Academic Publication

Intervention to improve maternal and child nutritional outcomes in rural Odisha, India

BMC Public Health
Publication Year:
April 29, 2020
  • SDG 2 - Zero Hunger
  • SDG 3 - Good Health and Well-Being
  • SDG 5 - Gender Equality

Abstract Background: Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. ‘Nutrition-sensitive’ agriculture programs could tackle the underlying causes of undernutrition.

Methods/design: This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women’s groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women’s groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women’s groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6–23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2 ) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0–23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children’s weight-for-height z-score < -2 standard deviations (SD). The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (< 10 km or ≥ 10 km), and low (< 30%), medium (30–70%), or high (> 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions.

Discussion: This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, videobased approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts.

Background: Maternal and child undernutrition are among the world’s most serious health, economic, and human development challenges. Undernutrition contributes to around 3.1 million (45%) child deaths annually [1]. In South Asia, more than a third of children are stunted and a third of women are underweight [2]. Maternal and child undernutrition have adverse consequences for pregnancy outcomes, children’s morbidity and mortality, their physical and cognitive development, and the incidence of chronic diseases in adulthood [3]. The impacts of undernutrition also extend beyond health, with negative consequences for educational attainment, economic productivity as adults, and human wellbeing [4]. India has made progress in reducing undernutrition, but the prevalence of child undernutrition remains strikingly high: 38% of children under 5 years of age are stunted (height-for-age z-score < -2 standard deviations, SD), 21% are wasted (weight-for-height z-score < -2 SD), and 58% are anaemic [5]. In addition, almost a quarter of Indian women aged 15–49 are underweight and more than half are anaemic [6].


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