Nutrition-sensitive agriculture programs increase dietary diversity in children under 5 years: A review and meta-analysis

Abstract

Background: Low-quality diets contribute to the burden of malnutrition and increase the risk of children not achieving their developmental potential. Nutrition-sensitive agriculture programs address the underlying determinants of malnutrition, though their contributions to improving diets do not factor into current nutrition impact modeling tools.

Objective: To synthesize the evidence on the effectiveness of nutrition-sensitive agriculture programs in improving dietary diversity in young children (6-23.9 months and 6-60 months).

Methods: A literature search was conducted for published trials through existing systematic reviews and individual database search of the ISI Web of Science. All dietary diversity measures in the studies selected to be in the analysis were extracted. Estimation of main pooled effects were conducted on outcomes of minimum diet diversity (MDD) and diet diversity score (DDS) using random-effects meta-regression models. We report pooled effect sizes as standardized mean differences (SMDs) or odds ratios (ORs).

Results: Nutrition-sensitive agricultural interventions have a significant positive impact on the diet diversity scores of children aged 6-23.9 months (SMD = 0.22, 95% confidence interval (CI) = 0.09-0.36) and on the odds of reaching minimum diet diversity (OR = 1.45, 95% CI = 1.20, 1.76). Similar impacts are found when analyses are expanded to include studies for children aged 6-60 months (DDS SMD = 0.22, 95% CI = 0.12-0.32) (MDD OR = 1.64, 95% CI: = 1.38-1.94).

Conclusion: Nutrition-sensitive agriculture interventions consistently have a positive impact on child dietary diversity. Incorporating this evidence in nutrition modeling tools can contribute to decision-making on the relative benefits of nutrition-sensitive interventions as compared with other maternal, newborn, child health and nutrition (MNCHN) interventions.

Figure 1

PRISMA flowchart (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Figure 2

Effects of nutrition-sensitive agricultural interventions on minimum dietary diversity in children aged 6-23.9 months. cRCT – cluster randomized controlled trial, QE – quasi-experimental study, BCC – behavior change communication, OWL – older woman leader, HC – health committee, ACGG – African Chicken Genetic Gains, ATONU – agriculture to nutrition, AG-G – agriculture, gender equity and women’s empowerment, ASF – animal-sourced foods.

Figure 3

Effects of Nutrition-sensitive Agricultural Interventions on Minimum Diet Diversity in Children Aged 6-60 months. cRCT – cluster randomized controlled trial, QE – quasi-experimental study, BCC – behavior change communication, OWL – older woman leader, HC – health committee, ACGG – African Chicken Genetic Gains, ATONU – agriculture to nutrition, AG-G – agriculture, gender equity and women’s empowerment, ASF – animal-sourced foods

Figure 4

Effects of nutrition-sensitive agriculture interventions on Diet Diversity Score in Children 6-23.9 months. cRCT – cluster randomized controlled trial, QE – quasi-experimental study, BCC – behavior change communication, OWL – older woman leader, HC – health committee, ACGG – African Chicken Genetic Gains, ATONU – agriculture to nutrition, AG-G – agriculture, gender equity and women’s empowerment, ASF – animal-sourced foods.

Figure 5

Effects of nutrition-sensitive agriculture interventions on Diet Diversity Score in Children 6-60 months. cRCT – cluster randomized controlled trial, QE – quasi-experimental study, BCC – behavior change communication, OWL – older woman leader, HC – health committee, ACGG – African Chicken Genetic Gains, ATONU – agriculture to nutrition, AG-G – agriculture, gender equity and women’s empowerment, ASF – animal-sourced foods