A Social Norms-Based Intervention Improves Dietary Diversity among Women in Rural India: The Reduction in Anemia through Normative Innovations (RANI) Project.

Sameera A. Talegawkar,Satyaranjan Behera,Rajiv Rimal,Rohini Ganjoo,Yichen Jin,Erica Sedlander,Loretta DiPietro

doi:10.3390/nu13082822

Abstract

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization’s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

Highlights

Anemia, an important public health concern in low- and middle-income countries, is associated with negative health outcomes, such as increased risk of pre-term delivery, maternal death, and reduced physical capacity in adults [1,2,3,4] as well as poor cognitive development in young children [5]
We examined over a six-month period the effect of a social norms-based intervention on diet diversity among non-pregnant
Between the treatment and control groups, women in the treatment group tended to be older, had a higher body mass index (BMI), and were less likely to be from the scheduled tribe (p for all

Summary

Introduction

An important public health concern in low- and middle-income countries, is associated with negative health outcomes, such as increased risk of pre-term delivery, maternal death, and reduced physical capacity in adults [1,2,3,4] as well as poor cognitive development in young children [5]. India has one of the highest global prevalences of anemia, and this is more pronounced among women of reproductive age [6]. According to the India’s National Family Health Survey (NFHS) 2015–2016, 53% of women aged. The primary cause of anemia in India is inadequate iron intake, as Indian diets often comprise plant-based foods with low iron bio-availability and few animal products [9]. Lack of financial resources to buy iron-rich foods affects diet diversity, exacerbating anemia prevalence [10]. India has implemented several iron and folic acid supplementation interventions to reduce the prevalence of iron deficiency anemia. Starting in 1970, the National Nutritional Anemia Prophylaxis

Methods

Results

Discussion

Conclusion