Dataset Information

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia.

ABSTRACT:

Introduction

Improving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding and reduce stunting. The Federal Ministries of Health and Agriculture and Natural Resources implement the intervention. The evaluation aims to assess a range of processes, outcomes and impacts.

Methods and analysis

The SURE evaluation study is a theory-based, mixed methods study comprising impact and process evaluations. We hypothesise that the package of SURE interventions, including integrated health and agriculture behaviour change communication for nutrition, systems strengthening and multisectoral coordination, will result in detectable differences in minimum acceptable diet in children 6-23?months and stunting in children 24-47?months between intervention and comparison groups. Repeated cross-sectional household surveys will be conducted at baseline and endline to assess impact. The process will be assessed using observations, key informant interviews and focus group discussions to investigate the fidelity and dose of programme implementation, behavioural pathways of impact and contextual factors interacting with the intervention. Pathways of impact will also be explored through statistical analyses.

Ethics and dissemination

The study has received ethics approval from the scientific and ethical review committees at the Ethiopian Public Health Institute and the London School of Hygiene and Tropical Medicine. The findings will be disseminated collaboratively with stakeholders at specified time points and through peer-reviewed publications and presentations.

SUBMITTER: Moss C

PROVIDER: S-EPMC6059290 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia.

Moss Cami C Bekele Tesfaye Hailu TH Salasibew Mihretab Melesse MM Sturgess Joanna J Ayana Girmay G Kuche Desalegn D Eshetu Solomon S Abera Andinet A Allen Elizabeth E Dangour Alan D AD

BMJ open 20180719 7

<h4>Introduction</h4>Improving complementary feeding in Ethiopia requires special focus on dietary diversity. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is a government-led multisectoral intervention that aims to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding and reduce stunting. The Federal Ministries of Health and Agriculture and Natural Resources implement the intervention. The evalu ...[more]

PMID: 30030320

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Project description:BACKGROUND:In Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers. METHODS:A qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes. RESULTS:SURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition. CONCLUSION:Despite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach.

Project description:As global health care demand continues to increase, medicinal plant productivity must progress without exhausting critical environmental resources. Hence, it is important to explore practices that can improve the quality, safety, and sustainability of medicinal plants, as well as ecological stability. Organic farming has recently gained significance as a sustainable cultivation alternative owing to increased awareness of the adverse effects of conventional cultivation method. Here, this study aimed to investigate the feasibility of organic farming as a solution for sustainable cultivation of medicinal plants from multiple perspectives and long-term benefits to the environment. Organic agricultural practices of medicinal plants were evaluated from a multi-dimensional perspective (environment, economy, and society) using extensive research data and literature and field surveys. Data from medicinal plant cultivation in Inner Mongolia were acquired for 76 sites from four data stations between 2014 and 2021. Data analysis revealed that organic medicinal plants can improve safety by reducing pesticide exposure risks. Simultaneously, organic agriculture of medicinal plants can improve biodiversity by effectively reducing pesticide and fertilizer use, which also provides natural safe products for health care. With the improvement of quality, the retail price will have a certain advantage, which will improve the income of farmers. Moreover, organic agriculture enhanced profitability because of the higher organic premium on medicinal plant products and improved ecosystem stability by increasing plant diversity. The findings of this study suggest that organic cultivation strategies can improve the quality and safety of medicinal plants and further provide a basis for promoting the sustainable development and ecological stability of medicinal plants. However, not all medicinal plant cultivators are guaranteed to adopt organic farming practices, but if all technological elements are correctly applied, the system can be maintained sustainably to expand the area of organically cultivated plants in the future.

Project description:BackgroundData are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar.ObjectivesThis study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6-23 mo in the Vakinankaratra region of Madagascar.MethodsKnowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than -2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach.ResultsMaternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers' workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding.ConclusionsIntegrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.

Project description:BackgroundPolicy discussions and debates in the last couple of decades emphasized efficiency of development policies for translating economic growth to development. One of the key aspects in this regard in the developing world is achieving improved nutrition through economic development. Nonetheless, there is a dearth of literature that empirically verifies the association between economic growth and reduction of childhood undernutrition in low- and middle-income countries. Thus, the aim of the study is to assess the interplay between economic growth and reduction of childhood undernutrition in Ethiopia.MethodsThe study used pooled data of three rounds (2000, 2005 and 2010) from the Demographic and Health Surveys (DHS) of Ethiopia. A multilevel mixed logistic regression model with robust standard errors was utilized in order to account for the hierarchical nature of the data. The dependent variables were stunting, underweight, and wasting in children in the household. The main independent variable was real per capita income (PCI) that was adjusted for purchasing power parity. This information was obtained from World Bank.ResultsA total of 32,610 children were included in the pooled analysis. Overall, 11,296 (46.7%) [46.0%-47.3%], 8,197(33.8%) [33.2%-34.4%] and 3,175(13.1%) [12.7%-13.5%] were stunted, underweight, and wasted, respectively. We found a strong correlation between prevalence of early childhood undernutrition outcomes and real per capita income (PCI). The proportions of stunting (r = -0.1207, p<0.0001), wasting (r = -0.0338, p<0.0001) and underweight (r = -0.1035, p<0.0001) from the total children in the household were negatively correlated with the PCI. In the final model adjustment with all the covariates, economic growth substantially reduced stunting [β = -0.0016, SE = 0.00013, p<0.0001], underweight [β = -0.0014, SE = 0.0002, p<0.0001] and wasting [β = -0.0008, SE = 0.0002, p<0.0001] in Ethiopia over a decade.ConclusionEconomic growth reduces child undernutrition in Ethiopia. This verifies the fact that the economic growth of the country accompanied with socio-economic development and improvement of the livelihood of the poor. Direct nutrition specific and nutrition sensitive interventions could also be recommended in order to have an impact on the massive reduction of childhood undernutrition in the country.

Dataset Information

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia.

Introduction

Methods and analysis

Ethics and dissemination

Publications

Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia.

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