Nutrition-sensitive Agriculture Research Articles

Training to Build Nutrition Capacity in the Nigerian Agricultural Sector: Initial Assessment and Future Directions.

In response to calls to increase nutrition-sensitive agriculture (NSA), the Federal Ministry of Agriculture and Rural Development developed the Nigeria Agricultural Sector Food Security and Nutrition Strategy 2016-2025 (AFSNS). Capacity development activities to facilitate the AFSNS implementation subsequently commenced. This study analyzed the processes and outputs of initial capacity development efforts, examined findings from the analysis using existing literature, and identified critical next steps for nutrition capacity development in the Nigerian agriculture sector. The study reviewed documents including a proposal for nutrition training of agriculture sector actors, reports of meetings held among 6 resource persons who designed and/or delivered training, training reports, participants' pre- and posttraining assessments, and participants' training evaluation. Interviews were conducted with 2 resource persons involved in training design and delivery. Documents and interviews were coded and analyzed to identify emergent themes. Participants' pre- and posttests results were compared using paired t test in Stata 12.0. Knowledge and practice gaps were more extensive than had been anticipated. Training had some but limited effects on knowledge scores at the federal level. Modules addressing implementation practices had to be scaled down for participants to keep up with the learning pace. Existing literature indicates that such training would have been better planned as part of a broader sectoral nutrition workforce strategy, to facilitate greater tailoring of training to participants' job roles. Effective AFSNS implementation requires developing and operationalizing a comprehensive short-, medium- and long-term Agriculture Sector Nutrition Capacity Development Strategy for Nigeria.

Stakeholders, Relationships, and Coordination: 2015 Baseline Study of Needed Enablers for Bridging Agriculture-Nutrition Gaps in Nigeria.

Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination. This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape. Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted. The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates. Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.

Improving Dietary Patterns to Combat Malnutrition in Rural Rwanda Using Small-Scale Nutrition-Sensitive Agriculture: A Mixed-Methods Community Level Study

Describe how collaborative community-based nutrition-sensitive agricultural interventions have the potential to increase household diet diversity, which may encourage sustained change in dietary patterns for nutritional adequacy.

The Association of Women's Participation in Farmer-Based Organizations with Female and Male Empowerment and its Implication for Nutrition-Sensitive Agriculture Interventions in Rural Ghana

ABSTRACTBackgroundFew studies have examined the influence of women's participation in farmer groups on female and male empowerment, which is considered essential to improving nutrition.ObjectivesThe study aimed to 1) assess the empowerment of Ghanaian women farmers, 1 adult male family decision-maker per household, and the household gender equality; and 2) investigate the relation of empowerment and household gender equality with women's participation in farmer-based organizations (FBOs), women's and men's nutritional status, and household food security.MethodsA cross-sectional study investigated secondary outcomes using baseline data from a nutrition-sensitive agriculture intervention implemented through FBOs in rural Ghana. Existing FBOs in 8 communities were selected based on 6 criteria (e.g., participation level, readiness to change). Female FBO (n = 166) and non-FBO (n = 164) members together with a male family member (n = 205) provided data on individual and household characteristics; empowerment was measured across 11 indicators with the project-level Women's Empowerment in Agriculture Index. Generalized linear mixed models tested the associations of empowerment and household gender equality with FBO membership, nutritional status, and household food security.ResultsWomen's FBO membership was associated with an increased likelihood of women's empowerment [adjusted odds ratio (aOR): 3.25; 95% CI: 1.97, 5.33] and household gender parity (aOR: 2.82; 95% CI: 1.39, 5.84) but not men's empowerment. Household food insecurity, but not nutritional status, was positively associated with women's FBO participation and individual empowerment indicators (financial services). Food insecurity was negatively associated with the women's empowerment indicator related to attitudes about domestic violence [adjusted β coefficient (aβ): −0.78; 95% CI: −1.35, −0.21] and men's overall empowerment (aβ: −0.79; 95% CI: −1.58, −0.01).ConclusionsUnderstanding the complexity in which FBO participation, empowerment, nutritional status, and food security are linked is critical in designing interventions that promote gender equality and improved nutrition.This trial was registered at clinicaltrials.gov as NCT03869853.

Crop commercialization and nutrient intake among farming households in Uganda

Agricultural commercialization is expected to enhance a wide array of household welfare indicators, notably, nutrition. Using LSMS-ISA survey data for Uganda, this paper examines the channels through which household nutrient intake is influenced under crop commercialization. A control function was employed to address issues of endogeneity, while the Generalized Propensity Score technique was used to estimate the continuous treatment effects. The results show that commercialization mainly affects nutrient intake through the resulting crop income. From a gender perspective, the findings show that female control of farm income positively and significantly affects the overall nutrient intake. The findings point to three important implications. First, interventions geared towards agricultural commercialization are beneficial to household nutrition via income generation. Given this income-nutrition linkage, proactive steps towards support for nutrition-sensitive commercial agriculture are needed to ensure that nutrient-rich foods are available on the market. Second, there is the need to improve knowledge and perception of what constitutes a good diet. This would provide a stronger linkage between agricultural production, income, and nutrition. Third, gender relations in a household are critical for nutrition outcomes. As such, measures which can empower women to own and control key agricultural production assets are needed to reinforce the link between commercialization and nutrition.

Identifying effective message-framing techniques in behaviour change communication for healthy diets: An experimental study of promoting biofortified maize adoption in Ethiopia

There is an increasing interest in using insights from behavioural economics and psychology to influence people's decisions. However, little is known as to how to leverage these insights to inform educational campaigns in the context of nutrition-sensitive agriculture. We help to fill this void by investigating the effect of framed messages (gain vs loss) in stimulating demand for nutritionally enhanced crops. We conducted a field experiment with 648 farmers and found the following key results. First, nutrition education stimulates demand for nutritionally enhanced crops among smallholder farmers. Without nutrition education, farmers are less likely to switch from producing conventional maize to nutritionally enhanced maize. Second, gain-framed messages are slightly more effective: they result in a higher willingness to pay for nutritionally enhanced maize than loss-framed messages. Third, motivational orientations and risk perceptions of individuals moderate the effect of the framed messages.

Understanding the effects of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutrition in rural Odisha, India: A mixed-methods process evaluation.

A trial of three nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women's group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women's knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision‐making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women's ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition‐sensitive agriculture interventions could include additional flexibility to address families’ land, water, labour and time constraints, as well as actively engage with spouses and in‐laws.

P044 Nutrition-Sensitive Agriculture Project Increased Bean Consumption and Improved Protein Quality of Rural Guatemalan Families

<h3>Objective</h3> To assess impact of nutrition-sensitive agricultural project on intake of beans and improved quality protein of indigenous women and their families in the Guatemalan highlands. <h3>Use of Theory</h3> Nutrition lessons were designed based on the Social Ecological Model taking into account the indigenous highland cultures and local foods grown. They were delivered across geographically dispersed communities in households using wood-burning stoves and no refrigeration. <h3>Target Audience</h3> Indigenous women and their families living in remote rural highland communities. <h3>Description</h3> Five-pound bags of improved bean seed varieties were provided to rural families coupled with training to grow them. Five group lessons with videos and activities were developed to address nutrition topics taught by cross-trained nutrition, health and agricultural extension educators: preventing chronic malnutrition; enhancing protein quality; nutrient needs in pregnancy and lactation; feeding the child 6-11 months; and feeding the child 1-3 years. Because these rural families rarely eat animal protein and had reduced bean consumption, protein complementarity was stressed. Previous assessments demonstrated that their diets were composed primarily of corn and other carbohydrates. <h3>Evaluation</h3> This was addressed two ways: by comparing the household intake of beans both before and after receiving the lessons; and using the Most Significant Change technique for qualitative assessment. <h3>Results</h3> The timeframe for the intervention was six months. Five hundred and seventy one households from 93 communities reported eating beans 1.5 x/week before receiving the bean seed and training and 2.8 x/week afterwards. Analysis of variance (ANOVA) for HH intakes showed statistically significant increases. Qualitative measurements 12 months after the intervention confirmed increased bean consumption across the study area. <h3>Conclusions</h3> This nutrition-sensitive food-based approach when coupled with seed distribution, agricultural and nutrition education resulted in an increased consumption of beans, which when combined with corn and other cereals, improved protein quality intake of women and their families in rural indigenous households. <h3>Funding</h3> USAID

Systematic Review of Social Behavior Change Strategies and Behavior Change Techniques Used in Nutrition Sensitive Agriculture Interventions

ObjectivesWhile social behavior change (SBC) is an important component of nutrition sensitive agriculture interventions (NSeAI), there is limited research on what specific behavior change techniques (BCT) are effective. This systematic review aims to 1) describe SBC design and implementation in the context of NSeAI 2) examine the BCTs used in NSeAI and 3) quantify associations between BCTs and improvements in diet diversity.MethodsLiterature on NSeAI with nutrition SBC was systematically reviewed. Papers published in 2000–2021, aimed to improve diet quality, and described nutrition SBC activities were selected. Agriculture-nutrition pathways and SBC approaches used by interventions were mapped. BCTs were coded using a validated taxonomy. Effectiveness ratios (ERs) were calculated to assess BCTs in relation to program success. Trials were considered effective if there was significant improvement (P < 0.05) in household, women's, and child diet diversity.ResultsOf the 56 interventions included in the study, most were in Sub-Saharan Africa (n = 30) and Asia (n = 21). Thirty-three interventions used formative research to guide SBC design; only six discussed applying a specific behavioral theory. Interventions aimed to increase home production for home consumption (n = 54); increase women's empowerment (n = 30) and increase agricultural income (n = 25) as a pathway to improved nutrition. Fifty-two projects used interpersonal communication, 36 projects used community engagement and 12 used mass media as an approach to behavior change. The most frequently used BCTs included “instructions on how to perform the behavior” (n = 56), “social support (unspecified)” (n = 39), and using a “credible source” for information dissemination (n = 35). On average, projects used 7 BCTs. The BCT “behavioral practice” had the highest effectiveness ratio (ER = 1.0).ConclusionsInterventions focused predominantly on the home production for home consumption pathway. Women's empowerment and agriculture for income pathways were less frequent. All interventions provided instructions on how to perform the behavior but relatively few provided opportunities for ‘behavioral practice’; however, this BCT had the highest effectiveness ratio with all interventions using this BCT demonstrating significant improvements in diet quality.Funding SourcesBill & Melinda Gates Foundation.

Landscape Analysis of Social and Behavior Change in Nutrition-Sensitive Agriculture Programs

ObjectivesNutrition-sensitive agriculture (NSeA) aims to improve consumption via improved production of and/or access to nutritious foods. Social and behavior change (SBC) has potential to maximize NSeA impacts on diet behaviors, but the design and implementation of SBC within NSeA is heterogeneous and often not documented. The objective of this research is to conduct a landscape analysis of SBC in NSeA programs. MethodsThirteen ongoing NSeA programs were enrolled in this landscape analysis. Data were collected in two phases: a desk review of program documents and remote interviews with program staff and stakeholders; and in-person site visits to conduct additional interviews, observe activities, and conduct focus group discussions with community members. Data collection is designed to understand program design, implementation, monitoring and evaluation of SBC in addition to overall implementation successes, challenges, and learnings. ResultsAfter considerable delays due to the ongoing COVID-19 pandemic, three of thirteen site visits have been completed. Initial learnings indicate variability both in SBC approaches employed by NSeA programs, and in alignment with SBC best practices. Interpersonal communication is a common approach in NSeA, often in concert with community engagement. Advocacy, while common, is infrequently identified as an SBC approach. We observed audience-focused, participatory participant engagement. Integration within existing systems and structures, often governmental, is common. We have less commonly observed programs that conduct formative research or utilize behavioral theory in intervention design; rather, programs rely heavily on local staff’s knowledge of communities and social norms. While many programs aim to engage multiple audiences, there are noted barriers to meaningful engagement with secondary audiences. Lastly, we observe that programs tend to rely on a primary platform or communication channel; additional channels may be present but not emphasized. ConclusionsInterpersonal communication and community engagement are cornerstones of SBC in NSeA. Alignment with best SBC practices is mixed, with limited strategic SBC design and implementation. A key challenge to this research is the lack of documentation of SBC design and implementation. Funding SourcesBill & Melinda Gates Foundation.

Collective Empowerment and Influential Group Membership Matter for Household Food Security

ObjectivesReducing the gender gap in empowerment within households is associated with indicators of improved diet. This study developed a household-level empowerment measure and then examined its association with food security. MethodsThis analysis used baseline data from a nutrition-sensitive agriculture intervention in rural Ghana (ClinicalTrials.gov NCT03869853). Only 198 of the 330 households with complete paired empowerment data for one female and one male were included. The household empowerment measure was constructed in two stages. First, the individual empowerment score was assessed using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI) with its 12 indicators (e.g., influential group membership, access to financial services). Participants were classified as empowered (≥75%, 9 out of 12 indicators) or disempowered (<75%). Then, the household was categorized as empowered (both members empowered; 50.5%), semi-empowered (only one member empowered; 34.9%) or disempowered (both members not empowered; 14.6%). Two of the pro-WEAI indicators were assessed also at the household level using the same technique. Food security was assessed with the 15-item Latin American and Caribbean Food Security Scale; a binary variable was created: food secure (0), food insecure (FIS; >0). Cluster-adjusted logistic regression models examined the relationship between FIS and household empowerment. ResultsOver half (58%) of households were FIS. Empowered compared to disempowered households had a lower odds of being FIS (aOR = 0.50, 95% CI [0.29, 0.86]). The model for influential group membership showed that empowered were less likely than disempowered households to be FIS (aOR = 0.27, 95% CI [0.13, 0.58]) while the model for access to financial services showed the opposite (aOR = 3.15, 95% CI [1.80, 5.51]). ConclusionsThese results highlight the complexity of empowerment measures and support empowerment approaches that target different members of the household. Funding SourcesThe Canadian Queen Elizabeth II Diamond Jubilee Scholarships (QES) is managed through a unique partnership of Universities Canada, RHF, CFC, and Canadian universities. The QES-AS is made possible with financial support from IDRC and SSHRC.

Design, delivery, and determinants of uptake: findings from a food hygiene behavior change intervention in rural Bangladesh

BackgroundMicrobial food contamination, although a known contributor to diarrheal disease and highly prevalent in low-income settings, has received relatively little attention in nutrition programs. Therefore, to address the critical pathway from food contamination to infection to child undernutrition, we adapted and integrated an innovative food hygiene intervention into a large-scale nutrition-sensitive agriculture trial in rural Bangladesh. In this article, we describe the intervention, analyze participation and uptake of the promoted food hygiene behaviors among intervention households, and examine the underlying determinants of behavior adoption.MethodsThe food hygiene intervention employed emotional drivers, engaging group activities, and household visits to improve six feeding and food hygiene behaviors. The program centered on an ‘ideal family’ competition. Households’ attendance in each food hygiene session was documented. Uptake of promoted behaviors was assessed by project staff on seven ‘ideal family’ indicators using direct observations of practices and spot checks of household hygiene conditions during household visits. We used descriptive analysis and mixed-effect logistic regression to examine changes in household food hygiene practices and to identify determinants of uptake.ResultsParticipation in the food hygiene intervention was high with more than 75% attendance at each session. Hygiene behavior practices increased from pre-intervention with success varying by behavior. Safe storage and fresh preparation or reheating of leftover foods were frequently practiced, while handwashing and cleaning of utensils was practiced by fewer participants. In total, 496 of 1275 participating households (39%) adopted at least 5 of 7 selected practices in all three assessment rounds and were awarded ‘ideal family’ titles at the end of the intervention. Being an ‘ideal family’ winner was associated with high participation in intervention activities [adjusted odds ratio (AOR): 11.4, 95% CI: 5.2–24.9], highest household wealth [AOR: 2.3, 95% CI: 1.4–3.6] and secondary education of participating women [AOR: 2.2, 95% CI: 1.4–3.4].ConclusionThis intervention is an example of successful integration of a behavior change food hygiene component into an existing large-scale trial and achieved satisfactory coverage. Future analysis will show if the intervention was able to sustain improved behaviors over time and decrease food contamination and infection.

Strengthening Vegetable Production and Consumption in a Kenyan Informal Settlement: A Feasibility and Preliminary Impact Assessment of a Sack Garden Intervention

BackgroundOver 85% of Kibera’s population, an informal settlement in Nairobi, Kenya, is food insecure. Nutrition-sensitive agriculture interventions, such as sack gardens, have the potential to diversify diets—in turn, improving household food security and diet quality. Furthermore, the sale of extra vegetables may provide an income for program participants. ObjectivesThe aim of this paper was to conduct a feasibility assessment and preliminary impact assessment of a nutrition-sensitive urban agriculture intervention that used sack gardens for women in Kibera. MethodsWomen, from a women’s empowerment program, in Kibera (n = 36; n = 21 full program participants, n = 11 withdrawn, n = 4 new members) were engaged in a sack garden intervention in June 2018. A mixed-method approach was used to assess the feasibility and preliminary impact of the program. Qualitative semi-structured interviews (n = 25; n = 18 full program participants, n = 5 withdrawn, n = 2 new members), administered at the end of the pilot phase (March 2019), identified barriers and facilitators (e.g., preferences, inputs, group dynamics) to the production, consumption, and sale of self-produced vegetables. Quantitative surveys (n = 21 full program participants), administered in June 2018 and March 2019, were conducted to evaluate preliminary intervention impact on food security and diet quality through analysis of the Household Hunger Scale (HHS) and Minimum Dietary Diversity for Women (MDD-W). ResultsKey barriers included insufficient inputs and group work difficulties, particularly around communication. Facilitators included positive intervention feedback, social bonds and teamwork, participants’ self-sufficiency, and preference for sack garden vegetables over market vegetables. Post-intervention, participants reported reduced household food insecurity. Recommendations for program scale-up include investment in additional inputs, a water-collection/irrigation system, additional training, and placing sack gardens closer to women’s homes to reduce time constraints. ConclusionsThis study suggests that sack gardens may provide partial solutions to improve diet quality; however, further research is needed to assess any impact on household income.

Home-Grown School Feeding: Implementation Lessons From a Pilot in a Poor Ethnic Minority Community in Vietnam.

Background:Undernutrition threatens the health and future of preschool children in disadvantaged remote communities. Home-grown school feeding (HGSF) in nursery schools could positively impact children’s nutrition while creating multiple benefits for the whole community. However, evidence is lacking on implementation of HGSF within multi-sectoral programs in remote areas.Objective:This study assessed an HGSF pilot intervention, part of a nutrition-sensitive agriculture (NSA) program, in a mountain ethnic minority community in Vietnam. It aimed to identify the changes brought about by the intervention, in particular diversity of children’s food, food sources, barriers and facilitators to change, and future challenges and strategies.Methods:Mixed-methods assessment covered school meal diversity, cost, and food sources but the key focus was on observed changes resulting from the HGSF intervention and perceived barriers and facilitators to its implementation. Data were collected mainly through semi-structured interviews (n = 30) and seven focus group discussions (n = 76).Results:School meals contributed to increasing diversity of food consumed by children. Above 30% of foods used were home-grown. Respondents reported increased school attendance; children’s food preferences and hygiene practices improved as did parents’ caring and feeding practices. Local food systems became less cash-crop-oriented and more self-reliant, contributing to household food security and income generation. Social capital increased. Positive changes were attributed to HGSF and synergy among NSA program components. Poverty and limited resilience to external shocks threatened sustainability.Conclusions:Implementing HGSF within an NSA program in a mountainous ethnic minority area with a high prevalence of undernutrition benefitted children and their communities.

Qualitative evidence for improved caring, feeding and food production practices after nutrition-sensitive agriculture interventions in rural Vietnam

BackgroundResearch on nutrition-sensitive agriculture (NSA) has mostly been aimed at demonstrating its impact on nutrition and explicating underlying pathways, and more rarely at understanding processes and lessons learnt from them. This study aimed to gain insights into the processes that influence behaviour change, contributing to improved caring, feeding and food production practices, using a program theory perspective. It also investigated perceived challenges to the sustainability of interventions and potential solutions, in the context of an NSA program in rural Vietnam. Using a participatory approach, data were gathered on impact pathways and perceived outcomes, on elements of program theory that led to behavioural change, as well as barriers and facilitators. Respondents in semi-structured interviews (n = 30) and seven focus group discussions (total n = 76) were selected purposively among program participants. Data was collected and triangulated across several stakeholder groups.ResultsThe impact pathways (production-consumption, caring and feeding, and home-grown school feeding) envisaged in the NSA program functioned as intended; synergies were revealed. The increased supply of locally produced nutrient-rich foods not only contributed to the emergence of a promising income sub-pathway but also reinforced synergy with the home-grown school feeding pathway. Improved diets, feeding and caring practices, and school attendance were key outcomes of the program. Successful elements were pathway-specific, such as flexibility in implementing context-appropriate agricultural models. Others, such as benefit-driven motivation and improved knowledge, triggered changes in multiple pathways. Role models, increased self-confidence, and change agents were the main process facilitators. The biggest barrier to both implementation and sustainability was the poor socio-economic conditions of the most disadvantaged households.ConclusionsThis study showed the relevance of NSA programs in addressing undernutrition in remote areas by enhancing self-reliance in local communities. The integration of behaviour change activities proved to be a key strategy in the process to enhance the impact of agriculture on nutrition outcomes. Though outcomes and influencing factors are very context-dependent, lessons on what worked and what did not work could inform the design and implementation of effective behaviour change strategies in future NSA programs in Vietnam and elsewhere.

Development of Scale to measure the Behavioural Intention of Farmers to Adopt Nutrition Sensitive Agriculture

A scale was developed to measure the "Behavioural intention of farmers to adopt Nutrition Sensitive Agriculture (NSA)". Based on the review of literature and discussion with the expert's, 74 statements were enlisted. The Likert's summated rating technique was followed in the construction of scale. The list of 74 statements was sent to a panel of 120 experts with the request, to critically evaluate each statement for itsrelevancy to measure thebehavioural intention of farmers to adopt Nutrition Sensitive Agriculture. Out of 120 expertsselected for the scale construction, 40 experts responded in time and at the earliest. Based on their judgment an aggregate of 40 statements was selected. Statements having Relevancy Weightage 0.80 and Mean Relevancy Score 2.4 were considered for the item analysis. In item analysis, the selected 40 statements were administered on 40 farmers in the non-sample area. Finally, a total of 24 statements were selected for the study, based on the‘t’ values (&gt; 1.75) resulted from the item analysis and were included in the final scale. The ‘R’ value of the scale was found to be 0.732 and the value of Cronbach’s alpha found to be 0.776 which was significant at 1% level indicating the high reliability. Hence, the scale developed wasfound to reliable and valid. Thus, the instrument developed to measure the behavioural intention of farmers to adopt Nutrition Sensitive Agriculture.

Maternal Participation Level in a Nutrition-Sensitive Agriculture Intervention Matters for Child Diet and Growth Outcomes in Rural Ghana

ABSTRACTBackgroundLittle is known about how the level of program participation affects child nutrition in rural interventions.ObjectivesThis study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana.MethodsNutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014–2015 and less than 18 mo in 2016–2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as “no participation.” Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category – 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services.ResultsCompared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length‐for‐age z‐scores (LAZ)/height‐for‐age z‐scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively].ConclusionThese results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.

The role of nutrition-sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study.

ObjectiveThe study aimed to investigate the role of nutrition‐sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia.MethodsAn adequacy evaluation study was used to see changes between the baseline and end‐line data after following for 1 year. A sample of 170 mother‐child pairs who had a 1‐year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model.ResultsA total of 170 and 270 mother‐child dyads were interviewed at baseline and end‐line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length‐for‐age Z‐score which changed from −1.18 to −0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction.ConclusionsSustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition‐sensitive agricultural and direct nutrition interventions along with behavioral‐based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.

Nutrition-sensitive agriculture programs increase dietary diversity in children under 5 years: A review and meta-analysis.

BackgroundLow-quality diets contribute to the burden of malnutrition and increase the risk of children not achieving their developmental potential. Nutrition-sensitive agriculture programs address the underlying determinants of malnutrition, though their contributions to improving diets do not factor into current nutrition impact modeling tools.ObjectiveTo synthesize the evidence on the effectiveness of nutrition-sensitive agriculture programs in improving dietary diversity in young children (6-23.9 months and 6-60 months).MethodsA literature search was conducted for published trials through existing systematic reviews and individual database search of the ISI Web of Science. All dietary diversity measures in the studies selected to be in the analysis were extracted. Estimation of main pooled effects were conducted on outcomes of minimum diet diversity (MDD) and diet diversity score (DDS) using random-effects meta-regression models. We report pooled effect sizes as standardized mean differences (SMDs) or odds ratios (ORs).ResultsNutrition-sensitive agricultural interventions have a significant positive impact on the diet diversity scores of children aged 6-23.9 months (SMD = 0.22, 95% confidence interval (CI) = 0.09-0.36) and on the odds of reaching minimum diet diversity (OR = 1.45, 95% CI = 1.20, 1.76). Similar impacts are found when analyses are expanded to include studies for children aged 6-60 months (DDS SMD = 0.22, 95% CI = 0.12-0.32) (MDD OR = 1.64, 95% CI: = 1.38-1.94).ConclusionNutrition-sensitive agriculture interventions consistently have a positive impact on child dietary diversity. Incorporating this evidence in nutrition modeling tools can contribute to decision-making on the relative benefits of nutrition-sensitive interventions as compared with other maternal, newborn, child health and nutrition (MNCHN) interventions.

Women\u2019s empowerment through homestead food production in rural Bangladesh

BackgroundWomen in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial.MethodsWe conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants.ResultsThe analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household.ConclusionsThis study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study.Trial registrationFAARM is registered with ClinicalTrials.gov (NCT02505711).