Dataset Information

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

ABSTRACT: Abstract

Objectives

Little is known about how level of participation affects nutrition outcomes in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention (NSA) and children's diet and anthropometric outcomes.

Methods

The Nutrition Links was a 2016–17 cluster RCT (clinicaltrials.gov NCT01985243) which enrolled caregivers with children < 18 mo in rural Ghana. Women in the intervention communities self-selected to receive poultry layers for egg production as part of a loan package, garden inputs, and nutrition education. Weekly meetings were used for education, for the staff to document egg production, and for the women to repay their loan and purchase feed. After endline, project participation was evaluated with a summative score that reflected 5 criteria: 1) egg productivity 2) timely and complete payment for feed and loan 3) meeting attendance 4) answering questions and making comments during the meetings and 5) attentiveness and helpfulness with the group. The field staff evaluated all criteria – from 1 (very poor) to 5 (excellent) – for each intervention woman who received poultry. Their participation was classified as high, medium, or low, based on tertiles. The participation of intervention women who never received poultry was ‘none’. Logistic and linear regressions tested the likelihood of consuming eggs and having a minimum diverse diet (MDD) and changes in anthropometric indices for the participation levels compared to those of the controls, who received standard-of-care services.

Results

In comparison to the control group, only a high participation level was significant for having a MDD (aOR  = 3.1, 95% CI [1.1, 8.8]). Both medium and high participation levels were associated with an increased likelihood in egg consumption (aOR = 2.1, 95% CI [1.0, 4.1]; aOR = 2.7, 95% CI [1.3, 5.4]), and length‐for‐age (LAZ)/height‐for‐age (HAZ) z‐scores (β = 0.4, 95% CI [0.2, 0.6]; β = 0.4, 95% CI [0.2, 0.7]), and weight‐for‐age (WAZ) (β = 0.2, 95% CI [0.0, 0.4]; β = 0.2, 95% CI [0.0, 0.5]), respectively.

Conclusions

These results show the potential effect of NSA interventions and highlight the importance of facilitating high participation of beneficiaries.

Funding Sources

Global Affairs Canada, Heifer International, World Vision, McGill University, International Development Research Centre.

SUBMITTER: Dallmann D

PROVIDER: S-EPMC8340822 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundFew 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.

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Project description:BACKGROUND:Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. 'Nutrition-sensitive' agriculture programs could tackle the underlying causes of undernutrition. METHODS/DESIGN:This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women's groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women's groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women's groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6-23 months consuming ??4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth >?42 days ago) mothers or female primary caregivers of children aged 0-23 months. Secondary outcomes are percentage of mothers consuming ??5 out of 10 food groups per day and percentage of children's weight-for-height z-score <?-2 standard deviations (SD). The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (<?10 km or ??10 km), and low (<?30%), medium (30-70%), or high (>?70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. DISCUSSION:This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. TRIAL REGISTRATION:ISRCTN , ISRCTN65922679 . Registered on 21 December 2016.

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