Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Impact of Food Security Interventions and Nutrition Education on Child Dietary Diversity

926 views

Published on

Presented by Alexander Kalimbira

Presented at 2015 ECAMA Research Symposium
Malawi Institute of Management, 4-5 June

  • Be the first to comment

  • Be the first to like this

Impact of Food Security Interventions and Nutrition Education on Child Dietary Diversity

  1. 1. Impact of Food Security Interventions & Nutrition Education on Child Dietary Diversity Results from 3 Cross-sectional Surveys The IMCF Team at the 2nd ECAMA Symposium Malawi Institute of Management Lilongwe 04 June 2015
  2. 2. Improving Infant & Young Child Feeding 2
  3. 3. Background – as of 2011  Inappropriate feeding practices during the complementary feeding period contribute to inadequate nutrient intake among infants & young children  Even when food resources are available in the home, caregivers are not able to make the best use of them:  Inadequate knowledge  Unhealthy beliefs & practices  Inappropriate advice  Need for interventions to improve quality of complementary foods by promoting consumption of a variety of foods, including local foods  Lack of evidence! 3
  4. 4. IFSN Project To improve food security & nutrition: • Support to joint nutrition education between Agriculture and Health for increased impact of knowledge and skills on: production, processing, storage and utilization including improved complementary feeding practices • Distribution of a range of agricultural inputs to vulnerable households including those with young children and pregnant women • Increased diversification of local production to include different livestock and nutritious food crops covering the six food groups
  5. 5. Key Activities 5  Promote diversified agriculture to improve availability, access and utilization of all six food groups  Capacity building of farmers, lead farmers, frontline staff  Promote income generating activities: fruit trees, apiary, mushrooms, vegetables, cassava, Irish potatoes, orange- fleshed sweet potatoes  Promotion of environment, soil & water conservation  Improve water & sanitation  Promotion of small scale irrigation-gravity fed, treadle pumps, residual moisture
  6. 6. Objectives of the Research Project … … was to test the following hypotheses: 1. TIPs formative research generates behaviour change communication messages & nutritionally improved recipes that lead to lasting improvements in complementary feeding practices, dietary intakes & child nutritional status 2. Locally available & affordable foods can provide a significant contribution to the nutritional requirements of children 6-23 months 6
  7. 7. 3. Nutrition education with focus on IYCF & linked with a food security intervention can improve child feeding practices & nutritional status, & 4. Using locally available foods for improving complementary feeding practices & children’s nutrition status is a sustainable strategy, which can be replicated by households at low cost & taken to scale using available Government services. 7 Objectives of the Research Project …
  8. 8. Cross-sectional nutrition baseline survey in households with children below 2 years (Aug 11; n=1041) Restricted randomization of intervention & control villages (mean height-for-age Z-score) Nutrition Education on complementary feeding (Dec 12 – Jan 14) Intervention area (12 clusters) Cross sectional mid-term survey (Aug 13; n=921) Food security interventions (Oct 11- Sep 12) e.g. farmer field schools, seed & fertilizer distribution, distribution of fruit seedlings, livestock Foodsecurity interventions 1year NEingroup1 &1monthsin group2;NE max9months Control area (12 clusters) Cross sectional impact survey (Aug 14; n=1221) Longi- tudinal study (n=124) Focus Group discus- sions, know- ledge tests, obser- vations 8
  9. 9. 9 Primary outcome indicator:  change in length of children Secondary outcome indicators:  achieved Minimum Dietary Diversity (MDD) among children  achieved Minimum Meal Frequency (MMF) among children  improved caregiver’s knowledge, attitudes & feeding, hygiene & food safety practices Enrolment criteria: Caregivers with children 6-9 months at first assessment Intervention area: member of FAO nutrition education group Control area: resident in FAO intervention villages; matched by sex & age in days (±14 days) Assessments: every 3 months for one year = five assessments Study Design
  10. 10. Cross-sectional Surveys Baseline, Mid-term, & Impact • Cross-sectional nutrition surveys in 24 EPA sections in Kasungu & Mzimba Districts • Study population: mothers/primary caregivers and children <2 years • Random selection of 3 villages on section (cluster) level (PPS) (baseline and mid-term) • Random selection of 4 villages per section (PPS) (impact) • Random selection of participants at village level 10
  11. 11. • Baseline: August/September 2011 (sample size: height-for- age z-score) – IFSN intervention villages • Mid-term: August/September 2013 (sample size: children’s dietary diversity) – Intervention area: nutrition education villages only (Round 1) – Control area: food security intervention villages only • Impact: August/September 2014 (sample size: height-for- age z-score) – Intervention area: nutrition education villages only (Round 1, same as in mid-term + 1 additional per section) – Control area: food security intervention villages only 11 Cross-sectional Surveys Baseline, Mid-term, & Impact
  12. 12. Study Population at Baseline, Mid-term, & Impact Baseline (N=1041) Aug/Sept 2011 Midterm (N=921) Aug/Sept 2013 Impact (N=1221) Aug/Sept 2014 Main characteristics Int. Cont. Int. Cont. Int. Cont. Percentage (%) Main income source = farming 73 78 77 81 68 77 Improved drinking water source 77 76 86 83 86 83 Improved sanitation facility 27 31 59 59 50 42 Mean (SD) HFIAS Score (min-max= 0 – 27) 6.9 ± 6.6 8.8 ± 6.9 4.4 ± 5.9 5.7 ± 6.5 Wealth index (min-max = -6.1 – 13.5) 0.4 ± 3.7 -0.1 ± 3.4 0.1 ± 3.7 -0.5 ± 3.4 0.2 ± 3.7 -0.1 ± 3.9 Years of school education of mother 5.6 ± 3.2 5.2 ± 3.1 6.3 ± 3.1 6.5 ± 2.9 7.0 ± 2.6 6.7 ± 2.9 Int.=Intervention area = food security intervention and nutrition education; Cont.=Control area = food security intervention only 12 Access to improved water & sanitation facilities increased over time Food security situation improved over time, was higher in intervention area Average years of schooling increased over time
  13. 13. WHO IYCF Indicators at Baseline, Mid-term, & Impact % children 6 to < 24 months receiving … Baseline Aug/Sep 2011 (n = 832 ) Midterm Aug/Sep 2013 (n = 780 ) Impact Aug/Sep 2014 (n = 977) Int. Cont. Int. Cont. Int. Cont. Breast milk 96 93 97 98 96 95 Minimum dietary diversity 63 56 71 49 71 55 Minimum meal frequency 89 80 85 79 91 81 Minimum acceptable diet 58 48 63 43 67 48 Standardised WHO indicators (WHO 2011) Int.= intervention area = food security and nutrition education Cont. = control area = food security only 13
  14. 14. Difference-in-Differences Model Baseline Impact Intervention Effect Intervention Control
  15. 15. Child Dietary Diversity Score (CDDS) 3.8 3.6 4.0 3.4 Baseline Impact Covariates: age of child, maternal education, wealth Estimatedmean CDDS P=0.003 Intervention Control
  16. 16. WHO Indicators: Complementary Feeding  CDDS significantly increased • Intervention effect 40%, P=0.003  MDD (minimum dietary diversity) significantly increased • Intervention effect 13%, P=0.004  MMF (minmum meal frequency) already high at baseline  MAD (minimum acceptable diet) significantly increased • Intervention effect 12%, P=0.007
  17. 17. Children Consuming ASF & Legumes a Day Before the Survey 0% 20% 40% 60% 80% Intervention Control Intervention Control Intervention Control Baseline Midterm Impact Animal source foods (ASF) Legumes 17
  18. 18. P=0.001 ASF Consumption – DiD Model 12% 13% 16% 6% Intervention Control Baseline Impact Covariates: age of child, maternal education, wealth Estimatedprevalence ofASFandegg consumption 45% 45% 52% 39% All ASF Eggs P=0.005
  19. 19. Legumes Consumption – DiD Model 67% 59% 76% 62% Baseline Impact Covariates: age of child, maternal education, wealth Estimatedprevalence oflegumes consumption P=ns Intervention Control
  20. 20. Mean (SD) height for age z-score (6-23 months old children, IMCF research area) 20 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 control intervention control intervention control intervention Baseline 08/2011 Mid-term 08/2013 Impact 08/2014 Meanheightforagez-score(HAZ)
  21. 21. Impact on Height-for-age Z-score (DiD) Midterm Survey & Impact Survey 21 • Midterm Survey: Sign. differences in mean HAZ between intervention (-0.17) & control (- 0.19) which can be related to the intervention: food security & nutrition education • Impact Survey: No sign. differences in mean HAZ between intervention (-0.17) & control (- 0.18)
  22. 22. Conclusions • Food security interventions & participatory nutrition education improved children’s nutritional status at community level • IFSN nutrition education approach using local resources has a high potential to improve dietary diversity of children 22
  23. 23. IMCF Project Team Malawi Cambodia Food security Project IFSN MALIS Research Institutions Lilongwe University of Agriculture and Natural Resources (LUANAR): Dr C Masangano Dr B Mtimuni Dr A Kalimbira Dr C Nthinda Mahidol University & NNP Cambodia: Dr O Kevanna Dr P Winichagoon Dr G Charoonruk Dr K Sranacharoenpong Students Ms J Kuchenbecker Ms G Chiutsi Phiri et al. Ms A Reinbott Mr M Khun et al. FAO Headquarters Rome, Italy Ms E Muehlhoff, Dr E Westaway, Ms T. Jeremias, Ms Graz, and until August 2013: Dr Gina Kennedy JLU Giessen, Germany Prof. MB Krawinkel, MD, Dr I Jordan, Dr J Herrmann, Dr E Heil 23
  24. 24. Registration & Funding German Clinical Trial Register (DRKS) https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do The research was conducted within the IMCF Project of FAO: http://www.fao.org/ag/humannutrition/nutritioneducation/70106/en/ 24

×