Improving Children's Diet And Nutritional Status Through An Agriculture Intervention With Nutrition Education In Upper Manya Krobo District Of Ghana
Authors: Marquis Grace S , Colecraft Esi K , Kanlisi Roland , Pinto Comfort , Aryeetey Richmond , Aidam Bridget , Bannerman Boat 
Published: November 2023

Integrated financial, agriculture, and education interventions can improve young children's diets by (i) increasing maternal income from small businesses that can be used to purchase nutrient‐rich foods and (ii) expanding access to home‐raised animal food products, such as eggs and milk. Nutrition Links is a 5‐y multi‐dimensional project to improve the health and economic well‐being of vulnerable rural populations in the Upper Manya Krobo district (Eastern Region) of Ghana. In 2013, a district‐wide census of households with infants < 12 mo was completed. A cluster randomized trial then tested the effect of an agriculture intervention with nutrition education sessions to improve young child nutritional status in three of the six sub‐districts. Enrollment occurred in two phases, one year apart. Phase 1 enrollment of 316 women and their children took place in 2014. Communities were randomly assigned to either the control arm or the intervention (poultry small business for egg production, home gardens, and weekly group meetings promoting nutrition and health education). Technical assistance was available each week to address concerns about poultry health, productivity, and egg marketing as well as the gardens. Caregivers reported on egg production and losses (consumption, breakage, donation) each week. Children's diet and nutritional status were documented at baseline and approximately one year later at the endline for phase 1. This analysis focused on dietary changes associated with the intervention and the resulting improvements in children's nutritional status during phase 1. At baseline, only 16% of all children had consumed eggs in the previous 24 hours; the control group tended to consume eggs more than intervention group (21% vs 14%; p=0.09). At endline, 27% of children had consumed eggs the previous day; there was a significant group difference (30% intervention vs. 20% control; p<0.05). A positive change in egg consumption behavior over time (‘no intake’ at baseline to ‘intake’ at endline) was more common among children in the intervention than the control group (24% vs 12%%; p<0.01). Children with this positive dietary behavior change had higher mean weight‐for‐length/height and BMI‐for‐age z‐scores compared to those with a negative change in egg consumption (‘intake’ at baseline to ‘no intake’ at endline) (p<0.01). Other food group changes over the project time, including changing patterns of dairy and legumes, were not associated with anthropometric outcomes. To date, the Nutrition Links project has been successful in increasing access to and consumption of eggs among children. Egg consumption was associated with better nutritional status. The efforts to implement nutrient‐rich vegetable gardens and the promotion of other foods for young children remain challenging, in part due to the harsh environmental conditions (e.g., sporadic rain); these require additional work. Clinical Trials # NCT01985243Support or Funding InformationGlobal Affairs Canada, World Vision Canada, McGill University