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Waid JL, Wendt AS, Kader A, Sobhan S, Gabrysch S. Impact of a Homestead Food Production Program on Dietary Diversity: Seasonal and Annual Results from the Cluster-Randomized FAARM Trial in Sylhet, Bangladesh. J Nutr 2024; 154:191-201. [PMID: 37871747 DOI: 10.1016/j.tjnut.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Rice-predominant diets are common in Bangladesh, leading to widespread nutritional deficiencies. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Sylhet, Bangladesh evaluated a homestead food production intervention implemented 2015-2018 through Helen Keller International, aiming to improve child growth. OBJECTIVES We estimated the intervention's impact on women's and children's dietary diversity, a secondary trial objective. METHODS We collected dietary diversity throughout the trial (March 2015 to June 2020) at multiple times each year using standard, United Nations-endorsed, self-reported measures for women (10-food group scale) and children (7-food group scale). We included 28,282 observations of 2701 women (out of 2705 enrolled) and 17,445 observations of their 3257 children (aged 6-37 mo) in 96 settlements, 48 of which received the intervention. We estimated the intervention's impact on dietary diversity by year of intervention, overall periods following the start of the intervention, and seasonally, using multilevel regression with the control group as the counterfactual, controlling for seasonality, baseline dietary diversity, and clustering by settlement and repeated measures. RESULTS At baseline, approximately one-third of women and children consumed a minimally diverse diet. Over the entire intervention and postintervention period, women's and children's odds of consuming a minimally diverse diet nearly doubled (odds ratio [OR] 1.8, P < 0.001, for both). This benefit was barely present in the first year, increased in the second, and peaked in the last intervention year (OR 2.4 for women, OR 2.5 for children, both P < 0.001) before settling at around double the odds in postintervention years (P < 0.001). Dietary improvement was observed throughout the year for both women and children with incremental increases in nearly all food groups. CONCLUSIONS The nutrition-sensitive agriculture intervention successfully increased dietary diversity in women and children, and these impacts persisted after the project closed, including during the early COVID 19 lockdown period. This trial was registered at clinicaltrials.gov as NCT02505711.
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Affiliation(s)
- Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Shafinaz Sobhan
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Mponela P, Manda J, Kinyua M, Kihara J. The impact of participatory action research and endogenous integrated soil fertility management on farm-gate dietary outputs in northern Tanzania. Heliyon 2023; 9:e21888. [PMID: 38034764 PMCID: PMC10682143 DOI: 10.1016/j.heliyon.2023.e21888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
In most developing countries, although agricultural extension and research devolved since 1980s to promote relevance, cost-effectiveness, ownership, and sustainability, participatory action research (PAR) have been run, albeit with limited empirical evidence on their impacts on farmers livelihoods. The study use a three-stage extended regression model (ERM) to estimate the effect PAR and the promoted agronomic practices on crop produce dietary outputs considering potential endogenous engagement, omitted variable bias, reverse causality, endogenous covariates, and factor simultaneity. Using a sample of 607 small family farms with varying levels of research engagement in the Northern Highlands of Tanzania, the study found that PAR was associated with increased farm-gate dietary outcomes: per-capita calories, proteins, and minerals produced by 139, 216, and 143 %, respectively, and consumption of farm-produced minerals by 74-200 %. The organic manure application was associated with increased the dietary outputs by 62-113 % while the application of inorganic fertilizer with increased protein and mineral outputs by 68 and 105 %, respectively. The crop diversification was associated with increased dietary outputs by 11-25 % while pest and diseases control with increased dietary outputs by 12-17 % but with reduced consumption by 13-14 %. Soil and water conservation measures including terracing were associated with decreased dietary outputs. These findings indicate that PAR contributes to nutritional outcomes of smallholder farmers contingent on the promotion of low-cost input sources and crop diversification which can be leveraged to inform upscaling of participatory policies, strategies, and technologies.
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Affiliation(s)
- Powell Mponela
- Alliance for Bioversity and CIAT, Duduville Campus, Nairobi, Kenya
| | - Julius Manda
- International Institute of Tropical Agriculture (IITA), C/O World Vegetable Centre, Arusha, Tanzania
| | - Michael Kinyua
- Alliance for Bioversity and CIAT, Duduville Campus, Nairobi, Kenya
| | - Job Kihara
- Alliance for Bioversity and CIAT, Duduville Campus, Nairobi, Kenya
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Gelli A, Collishaw A, Awonon J, Becquey E, Diatta A, Diop L, Ganaba R, Headey D, Hien A, Ngure F, Pedehombga A, Santacroce M, Toe LC, Verhoef H, Alderman H, Ruel MT. Effects of an integrated poultry value chain, nutrition, gender and WASH intervention (SELEVER) on hygiene and child morbidity and anthropometry in Burkina Faso: A secondary outcome analysis of a cluster randomised trial. MATERNAL & CHILD NUTRITION 2023; 19:e13528. [PMID: 37244872 PMCID: PMC10483954 DOI: 10.1111/mcn.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/29/2023]
Abstract
Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2-4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15-49 years with an index child aged 2-4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04-0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03-0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Anissa Collishaw
- Department of Agricultural and Consumer EconomicsUniversity of Illinois at Urbana‐ChampaignIllinoisUrbanaUSA
| | - Josue Awonon
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Ampa Diatta
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Loty Diop
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | | | - Derek Headey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | | | | | | | - Marco Santacroce
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Laeticia C. Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Institut de Recherche en Sciences de la Santé (IRSS)Unité Nutrition et Maladies MétaboliquesBobo‐DioulassoBurkina Faso
| | - Hans Verhoef
- Division of Human Nutrition and HealthWageningen UniversityWageningenNetherlands
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Harold Alderman
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Marie T. Ruel
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
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4
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Connors K, Jaacks LM, Awasthi A, Becker K, Bezner Kerr R, Fivian E, Gelli A, Harris-Fry H, Heckert J, Kadiyala S, Martinez E, Santoso MV, Young SL, Bliznashka L. Women's empowerment, production choices, and crop diversity in Burkina Faso, India, Malawi, and Tanzania: a secondary analysis of cross-sectional data. Lancet Planet Health 2023; 7:e558-e569. [PMID: 37437997 DOI: 10.1016/s2542-5196(23)00125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Bolstering farm-level crop diversity is one strategy to strengthen food system resilience and achieve global food security. Women who live in rural areas play an essential role in food production; therefore, we aimed to assess the associations between women's empowerment and crop diversity. METHODS In this secondary analysis of cross-sectional data, we used data from four cluster-randomised controlled trials done in Burkina Faso, India, Malawi, and Tanzania. We assessed women's empowerment using indicators from the Women's Empowerment in Agriculture Index. Farm-level crop diversity measures were the number of food crops grown, number of food groups grown, and if nutrient-dense crops were grown. We used a two-stage modelling approach. First, we analysed covariate-adjusted country-specific associations between women's empowerment and crop diversity indicators using multivariable generalised linear models. Second, we pooled country-specific associations using random-effects models. FINDINGS The final analytic sample included 1735 women from Burkina Faso, 4450 women from India, 547 women from Malawi, and 574 women from Tanzania. Across all countries, compared with households in which women provided input into fewer productive decisions, households of women with greater input into productive decisions produced more food crops (mean difference 0·36 [95% CI 0·16-0·55]), a higher number of food groups (mean difference 0·16 [0·06-0·25]), and more nutrient-dense crops (percentage point difference 3 [95% CI 3-4]). Across all countries, each additional community group a woman actively participated in was associated with cultivating a higher number of food crops (mean difference 0·20 [0·04-0·35]) and a higher number of food groups (mean difference 0·11 [0·03-0·18]), but not more nutrient-dense crops. In pooled associations from Burkina Faso and India, asset ownership was associated with cultivating a higher number of food crops (mean difference 0·08 [0·04-0·12]) and a higher number of food groups (mean difference 0·05 [0·04-0·07]), but not more nutrient-dense crops. INTERPRETATION Greater women's empowerment was associated with higher farm-level crop diversity among low-income agricultural households, suggesting that it could help enhance efforts to strengthen food system resilience. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kaela Connors
- Harvard T H Chan School of Public Health, Boston, MA, USA; Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK
| | - Lindsay M Jaacks
- Harvard T H Chan School of Public Health, Boston, MA, USA; Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK
| | | | - Karoline Becker
- Department of International Development, University of Oxford, Oxford, UK
| | | | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aulo Gelli
- International Food Policy Research Institute, Washington, DC, USA
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica Heckert
- International Food Policy Research Institute, Washington, DC, USA
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Martinez
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Lilia Bliznashka
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, UK; International Food Policy Research Institute, Washington, DC, USA.
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5
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Santoso MV, Petrie HC, Kerr RB, Lane C, Kassim N, Martin H, Mtinda E, Lupafya E, Young S. A Mixed Methods Exploration of the Role of Participation in a Nutrition-Sensitive Agroecology Intervention in Rural Tanzania. Curr Dev Nutr 2023; 7:100098. [PMID: 37396961 PMCID: PMC10314235 DOI: 10.1016/j.cdnut.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 07/04/2023] Open
Abstract
Background Participation is key to the successful implementation of nutrition-related interventions, but it has been relatively overlooked. Objective We sought to describe participation intensity among smallholder farmers in a randomized nutrition-sensitive agroecology study in rural Tanzania. We explored the association between baseline characteristics and overall participation intensity (quantitatively at the individual level and qualitatively at the group level), the association of participation intensity with 2 process indicators, and the association between participation intensity and key study outcomes. Methods Data came from 7 rounds of surveys with 295 women and 267 men across 29 months and 2 rounds of semi-structured interviews with the 20 "mentor farmers" who delivered the intervention. Participation intensity was based on the number of months of attendance at village-level project meetings or household visits (range: 0-29). Multivariable models of participation were built. Results Women and men participated for 17.5 ± 7.2 and 13.6 ± 8.3 months, respectively. Participation intensity followed 1 latent trajectory: initially low, with a sharp increase after month 7, and plateaued after the first year. At baseline, higher participation intensity was associated with older age, higher education, level of women's empowerment, being in the middle quintile of wealth, and qualitatively, village residence. Higher participation intensity was associated with 2 process indicators - better recall of topics discussed during meetings and greater knowledge about key agroecological methods. High participation intensity was positively associated with increased use of sustainable agricultural practices among all participants, and among women, with husband's involvement in household tasks and child's dietary diversity score. Conclusions Participation intensity covaried with key study outcomes, suggesting the value of increased attention to implementation in nutrition-related programs for providing insights into drivers of impact. We hope that investigations of participation, including participation intensity, will become more widespread so that intervention impacts, or lack thereof, can be better understood.
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Affiliation(s)
| | - Halle Claire Petrie
- Department of Anthropology, Northwestern University, Evanston, IL, United States
| | - Rachel Bezner Kerr
- Department of Global Development, Cornell University, Ithaca, NY, United States
| | - Charlotte Lane
- International Initiative for Impact Evaluation, Washington, DC, United States
| | - Neema Kassim
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Haikael Martin
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | | | - Esther Lupafya
- Soils, Food and Healthy Communities (SFHC), Ekwendeni, Malawi
| | - Sera Young
- Department of Anthropology, Northwestern University, Evanston, IL, United States
- Institute for Policy Research, Northwestern University, Evanston, IL, United States
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6
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Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
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The rights way forward: reconciling the right to food with biodiversity conservation. ORYX 2023. [DOI: 10.1017/s0030605322000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Abstract
The current paradigm of biodiversity conservation, with its continued focus on the notion of pristine nature, has resulted in the separation of humans and nature at the expense of both biological and cultural–linguistic diversity. The continued annexation of land for the cause of conservation has resulted in the curtailment of both rights and access to local and diverse food sources for many rural communities. Indigenous Peoples and local communities are fundamental to conserving biodiversity through sustainable use of nature despite repeated attempts to dispossess them from their lands, cultures and knowledge. It has been this traditional and land-based knowledge that has contributed to the conservation of biodiversity whilst also supporting healthy, diverse and nutritious diets. If we are to achieve a more just and sustainable future, we need to continue to centre conservation initiatives around rights, access and equity whilst respecting a plurality of perspectives, worldviews and knowledge systems. Here we review alternative approaches that help reconcile the right to food with biodiversity conservation, such as biocultural rights, rights-based approaches and integrated land management schemes, with the aim of identifying optimal ways forward for conservation that break away from the dichotomous view that pits people against nature and instead embrace the importance of this symbiotic relationship.
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Paramashanti BA, Dibley MJ, Alam A, Huda TM. Wealth- and education-related inequalities in minimum dietary diversity among Indonesian infants and young children: a decomposition analysis. Glob Health Action 2022; 15:2040152. [PMID: 35389332 PMCID: PMC9004518 DOI: 10.1080/16549716.2022.2040152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Over the last two decades, Indonesia has experienced remarkable economic growth. However, the percentage of infants and young children meeting the minimum dietary diversity (MDD) criteria has stagnated. Despite the growing body of evidence of the association between MDD and socioeconomic factors, there is little information about socioeconomic inequalities in MDD in Indonesia. Objectives The current study seeks to quantify the wealth- and education-related inequalities in MDD among infants and young children in Indonesia and determine the contribution of different factors to these disparities. Methods We included a total of 5038 children aged 6–23 months of the 2017 Indonesia Demographic and Health Survey. We measured wealth- and education-related inequalities using the concentration curve and Wagstaff normalised concentration index. Using a concentration index decomposition analysis, we then examined factors contributing to wealth- and education-related inequalities in MDD. Results The concentration indices by household wealth and maternal education were 0.220 (p < 0.001) and 0.192 (p < 0.001), respectively, indicating more concentration of inequalities among the advantaged population. The decomposition analysis revealed that household wealth (29.8%), antenatal care (ANC) visits (16.6%), paternal occupation (15.1%), and maternal education (11.8%) explained the pro-rich inequalities in MDD in Indonesia. Maternal education (26.1%), household wealth (19.1%), ANC visits (14.9%), and paternal occupation (10.9%) made the most considerable contribution to education-related inequalities in MDD. Conclusions There is substantial wealth- and education-related inequalities in MDD. Our findings suggest an urgent need to address the underlying causes of not reaching dietary diversity by promoting infant and young child feeding equity in Indonesia.
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Affiliation(s)
- Bunga A Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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9
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Bliznashka L, Roy A, Jaacks LM. Pesticide exposure and child growth in low- and middle-income countries: A systematic review. ENVIRONMENTAL RESEARCH 2022; 215:114230. [PMID: 36087771 PMCID: PMC7614514 DOI: 10.1016/j.envres.2022.114230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), pesticides are widely used in agricultural and residential settings. Little is known about how pesticides affect child growth. OBJECTIVES To systematically review and synthesise the evidence on the associations between pesticide exposure and adverse birth outcomes and/or impaired postnatal growth in children up to 5 years of age in LMICs. METHODS We searched 10 databases from inception through November 2021. We included cohort and cross-sectional studies investigating associations between self-reported or measured prenatal or postnatal pesticide exposure and child growth (postnatal child linear/ponderal growth, and/or birth outcomes). Two researchers screened studies, extracted data, and assessed certainty using GRADE. The protocol was preregistered with PROSPERO (CRD42021292919). RESULTS Of 939 records retrieved, 31 studies met inclusion criteria (11 cohort, 20 cross-sectional). All studies assessed prenatal exposure. Twenty-four studies reported on birth weight. Four found positive associations with organochlorines (0.01-0.25 standardised mean difference (SMD)) and two found negative associations (-0.009 SMD to -55 g). Negative associations with organophosphates (-170 g, n = 1) and pyrethroids (-97 to -233 g, n = 2) were also documented. Two (out of 15) studies reporting on birth length found positive associations with organochlorines (0.21-0.25 SMD) and one found negative associations (-0.25 to -0.32 SMD). Organophosphate exposure was negatively associated with birth length (-0.37 cm, n = 1). Organophosphate exposure was also associated with higher risk/prevalence of low birth weight (2 out of nine studies) and preterm birth (2 out of six studies). Certainty of the evidence was "very low" for all outcomes. CONCLUSION The limited literature from LMICs shows inconclusive associations between prenatal pesticide exposure, child growth, and birth outcomes. Studies with accurate quantitative data on exposure to commonly used pesticides in LMICs using consistent methodologies in comparable populations are needed to better understand how pesticides influence child growth.
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Affiliation(s)
- Lilia Bliznashka
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Alexander Robertson Building, Easter Bush Campus, Midlothian, EH25 9RG, UK.
| | - Aditi Roy
- Centre for Environmental Health, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurugram, 122002, India
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Alexander Robertson Building, Easter Bush Campus, Midlothian, EH25 9RG, UK
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10
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van Zutphen KG, van den Berg S, Gavin-Smith B, Imbo E, Kraemer K, Monroy-Gomez J, Pannatier M, Prytherch H, Six J, Thoennissen C, Winter S, Barjolle D. Nutrition as a driver and outcome of agroecology. NATURE FOOD 2022; 3:990-996. [PMID: 37118296 DOI: 10.1038/s43016-022-00631-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/07/2022] [Indexed: 04/30/2023]
Abstract
The principles of agroecology do not explicitly state a link with nutrition. Yet, we argue that among them, input reduction, biodiversity, economic diversification, social values and diets, fairness, connectivity and participation are directly linked to nutrition. Nutrition can serve as a critical outcome and driver of agroecological practices and can drive transformative change across the food system.
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Affiliation(s)
| | - Sophie van den Berg
- Group of Sustainable Agroecosystems, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | | | - Elizabeth Imbo
- Syngenta Foundation for Sustainable Agriculture, Nairobi, Kenya
| | - Klaus Kraemer
- Sight and Life Foundation, Basel, Switzerland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Marnie Pannatier
- Syngenta Foundation for Sustainable Agriculture, Basel, Switzerland
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Johan Six
- Group of Sustainable Agroecosystems, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | | | - Simon Winter
- Syngenta Foundation for Sustainable Agriculture, Basel, Switzerland
| | - Dominique Barjolle
- Group of Sustainable Agroecosystems, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland.
- Institute of Geography and Sustainability, University of Lausanne, Lausanne, Switzerland.
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11
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Cohen CR, Weke E, Frongillo EA, Sheira LA, Burger R, Mocello AR, Wekesa P, Fisher M, Scow K, Thirumurthy H, Dworkin SL, Shade SB, Butler LM, Bukusi EA, Weiser SD. Effect of a Multisectoral Agricultural Intervention on HIV Health Outcomes Among Adults in Kenya: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2246158. [PMID: 36508217 PMCID: PMC9856331 DOI: 10.1001/jamanetworkopen.2022.46158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Importance Food insecurity and HIV health outcomes are linked through nutritional, mental health, and health behavior pathways. Objective To examine the effects of a multisectoral agriculture and livelihood intervention on HIV viral suppression and nutritional, mental health, and behavioral outcomes among HIV-positive adults prescribed antiretroviral therapy (ART). Design, Setting, and Participants This cluster randomized clinical trial was performed in 8 pairs of health facilities in Kenya. Participants were 18 years or older, living with HIV, and receiving ART for longer than 6 months; had moderate to severe food insecurity; and had access to arable land and surface water and/or shallow aquifers. Participants were followed up every 6 months for 24 months. Data were collected from June 23, 2016, to June 13, 2017, with follow-up completed by December 16, 2019. Data were analyzed from June 25 to August 31, 2020, using intention-to-treat and per-protocol methods. Interventions A loan to purchase a human-powered irrigation pump, fertilizer, seeds, and pesticides combined with the provision of training in sustainable agriculture and financial literacy. Main Outcomes and Measures The primary outcome was the relative change from baseline to the end of follow-up in viral load suppression (≤200 copies/mL) compared between study groups using difference-in-differences analyses. Secondary outcomes included clinic attendance, ART adherence, food insecurity, depression, self-confidence, and social support. Results A total of 720 participants were enrolled (396 women [55.0%]; mean [SD] age, 40.38 [9.12] years), including 366 in the intervention group and 354 in the control group. Retention included 677 (94.0%) at the 24-month visit. HIV viral suppression improved in both groups from baseline to end of follow-up from 314 of 366 (85.8%) to 327 of 344 (95.1%) in the intervention group and from 291 of 353 (82.4%) to 314 of 333 (94.3%) in the control group (P = .86). Food insecurity decreased more in the intervention than the control group (difference in linear trend, -3.54 [95% CI, -4.16 to -2.92]). Proportions of those with depression during the 24-month follow-up period declined more in the intervention group (from 169 of 365 [46.3%] to 36 of 344 [10.5%]) than the control group (106 of 354 [29.9%] to 41 of 333 [12.3%]; difference in trend, -0.83 [95% CI, -1.45 to -0.20]). Self-confidence improved more in the intervention than control group (difference in trend, -0.37 [95% CI, -0.59 to -0.15]; P = .001), as did social support (difference in trend, -3.63 [95% CI, -4.30 to -2.95]; P < .001). Conclusions and Relevance In this cluster randomized trial, the multisectoral agricultural intervention led to demonstrable health and other benefits; however, it was not possible to detect additional effects of the intervention on HIV clinical indicators. Agricultural interventions that improve productivity and livelihoods hold promise as a way of addressing food insecurity and the underpinnings of poor health among people living with HIV in resource-limited settings. Trial Registration ClinicalTrials.gov Identifier: NCT02815579.
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Affiliation(s)
- Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | | | - Lila A. Sheira
- Department of Medicine, University of California, San Francisco
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Adrienne Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | | | - Kate Scow
- Department of Land, Air and Water Resources, University of California, Davis
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shari L. Dworkin
- School of Nursing and Health Studies, University of Washington-Bothell, Bothell
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lisa M. Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | - Sheri D. Weiser
- Department of Medicine, University of California, San Francisco
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12
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Prost A, Harris‐Fry H, Mohanty S, Parida M, Krishnan S, Fivian E, Rath S, Nair N, Mishra NK, Padhan S, Pradhan R, Sahu S, Skordis J, Danton H, Koniz‐Booher P, Beaumont E, James P, Allen E, Elbourne D, Kadiyala S. 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. MATERNAL & CHILD NUTRITION 2022; 18:e13398. [PMID: 35851750 PMCID: PMC9480959 DOI: 10.1111/mcn.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/14/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
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. In rural eastern India, participatory videos and women's group meetings on agriculture and maternal and child nutrition increased women's knowledge, motivation and confidence to improve their and their children's diets. Given strong constraints linked to small landholdings, poor access to water and gender norms which meant that in‐laws' and husbands' assent or support were often required for cultivation decisions, many women responded to interventions by increasing rainfed homestead garden cultivation for consumption rather than cultivating for income. Women's and children's diets may have improved because of discussions about nutrition and an increase in homestead garden cultivation. These dietary changes alone were likely insufficient to improve women's and children's nutritional status. The interventions’ ability to influence the adoption of nutrition‐sensitive agriculture practices could be improved by being family‐centric: understanding women's decision‐making power in a family context, using tailored problem‐solving to address households' individual constraints to cultivation, and including women's husbands and in‐laws.
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Affiliation(s)
- Audrey Prost
- Institute for Global Health University College London London UK
| | - Helen Harris‐Fry
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Sneha Krishnan
- Jindal School of Environment and Sustainability Jindal Global University Haryana India
| | - Emily Fivian
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Naba K. Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | | | | | - Jolene Skordis
- Institute for Global Health University College London London UK
| | - Heather Danton
- JSI Research & Training Institute, Inc. Arlington Virginia USA
| | | | - Emma Beaumont
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Philip James
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Elizabeth Allen
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Diana Elbourne
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Suneetha Kadiyala
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
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13
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Allotey D, Flax VL, Ipadeola AF, Kwasu S, Adair LS, Valle CG, Bose S, Martin SL. Fathers' Complementary Feeding Support Strengthens the Association Between Mothers' Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria. Curr Dev Nutr 2022; 6:nzac098. [PMID: 35854939 PMCID: PMC9283102 DOI: 10.1093/cdn/nzac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding. Objectives This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support. Methods Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6-23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents. Results The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents' perspectives of mothers' autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents' perspectives of fathers' complementary feeding support. Conclusions In Nigeria, high levels of fathers' complementary feeding support strengthen the association of mothers' decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).
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Affiliation(s)
- Diana Allotey
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie L Flax
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | - Sarah Kwasu
- Alive & Thrive, Kaduna State, Kauna, Nigeria
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Public Health Insurance and Enrollees’ Diet Structure in Rural China. Heliyon 2022; 8:e09382. [PMID: 35620627 PMCID: PMC9126930 DOI: 10.1016/j.heliyon.2022.e09382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/31/2021] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
This study examines the consumption-stimulation function of public health insurance (PHI) programs from the perspective of food consumption. We estimate the impact of enrollment in rural China's PHI program, the New Cooperative Medical Scheme (NCMS), on the insured's diet diversity and diet balance using panel data from the China Health and Nutrition Survey. Exploiting temporal and spatial variations in the program's local implementation, our difference-in-differences estimation (combined with propensity score matching in some analyses) reveals significant increases in the insured's diet diversity, overall diet balance, and nutrition intakes. However, the program's consumption-stimulation function is not entirely beneficial. While NCMS enrollment reduced the incidence of under-consumption of animal products and fruits, it raised that of over-consumption of grains, imposing potential health risks on the insured.
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Younker T, Radunovich HL. Farmer Mental Health Interventions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010244. [PMID: 35010504 PMCID: PMC8751007 DOI: 10.3390/ijerph19010244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/09/2023]
Abstract
The prevalence of mental health disorders and suicide amongst agricultural producers is a global problem. Community leaders, researchers, policymakers, and clinicians have mobilized to develop programs to address this issue. This study reviewed a wide range of mental health interventions targeting farmer mental health spanning over 50 years and examined their reported effectiveness and constraints. A total of ninety-two articles on farmer mental health were included in a final systematic review. Most articles were written concerning mental health literacy and peer and paraprofessional support interventions in the United States and Australia. Among the 56 studies reporting empirical evaluative data, 21 were mixed-method, 20 quantitative, 11 qualitative, and 5 literature synthesis. Non-experimental, self-reported, and qualitative data suggest efficacy of mental health literacy programs, peer and paraprofessional support, and community-based and agroecological interventions. However, most interventions were not subject to rigorous evaluation and only one intervention was evaluated using a control condition. The heterogeneity of existing studies and paucity of rigorous evaluation proscribes firm conclusions related to program-type efficacy. This review demonstrates that there is still a need for a stronger and broader evidence base in the field of farmer mental health interventions, which should focus on both holistic, multi-component programs and targeted approaches.
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Frongillo EA, Leroy JL. Evaluation of Complex Agriculture, Nutrition, and Health Interventions Leading to Sustainable Healthy Diets. J Nutr 2021; 151:1682-1683. [PMID: 33973010 DOI: 10.1093/jn/nxab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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17
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Bezner Kerr R, Madsen S, Stüber M, Liebert J, Enloe S, Borghino N, Parros P, Mutyambai DM, Prudhon M, Wezel A. Can agroecology improve food security and nutrition? A review. GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100540] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Food security mediates the decrease in women's depressive symptoms in a participatory nutrition-sensitive agroecology intervention in rural Tanzania. Public Health Nutr 2021; 24:4682-4692. [PMID: 33706829 DOI: 10.1017/s1368980021001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women's depressive symptoms. DESIGN We used annual longitudinal data (four time points) from a cluster-randomised effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project. Structural equation modelling estimation of total, natural direct and natural indirect effects was used to investigate food security's role in the intervention's impact on women's risk of probable depression (Center for Epidemiologic Studies Depression Scale > 17) across 3 years. SETTING Rural Singida, Tanzania. PARTICIPANTS 548 food insecure, married, smallholder women farmers with children < 1 year old at baseline. RESULTS At baseline, one-third of the women in each group had probable depression (Control: 32·0 %, Intervention: 31·9 %, P difference = 0·97). The intervention lowered the odds of probable depression by 43 % (OR = 0·57, 95 % CI: 0·43, 0·70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0·90, 95 % CI: 0·83, 0·95). CONCLUSIONS This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women's depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e. improvements in mental health; changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women's well-being in farming communities.
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