3% of children in the study sample were stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six years of Feed the Future's implementation, children in 12 countries with the initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to 5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1) greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater decline in underweight levels compared with children in 21 countries without the initiative and compared with trends in undernutrition before Feed the Future was launched. These decreases translate to around two million fewer stunted and underweight children aged less than 5 years and around a half million fewer children with wasting. For context, about 22 million children were stunted, 11 million children were underweight, and four million children were wasted in the Feed the Future countries at baseline. CONCLUSIONS Feed the Future's activities were closely linked to notable improvements in stunting and underweight levels and moderate improvements in wasting in children younger than 5 years. These findings highlight the effectiveness of this large, country tailored initiative focused on agriculture and food security and have important implications for the future of this and other nutrition interventions worldwide.

中文翻译：

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撒哈拉以南非洲地区“未来喂养行动”对5岁以下儿童营养的影响：差异分析。

目的评估撒哈拉以南非洲地区美国政府的“未来养活”计划对5岁以下儿童营养结局的影响。设计差异差异准实验方法。地点撒哈拉以南非洲33个中低收入国家的家庭。2000年至2017年之间，在33个国家/地区进行的118项调查中记录了883309名5岁以下的体重，身高和年龄的儿童：388052例儿童来自``未来饲料''国家，495257例儿童来自非``未来饲料''国家。主要观察指标：采用差异研究方法比较了该计划实施后干预国家的儿童与实施该计划之前的儿童与非干预国家儿童的结果，控制相关的协变量，时不变的国家差异和时间趋势。主要结果是发育迟缓（年龄低于2个标准差的身高，低于参考中位数），这是儿童营养不足的关键指标。次要结局为消瘦（身高体重低）和体重不足（年龄低体重）。结果在所有年份和所有国家/地区中，研究样本中38.3％的儿童发育不良，8.9％的儿童体重下降，21.3％的体重不足。在实施“养活未来”计划的头六年中，在该倡议下的12个国家/地区的儿童发育迟缓下降了3.9个百分点（95％的置信区间为2.4至5.5），消瘦下降的幅度更大了1.1个百分点（0.1-2.1） ，以及2.8个百分点（1.6到4）。0）与21个国家未采取主动行动的儿童相比，体重不足水平的下降幅度更大；与“未来养活”计划推出之前营养不足的趋势相比，下降幅度更大。这些减少意味着5岁以下的发育不良和体重不足的儿童减少了约200万，浪费的儿童减少了约50万。在背景情况下，大约2200万儿童发育迟缓，1100万儿童体重不足，400万儿童被浪费在“未来饲料”国家中。结论养活未来的活动与发育迟缓和体重不足水平的显着改善以及5岁以下儿童消瘦的适度改善密切相关。这些发现凸显了这种庞大的，