Abstract
Successful integration of nutrition interventions into large-scale development programmes from nutrition-relevant sectors, such as agriculture, can address critical underlying determinants of undernutrition and enhance the coverage and effectiveness of on-going nutrition-specific activities. However, evidence on how this can be done is limited. This study examines the feasibility of delivering maternal, infant, and young child nutrition behaviour change communication through an innovative agricultural extension programme serving nutritionally vulnerable groups in rural India. The existing agriculture programme involves participatory production of low-cost videos promoting best practices and broad dissemination through village-level women’s self-help groups. For the nutrition intervention, 10 videos promoting specific maternal, infant, and young child nutrition practices were produced and disseminated in 30 villages. A range of methods was used to collect data, including in-depth interviews with project staff, frontline health workers, and self-help group members and their families; structured observations of mediated video dissemination sessions; nutrition knowledge tests with project staff and self-help group members; and a social network questionnaire to assess diffusion of promoted nutrition messages. We found the nutrition intervention to be well-received by rural communities and viewed as complementary to existing frontline health services. However, compared to agriculture, nutrition content required more time, creativity, and technical support to develop and deliver. Experimentation with promoted nutrition behaviours was high, but sharing of information from the videos with non-viewers was limited. Key lessons learned include the benefits of and need for collaboration with existing health services; continued technical support for implementing partners; engagement with local cultural norms and beliefs; empowerment of women’s group members to champion nutrition; and enhancement of message diffusion mechanisms to reach pregnant women and mothers of young children at scale. Understanding the experience of developing and delivering this intervention will benefit the design of new nutrition interventions which seek to leverage agriculture platforms.
Highlights
Maternal and child undernutrition remains a leading global public health challenge with short, medium, and long-term consequences [1,2]
The burden of maternal and child undernutrition in India is far greater than any other country; the last National Family Health Survey (NFHS) in 2005–06 showed that over a third of women of reproductive age were underweight (BMI
In India, the last NFHS revealed coverage of 12 essential child nutrition interventions to be under 50%, with low coverage for interventions related to dietary adequacy and hygiene practices [10]
Summary
Maternal and child undernutrition remains a leading global public health challenge with short-, medium-, and long-term consequences [1,2]. It has been calculated that implementing a set of ten proven nutrition-specific interventions (i.e. those that address immediate determinants of maternal, infant, and young child nutrition (MIYCN), such a micronutrient supplementation, optimal child feeding practices, and management of severe acute malnutrition) at 90% coverage could reduce deaths and stunting prevalence among children under five by 15% and 20% respectively [9]. Coverage of these interventions remains limited, especially in sub-Saharan Africa and South Asia, where need is the highest [6]. In India, the last NFHS revealed coverage of 12 essential child nutrition interventions to be under 50%, with low coverage for interventions related to dietary adequacy and hygiene practices [10]
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