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      Nutrition integrated agricultural extension—a case study in Western Kenya

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          Summary

          Integrating nutrition communication in agricultural intervention programs aimed at increased food availability and accessibility in resource-poor areas is crucial. To enhance the sustainability and scalability of nutrition communication, the present study piloted the approach of ‘nutrition integrated agricultural extension’ and tested nutrition-related outcomes with two types of nutrition messages (specific vs. sensitive) and two delivery channels (public sector vs. private sector). The study intervention comprised (i) vegetable seed kit distribution, (ii) ongoing agricultural extension activities by public or private sectors and (iii) nutrition communication with two different messages. The intervention was tested with three treatment arms and reached 454 farmers (>65% female) in rural Kakamega County, Western Kenya. Pre-/post-surveys measured outcome variables focused on farmers’ nutrition-related knowledge, attitudes and practices in vegetable production and consumption, and household dietary diversity score. Results showed that all treatments increased nutrition knowledge ( p < 0.05). Nutrition-specific communication was more effective than nutrition-sensitive communication. Nutrition communication through either the public or the private agricultural sector was both effective. Before the study intervention, many participants believed that vegetable consumption was beneficial and wanted to increase intake. After the intervention, the number of participants who felt eating more vegetables was challenging decreased slightly. Nutrition communication was found to be especially important in conveying recommended food amounts and promoting increased vegetable consumption. Seasonality affected on-farm crop diversity and vegetable consumption results in this study.

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          Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

          Acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions. We reviewed evidence of nutritional effects of programmes in four sectors--agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women's empowerment. However, evidence of the nutritional effect of agricultural programmes is inconclusive--except for vitamin A from biofortification of orange sweet potatoes--largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some effects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefits. Combined early child development and nutrition interventions show promising additive or synergistic effects on child development--and in some cases nutrition--and could lead to substantial gains in cost, efficiency, and effectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the effectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women's nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specific interventions and create a stimulating environment in which young children can grow and develop to their full potential. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Nutrition-sensitive agriculture: What have we learned so far?

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              Maternal and child nutrition in Sub-Saharan Africa: challenges and interventions.

              Women of child-bearing age (especially pregnant and lactating women), infants and young children are in the most nutritionally-vulnerable stages of the life cycle. Maternal malnutrition is a major predisposing factor for morbidity and mortality among African women. The causes include inadequate food intake, poor nutritional quality of diets, frequent infections and short inter-pregnancy intervals. Evidence for maternal malnutrition is provided by the fact that between 5 and 20% of African women have a low BMI as a result of chronic hunger. Across the continent the prevalence of anaemia ranges from 21 to 80%, with similarly high values for both vitamin A and Zn deficiency levels. Another challenge is the high rates of HIV infection, which compromise maternal nutritional status. The consequences of poor maternal nutritional status are reflected in low pregnancy weight gain and high infant and maternal morbidity and mortality. Suboptimal infant feeding practices, poor quality of complementary foods, frequent infections and micronutrient deficiencies have largely contributed to the high mortality among infants and young children in the region. Feeding children whose mothers are infected with HIV continues to remain an issue requiring urgent attention. There are successful interventions to improve the nutrition of mothers, infants and young children, which will be addressed. Interventions to improve the nutrition of infants and young children, particularly in relation to the improvement of micronutrient intakes of young children, will be discussed. The recent release by WHO of new international growth standards for assessing the growth and nutritional status of children provides the tool for early detection of growth faltering and for appropriate intervention.
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                Author and article information

                Journal
                Health Promot Int
                Health Promot Int
                heapro
                Health Promotion International
                Oxford University Press
                0957-4824
                1460-2245
                April 2022
                07 September 2021
                07 September 2021
                : 37
                : 2
                : daab142
                Affiliations
                [1 ] Center for Development Research, University of Bonn, Bonn, Germany Genscherallee 3, 53113 Bonn, Germany
                [2 ] World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
                [3 ] World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
                [4 ] World Vegetable Center - Eastern and Southern Africa, Arusha, Tanzania P.O. Box 10, Duluti, Arusha, Tanzania
                [5 ] National Commission for Science, Technology and Innovation, Nairobi, Kenya O. Box 30623, 00100 Nairobi, Kenya
                [6 ] Syngenta Foundation for Sustainable Agriculture , 6th Floor, Avenue 5 Building, Rose Avenue, Nairobi, Kenya
                [7 ] World Vegetable Center, West and Central Africa – Coastal and Humid Regions IITA-Benin Campus , 08 BP 0932 Tri Postal, Cotonou Benin
                [8 ] World Vegetable Center, Headquarters , Tainan, No. 60, Yi-Min Liao, Shanhua, Tainan, 74199, Taiwan (ROC)
                Author notes

                Present address for Gudrun B. Keding: Department of Crop Sciences, University of Göttingen, Carl-Sprengel-Weg 1, 37075 Göttingen, Germany.

                Present address for Ray-Yu Yang: Food and Fertilizer Technology Center for the Asian and Pacific Region 5F, No. 14, Wenchow St., Taipei, 10648, Taiwan (ROC).

                Corresponding author. E-mail: ray-yu.yang@ 123456fftc.org.tw
                Author information
                https://orcid.org/0000-0002-6136-3943
                Article
                daab142
                10.1093/heapro/daab142
                9053460
                34491316
                b9f0c209-e5d7-4344-8fa5-098ab7f36b47
                © The Author(s) 2021. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 13
                Funding
                Funded by: Federal Ministry for Economic Cooperation and Development, DOI 10.13039/501100006456;
                Award ID: 81194998
                Categories
                Articles
                AcademicSubjects/MED00860

                Public health
                africa,communication,community-based intervention,nutrition,intersectoral partnerships

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