The paradox of food production, expenditure, poverty and stunting &nbsp;in Tanzania: an ecological study design

Novatus Tesha; Malale Tungu; Alphoncina Kagaigai; Boniface Yohana; Hevenlight A. Paulo

doi:10.12688/f1000research.74295.2

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Research Article

Revised

The paradox of food production, expenditure, poverty and stunting in Tanzania: an ecological study design

[version 2; peer review: 2 approved with reservations]

Novatus Tesha ¹, Malale Tungu¹, Alphoncina Kagaigai¹, Boniface Yohana², Hevenlight A. Paulo³

Novatus Tesha ¹, Malale Tungu¹, [...] Alphoncina Kagaigai¹, Boniface Yohana², Hevenlight A. Paulo³

PUBLISHED 06 Feb 2026

Author details Author details

¹ Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania
² Department of National Accounts, National Bureau of Statistics, Dodoma, Tanzania
³ Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Novatus Tesha
Roles: Conceptualization, Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Malale Tungu
Roles: Conceptualization, Formal Analysis, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Alphoncina Kagaigai
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Boniface Yohana
Roles: Methodology, Validation

Hevenlight A. Paulo
Roles: Methodology, Visualization

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Agriculture, Food and Nutrition gateway.

Abstract

Background

There have been claims amongst nutrition stakeholders in Tanzania that the food basket regions, are the regions most affected by stunting among children. However, this study could not find evidence that combines food production and stunting levels, to substantiate this claim. Therefore, this study aims to compare data on stunting, food production and consumption within administrative regions of the Tanzania mainland.

Methods

The study used an ecological study design to show the relationship between stunting, poverty, food production and food and non-food consumption expenditure across administrative regions in Tanzania mainland. The study used data from three national wide surveys: 2017/2018 Household Budget Survey (HBS), Tanzania National Nutrition Survey (TNNS) 2018 and Agriculture Statistics for Food Security report 2018/2019.

Results

The study showed that there is a positive relationship between the prevalence of stunting and food production (r=0.43, p=0.03), while there is a negative relationship between stunting and the level of both the average monthly household food consumption expenditure (r = -0.51, p = 0.01) and average monthly household non-food consumption expenditure (r = -0.51, p = 0.01). It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.

Conclusion

The study found a positive relationship between food production and the prevalence of stunting using data across regions in mainland Tanzania. This is an indication that regional food production may not entail nutrition outcomes, hence a call for more advocacy on nutrition-sensitive agriculture.

Keywords

Stunting, Food Production, Basic Need Poverty and Household Consumption

Corresponding author: Novatus Tesha

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2026 Tesha N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Tesha N, Tungu M, Kagaigai A et al. The paradox of food production, expenditure, poverty and stunting in Tanzania: an ecological study design [version 2; peer review: 2 approved with reservations]. F1000Research 2026, 11:32 (https://doi.org/10.12688/f1000research.74295.2) First published: 12 Jan 2022, 11:32 (https://doi.org/10.12688/f1000research.74295.1) Latest published: 06 Feb 2026, 11:32 (https://doi.org/10.12688/f1000research.74295.2)

Revised Amendments from Version 1

In this revised version 2 of the manuscript, we have improved the manuscript based on the reviewers’ comments, which have greatly improved our work. The revisions are made on the title, abstract, methods, results (texts, tables and figures) and in the discussion. The changes include replacing all figures with new figures with the line of fit. We have included all regions of Tanzania in the figures. We have also added the map of Tanzania, which shows the setting of Tanzania with its discussed regions. Average household consumption expenditure on non-food has been added and we have removed the average household consumption variable. In case of food diversity, we have added an explanation of the details on the food that were included in the food production variable. We have changed our focus on food and nutrition security to food availability and its relationship with the related nutrition outcomes.

See the authors' detailed response to the review by Nahomi Imaeda
See the authors' detailed response to the review by Joyce Kinabo

Introduction

Stunting, defined as being too short for one’s age, is among the important indicators to track children’s malnutrition.¹ Globally, the number of stunted children is decreasing, however, its prevalence level is still unacceptable. In the past 18 years, the number of stunted children globally, decreased by 49.2 million. It has been reported that in 2018, over 149 million (21.9%) children were estimated to have stunted growth globally, compared to 198.2 million children in 2000.² Most of the stunted children live in developing countries, especially in Asia and Africa with 55% and 39% of children suffering from stunting, respectively. Africa is the only region where the number of cases is increasing; rising from 50.3 million in 2000 to 58.8 million in 2018 with disparities existing at the sub-national level.²^,³

The prevalence of stunting in Tanzania decreased by 18% from the 1990s, from 50% of children to 32% in 2018.⁴ This rapid change was due to the different strategies taken by the government, in collaboration with development partners, including implementation of the National Nutrition Strategy 2011/2012 to 2015/2016⁵ and the National Multi-Sectoral Nutrition Action Plan 2016 – 2021.⁶ However, this level is still high as per the World Health Organization (WHO) recommended thresholds (>= 30%). WHO defines levels of stunting in four levels: low (<20%); Medium (20 – 29%), High (30 – 39%) and very high (>=40).¹³^,¹⁴ Despite the decrease in the prevalence level, the number of stunted children is increasing. It increased from 2.5 million in 2005 to 3 million in 2018.⁷ The disparity exists across regions in Tanzania Mainland. Out of 26 regions, 15 regions have a stunting prevalence of above 30%, among them, six regions have above 40%. The regions with the highest stunting levels are Njombe (53%), Rukwa (47.9%), Iringa (47.1%), Songwe (43.3), Kigoma (42.2) and Ruvuma 41%.⁸

The reviewed literature has shown that under-five stunting can be explained by different immediate and intermediate factors. Some of the factors include income levels, family size, education level of the mother, sex of the baby, age of the baby, feeding practices, food preparations, overall health status, types of occupation of the mother, weight of the baby and age of the mother at birth.⁹^–¹² The underlying factors of stunting are government policies, pricing of food, access to social services, farming practices and economic status of the household.⁶ Household poverty level and other factors related to poverty are also cited as determinates of stunting at household levels.¹¹^,¹²^,¹⁴

In Tanzania, some regions that are leading in food production and with a small prevalence of poverty, are also leading in the prevalence of stunting. For example, Njombe has the highest level of stunting (53%) and yet, it is the region with the third lowest rate of poverty (13.2%), just above are Dar es Salaam and Kilimanjaro with 8% and 10% levels respectively.⁴^,¹⁵ Similarly, in 2018, Ruvuma was the highest region in terms of food production but it had a stunning level of 41%. There has been a debate amongst nutrition stakeholders (those working in the government, United Nations Agencies and donor countries supporting nutrition interventions, academia and non-governmental organization in nutrition), on the controversy on regions with both high food production and stunting levels. However, to the best of our knowledge, we have not found previous research conducted to investigate this. Therefore, this study aims to compare data on stunting, food production and consumption across administrative regions of Tanzania.

Methods

Study design and data source

This is an ecological study design using secondary data compiled from three sources: Tanzania Household Budget Survey (HBS) 2017/2018,¹⁵ Tanzania National Nutrition Survey (TNNS) 2018⁴ and Agriculture Statistics for Food Security report 2018/2019.¹⁶ Both HBS and TNNS are national-wise cross-sectional data organized by the Ministry of Finance and Planning and Ministry of Health respectively, while Agriculture Statistics for Food Security report 2018/2019 was prepared by the Ministry of Agriculture.

Study setting

Data for this study was sourced from 26 Tanzania mainland administrative regions. The regions were chosen because currently, aggregated data are representative at the regional level. Similarly, regions were chosen to determine whether food production could be a determinant of stunting at the regional level and hence answering the paradox ( Figure 1).

Figure 1. The map of Tanzania with the administrative regions.

A sampling of the Household Budget Survey and Tanzania National Nutrition Survey

The 2017/18 HBS had a sample of 9,552 individuals, which allowed disintegration of the results at the regional level. The data set adopted a two-stage cluster sample design. The first stage involved the selection of enumeration areas, Primary Sampling Units, (PSUs) from the 2012 Population and Housing Census Frame.¹⁵ The second stage involved systematic sampling of households from the updated PSUs list. All household members, regardless of their age, who were the usual members of the selected households and all the visitors who were present in the household on the night before the survey, were eligible. The survey took place from 1^st December 2017 to 30^th November 2018.

TNNS used two-stage cluster sampling using Probability Proportional to Size (PPS), a representative at the regional and national level. The first stage sample of clusters was drawn independently for each domain. The second stage of sampling consisted of selecting households within each selected cluster, by using a systematic random selection procedure. Data were collected from the sample of 17,524 children aged 0-59 months and 9,426 women aged 15-49 years old. Data collection took place from 25^th of September and finished on the 17^th of November 2018.

The agriculture statistics were obtained from the agricultural statistics for food security report. This is the national wide report which synthesis data collected through various ways including 10 different tools. Among the tools were a tool for target and implementation of crop cultivation at field level, food availability at local markets and food security questinnaire 1 (FSQ1).¹⁶ The foods which were included in this reports include cereal and non-cereal. For cereal food it included maize, sorghum, finger millet, bulrush millet, rice, wheat and cereals. The non-cereals include beans, peagon peas, cowpeas, groundnuts, greengram, bambaranuts, cassava, banana, sweet potatoes and round patatoes.

Variables

The outcome variable of this study is the regional prevalence of stunting. Children were reported to be stunted if their height-for-age is more than two standard deviations below the World Health Organization’s Child Growth Standards median.¹⁶ The exposure variables were the regional food production (cereal and non-cereals food crops in metric tons), the proportion of basic need poverty, and average monthly household food and non-food consumption expenditure.

Data management and analysis

Data were cleaned and analyzed using Microsoft Excel and STATA version 15. Mean and standard divisions were used to summarize the numerical variables. Correlation coefficients and scatter plots were used to determine the linear relationship between outcome (regional prevalence of stunting) and exposure variables (food production, average household monthly food and non-food consumption expenditure and proportion of regional basic need poverty). Findings were presented using tables, figures and narrations. The significance level was set at 5%.

Results

Summary statistics of the variables

The overall prevalence of stunting for the Tanzania mainland is 33.5%, ranging from 20% in Kilimanjaro to 53.6% in the Njombe region. Basic need poverty stands at 27.5%, ranging from 8% in Dar es Salaam to 45% in the Rukwa region. On the other hand, the average food production is 977,544.80 Metric tons per year and the mean average monthly household food consumption expenditure is 47,986 ranging from 34,354 in Kigoma to 70,966 in Dar es Salaam (see Table 1).

Table 1. Summary statistics of the variables (n = 26).

Variable	Mean/prevalence	Standard deviation
Stunting (overall prevalence)	33.5	8.8
Food production (metric tons)	977,544.8	434,201.7
Basic need poverty	27.6	9.0
Average monthly household food consumption expenditure (TZS)	47,986 (USD 20.8)	8,603 (USD 3.7)
Average monthly household food consumption expenditure	41,345 (USD 17.9)	8,603 (USD 3.7)

Stunting and food production

There is a significant positive linear relationship between the prevalence of stunting and the level of food production (r = 0.43, p = 0.03) i.e. the higher the level of food production the higher is the prevalence of stunting ( Figure 2).

Figure 2. Prevalence of stunting and food production in mainland regions of Tanzania.

Stunting and average monthly household food consumption expenditure

The result indicated that there is a significant negative relationship between the prevalence of stunting and the average monthly food consumption expenditure levels per household per month (r = -0.51, p = 0.01) i.e. the higher the average monthly household food consumption expenditure, the higher is the prevalence of stunting (see Figure 3).

Figure 3. Prevalence of stunting by average monthly household food consumption expenditure in mainland regions of Tanzania.

Stunting and average monthly household non-food consumption expenditure

It was observed that there is a negative relationship between average monthly household non-food consumption expenditure and prevalence of stunting (r = -0.509, p = 0.01) i.e. as the average montly household non-food consumption expenditure increases the prevelence of stunting decreases (see Figure 4).

Figure 4. Stunting and average monthly household non-food consumption expenditure.

Relationship Between Stunting and Basic Need Poverty

The relationship between stunting and basic needs poverty indicated that Njombe, which is the region with the highest level of stunting in the country (53%), is the region with the third lowest level of poverty (13.2%), next to Kilimanjaro (8%) and Dar es Salaam (10.5%). The prevalence of basic need poverty in Njombe, Iringa and Songwe, with stunting levels above 40%, is lower compared to other regions. However, the level of poverty and stunting in Rukwaa and Geita do not show notable differences. This trend is also observed for the regions with the lowest levels of stunting which are Kilimanjaro, Dar es Salama and Morogoro ( Figure 5).

Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland.

Discussion

Findings show that regions with the highest food production had a high prevalence of stunting. This result concurs with the study done in Bukombe, Tanzania, which found that children from peasants households producing plenty food were more likely to be stunted compared to other occupations.¹⁷ This might be true because food-producing regions entail a great deal work, often done by mothers in their small scale farms, and hence little time is given for them to take care of and feed, their children. This indicates that food availability may not entail food consumption and related outcomes. This may mean that very low income households spend the majority of their time on the farm, producing and consuming one type of food and are thus severely affected by seasonal household food availability. Low income households may food available in the harvest season and food unavailabe in other seasons of the year while other occupations’ household may buy their food and hence have more food diversity.¹⁷^,¹⁸ However, these findings contrast other studies that have found households with food insecurity and small cultivation size, were more affected by stunting, compared to those who are food secure and those with large cultivated areas.⁹^,¹⁹

Our study found that some regions like Njombe, which are among the regions with the lowest levels of poverty, have higher levels of stunting. The findings are contrary to several studies done on the determinants of stunting in developing countries across the globe, which shows that poverty is positively associated with stunting.⁹^–¹¹^,²⁰ The reason for this might be that mothers in regions like Njombe, are involved in several economic activities to earn their income.¹⁷ Due to this, they may have limited time with their children.¹⁷^,¹⁸ In addition, labour laws in Tanzania, gives women only about three months’ maternity leave.²¹ Therefore, due to mothers works in the farms or as employee in the govermenent or private institurions they do not have enough time to breastfed their children, take them to hospitals and feed them accordingly.¹⁷^,¹⁸

In addition, the results of the study show that regions with higher monthly household food and non-food consumption expenditure, had lower levels of stunting. This means that higher consumption means increased purchasing of a variety of foods, which reduces malnutrition. This finding concurs with a study done in Tanzania, which showed that families which were not dependent on farming their own food, bought a variety of food for their families, unlike those which produce their food.¹⁷ Similarly, the family from farming family had lower dietary diversity (71%), compared to those from other occupation (55%).¹⁸

Conclusion and Recommendations

This study has found that the more the region produces food, the more likely it is to have higher levels of stunting. In addition, it has found that some regions with the lowest levels of poverty have higher levels of stunting. Regions with higher monthly household food and non-food consumption expenditure have higher levels of stunting. Therefore, this indicates that food production and a lower level of poverty, might not lead to nutrition outcomes. This study provides a picture of the relationship between food production; consumption, poverty and stunting in Tanzania. Therefore, it provides the foundation for further studies in this area. to understand contextual factors leading to high stunting in regions which have abountance of food. A comparative study can be done comparing regions with high food production with lower stunting level and those with higher level of food production performing poorly on stunting. Similarly, this information can enlighten policymakers on rethinking how to make agriculture nutrition-sensitive and education using of locally available food to attain nutrition outcomes especially diatary divirsity so that Tanzania can attain the Sustainable Development Goals (SDGs) goal of ending malnutrition in all its forms.²²

Limitations of the study

This study faced a few limitations, one of them being that the study used secondary data of which some of the variables were missing, limiting our analysis. Furthermore, data were aggregated at the regional level rather than individual level, which limited the interpretation of factors associated with malnutrition. The food production included cereals and non-cereals. It did not include vegatables, fruits and animal products which are important for stunting reduction.

Data availability

Underlying data

Dryad: The Paradox of Food Production, Consumption, Poverty and Malnutrition in Tanzania

https://doi.org/10.5061/dryad.gxd2547n9

This project contains the following underlying data:

• Data_for_Regional_Stunting__Food_Production__Consumption_and_Poverty_Levels_-_Tanzania.xls

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Acknowledgements

We would like to thank the Ministry of Finance and Planning, Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Ministry of Agriculture for conducting the surveys and reports, which are available online for further use.

References

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Version 2

VERSION 2 PUBLISHED 12 Jan 2022

Author details Author details

Novatus Tesha
Roles: Conceptualization, Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Malale Tungu
Roles: Conceptualization, Formal Analysis, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Alphoncina Kagaigai
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Boniface Yohana
Roles: Methodology, Validation

Hevenlight A. Paulo
Roles: Methodology, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 06 Feb 2026, 11:32

https://doi.org/10.12688/f1000research.74295.2

version 1

Published: 12 Jan 2022, 11:32

https://doi.org/10.12688/f1000research.74295.1

© 2026 Tesha N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Tesha N, Tungu M, Kagaigai A et al. The paradox of food production, expenditure, poverty and stunting in Tanzania: an ecological study design [version 2; peer review: 2 approved with reservations]. F1000Research 2026, 11:32 (https://doi.org/10.12688/f1000research.74295.2)

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Open Peer Review

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PUBLISHED 12 Jan 2022

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Reviewer Report 10 Aug 2022

Nahomi Imaeda, Department of Nutrition, Shigakkan University, Aichi, Japan

Approved with Reservations

https://doi.org/10.5256/f1000research.78033.r144313

Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.

Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Furthermore, for mothers in Region Njombe, the author should show statistical data on longer hours of work in comparison with other areas.

In Figures 1-3:

The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed.
The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: public health, dietary surveys, nutritional epidemiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

06 Feb 2026

Author Response

We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' ... Continue reading We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' comments, which we have all agreed on and worked on.

1. Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.
Response

Thank you

2. Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Response
Thank you very much, the data we have used are for food that are non-commercial. This includes cereals and non-cereals. The non-cereals include beans, pigeon peas, cowpeas, groundnuts, greengram, bambaranus, cassava, banana, sweet potatoes and round potatoes. Have added this explanation in the method section. Page 5

3. The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed
Thank you, all figures have been changed. Pages 7-10

4. The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Response
Thank you very much, this has been applied to all figures. Pages 7-10

5 Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

Response
Thank you, we have added Figure 1 from Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1.
Page 4

6. In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

Response
Thank you, the figures now include all regions of Tanzania Page 10

7. The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Response
Thank you. We have used these terms based on the reports from which it was obtained for easy of reference.
We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' comments, which we have all agreed on and worked on.

1. Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.
Response

Thank you

2. Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Response
Thank you very much, the data we have used are for food that are non-commercial. This includes cereals and non-cereals. The non-cereals include beans, pigeon peas, cowpeas, groundnuts, greengram, bambaranus, cassava, banana, sweet potatoes and round potatoes. Have added this explanation in the method section. Page 5

3. The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed
Thank you, all figures have been changed. Pages 7-10

4. The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Response
Thank you very much, this has been applied to all figures. Pages 7-10

5 Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

Response
Thank you, we have added Figure 1 from Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1.
Page 4

6. In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

Response
Thank you, the figures now include all regions of Tanzania Page 10

7. The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Response
Thank you. We have used these terms based on the reports from which it was obtained for easy of reference.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

06 Feb 2026

Author Response

We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' ... Continue reading We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' comments, which we have all agreed on and worked on.

1. Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.
Response

Thank you

2. Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Response
Thank you very much, the data we have used are for food that are non-commercial. This includes cereals and non-cereals. The non-cereals include beans, pigeon peas, cowpeas, groundnuts, greengram, bambaranus, cassava, banana, sweet potatoes and round potatoes. Have added this explanation in the method section. Page 5

3. The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed
Thank you, all figures have been changed. Pages 7-10

4. The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Response
Thank you very much, this has been applied to all figures. Pages 7-10

5 Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

Response
Thank you, we have added Figure 1 from Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1.
Page 4

6. In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

Response
Thank you, the figures now include all regions of Tanzania Page 10

7. The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Response
Thank you. We have used these terms based on the reports from which it was obtained for easy of reference.
We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' comments, which we have all agreed on and worked on.

1. Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.
Response

Thank you

2. Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Response
Thank you very much, the data we have used are for food that are non-commercial. This includes cereals and non-cereals. The non-cereals include beans, pigeon peas, cowpeas, groundnuts, greengram, bambaranus, cassava, banana, sweet potatoes and round potatoes. Have added this explanation in the method section. Page 5

3. The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed
Thank you, all figures have been changed. Pages 7-10

4. The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Response
Thank you very much, this has been applied to all figures. Pages 7-10

5 Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

Response
Thank you, we have added Figure 1 from Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1.
Page 4

6. In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

Response
Thank you, the figures now include all regions of Tanzania Page 10

7. The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Response
Thank you. We have used these terms based on the reports from which it was obtained for easy of reference.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 14 Mar 2022

Joyce Kinabo, Department of Food Technology Nutrition and Consumer Sciences, College of Agriculture, Sokoine University of Agriculture, Morogoro, Tanzania

Approved with Reservations

https://doi.org/10.5256/f1000research.78033.r123223

Commendation:
I would like to commend the authors for coming up with this paper in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food producing regions are also leading in the prevalence of stunting.

Suggestion: change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper.

Methodology:

Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.
Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Results:

Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables.
Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.
Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistency.
Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.
It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children.

Discussion

“This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study.
Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS).

Conclusion:

The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

CITE

Report a concern

Author Response 06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

06 Feb 2026

Author Response

We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments ... Continue reading We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments have improved our work.

Commendation

1. I would like to commend the authors for coming up with this paper, in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food-producing regions are also leading in the prevalence of stunting

Response

Thank you

Tittle

2. Change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper

Response

Thank you, we agree with the reviewer, the title has been revised as suggested.
N/A

Methodology

3. Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.

Response

Thank you, we agree with the reviewer. The survey dates have been added: HBS 1st December 2017 to 30th November 2018 and TNNS 17th of November 2018. Regarding the agriculture statistics, it is a synthesis report which collects reports from 10 different tools collected from all districts of the country. The report does not give details on the dates and how each tools sampled its population. Pages
4 & 5

4. Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Response
Thank you, we agree with the reviewer. We have added the average household expenditure on non-food and removed the average consumption variable. In case of food diversity, we have added an explanation on the details on the food that were included in the food production variable. Pages
5, 7 - 9

Findings

5. Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables

Response
Thank you, this have been added throughout all figures. Pages 8-10

6. Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.

Response
Thank you very much there was a typo. We agree with the reviewer , however, we have removed this variable so that food and non-food household expenditure can be reported. Pages 7-9

7. Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistence

Response
Thank you very much we have added an elaboration of the relationship. Page 8

8. Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.

Response
Thank you, all 25 regions have now been presented in the figures. Pages 9-10

9 It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children

Response
Thank you. We agree with the reviewer. We have added non-food expenditure in our analysis. Pages 7-9

Discussions

10 “This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study

Response
Thank you. We agree with the reviewer and edited the section to food availability may not entail food consumption and related outcomes. Page 10 and throughout the discussion section

11 Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS)

Response
Thank you very much, we have added the findings on dietary divisity which found children from farming household performed lower on diatary diversity compared to other occupation. Page 11

Conclusion

12 The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected

Response
Thank you, we agree with the reviewer. We have edited the conclusion. We have added research specific recommendation and the policy recommendation for understanding further the the contextual factors for the paradox and solutions to the paradox. Page 11
We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments have improved our work.

Commendation

1. I would like to commend the authors for coming up with this paper, in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food-producing regions are also leading in the prevalence of stunting

Response

Thank you

Tittle

2. Change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper

Response

Thank you, we agree with the reviewer, the title has been revised as suggested.
N/A

Methodology

3. Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.

Response

Thank you, we agree with the reviewer. The survey dates have been added: HBS 1st December 2017 to 30th November 2018 and TNNS 17th of November 2018. Regarding the agriculture statistics, it is a synthesis report which collects reports from 10 different tools collected from all districts of the country. The report does not give details on the dates and how each tools sampled its population. Pages
4 & 5

4. Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Response
Thank you, we agree with the reviewer. We have added the average household expenditure on non-food and removed the average consumption variable. In case of food diversity, we have added an explanation on the details on the food that were included in the food production variable. Pages
5, 7 - 9

Findings

5. Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables

Response
Thank you, this have been added throughout all figures. Pages 8-10

6. Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.

Response
Thank you very much there was a typo. We agree with the reviewer , however, we have removed this variable so that food and non-food household expenditure can be reported. Pages 7-9

7. Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistence

Response
Thank you very much we have added an elaboration of the relationship. Page 8

8. Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.

Response
Thank you, all 25 regions have now been presented in the figures. Pages 9-10

9 It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children

Response
Thank you. We agree with the reviewer. We have added non-food expenditure in our analysis. Pages 7-9

Discussions

10 “This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study

Response
Thank you. We agree with the reviewer and edited the section to food availability may not entail food consumption and related outcomes. Page 10 and throughout the discussion section

11 Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS)

Response
Thank you very much, we have added the findings on dietary divisity which found children from farming household performed lower on diatary diversity compared to other occupation. Page 11

Conclusion

12 The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected

Response
Thank you, we agree with the reviewer. We have edited the conclusion. We have added research specific recommendation and the policy recommendation for understanding further the the contextual factors for the paradox and solutions to the paradox. Page 11
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

06 Feb 2026

Author Response

We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments ... Continue reading We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments have improved our work.

Commendation

1. I would like to commend the authors for coming up with this paper, in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food-producing regions are also leading in the prevalence of stunting

Response

Thank you

Tittle

2. Change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper

Response

Thank you, we agree with the reviewer, the title has been revised as suggested.
N/A

Methodology

3. Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.

Response

Thank you, we agree with the reviewer. The survey dates have been added: HBS 1st December 2017 to 30th November 2018 and TNNS 17th of November 2018. Regarding the agriculture statistics, it is a synthesis report which collects reports from 10 different tools collected from all districts of the country. The report does not give details on the dates and how each tools sampled its population. Pages
4 & 5

4. Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Response
Thank you, we agree with the reviewer. We have added the average household expenditure on non-food and removed the average consumption variable. In case of food diversity, we have added an explanation on the details on the food that were included in the food production variable. Pages
5, 7 - 9

Findings

5. Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables

Response
Thank you, this have been added throughout all figures. Pages 8-10

6. Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.

Response
Thank you very much there was a typo. We agree with the reviewer , however, we have removed this variable so that food and non-food household expenditure can be reported. Pages 7-9

7. Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistence

Response
Thank you very much we have added an elaboration of the relationship. Page 8

8. Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.

Response
Thank you, all 25 regions have now been presented in the figures. Pages 9-10

9 It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children

Response
Thank you. We agree with the reviewer. We have added non-food expenditure in our analysis. Pages 7-9

Discussions

10 “This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study

Response
Thank you. We agree with the reviewer and edited the section to food availability may not entail food consumption and related outcomes. Page 10 and throughout the discussion section

11 Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS)

Response
Thank you very much, we have added the findings on dietary divisity which found children from farming household performed lower on diatary diversity compared to other occupation. Page 11

Conclusion

12 The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected

Response
Thank you, we agree with the reviewer. We have edited the conclusion. We have added research specific recommendation and the policy recommendation for understanding further the the contextual factors for the paradox and solutions to the paradox. Page 11
We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments have improved our work.

Commendation

1. I would like to commend the authors for coming up with this paper, in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food-producing regions are also leading in the prevalence of stunting

Response

Thank you

Tittle

2. Change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper

Response

Thank you, we agree with the reviewer, the title has been revised as suggested.
N/A

Methodology

3. Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.

Response

Thank you, we agree with the reviewer. The survey dates have been added: HBS 1st December 2017 to 30th November 2018 and TNNS 17th of November 2018. Regarding the agriculture statistics, it is a synthesis report which collects reports from 10 different tools collected from all districts of the country. The report does not give details on the dates and how each tools sampled its population. Pages
4 & 5

4. Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Response
Thank you, we agree with the reviewer. We have added the average household expenditure on non-food and removed the average consumption variable. In case of food diversity, we have added an explanation on the details on the food that were included in the food production variable. Pages
5, 7 - 9

Findings

5. Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables

Response
Thank you, this have been added throughout all figures. Pages 8-10

6. Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.

Response
Thank you very much there was a typo. We agree with the reviewer , however, we have removed this variable so that food and non-food household expenditure can be reported. Pages 7-9

7. Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistence

Response
Thank you very much we have added an elaboration of the relationship. Page 8

8. Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.

Response
Thank you, all 25 regions have now been presented in the figures. Pages 9-10

9 It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children

Response
Thank you. We agree with the reviewer. We have added non-food expenditure in our analysis. Pages 7-9

Discussions

10 “This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study

Response
Thank you. We agree with the reviewer and edited the section to food availability may not entail food consumption and related outcomes. Page 10 and throughout the discussion section

11 Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS)

Response
Thank you very much, we have added the findings on dietary divisity which found children from farming household performed lower on diatary diversity compared to other occupation. Page 11

Conclusion

12 The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected

Response
Thank you, we agree with the reviewer. We have edited the conclusion. We have added research specific recommendation and the policy recommendation for understanding further the the contextual factors for the paradox and solutions to the paradox. Page 11
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VERSION 2 PUBLISHED 12 Jan 2022

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Version 2 (revision) 06 Feb 26
Version 1 12 Jan 22	read	read

Joyce Kinabo, Sokoine University of Agriculture, Morogoro, Tanzania
Nahomi Imaeda, Shigakkan University, Aichi, Japan

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Reviewer Report

32 Views

10 Aug 2022 | for Version 1

Nahomi Imaeda, Department of Nutrition, Shigakkan University, Aichi, Japan

32 Views Cite this report Responses(1)

Approved With Reservations

The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed.
The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

public health, dietary surveys, nutritional epidemiology

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Responses (1)

Author Response

06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

We are very thankful to the reviewer for reviewing our work. The reviewers' comments and inputs have been crucial in improving our work. Below, we provide point-by-point responses to reviewers' comments, which we have all agreed on and worked on.

1. Despite the need for epidemiological studies targeting developing countries, there are still few publications. In this context, an ecological study design that allows low-cost analysis would be beneficial. I read this paper with great interest.
Response

Thank you

2. Ecological studies cannot prove causality, but the author should choose appropriate parameters to clarify the relationship with the prevalence of stunting. The author describes it as a paradox that the food production value is positively correlated with stunting, but the indicators observed are not appropriate. The author should observe in more detail what food groups are produced. For example, the production of coffee beans would not be directly related to an increase in nutrient intake.

Response
Thank you very much, the data we have used are for food that are non-commercial. This includes cereals and non-cereals. The non-cereals include beans, pigeon peas, cowpeas, groundnuts, greengram, bambaranus, cassava, banana, sweet potatoes and round potatoes. Have added this explanation in the method section. Page 5

3. The graphs presenting the 26 regions should show approximate equations. In addition, for those regions that had large residuals from the equation, the reasons should be discussed
Thank you, all figures have been changed. Pages 7-10

4. The figures should be drawn squares with numbers like [1], [2] - [26], indicating the name of the region, rather than a square black box, so that the stunting situation and economic situation in Tanzania can be understood.

Response
Thank you very much, this has been applied to all figures. Pages 7-10

5 Since most of the readers have unknown area names in Tanzania, I suppose that as possible as simple maps should be shown with transport infrastructure (road network or ocean ports). In this peer review, I was able to get some Tanzania information by the administrative regions of Tanzania map (referred Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1), or the Tanzania transport map (website: https://www.tanzaniainvest.com/transport ). The figures of present paper did not provide enough information about regions in Tanzania.

Response
Thank you, we have added Figure 1 from Tanzania National Nutrition Survey 2018.pdf, page 7, Figure 1.
Page 4

6. In Figures 4 and 5, only 8 regions were observed, so the explanation is not sufficient.

Response
Thank you, the figures now include all regions of Tanzania Page 10

7. The keyword “basic needs poverty” should be changed to “basic human needs” and “poverty”? or “basic needs poverty line”? And according to the PubMed Mesh, the keyword "stunting" is included in Growth Disorders. I recommend you refer to the PubMed Mesh to increase the number of web-search hits.

Response
Thank you. We have used these terms based on the reports from which it was obtained for easy of reference.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

39 Views

14 Mar 2022 | for Version 1

Joyce Kinabo, Department of Food Technology Nutrition and Consumer Sciences, College of Agriculture, Sokoine University of Agriculture, Morogoro, Tanzania

39 Views Cite this report Responses(1)

Approved With Reservations

Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.
Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Results:

Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables.
Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.
Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistency.
Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.
It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children.

Discussion

“This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study.
Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS).

Conclusion:

The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Respond to this report

Responses (1)

Author Response

06 Feb 2026

Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania

We are very thankful to the reviewer who reviewed our work. We agree with all comments and have provided a point-by-point response detailing how we have addressed them. These comments have improved our work.

Commendation

1. I would like to commend the authors for coming up with this paper, in which they have attempted to provide some answers about the paradox relationship between food production, stunting, expenditure, and poverty in Tanzania. They have correctly pointed out that high food-producing regions are also leading in the prevalence of stunting

Response

Thank you

Tittle

2. Change the title to read “the paradox of food production, expenditure, poverty, and stunting in Tanzania….” To reflect what is described in the paper

Response

Thank you, we agree with the reviewer, the title has been revised as suggested.
N/A

Methodology

3. Sampling procedure for the Household Budget Survey and Tanzania National Nutrition Survey has been described but not for the agriculture statistics. The authors should explain how the data on agriculture production is collected. It would also be useful to indicate when these various surveys were carried out (date and month). This information has implications on the relationships of the variables and therefore interpretation of the results.

Response

Thank you, we agree with the reviewer. The survey dates have been added: HBS 1st December 2017 to 30th November 2018 and TNNS 17th of November 2018. Regarding the agriculture statistics, it is a synthesis report which collects reports from 10 different tools collected from all districts of the country. The report does not give details on the dates and how each tools sampled its population. Pages
4 & 5

4. Provide the definition of average consumption. The household budget survey presents proportion of food and non-food expenditures, it would be more logical to look into these categories and assess how they relate to stunting instead of just looking at the average expenditure and expenditure on food only. In addition, what are the kinds of foods that are accessed by households? Do they add to the diversity of nutritious foods?

Response
Thank you, we agree with the reviewer. We have added the average household expenditure on non-food and removed the average consumption variable. In case of food diversity, we have added an explanation on the details on the food that were included in the food production variable. Pages
5, 7 - 9

Findings

5. Add lines of fit on the correlation graphs (scatter plots) to assist the reader to get a clear picture of the relationship between the variables

Response
Thank you, this have been added throughout all figures. Pages 8-10

6. Stunting and average monthly household consumption expenditure (AMHCE): the authors have stated that there was a significant negative relationship between stunting and AMHCE; but explained that as AMCHE increased, stunting also increased. Is this the meaning of a negative relationship? This area needs clarification.

Response
Thank you very much there was a typo. We agree with the reviewer , however, we have removed this variable so that food and non-food household expenditure can be reported. Pages 7-9

7. Stunting and AMHFCE: authors observed a negative relationship, but did not elaborate further on this relationship the way they have done for other relationships. There is a need for consistence

Response
Thank you very much we have added an elaboration of the relationship. Page 8

8. Stunting and basic need poverty: what is the basis of selecting only eight regions. It is better to present data for all regions to give the reader a full perspective of the data you have analysed and single out the eight regions in the description of the results. In the current analysis, the Njombe region should appear in both figures 4 and 5. However, it would also be interesting to identify regions that appear in both figures 4&5.

Response
Thank you, all 25 regions have now been presented in the figures. Pages 9-10

9 It would also be more informative to present data on the relationship between stunting and monthly food and non food expenditures to show how the two types of expenditure contribute to stunting. Nevertheless, this is not a very strong indicator since it does not tell us what types of foods are purchased and consumed by children

Response
Thank you. We agree with the reviewer. We have added non-food expenditure in our analysis. Pages 7-9

Discussions

10 “This indicates that food security may not entail nutrition security” This is a statement in the discussion, but not explained fully. Authors should be cautious when using these terminologies. In this particular study, they assessed the relationship between food production or availability and stunting and not food security, which has four pillars. It would be better to say that food availability may not entail food consumption and related outcomes; rather than using words such as food and nutrition security, which were not assessed in this study

Response
Thank you. We agree with the reviewer and edited the section to food availability may not entail food consumption and related outcomes. Page 10 and throughout the discussion section

11 Page 7 para 3 is more speculative and not supported by the available data. It should be revised to provide more information about expenditure and what kinds of foods are purchased and actually fed to children. It would also be more logical to consider other variables such as minimum acceptable diet (MAD) for children and household dietary diversity score (HDDS)

Response
Thank you very much, we have added the findings on dietary divisity which found children from farming household performed lower on diatary diversity compared to other occupation. Page 11

Conclusion

12 The authors have not been able to explain the paradox. The conclusion is the same as introduction. It was expected to get an explanation about the paradox and how that can be corrected

Response
Thank you, we agree with the reviewer. We have edited the conclusion. We have added research specific recommendation and the policy recommendation for understanding further the the contextual factors for the paradox and solutions to the paradox. Page 11

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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The paradox of food production, expenditure, poverty and stunting in Tanzania: an ecological study design

Abstract

Background

Methods

Results

Conclusion

Keywords

Revised Amendments from Version 1

Introduction

Methods

Study design and data source

Study setting

Figure 1. The map of Tanzania with the administrative regions.

A sampling of the Household Budget Survey and Tanzania National Nutrition Survey

Variables

Data management and analysis

Results

Summary statistics of the variables

Table 1. Summary statistics of the variables (n = 26).

Stunting and food production

Figure 2. Prevalence of stunting and food production in mainland regions of Tanzania.

Stunting and average monthly household food consumption expenditure

Figure 3. Prevalence of stunting by average monthly household food consumption expenditure in mainland regions of Tanzania.

Figure 4. Stunting and average monthly household non-food consumption expenditure.

Relationship Between Stunting and Basic Need Poverty

Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland.

Discussion

Conclusion and Recommendations

Limitations of the study

Data availability

Underlying data

Acknowledgements

References

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