Peer Review Report For: The paradox of food production, expenditure, poverty and stunting in Tanzania: an ecological study design [version 2; peer review: 1 approved, 1 approved with reservations]

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.