Livestock-Climate Change CRSP Annual Meeting 2011: Integrating Human Nutrition in CRSP Programs (G. Marquis)

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Tips for integrating human nutrition into research on the interaction between livestock/agricultural production and climate change; overview of the Global Livestock CRSP's ENAM project in Ghana. Presentation given by G. Marquis (McGill University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.

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  • We used a variety of data collection tools to document the effect of the intervention on our outcomes of interest : - household food security - children’s dietary intakes and the incorporation of ASF - children’s nutritional statusData were collected on the participants, the non-participants from the intervention communities, and the non-participants from the control communities at: Baseline 4 follow-up time points, 4 months apart.In addition, there was a baseline and project survey of the entire community.The data collected included: Microcredit performance:attendance, Repayments, Savings Cash flow for IGA (sub-sample) Household socio-demographic, food security, ASF expenditures Caregiver expenditures, child nutrition and health knowledge (related to topics taught in our sessions), Child dietary intakes using FFQ, Weighed food (subsample), and anthropometryOther data collected Case studies (post intervention only)Analysis is on-going  so the quantitative analysis is preliminary
  • Livestock-Climate Change CRSP Annual Meeting 2011: Integrating Human Nutrition in CRSP Programs (G. Marquis)

    1. 1. Integrating human nutrition in CRSP programs<br />Grace S Marquis<br />McGill University/Iowa State University<br />
    2. 2. LCC & nutrition frameworks reflect multiple layers of determinants that contribute to human well-being & livelihoods<br />UNICEF. Global Framework for Action. 2006<br />LCC-CRSP Technical Approach.<br />
    3. 3. Cognitive development <br />Reproductive success<br />Work capacity/efficiency<br />Adult-onset chronic diseases<br />Environmental Health<br />Production<br />Animal & Human Health<br />Climate change<br />Training, management<br />Policies, laws, markets<br />
    4. 4. Take-home messages<br /> Prevalence of malnutrition remains unacceptably high, especially in SSA and Asia, and urban/rural disparities continue<br />Maternal and young child nutritional status matters for society and should be the focus of interventions<br /> There are interventions that have been proven effective (SUN)<br /> Nutrition lends itself to being integrated (relatively easily) into diverse projects<br /> There is a growing recognition of the need and desire for integrated approaches<br />
    5. 5. In Sept., 2000,Millennium Declaration was signed by 189 countries<br /> “to create an environment – at the national and global levels alike – which is conducive to development and the elimination of poverty”<br />Improving nutrition is key to achieving the majority of the MDGs <br />Nutrition interventions should 1st focus on vulnerable populations<br /> - women of reproductive age<br /> - children < 2 y<br />
    6. 6. ~ 25% reduction in mortality for every 1 g/dL increase in hemoglobin<br />Stoltzfus www.who.int/publications/cra/chapters/volume1/0163-0210.pdf<br />
    7. 7. Low maternal prepregancy BMI and inadequate weight gain are primary predictors of low birth weight.<br />Low birth weight is ~ at least 30% of deaths among children < 5 y (75% of neonatal deaths)<br />MDG Report 2010<br />
    8. 8. Underweight in < 5 y as an indicator of Goal 1<br />Will not meet 2015 goal<br />(i) Starts at birth: birth weights & lengths in LMC are below WHO growth standards<br />(ii) Early growth faltering is faster than currently assumed. <br />(iii) Nutrition interventions needed before birth & in 1st 2 y of life. Victora et al. 2010 <br />
    9. 9. “Unfortunately, there has been little appreciable change over the last two decades in the high worldwide prevalence of iron deficiency anaemia. Few active programmes in both developed and developing countries have succeeded in reducing iron deficiency and anaemia. Important factors contributing to the lack of progress include failure to recognize the causes of iron deficiency and anaemia, lack of political commitment to control it, inadequate planning of control programmes, insufficient mobilization and training of health staff, and insufficient community involvement in solving the problem.” (WHO 2000)<br />
    10. 10. Maternal & young child nutrition matters – Lancet 2008 series<br />Short-term consequences<br />Significant increased risk before classified as underweight<br />Black et al. Lancet. 2008<br />
    11. 11. Maternal & young child nutrition matters<br />Long-term consequences<br />Income<br /><ul><li>1 z-score HAZ ~ 8% increase in income </li></ul>Victora et al. Lancet. 2008<br />
    12. 12. Scaling Up Nutrition (SUN)<br />Cost of scaling up a minimal package of 13 proven nutrition interventions to full coverage in 36 countries with highest burden (90% of stunting).<br />World Bank 2010<br />
    13. 13. Proven nutrition interventions<br /><ul><li> Behavior change interventions - </li></ul>Community-based nutrition programs to promote<br /> breastfeeding<br /> appropriate complementary feeding practices (but excluding provision of food)<br /> proper hygiene, specifically hand washing <br />• Micronutrient and deworming interventions <br />children under the age of five <br /> vitamin A supplements <br /> therapeutic zinc supplements to manage diarrhea<br /> multiple micronutrient powders<br /> deworming drugs<br /> pregnant women <br /> iron-folic acid supplements<br /> iodized oil capsules where iodized salt is not available<br /> general population<br /> iron fortification of staple foods <br /> salt iodization<br />• Complementary and therapeutic feeding interventions <br />Children 6–23 months <br /> micronutrient-fortified/enhanced complementary foods (prevention/trt mod. malnutrition)<br /> Children < 5 y<br /> community-based management of severe acute malnutrition<br />
    14. 14. Traditional complementary foods fed by West African mothers <br />
    15. 15. Example of successful community-based nutrition <br />education intervention on complementary feeding<br />(where common 1st foods were soups & porridges)<br />Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial<br />ME Penny et al. Lancet 2005;365:1863-72<br />
    16. 16. General Objectives<br />To implement and evaluate an educational intervention to improve breastfeeding and complementary feeding of infants in Trujillo<br />2. To implement the intervention through existing and feasibily enhanced resources in health facilities and the community.<br />
    17. 17. Study Design<br />Randomized controlled effectiveness trial<br />6 pairs of matched health facilities with their communities in peri-urban Trujillo, a town on the northern coast of Peru<br />
    18. 18. Rationale for Health Services <br />The health service in Peru is well organized, extensively used by poorer families and there is a clear policy facilitating community outreach activities. <br />In urban shanty towns there is easy access to government health facilities which offer a comprehensive service. <br />The health service is the most sustainable institution in these poor areas.<br />
    19. 19. Formative Research Methods<br />Community<br />Motivations<br />Interviews<br />with<br />mothers<br />of development<br />Perception<br />and<br />Perception<br />of<br />CRED<br />Focus<br />Groups<br />Feeding practices<br />of<br />micronutrient<br />Attributes<br />rich foods<br />Household Trials<br />Difficulties with feeding<br />Interviews<br />with<br />community<br />agents<br />: <br />midwives<br />, <br />presidents of community kitchens<br />glass<br />of<br />milk<br />program<br />, <br />health<br />promoters<br />
    20. 20.
    21. 21. Household Trials<br />Mothers of children 6 - 18 months<br />
    22. 22. 4<br />5<br />3<br />2<br />1<br />5<br />4<br />3<br />2<br />1<br />Feasibility<br />Specialingredient (liver, fish, egg)<br />Thick puree<br />Puree first<br />5 times a day<br />Love,patience and good humour<br />Avoid sweets before lunch<br />Eat with dad<br />Repeat serving<br />Different flavours<br />Imitation<br />Finger pieces<br />Impact<br />Eat with hands<br />Portion mid afternoon<br />Give own plate<br />Small servings<br />Have child sit<br />Results: “Teach your child to eat with love, patience, and good humour” <br /> High acceptability, High impact factor, lasting<br />
    23. 23. Nutrition Education Intervention<br />Components<br /><ul><li>Messages: key & secondary in allservices
    24. 24. Allhealthstaffweretrained
    25. 25. Accreditation of clinic
    26. 26. Well-babyclinicactivities
    27. 27. Evaluation of nutritional status
    28. 28. Recipes and demonstrations of purees</li></li></ul><li>Trujillo Peru intervention study<br />Penny et al. Lancet 2006;365<br />
    29. 29. HEALTH FACILITY<br />
    30. 30. Evaluation of Exposure to Intervention:<br />Structured observations <br />197 children 6-24 months <br />Exit interviews,<br />216 children, 6-24 months<br />Midterm survey, <br />9 months after starting <br />476 children 6-14 months <br /> Evaluation of exposure to “How” questions<br /> Spontaneous recall<br /> Recognition of educational material<br /> Prompted recall<br />
    31. 31. 100<br />90<br />80<br />70<br />60<br />50<br />40<br />30<br />20<br />10<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />Intervention<br />center<br />Control<br />center<br />N=6<br />N=39<br />N=55<br />N=8<br />N=39<br />N=6<br />N=8<br />N=39<br />N=3<br />N=56<br />N=37<br />N=9<br />N=56<br />N=3<br />N=9<br />N=56<br />Example: Exit Interviews with messages reported received<br />Any <br />“how”<br />message<br />Any <br />nutrition<br />message<br />Any <br />“how”<br />message<br />Any <br />nutrition<br />message<br />Any <br />“how”<br />message<br />Any <br />nutrition<br />message<br />Key <br />message<br />Key <br />message<br />Key <br />message<br />Nutrition<br />Well Baby<br />Clinic<br />Doctor<br />Vaccines<br />Well Baby<br />Clinic<br />Doctor<br />Vaccines<br />Well Baby<br />Clinic<br />Doctor<br />Vaccines<br />% caretakers<br /> reporting<br /> message<br />% caretakers<br /> reporting<br /> message<br />% caretakers<br /> reporting<br /> message<br />
    32. 32. Intervention improved dietary outcomes<br />P<0.05<br />Penny et al. Lancet 2006;365<br />
    33. 33. Education alone improved nutrition outcomes<br />Penny et al. Lancet 2006;365<br />
    34. 34. The importance of animal source foods for young child growth<br />The ENAM project <br />
    35. 35. Iowa State U Co-PIs<br />U of Ghana Co-PIs<br />Grace Marquis<br />US PI<br />Owuraku Sakyi-Dawson<br />Ghana PI<br />Lorna<br />Butler<br />Manju<br />Reddy<br />Helen <br />Jensen<br />Elizabeth<br />Lonergan<br />Anna <br />Lartey<br />Ben <br />Ahunu<br />Emmanuel <br />Canacoo<br />Esi Colecraft<br />Project manager<br />Richard Tweneboah-Kodua, Aaron Christian<br />Field supervisors / data management<br />Selasie Agamah, Gymfiwah Nikoi<br />Administrative officer<br />Mawunyo Timbo, Gifty Nyarko <br />Data entry <br />24 sponsored <br />students <br />(Ghana, USA, Canada)<br />Felix Boadu<br />Driver<br />William Quarmine, Clifford Marquaye<br />Data analysis assistants <br />Temporary region-based<br />data collection team<br />Staff from:<br />Women in Agricultural Development/MoFA<br />Ghana Health Services<br />Heifer International-Ghana<br />Freedom from Hunger-Ghana<br />Rural banks<br />Felicia Kudomor<br /> Winneba<br />Dinah Amoah<br />Techiman<br />Thomas Kambonga<br />Navrongo<br />Regional managers<br />
    36. 36. CRSP work leading up to ENAM<br />Nutrition CRSP (1980’s)<br /><ul><li> Observational study in Kenya, Egypt, Mexico
    37. 37. Animal source foods (ASF) predicted physical growth, cognitive function, school performance, physical activity</li></ul>Global Livestock CRSP (1990’s)<br /><ul><li> Randomized controlled trial in Kenya
    38. 38. Meat group showed increases in indicators of physical growth, cognitive function and school performance, and physical activity</li></ul>Global Livestock CRSP (2002)<br />Sought proposals that address the question: <br />What are the constraints to the availability, accessibility, preparation, and allocation of ASF for children in developing countries?<br />
    39. 39. Primary objectives of Planning Grant 2003 - 2004<br /><ul><li> Develop a Problem Model with key stakeholders to study the constraints to the intake of animal source food (ASF) in children
    40. 40. Identify potential mechanisms to increase the consumption of ASF</li></ul>Primary objectives of Research Grant 2004 - 2009<br /><ul><li> Implement a multi-sectoral sustainable intervention (health, agriculture, and business) to respond to the constraints identified in the Problem Model
    41. 41. Integrate training and research for capacity building</li></li></ul><li>ENAM ProjectEnhancing child Nutrition through Animal source food Management<br /> Enam = “animal-based products” (Twi)<br />
    42. 42. Phase 1Participatory process to develop problem model<br />Phase 2Implement an income-generation and education/training intervention<br />Phase 3Transfer of activities to local agents for sustainability<br />
    43. 43. Phase 1Participatory process to develop problem model for constraints on animal source foods (ASF)Availability (does it exist?)Accessibility (is it affordable?)Utilization (does the child get it?)<br />
    44. 44. Selection of research communities<br />Distinct ecological zones<br />Upper East Region<br />Communities chosen with ministry …1. availability or use of ASF typical to the agro-ecological zone<br />2. presence of community- or household-level livestock/animal-rearing activities<br />3. logistical accessibility to the community<br />Brong-Ahafo Region<br />Central Region<br />
    45. 45. Initial data collection“What are the constraints on ASF?”<br />1. Interviews & focus groups<br /><ul><li> Availability, accessibility, utilization</li></ul> Regional & national managers in agriculture and health ministries <br /> Non-governmental organization staff<br /> Extension workers<br /> Community leaders<br /> Caregivers<br /> Tracking ASF sources<br /><ul><li> Availability & accessibility
    46. 46. Caregivers
    47. 47. Vendors</li></li></ul><li>Stakeholders’ workshop to analyze results <br />Participants<br /><ul><li> Researchers
    48. 48. Ministry of Food and Agriculture (MOFA)/Women in Agriculture and Development (WIAD)
    49. 49. Ghana Health Services (GHS)
    50. 50. Commodity organizations
    51. 51. Non-governmental organizations
    52. 52. Community residents</li></li></ul><li>Final problem model for constraints on ASF<br />Feeding skills and nutrition knowledge<br />Number of extension field staff<br />Seasonality<br />Household food allocation<br />Processing and storage<br />ASF<br /> Availability<br />Accessibility<br />Utilization<br />Pests and diseases<br />Household size<br />Marketing <br />linkages<br />Cultural beliefs and attitudes<br />Caregiver empowerment<br />Financial services<br />Income<br />
    53. 53. Suggested interventions to overcome constraints<br />Community level<br /><ul><li> Stimulate income-generation activities (IGA)
    54. 54. Provide access to micro-credit loans
    55. 55. Food processing/storage training
    56. 56. Entrepreneurship/marketing training
    57. 57. Nutrition education training</li></ul>Regional/country level<br /><ul><li>Extension continuing education
    58. 58. Ministry and NGO staff</li></li></ul><li>Results of Phase 1 participatory process<br /> Problem model2. Intervention plan3. Committed partners <br />
    59. 59. Phase 2Implement an income-generation and education/training intervention<br />
    60. 60. Research question<br />Does the implementation of an intervention with micro-credit,entrepreneurship training, and nutrition educationimprove household food security, use of animal source foods for children, and children’s nutritional status in rural Ghana?<br />
    61. 61. Study communities<br />
    62. 62. Step 1: Income-generation activities<br />Community<br />ENAM Team<br />Community<br />Develop list of IGA<br />Consensus on IGA to support<br />Promotion of selected IGA<br />Reviewed IGA suitability<br />Develop support packages for<br />selected IGA<br />Cash flow analysis<br />
    63. 63. Supported IGA <br /><ul><li> Fish smoking
    64. 64. Fish selling (fishmongering)
    65. 65. Poultry egg production
    66. 66. Selling of foodstuffs</li></ul> (yams)<br /><ul><li> Selling of cooked foods
    67. 67. Processing & sale of foods </li></ul> (shea butter, rice parboiling)<br />
    68. 68. Organization of micro-credit for IGA<br />Caregiver <br />self-selection<br />CSA leadership President<br /> Treasurer<br /> Secretary<br /> Organizer<br />Orientation training<br />Eligible caregivers for solidarity groups <br />(3-5/group)<br />Loan requirements:<br /> Group concept<br /> $50 maximum initially<br /> Loan cycle (16 wk)<br /> Repayment weekly<br /> Savings (10%)<br /> Education<br />Future loans require:<br /> Meeting attendance<br /> Savings<br /> Group appraisal<br />Solidarity<br /> group<br />Solidarity<br /> group<br />Village <br />Credit & <br />Savings <br />Association<br />(CSA) <br />Solidarity<br /> group<br />Solidarity<br /> group<br />Develop group rules and by-laws<br /> Membership requirements<br /> Penalties<br />Loan appraisal<br />
    69. 69. Example of support for IGA: Specialized training<br />Poultry raising<br />Coup construction & maintenance<br />Poultry health<br />Feed management<br />Marketing poultry products<br />Technical assistance:<br />Heifer Int’l, Ghana<br /> Veteran poultry farmers<br /> U of CA Avian Flu School<br />
    70. 70. Operation of microcredit scheme<br />Microcredit loans & savings<br />Entrepreneurship education <br />Nutrition education<br />Weekly <br />meeting<br />
    71. 71. Step 2: Nutrition education<br />Weekly education sessions before loan/saving payments<br />Group dynamics<br /> Lesson: cycles 1,2,4<br />Technical assistance<br />Health Promotion Unit of Ghana Health Services<br /> Women in Agriculture Development (WIAD)<br />Teaching approaches<br /> Flip charts for group discussion<br /><ul><li>Growing well
    72. 72. Child feeding styles
    73. 73. Malnutrition signs
    74. 74. Benefits of ASF
    75. 75. Balanced plate
    76. 76. Hygiene</li></li></ul><li>Teaching approaches<br /> Cooking competition to reinforce lessons<br />Evaluation of meal prepared<br /> Rationale focused on child<br /> Knowledgeable about nutritional value<br /> Includes ASF and iodized salt<br /> Practical<br /> Adequate portion size<br /> Hygiene<br />Feeding style<br />
    77. 77. Step 3: Entrepreneurial education<br />Weekly education sessions before loan/saving payments<br />Group dynamics<br /> Lessons: cycles 2, 3, 4<br />Teaching approaches<br />Flip charts for group discussion<br /><ul><li>Marketing and customer care
    78. 78. Record keeping
    79. 79. Financial literacy</li></ul> Skits on lessons learned<br />Technical assistance<br />Women in Agriculture Development (WIAD)<br />
    80. 80. Entrepreneurial Flipchart<br />Nutrition Flipchart<br />
    81. 81. Participants interviewed<br />179 participants <br /> open to all women with <br /> 2- 5 y old children<br /> living in community<br /> self-selected<br />142 non-participants <br /> living in community with<br /> 2-5 y old child<br /> matched wealth ranking<br />287 controls <br /> living in control community with 2-5 y old child<br /> matched wealth ranking<br />
    82. 82. Data collection<br />Baseline<br />FUP1, 4 mo<br />FUP2, 8 mo<br />FUP3, 12 mo<br />FUP4, 16 mo<br />Longitudinal data collected<br />Microcredit performance<br />Meeting attendance<br />Repayments<br />Savings<br />Cash flow for IGA (sub-sample)<br />Household <br /> Socio-demographic<br /> Food security<br /> ASF expenditures<br />Caregiver <br /> Child nutrition/health knowledge<br />Child <br /> Dietary intakes<br /> FFQ <br /> Weighed food (subsample)<br /> Anthropometry<br />Other data collected<br />Case studies (post intervention only)<br />
    83. 83. Baseline caregiver characteristics<br />In bold P<0.05<br />
    84. 84. Baseline child characteristics<br />In bold P<0.05<br />
    85. 85. Evidence that the intervention took place<br />ENAM Project CSA members' weekly meeting attendance rates by loan cycle<br />
    86. 86. Microcredit performance 100% recovery in 16-21 wk/cycle<br />Loans<br />Savings<br />Savings<br />
    87. 87. SUCCESS<br />Previous <br />business <br />experiences<br />Higher loan <br />amount<br />Supportive family <br />Business <br />commitment <br /> and vision <br />Healthy <br />maternal status<br />What factors contribute to participants’ success …….<br />… implications for interventions<br />
    88. 88. Research question<br />Does the implementation of an intervention with micro-credit,entrepreneurship training, and nutrition educationimprove household food security, use of animal source foods for children, and children’s nutritional status in rural Ghana?<br />
    89. 89. Baseline: household food insecurity in previous month<br />75%<br />54%<br />42%<br />32%<br />
    90. 90. Food insecurity is linked to quality of diet<br />Food secure/at risk<br />Food insecure<br />P<0.05<br />0 5 10 15 20<br />Percent of hh (%)<br />0 2 4 6 8 10<br />Number of ASF types consumed<br />Food secure/at risk<br />Food insecure (moderate & severe)<br />*<br />100<br />*<br />80<br />*<br />*<br />*<br />*<br />60<br />Percent of hh (%)<br />*<br />40<br />20<br />0<br />1 Accounting for region, ethnicity, and child age<br />* P<0.05<br />Children in moderate-severe food insecure households consumed fewer types of ASF1. <br />They were less likely to eat individual ASF types except for fish powder.<br />*<br />
    91. 91. There were no differences in food insecurity among groups at baseline. <br />After 16 months, intervention families were half as likely to report food insecurity as comparison families (OR=0.50; p<0.001).<br />
    92. 92. ASF diversity is higher with ↑ income & ↑access<br />Christian, 2010<br />
    93. 93. “Before the project, I would sell all the fish because I wanted the money. But now, I make sure there is always some fish left at home for them [the children]…My other children did not benefit from what I now know and they were always falling ill…Dominic is very good in school, even the teachers say so. And I know this is because of what I feed him”.<br />
    94. 94. Micronutrient intakes increased among children in intervention households<br />Dietary intakes based on 2-day weighed food records (Mean ±SE)<br />In bold P<0.05<br />Lartey A. 2008<br />
    95. 95. Intervention effect on child weight-for-age<br />*<br />*<br />*<br />Wt-for-age Z-score<br />Baseline and Follow-up time points 1-4<br />Mixed linear regression hierarchical model <br /> Includes district, lives with partner, income, caregiver occupation, time<br /> Intervention effect overall: + 0.26 Z-score P< 0.001<br />
    96. 96. Intervention effect on child height-for-age<br />*<br />Ht-for-age Z-score<br />Baseline and Follow-up time points 1-4<br />Mixed linear regression hierarchical model <br /> Includes district, lives with partner, income, caregiver occupation, time<br /> Intervention effect + 0.11 z-score P= 0.12<br />
    97. 97. Phase 3Transfer of activities to local agents for sustainability<br />
    98. 98. Partnership framework for sustainability<br />Freedom <br />from<br />Hunger, Ghana<br />Institutionalization<br />Rural Banks<br />MOU signed<br />ENAM Project<br />Adoption and scale-up<br />Logistical support<br />Rural Women’s<br />Credit & Savings <br />Associations<br />
    99. 99. Sustainability – (i) Access to credit<br />Enabling institutions<br /> Freedom from Hunger, Ghana<br /> MOU ENAM, FFH, banks<br /> “Credit with Education” program for private banks<br />Permanent institutions<br />Rural banks (private)<br />Akyimpem Rural Bank (Central) <br />Fiagya Rural Bank (Techiman)<br />Naara Rural Bank (Navrongo)<br />Mechanism of sustainability<br /> 15% interest / 4 month cycle<br /> Offer 1st to ENAM mothers, then expand <br />
    100. 100.
    101. 101. “We must say that at the end of the Credit with Education loan cycle we had 100% recovery which is Unprecedented in the history of any loan product of the bank “ <br />Microfinance coordinator, participating rural bank, Northern Ghana<br />
    102. 102. Sustainability – (ii) access to education<br />(a)<br />Enabling institutions<br /> Freedom from Hunger, Ghana<br /> “Credit with Education” program<br />Permanent institutions<br /> Three rural banks<br />Mechanism of sustainability<br /> Sessions with loan payment & savings <br />
    103. 103. Sustainability – (ii) access to education<br />(b)<br />Enabling institutions<br /> University of Ghana<br />Permanent institutions<br />Communities<br />Mechanism of sustainability<br /> Peer educators<br /> Peer educator manuals<br />
    104. 104. Sustainability – (ii) access to education<br />(c)<br />Enabling institutions<br /> University of Ghana<br />Permanent institutions<br />University of Ghana<br />NGO<br />Ghana Health Services<br />Mechanism of sustainability<br /> Undergraduate course<br /> Continuing education short course<br />
    105. 105.
    106. 106. Expanding the LCC-CRSP overall vision...<br />To reduce vulnerability, increase adaptive capacity, and augment the income of livestock producers in regions where agricultural systems are rapidly changing, available resources are shrinking, and climate change is having an impact,<br />to assure the physical and cognitive development of at-risk populations so that society reaches its full potential.<br />
    107. 107. The ENAM Project is funded through the Global Livestock -CRSP funded in part by US-AID Grant No. PCE-G-00-98-00036-00; Women in Development, US-AID; and the Jim Ellis Graduate Mentorship Program. In addition, substantial support was provided by Iowa State University, the University of Ghana, and McGill University.<br />

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