Nutrition-sensitive Agricultural Interventions Research Articles

The sustainability of a nutrition-sensitive agriculture intervention: a case study from urban Senegal

The sustainability of nutrition-sensitive agriculture projects has been identified as a research gap, and there is limited research available examining such initiatives in an urban context. We examine the sustainability of a nutrition-sensitive agriculture project implemented in Dakar, Senegal. It included provision of two “microgarden” tables, a henhouse, chickens, inputs, training, and education on nutrition and hygiene. This study was conducted 18 months after the project's end and sought to assess the intervention’s sustainability via a survey and in-depth interviews with former project participants. The microgarden tables had poor sustainability: only 5% of respondents continued to use them to grow vegetables. Most of those who continued saw it as a hobby, not a main productive activity. In contrast, 75% continued poultry-rearing activities, and 20% had more chickens than provided by the project. Some former participants had switched to more lucrative models of chicken production, with sales being more common than during the project and considerable revenues earned. This ability to earn income from chicken sales was the dominant motivator of continued production. Nutrition knowledge and practices remained at or near project levels. We discuss lessons for the sustainability of nutrition-sensitive agriculture more generally. These include that in the absence of project-provided incentives, some dis-adoption should be expected; in an urban area, improving incomes may be more relevant than improving production; and behavior change communication likely needs to be re-enforced over time to ensure sustainable changes in nutrition knowledge among parents of young children.

Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh

IntroductionChronic undernutrition affects over 150 million children worldwide and has serious consequences. The causes are complex and include insufficient dietary diversity and poor hygiene practices. Systematic reviews of nutrition-sensitive agricultural...

Marital Status and Support for Women’s and Children’s Wellbeing: Perspectives of Rural Ghanaian Women (P04-038-19)

Abstract Objectives Cohabiting but previously divorced women may be at increased risk of food insecurity. This study explored women's perceptions of how current and prior marital status could influence food security status. Methods Nine focus group (FG) discussions were held with mothers of young children who participated in a nutrition-sensitive agriculture intervention (Nutrition Links) in rural Ghana. Nine of 13 intervention communities were purposively selected to participate. Each FG had 5 to 9 women who were asked about the support they received from their partners regarding food for the household, entrepreneurship activities, and their children's healthcare. How this support changed with marital status, and from where else women could get support was further probed. Translated transcriptions of FG were thematically analyzed. Results Most women reported that men helped with money for food for the household or food stuff from farm. Divorced women would not receive that kind of support. The only support women agreed that men provided independent of marital status was for children's healthcare. Often, the main support network women counted on was that of their immediate family. Co-habiting women would be “pampered” by their partners. However, they would receive little support to develop their own business because men feared that a woman might leave if she were successful. FG participants complained about the lack of freedom married women had, but most of them agreed that married women had a better economic and social standing and had more support from their husband's family than non-married women. FG women reported that married men were more likely to support their wives’ business - assuming that they would also benefit - but a man would hinder his wife's entrepreneurial growth out of jealousy if he perceived that she was moving ahead of him. Conclusions Marital status might affect the support women receive for food security in complex ways. Divorced women do not receive economic support from their ex-husbands and cohabiting women do not receive support to develop their business. As previous studies suggested, focusing solely on female household headship might not be enough to identify the most vulnerable individuals. Thus, interventions and policies targeting maternal and child nutrition should consider women's marital status as well as their support networks. Funding Sources International Development Research Centre (IDRC) Global Affairs Canada McGill University World Vision University of Ghana

Production Diversity, Men’s Help with Household Tasks, & Lower Women’s Depression Mediate Impact of an Agriculture Intervention on Child’s Dietary Diversity in Tanzania (FS01-06-19)

ObjectivesProduction diversity and women’s empowerment are two ways by which nutrition-sensitive agriculture interventions are thought to improve children’s diet, but, few empirical studies have tested these pathways. We therefore investigated the impact of the Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876) on child’s dietary diversity, as well as the mediating role of production diversity and women’s empowerment on that relationship. MethodsSNAP-Tz is a randomized trial of a participatory agroecology and nutrition intervention on which mentor farmers lead their fellow farmers with children < 1 y.o. at baseline (n = 587) in learning and experimentation on agroecology, nutrition, and gender equity. We estimated the intention-to-treat impact of SNAP-Tz on Child’s Dietary Diversity Score (CDDS) [0–7] using difference-in-difference analysis between 2016 and 2018. Average Causal Mediation Effect (ACME5) were estimated for production diversity (Crop Nutritional Functional Richness; 0–7) and 4 measures of women’s empowerment: Abbreviated Women’s Empowerment in Agriculture Index (AWEAI, 0–1), women’s ability to allocate income (WEAI questions; 0–1), men’s help with household chores (with 7 activities; 0–7), and women’s depression (Center for Epidemiologic Studies Depression Scale; 0–60). All analyses were done on Stata14 and controlled for geographic clustering and social desirability bias. ResultsSNAP-Tz significantly improved child’s dietary diversity (β = 0.53, P < 0.01). Increased production diversity, greater male involvement in household chores, and lower women’s depression mediated 11% (ACME: .06; 95%CI: .01-.11), 6% (ACME: .04; 95CI: .00-.08), and 7% (ACME: .03; 95%CI: .00-.07) of SNAP-Tz’s impact on child’s dietary diversity, respectively. Mediation of AWEAI and income allocation decision making, on the other hand, were not significant. ConclusionsSNAP-Tz improved child’s dietary diversity through increasing agricultural production diversity, men’s involvement in household chores, and women’s mental health. By engaging men in household tasks and prioritizing women’s mental health, we can optimize the impact of nutrition-sensitive agriculture projects. Funding SourcesSNAP-Tz is funded by the McKnight Foundation. SLY was supported by the NIH (K01MH098902).

Production Diversity, Men’s Help with Household Tasks, & Lower Women’s Depression Mediate Impact of an Agriculture Intervention on Child’s Dietary Diversity in Tanzania (FS01-06-19)

ObjectivesProduction diversity and women’s empowerment are two ways by which nutrition-sensitive agriculture interventions are thought to improve children’s diet, but, few empirical studies have tested these pathways. We therefore investigated the impact of the Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876) on child’s dietary diversity, as well as the mediating role of production diversity and women’s empowerment on that relationship. MethodsSNAP-Tz is a randomized trial of a participatory agroecology and nutrition intervention on which mentor farmers lead their fellow farmers with children <1 y.o. at baseline (n = 587) in learning and experimentation on agroecology, nutrition, and gender equity. We estimated the intention-to-treat impact of SNAP-Tz on Child’s Dietary Diversity Score (CDDS) [0–7] using difference-in-difference analysis between 2016 and 2018. Average Causal Mediation Effect (ACME5) were estimated for production diversity (Crop Nutritional Functional Richness; 0–7) and 4 measures of women’s empowerment: Abbreviated Women’s Empowerment in Agriculture Index (AWEAI, 0–1), women’s ability to allocate income (WEAI questions; 0–1), men’s help with household chores (with 7 activities; 0–7), and women’s depression (Center for Epidemiologic Studies Depression Scale; 0–60). All analyses were done on Stata14 and controlled for geographic clustering and social desirability bias. ResultsSNAP-Tz significantly improved child’s dietary diversity (β = 0.53, P < 0.01). Increased production diversity, greater male involvement in household chores, and lower women’s depression mediated 11% (ACME: .06; 95%CI: .01-.11), 6% (ACME: .04; 95CI: .00-.08), and 7% (ACME: .03; 95%CI: .00-.07) of SNAP-Tz’s impact on child’s dietary diversity, respectively. Mediation of AWEAI and income allocation decision making, on the other hand, were not significant. ConclusionsSNAP-Tz improved child’s dietary diversity through increasing agricultural production diversity, men’s involvement in household chores, and women’s mental health. By engaging men in household tasks and prioritizing women’s mental health, we can optimize the impact of nutrition-sensitive agriculture projects. Funding SourcesSNAP-Tz is funded by the McKnight Foundation. SLY was supported by the NIH (K01MH098902).

Protocol for the cost-consequence and equity impact analyses of a cluster randomised controlled trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child dietary diversity and nutritional status in rural Odisha, India (UPAVAN trial)

BackgroundUndernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach.MethodsThe economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted.DiscussionEvidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes.Trial registrationISRCTN65922679. Registered on 21 December 2016

Nutrition-Sensitive Agriculture Interventions in Mountain Areas—Lessons Learned From a 5-Country Project to Upscale Best Practices

Many people living in mountain regions in lowand middle-income countries are vulnerable to food and nutrition insecurity, which contributes to poor nutritional status. Food and nutrition security require stability of access to affordable, safe, diverse, and nutritious foods. In mountainous areas, affordability and access to diverse foods are challenged by climatic factors constraining agricultural production, poor infrastructure, and geographic isolation. This article describes a nutrition-sensitive agriculture (NSA) project focusing on 5 countries—Ethiopia, Kyrgyzstan, Nepal, Pakistan, and Peru— where 132 microinterventions were implemented by rural service providers (RSPs) who received training and technical support from the project. These microinterventions serve as learning cases for advocacy work to promote the NSA approach at the local, national, and global levels. They are also documented on an Internet platform allowing RSPs and other stakeholders to share best practices and lessons learned at the national and global levels. Preliminary results indicate that this approach is highly effective in addressing nutrition and livelihood issues in remote mountain areas. To scale up the approach and boost its integration into policies at the local, national, and global levels, 2 aspects will be critical. First, more systemic and integrated NSA initiatives need to be implemented that functionally combine production- and consumption-related aspects to effectively change nutrition behavior and serve as learning cases for scaling up. Second, effective capacity development of RSPs and encouragement of interaction among them is key to empowering them as change agents.

Nutrition-sensitive agricultural interventions, agricultural diversity, food access and child dietary diversity: Evidence from rural Zambia

We study a nutrition-sensitive agricultural program in low-income rural Zambia between 2011 and 2015. Using a pre-post design with a control group, we measure program effects along established pathways connecting agriculture to nutrition: diversity of agricultural production, crop sales, household food access and child and maternal diets. The program increased diversity in crops grown and the number of months in which various food groups were harvested. In particular, the program substantially increased the percentage of households producing three nutritious crops it promoted (groundnuts, rape and tomatoes). As a consequence there were modest increases in household access to diverse food groups. Despite modest increases in the proportion of children consuming pulses, legumes and nuts, ultimately there were no significant improvements in the overall dietary diversity of young children or their mothers. A nutrition-sensitive agricultural program can increase diversity in agricultural production and to a lesser extent access to nutritious foods, but this may not always be sufficient to improve child diets or nutrition.

The effect of farmer nutrition schools on household food production and women's dietary diversity in Bangladesh

Introduction: The nutrition situation in Bangladesh has improved substantially over the last decade. Nevertheless, dietary diversity of women of reproductive age continues to be low. In addition, global evidence on the effect of nutrition-sensitive agriculture interventions on dietary diversity is still developing. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project implemented a Farmer Nutrition School (FNS) intervention in two divisions (regions) in Bangladesh from 2012 to 2016. FNS targeted pregnant women and mothers with children less than two years of age (PLW) in the lowest two wealth quintiles. FNS was based on three well-established, evidence-based strategies--the essential nutrition and hygiene actions, the homestead food production approach, and farmer field schools.&#x0D; Methods: This study aims to assess the effect of SPRING’s FNS program on women’s dietary diversity, measured by a women’s dietary diversity score (WDDS) based on the nine-item FANTA/FAO scale. We followed up one cohort of women who participated in FNS beginning in November 2014. We undertook a two-stage sampling design to identify these women. First, forty-four FNS groups were randomly selected from the 2,560 FNS that were planned to be implemented during 2014-15. Second, 10 women were randomly drawn from each of the 44 FNS groups, which were scattered across 38 upazilas (sub-districts), 19 each in Barisal and Khulna Divisions. Sample size was calculated to detect a 0.25 effect size in the WDDS with a power of 80% and confidence interval of 95%. Three phases of surveys were conducted: before the FNS began (Phase 1-P1, November 2014), immediately after the completion of the FNS (Phase 2-P2, July - August, 2015), and one year after (Phase 3-P3, July 2016). A total of 386 women completed all three surveys. Data analyses included descriptive statistics and t-tests. Statistical significance is tested by the adjusted Wald test with a 95% confidence interval.&#x0D; Results: The percentage of FNS participants’ households that produced vegetables, poultry and fish significantly increased between P1 and P2, from 43% to 95% (p&lt;.05), from 75% to 87% (p&lt;.05), and from 48% to 67% (p&lt;.05), respectively. The increases were more or less sustained at P3, at 86%, 92%, and 63%, respectively. Additionally, the mean numbers of vegetable types grown and of chickens reared increased significantly from P1 to P2 (p&lt;.05) and were sustained at P3, from 1.3 to 4.9 to 4.6, and from 5.3 to 7.9 to 8.4, respectively. The mean WDDS significantly increased from 3.9 to 6.0 between P1 and P2 (p&lt;.05), and was sustained at 5.6 at P3. The proportion of women who reported consuming items promoted in FNS, such as eggs, vitamin-A rich fruits and vegetables, and flesh foods also increased significantly.&#x0D; Conclusions: The FNS approach, which supports agriculture interventions with an explicit nutrition objective, generated rapid and sustained improvement in food production and dietary quality. This study suggests that a program design based on local contexts with moderate management support and minimum material inputs can have a powerful effect on women’s dietary diversity within a short time. Furthermore, with community involvement and ownership in a context like rural Bangladesh, the improvements can be sustained, at least for one year. While this cohort study did not have a built-in control group, the magnitude of the increases in production outcomes and WDDS among FNS participants, coupled with much smaller or no increases at the population level over even longer time periods, suggested that these results were probably largely due to the SPRING FNS intervention.

Prevalence and predictors of stunting and underweight among children under 5 years in Tigray, Ethiopia: Implications for nutrition-sensitive agricultural interventions

ABSTRACTUnderstanding local drivers of malnutrition can help improve the design of agricultural interventions intended to reduce child stunting and underweight. This study reports the prevalence of child under-5 stunting and underweight from 10 rural districts in the Tigray region of Ethiopia; analyzes factors associated with child undernutrition; and presents implications for designing and selecting indicators for agricultural programs intended to improve nutrition. Overall prevalence of stunting and underweight was 40.0% and 34.6%, respectively. There was significant variation among the districts in the proportion of children classified as stunted and underweight (p > 0.05). Stunting rates ranged from 26.7% to 66.7%, underweight rates ranged from 13.3% to 63.3%. Geographic location (odd ratio [OR] = 1.99; 95% confidence interval [CI], 0.81–4.87), no maternal history of eye issues (OR = 1.67; 95% CI, 1.01–2.78), and not owning a mobile phone (OR = 1.5; 95% CI, 0.91–2.49) were factors that increased odds of stunting. Geographic location (OR = 1.17; 95% CI, 0.5–2.76) and no maternal history of eye issues (OR = 1.71; 95% CI, 1.01–2.91) increased odds of underweight. The aggregate data masked influential social and behavioral factors affecting nutrition within certain districts and subgroups. Nutrition-specific approaches that target women and children and nutrition-sensitive approaches that strengthen local sources of resilience are needed to accelerate progress toward improved nutrition and reduce health disparities.

Participatory Assessment of Factors Influencing Nutrition and Livelihoods in Rural Ethiopia: Implications for Measuring Impacts of Multisector Nutrition Programs.

Agricultural interventions more effectively improve nutrition when they are adapted to local contexts and engage multiple sectors. However, evidence is limited for how to design and measure the impacts of such interventions. We piloted a participatory methodology to collect community feedback to inform the design and selection of measures for a multisector nutrition intervention in Ethiopia. Study participants were purposively recruited from 6 rural districts in Tigray and the Southern Nations, Nationalities, and Peoples' regions. Qualitative data were collected from 12 focus group discussions with smallholder farmers (men and women) participating in a nutrition-sensitive agriculture intervention. The Sustainable Livelihoods Approach (SLA) combined with an ecological systems model informed the survey tool and analyses. Analyses revealed 3 key findings. First, there were regional differences in how communities defined assets important for nutrition. Second, when asked to prioritize which assets were most important, communities selected every SLA capital category; however, the types of assets within each category differed by region. Third, the most commonly reported barriers to good nutrition were traditional feeding behaviors (eg, men eating before women) and lack of nutrition knowledge. How households use assets to enhance nutrition is influenced by diverse and dynamic cultural, social, economic, and ecological factors. The participatory methods piloted in this study present a novel approach to identify contextually relevant household, community, and institutional assets used to support food and nutrition security.

The process of developing a nutrition-sensitive agriculture intervention: a multi-site experience

Nutrition-sensitive agriculture (NSA) interventions are of increasing interest to those working in global health and nutrition. However NSA is a broad concept, and there are numerous candidate NSA interventions that could be implemented in any given setting. While most agriculture interventions can be made “nutrition-sensitive”, there are few guidelines for helping to decide what agriculture component should be tried in an NSA intervention. Based on previous models, we developed a framework with explicit questions about community factors (agricultural production, diets, power and gender), project factors (team capacity, budget, timelines) and external factors that helped our team of agriculture scientists, nutritionists and local officials identify NSA interventions that may be feasibly implemented with a reasonable chance of having positive agricultural and nutritional impacts. We applied this framework to two settings in upland Vietnam, and one setting in upland Thailand. From an initial list of nineteen interventions that have been tried elsewhere, or may reasonably be expected to be appropriate for NSA, five or six candidate interventions were chosen per site. Based on the criteria, three to four interventions were selected per site and are being implemented. Poultry rearing and home gardening were selected in each site. They and the other selected interventions, hold promise for capitalizing on underused agricultural potential to improve diets, while working with (or improving) existing gender relationships and power structures. The process for identifying NSA interventions was thorough and identified reasonable candidates, but it was very time consuming. Further efforts should focus on streamlining the process, so that promising and appropriate NSA interventions can be identified quickly and reliably.

Child dietary quality in rural Nepal: Effectiveness of a community-level development intervention

Nutrition-sensitive agricultural interventions have the potential to improve child dietary quality in rural households, as evidenced by a growing body of work which concurrently measures agricultural and nutrition indicators. Our objective was to investigate whether children in rural farming communities of Nepal participating in a community-level, nutrition-sensitive development intervention had improved dietary quality compared with children living in non-participating matched rural communities. Six rural communities of Nepal where livelihoods were predominantly agricultural were selected to participate in the phased implementation of a community-level development intervention by Heifer International. Households and children in each community were surveyed at baseline, and follow-up surveys were implemented every six months for twenty-four months. Detailed data on food consumption for children older than 6months of age were collected using a 24h recall for 17 foods and food groups; parents responded for children. A difference-in-differences model with household fixed-effects and an analysis of covariance model were used to analyze the resulting panel data. Results indicated that the impacts of the intervention varied by agro-ecological region and by season. In the Hills region, which is poorer on average and more conducive to livestock production, children who had received the intervention for two years were 2.2 times as likely to have consumed food from an additional food group, 1.27 times as likely to have achieved minimum dietary diversity and 1.38 times as likely to have consumed animal source foods as children who received the intervention for only one year. In the Terai region, which is more conducive to crop production, there was no significant change in dietary quality attributable to the intervention. These results provide evidence that particularly vulnerable families can take advantage of community-level development activities. Given that the effects of community-level development activities were disparate across communities within the same country, we conclude that tailoring development activities for particular locations is necessary for success.

Role of Pulses in Enhancing Nutritional Status of Rural Poor: Micro-Level Evidence from Semi-Arid Tropics of India

This paper has presented evidence on the role of pulses in enhancing the nutritional status of the rural communities in the semi-arid tropics (SAT) of India. The paper has used primary data from the ICRISAT VLS nutrition surveys (8 villages from Telangana, Andhra Pradesh and Maharashtra) and the longitudinal panel micro-level data (for 6 villages of Telangana and Maharashtra) from 2009 to 2014. The study has revealed that there has been a decline in the area and production of pulses in the SAT villages of India, even though at the macro-level, pulses production has shown an increase. Pulses do contribute to the diversity in diets but the adequacy of protein from the pulses in the diet has not been analyzed in this paper. The regression analysis has indicated the importance and role of pulses in improving the nutritional status of the rural communities. The paper has concluded that there has to be a concerted policy and program action to reintroduce pulses into the cropping pattern in SAT-India and improve the consumption of pulses to the level that has a positive impact on human nutrition. Empowering women along the entire pulse value chain has been observed as one approach to enhance pulse productivity and consumption. Nutrition education, awareness generation and nutrition-sensitive agricultural interventions for pulses are the ways forward to reduce malnutrition in India.

How Does Homestead Food Production Improve Child Nutrition? Path Analysis of the AAMA Project in Nepal

The Action Against Malnutrition through Agriculture (AAMA) Project is an Enhanced Homestead Food Production Project implemented by Helen Keller International and local partners in Far Western Nepal that combined a nutrition‐sensitive agriculture intervention with behavior change communication to improve nutrition and health. Data from a cross‐sectional endline survey were used to measure variables along HKI's hypothesized Program Impact Pathway (PIP), from inputs through key outcomes of interest, including child growth and maternal and child hemoglobin. Survey respondents included mothers with children aged 12‐48 months at the time of the interview (n=2614). We used path analysis to assess the relative contribu&lt;a name=”_GoBack”&gt;&lt;/a&gt;tion of specific mechanisms of effect on nutrition and health as outlined in the PIP. The hypothesized model for height‐for‐age z‐score fit the data well (χ²(19)=55.8, p&lt;0.001; RMSEA=0.027; CFI=0.945), while the model for child hemoglobin (χ²(20)=297.7, p&lt;0.001; RMSEA=0.073, CFI=0.913) was a moderate fit, and some models did not achieve adequate fit. Agricultural inputs is the program component with the strongest path in the model (β=0.022, p&lt;0.001). Areas of weak association and poor model fit may be attributed to weaknesses in measurement, intervention fidelity, and contextual factors unaccounted for in the PIP. These findings guide program improvements by highlighting areas for enhancements in program design, implementation or evaluation.