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

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Paulo" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " 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. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-32/v2", "name": "The paradox of food production, expenditure, poverty and stunting..." } } ] } Home Browse The paradox of food production, expenditure, poverty and stunting... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article 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: 1 approved, 1 approved with reservations] . F1000Research 2026, 11 :32 ( https://doi.org/10.12688/f1000research.74295.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised 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] Novatus Tesha https://orcid.org/0000-0001-7137-0058 1 , Malale Tungu https://orcid.org/0000-0002-8821-493X 1 , Alphoncina Kagaigai https://orcid.org/0000-0001-7130-9433 1 , Boniface Yohana 2 , Hevenlight A. Paulo https://orcid.org/0000-0002-3162-9982 3 Novatus Tesha https://orcid.org/0000-0001-7137-0058 1 , Malale Tungu https://orcid.org/0000-0002-8821-493X 1 , [...] Alphoncina Kagaigai https://orcid.org/0000-0001-7130-9433 1 , Boniface Yohana 2 , Hevenlight A. Paulo https://orcid.org/0000-0002-3162-9982 3 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 DETAILS 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. READ ALL READ LESS Keywords Stunting, Food Production, Basic Need Poverty and Household Consumption Corresponding Author(s) Novatus Tesha ( [email protected] ) Close 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: 1 approved, 1 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: 26 Feb 2026, 11 :32 ( https://doi.org/10.12688/f1000research.74295.3 ) 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. 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 READ REVIEWER RESPONSES  There is a newer version of this article available. Suppress this message for one day. 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 2015/2016 5 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 (=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) 2018 4 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 1. World Health Organization: Global nutrition targets 2025: Stunting policy brief. World Health Organization; 2014. 2. Micha R, Mannar V, Afshin A, et al. : Global nutrition report: action on equity to end malnutrition.2020. 3. World Health Organization: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: levels and trends in child malnutrition: key findings of the 2020 edition. 4. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], Tanzania Food and Nutrition Centre (TFNC), National Bu- reau of Statistics (NBS), Office of the Chief Government Statistician (OCGS) [Zanzibar] and UNICEF: Tanzania National Nutrition Survey using SMART Methodology (TNNS) 2018 Summary of the Findings. Dar es Salaam, Tanzania: MoHCDGEC, MoH, TFNC, NBS, OCGS, and UNICEF; 2018. 5. Ministry of Health and Social Welfare: National Nutrition Strategy 201/12-2015/16.2011. 6. United Republic of Tanzania: National Multisectoral Nutrition Action Plan (NMNAP) for the period July 2016 – June 2021.2016. 7. Prime Minister’s Office (PMO), Tanzania Food and Nutrition Centre (TFNC) and UNICEF: Mid-Term Review of the National Multisectoral Nutrition Action Plan 2016-21. Dar es Salaam, Tanzania: PMO, TFNC and UNICEF; 2019. 8. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], Tanzania Food and Nutrition Centre (TFNC), National Bu- reau of Statistics (NBS), Office of the Chief Government Statistician (OCGS) [Zanzibar] and UNICEF: Tanzania National Nutrition Survey using SMART Methodology (TNNS) 2018. Dar es Salaam, Tanzania: MoHCDGEC, MoH, TFNC, NBS, OCGS, and UNICEF; 2018. 9. Adhikari RP, Shrestha ML, Acharya A, et al. : Determinants of stunting among children aged 0-59 months in Nepal: Findings from Nepal Demographic and health Survey, 2006, 2011, and 2016. BMC Nutr. 2019; 5 (1): 1–10. Publisher Full Text 10. Adekanmbi VT, Kayode GA, Uthman OA: Individual and contextual factors associated with childhood stunting in Nigeria: A multilevel analysis. Matern Child Nutr. 2013; 9 (2): 244–259. PubMed Abstract | Publisher Full Text 11. Sunguya BF, Zhu S, Mpembeni R, et al. : Trends in prevalence and determinants of stunting in Tanzania: An analysis of Tanzania demographic health surveys (1991-2016). Nutr J. 2019; 18 (1): 1–13. Publisher Full Text 12. Semali IA, Tengia-Kessy A, Mmbaga EJ, Leyna G: Prevalence and determinants of stunting in under-five children in central Tanzania: Remaining threats to achieving Millennium Development Goal 4. BMC Public Health. 2015; 15 (1): 1153. Publisher Full Text 13. Correia LL, AC ES, Sales Campos J, et al. : Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil. Rev Saude Publica. 2014; 48 (1): 19–28. PubMed Abstract | Publisher Full Text 14. Chirande L, Charwe D, Mbwana H, et al. : Determinants of stunting and severe stunting among under-fives in Tanzania: Evidence from the 2010 cross-sectional household survey. BMC Pediatr. 2015; 15 (1): 165. Publisher Full Text 15. Ministry of Finance and Planning - Poverty Eradication Division (MoFP- PED) [Tanzania Mainland] and National Bureau of Statistics (NBS): Tanzania Mainland Household Budget Survey 2017-18. Dodoma, Tanzania: Key Indicators Report; 2019. 16. De Onis M, Borghi E, Arimond M, et al. : Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr. 2019; 22 (1): 175–179. PubMed Abstract | Publisher Full Text 17. Shilugu LL, Sunguya BF: Stunting in the Context of Plenty: Unprecedented Magnitudes Among Children of Peasant’s Households in Bukombe, Tanzania. Frontiers in nutrition. 2019; 7 (6): 168. 18. Nordang S, Shoo T, Holmboe-Ottesen G, et al. : Women’s work in farming, child feeding practices and nutritional status among under-five children in rural Rukwa, Tanzania. British Journal of Nutrition. 2015; 114 : 1594–1603. PubMed Abstract | Publisher Full Text 19. Mbwana HA, Kinabo J, Lambert C, et al. : Factors influencing stunting among children in rural Tanzania: an agro-climatic zone perspective. Food Secur. 2017; 9 (6): 1157–1171. Publisher Full Text 20. Leal VS, Lira PI, Menezes RC, et al. : Factors associated with the decline in stunting among children and adolescents in Pernambuco. Northeastern Brazil. Revista de saude publica. 2012; 46 (2): 234–241. Publisher Full Text 21. United Republic of Tanzania: Employment and Labour Act: 2006. PubMed Abstract 22. Abila S: An Analyses of Threats to the Realisation of the United Nations’ Sustainable Development Goals Report 2019 in the Light of the Recent Report of the Global Futures (ie the World Wildlife Fund) on the Unfolding Trends on the Environment in Nigeria and the Globe-A Call for Sustained Global Action. JL Pol’y & Globalization. 2020; 95 : 38. Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 12 Jan 2022 ADD YOUR COMMENT Comment 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 Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 26 Feb 2026, 11:32 https://doi.org/10.12688/f1000research.74295.3 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 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. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article 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: 1 approved, 1 approved with reservations] . F1000Research 2026, 11 :32 ( https://doi.org/10.12688/f1000research.74295.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE 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 Version 2 VERSION 2 PUBLISHED 06 Feb 2026 Revised Views 0 Cite How to cite this report: Imaeda N. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.196035.r456265 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v2#referee-response-456265 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 12 Feb 2026 Nahomi Imaeda , Department of Nutrition, ​Shigakkan University, Aichi, Japan Approved VIEWS 0 https://doi.org/10.5256/f1000research.196035.r456265 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in ... Continue reading READ ALL Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. 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. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Imaeda N. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.196035.r456265 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v2#referee-response-456265 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Feb 2026 Novatus Tesha , Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania 26 Feb 2026 Author Response We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We ... Continue reading We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We agree with all the comments raised and have addressed them as shown below. Reviewer comment 1 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. Response We are very thankful to the reviewer for these comments. We agree with the reviewer, and we have made changes to the abstract to include these suggestions. Reviewer comment 2 In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Thank you. We agree with the reviewer and have added a note to Figure 5. The figure legend is now " Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland (Blue squares: 8 regions with high prevalence of stunting and 8 regions with the lowest prevalence of stunting) Reviewer comment Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. Response Thank you We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We agree with all the comments raised and have addressed them as shown below. Reviewer comment 1 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. Response We are very thankful to the reviewer for these comments. We agree with the reviewer, and we have made changes to the abstract to include these suggestions. Reviewer comment 2 In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Thank you. We agree with the reviewer and have added a note to Figure 5. The figure legend is now " Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland (Blue squares: 8 regions with high prevalence of stunting and 8 regions with the lowest prevalence of stunting) Reviewer comment Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. Response Thank you Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Feb 2026 Novatus Tesha , Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania 26 Feb 2026 Author Response We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We ... Continue reading We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We agree with all the comments raised and have addressed them as shown below. Reviewer comment 1 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. Response We are very thankful to the reviewer for these comments. We agree with the reviewer, and we have made changes to the abstract to include these suggestions. Reviewer comment 2 In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Thank you. We agree with the reviewer and have added a note to Figure 5. The figure legend is now " Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland (Blue squares: 8 regions with high prevalence of stunting and 8 regions with the lowest prevalence of stunting) Reviewer comment Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. Response Thank you We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We agree with all the comments raised and have addressed them as shown below. Reviewer comment 1 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. Response We are very thankful to the reviewer for these comments. We agree with the reviewer, and we have made changes to the abstract to include these suggestions. Reviewer comment 2 In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Thank you. We agree with the reviewer and have added a note to Figure 5. The figure legend is now " Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland (Blue squares: 8 regions with high prevalence of stunting and 8 regions with the lowest prevalence of stunting) Reviewer comment Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. Response Thank you Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 12 Jan 2022 Views 0 Cite How to cite this report: Imaeda N. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r144313 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v1#referee-response-144313 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Aug 2022 Nahomi Imaeda , Department of Nutrition, ​Shigakkan University, Aichi, Japan Approved with Reservations VIEWS 0 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 ... Continue reading READ ALL 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. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Imaeda N. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r144313 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v1#referee-response-144313 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS 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 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 COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Kinabo J. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r123223 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v1#referee-response-123223 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details 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 VIEWS 0 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 ... Continue reading READ ALL 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. 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. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kinabo J. Reviewer 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r123223 ) The direct URL for this report is: https://f1000research.com/articles/11-32/v1#referee-response-123223 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS 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 Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 12 Jan 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline 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 Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 26 Feb 26 read Version 2 (revision) 06 Feb 26 read Version 1 12 Jan 22 read read Joyce Kinabo , Sokoine University of Agriculture, Morogoro, Tanzania Nahomi Imaeda , ​Shigakkan University, Aichi, Japan Zelda Anne Elum , University of Port Harcourt, Choba, Nigeria Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Anne Elum Z. This is an open access peer review report 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. 16 Mar 2026 | for Version 3 Zelda Anne Elum , University of Port Harcourt, Choba, Rivers, Nigeria 0 Views copyright © 2026 Anne Elum Z. This is an open access peer review report 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. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline 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 The study result showing that the Tanzania regions which have high level of food production but associated with high stunting is an indication of lack of access to food. That is, the inability to purchase available food or consume other varieties of food. The implication is the need to improve access to food by improving household income and also the need to educate the people on food utilisation. Under the "Stunting and average monthly household food consumption expenditure" subheading, there is an incorrect statement as the negative correlation value should be interpreted as: "the higher the average monthly household food consumption expenditure, the lower is the prevalence of stunting". The paper contain other typos that need to be corrected. In addition, the negative correlation between the prevalence of stunting and household food consumption reinforces the importance of food accessibility or the affordability of food. As evidenced in the literature, peasant farmers often depend on their own production for household food consumption and they lack the means to afford other varieties of foods not produced. Conclusively, consistent food production addresses one dimension (availability) of food security. There is need for other dimensions (accessibility, utilisation and stability) to be improved. 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? Yes 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. Reviewer Expertise Agricultural production economics, agricultural finance, food security, gender studies, climate impacts on agriculture and adaptation. 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. reply Respond to this report Responses (0) Anne Elum Z. 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.196830.r462961) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-32/v3#referee-response-462961 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Imaeda N. This is an open access peer review report 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. 12 Feb 2026 | for Version 2 Nahomi Imaeda , Department of Nutrition, ​Shigakkan University, Aichi, Japan 0 Views copyright © 2026 Imaeda N. This is an open access peer review report 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. format_quote Cite this report speaker_notes Responses (1) Approved info_outline 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 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. 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. reply Respond to this report Responses (1) Author Response 26 Feb 2026 Novatus Tesha, Development of Development Studies, Muhimbilili University of Health and Allied Sciences, Dar es Salaam, Tanzania We are thankful for the reviewer for taking part in reviewing our work. We are thankful for the comments provided, which continue to improve and make our work clearer. We agree with all the comments raised and have addressed them as shown below. Reviewer comment 1 Thank you for carefully addressing the previous comments. I appreciate that the revised manuscript now clearly specifies the regional names (e.g., Njombe), which substantially improves the transparency and interpretability of the findings. This clarification strengthens the ecological comparisons presented in the study. I would like to offer one additional suggestion to further enhance clarity in the abstract and to minimize potential ambiguity. In particular, the sentence: “It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty.” may be somewhat difficult for readers to interpret unambiguously. The phrase “lowest level of basic need poverty” could be open to different interpretations, as it is not immediately clear whether this refers to poverty depth, poverty severity, or poverty rate. As “basic needs poverty” appears to represent the proportion of households unable to meet minimum consumption needs, it may improve clarity to explicitly refer to “poverty rates.” For example, the sentence could be revised as follows: “Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates.” This wording more directly conveys the paradoxical pattern described in the title — namely, that regions with higher stunting do not necessarily correspond to regions with higher poverty rates — and would help readers more readily grasp the conceptual contrast highlighted in the study. Clarifying this expression would further strengthen the internal consistency between the title (“paradox”), the reported results, and their interpretation in the abstract. Response We are very thankful to the reviewer for these comments. We agree with the reviewer, and we have made changes to the abstract to include these suggestions. Reviewer comment 2 In addition, Figure 5 should ideally be self-explanatory without requiring reference to the main text. I would recommend adding a brief note in the figure legend clarifying the meaning of the blue squares and pink circles to improve readability. Thank you. We agree with the reviewer and have added a note to Figure 5. The figure legend is now " Figure 5. Stunting prevalence and basic need poverty in Tanzania Mainland (Blue squares: 8 regions with high prevalence of stunting and 8 regions with the lowest prevalence of stunting) Reviewer comment Overall, the manuscript has improved substantially, and with minor clarifications to wording and figure presentation, it will provide a clearer and more compelling account of the ecological paradox described. Response Thank you View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Imaeda N. 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.196035.r456265) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-32/v2#referee-response-456265 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2022 Imaeda N. This is an open access peer review report 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. 10 Aug 2022 | for Version 1 Nahomi Imaeda , Department of Nutrition, ​Shigakkan University, Aichi, Japan 0 Views copyright © 2022 Imaeda N. This is an open access peer review report 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. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline 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 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. reply 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 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. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Imaeda N. 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r144313) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-32/v1#referee-response-144313 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2022 Kinabo J. This is an open access peer review report 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. 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 0 Views copyright © 2022 Kinabo J. This is an open access peer review report 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. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline 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 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. 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. reply 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. reply Respond Report a concern Kinabo J. 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] . F1000Research 2026, 11 :32 ( https://doi.org/10.5256/f1000research.78033.r123223) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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