A rural health program can either distribute vouchers for locally available animal-source foods twice weekly or provide bulk fortified cereal every day. Applying principles of PEM prevention, which choice is most likely to sustainably reduce both stunting and kwashiorkor risk and why?

• A. Bulk fortified cereal every day is always superior because daily caloric quantity trumps protein quality and will prevent both kwashiorkor and stunting in any population without additional considerations.
• B. Neither intervention matters; water sanitation alone is sufficient to prevent PEM, so funds should be redirected away from food programs.
• C. Provide only vitamin pills because micronutrients are the sole cause of kwashiorkor and stunting, and actual food-based programs are unnecessary.
• D. Vouchers for locally acceptable animal-source foods twice weekly are likely more effective because they supply high-quality protein and bioavailable micronutrients essential for growth and plasma protein synthesis, even if offered less frequently, whereas fortified cereal may not provide sufficient bioavailable protein to prevent kwashiorkor.

Answer: (D)