Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia

Abstract

Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children's dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric measurements were taken. A difference-in-differences model was applied. The sample comprised 743 households with children ≥6 months of age at baseline and 921 at impact. After 1 year of NE, 69 % of the intervention households reported to have participated in the NE. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3·6 and 3·9, respectively). In particular, the consumption of pro-vitamin A-rich foods and other fruits and vegetables increased. No treatment effects on height-for-age Z-scores could be shown. NE led to improvements in children's diets. For effects on growth, it is assumed that longer NE activities are required to achieve sustainable behaviour change of age-appropriate infant feeding.

Keywords: CDDS child dietary diversity score; CNP community nutrition promoter; DiD difference-in-differences; HAZ height-for-age Z-scores; HH household; IYCF infant and young child feeding practices; MALIS improving market linkages for smallholder farmers; NGO non-governmental organisation; Child dietary diversity; Community-based nutrition; Nutrition education; Stunting.

Fig. 1

Research design. , FAO project components; , Liebig University research activities. MALIS, improving market linkages for smallholder farmers.

Fig. 2

Participation in FAO activities at impact. Participation in any other nutrition education or food security activities is not presented in this figure. MALIS, improving market linkages for smallholder farmers; , don’t know; , no participation in any MALIS activity at impact survey; , nutrition education; , nutrition education+farmer field/business school; , farmer field/business school.

Fig. 3

Mean child dietary diversity scores (+1 sd) of children in the intervention and comparison groups by 2-month age groups. Number per age group (months) comparison/intervention: 6–7=50/59; 8–9=43/58; 10–11=57/83; 12–13=37/69; 14–15=39/52; 16–17=21/42; 18–19=50/44; 20–21=59/58; 22–23=38/55. Group differences with independent sample t test: ** P<0·01, * P<0·05. WHO recommended minimum number of food groups to be consumed in 1 d. , Comparison (n 394); , intervention (n 520).

Fig. 4

Mean height-for-age Z-scores (±1 sd) of children in the intervention and comparison groups by 2-month age group at impact. Number per age group (months) comparison ()/intervention (): 6–7=51/58; 8–9=43/58; 10–11=57/82; 12–13=37/69; 14–15=39/52; 16–17=20/42; 18–19=49/44; 20–21=59/58; 22–23=38/55.

Fig. 5

Differences in estimated mean child dietary diversity (differences-in-difference (DiD) model). A, differences between comparison and intervention at baseline=−0·22, P=0·048; B, hypothetical development of intervention group without intervention (DiD assumption); C, treatment effect=0·49, P=0·001; , comparison; , intervention; , intervention (counterfactual).