Grace S. Marquis

We aimed to examine the association between women's empowerment and childhood nutritional status while accounting for the mediating role of household headship structure. Cross‐country, cross‐sectional quantitative data from the most recent Demographic and Health Surveys (2015–2018) were used. Women's empowerment was measured as a composite index of participation in household decision‐making, attitude towards domestic violence, and asset ownership. Childhood nutrition status was measure as anaemia (haemoglobin concentration < 110g/L), stunting (height‐for‐age z‐scorescore <−2) and the co‐occurrence of anaemia and stunting. Applying the Lewbel two‐stage least squares, women's migration status was used as an instrumental variable. We used data on 25,665 woman‐child dyads from eight sub‐Saharan African countries: Burundi (2016), Ethiopia (2016), Guinea (2018), Malawi (2016), Mali (2018), Zimbabwe (2015), Uganda (2016), and Tanzania (2015). The women were in their reproductive ages (15–49 years) and children were under 5 years old. The findings showed that an increase in women's empowerment index reduces children's likelihood of being anaemic and having a co‐occurrence of anaemia and stunting [coeff (SE), −0.114 (0.025) and −0.072 (0.032), respectively]. Specifically, an increase in asset ownership or decision‐making dimensions of empowerment significantly reduces the likelihood of anaemia and the co‐occurrence of anaemia and stunting among children. Children of empowered women from male‐headed households were more likely to be anaemic and be concurrently anaemic and stunted compared to their counterparts whose mothers were from female‐headed households. Interventions designed to improve childhood nutrition through women's empowerment approaches need to consider asset ownership and instrumental agency of women while acknowledging the mediating effect of household headship typology.

Despite the recognition of nutrition as a multisectoral development issue, institutional silos persist as barriers to addressing community nutrition challenges effectively and sustainably. Over the past two decades, three integrated agriculture, livelihoods, nutrition, and health interventions have been implemented in rural communities across Ghana aimed at nurturing multisectoral collaborations to enhance institutional capacity, women's empowerment, children's diets and nutritional status, and general household well-being. Using information from published articles on the interventions, workshop reports, informal institutional engagements, and field notes, insights on the efforts to garner multisectoral participation to sustain these interventions are presented. Challenges and opportunities encountered in the process of growing and learning together relative to overcoming institutional cultures, building trust, empathizing with partners’ institutional challenges, making collective decisions, and building common ownership and accountability are explored. Fostering effective multisectoral participation is a dynamic process of continuous learning.

Few studies have examined the influence of women's participation in farmer groups on female and male empowerment, which is considered essential to improving nutrition. The study aimed to (1) assess the empowerment of Ghanaian women farmers, one adult male family decision maker, and the household gender equality, and (2) investigate the relationship of empowerment and household gender equality with women's participation in farmer-based organizations (FBO), women's and men's nutritional status, and household food security. A cross-sectional study investigated secondary outcomes using baseline data from a nutrition-sensitive agriculture intervention implemented through FBOs in rural Ghana (ClinicalTrials.gov (NCT03869853). Existing FBOs in eight communities were selected based on six criteria (e.g., participation level, readiness to change). Female FBO (n = 166) and non-FBO (n = 164) members together with a male family member (n = 205) provided data on individual and household characteristics; empowerment was measured across 11 indicators with the project-level Women's Empowerment in Agriculture Index. Generalized linear mixed models tested the associations between empowerment and household gender equality with FBO membership, nutritional status, and household food security. Women's FBO membership was associated with an increased likelihood of women's empowerment (aOR = 3.25; 95% CI [1.97, 5.33]) and household gender parity (aOR = 2.82; 95% CI [1.39, 5.84]) but not men's empowerment. Household food insecurity, but not nutritional status, was positively associated with women's FBO participation and individual empowerment indicators (financial services). Food insecurity was negatively associated with women's empowerment indicator related to attitudes about domestic violence (aβ = −0.78; 95% CI [−1.35, −0.21]) and men's overall empowerment (aβ = −0.79; 95% CI [−1.58, −0.01]). Understanding the complexity in which FBO participation, empowerment, nutritional status, and food security are linked is critical in designing interventions that promote gender equality and improved nutrition.

Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions. This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders. A 2018–2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13–16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention – a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention – 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews. The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes. Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.

Little is known about how the level of program participation affects child nutrition in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014–2015 and less than 18 mo in 2016–2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as “no participation.” Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category – 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length‐for‐age z‐scores (LAZ)/height‐for‐age z‐scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively]. These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.

The World Health Organization recommends deworming to reduce soil‐transmitted helminth (STH)‐attributable morbidity in women of reproductive age, including pregnant and lactating women, to reduce blood loss, iron deficiency anaemia and nutrient malabsorption. This study assessed the impact of maternal postpartum deworming with albendazole approximately 1 day after delivery on infant milk intake among a subset of 216 randomly selected mother–infant pairs recruited into a large trial in Peru. Infant milk intake was measured using the deuterium‐oxide method at 1‐ and 6‐month postpartum. Maternal STH infection was measured at 6‐month postpartum. At 1‐month postpartum, mean intake was 756 ± 16 and 774 ± 18 mL day⁻¹in the albendazole and placebo groups, respectively (mean difference: −18 mL day⁻¹; 95% CI: −65, 30). At 6‐month postpartum, mean intake was 903 ± 16 and 908 ± 18 mL day⁻¹in the albendazole and placebo groups, respectively (mean difference: −5 mL day⁻¹; 95% CI: −52, 43). There was no statistically significant difference in milk intake between groups at either time point. At 6‐month postpartum, mothers infected withTrichuris trichiurahad infants with higher milk intakes (adjusted mean difference: 70 mL day⁻¹; 95% CI: 20, 120) compared with uninfected mothers. However, there was no statistically significant difference in infant milk intake between mothers who had moderate‐and‐heavy intensity infection compared with the comparison group (mothers with no and light intensity infection). A lower prevalence and intensity of infection, and inclusion of uninfected mothers in both arms of the trial, resulting in effect dilution, may explain the null findings.

The overarching Ethiopia project examined the effects of early market introduction of iodized salt on the growth and mental development of young children. Sixty districts were randomly assigned to intervention (early market access to iodized salt) or control (later access through market forces), and one community per district was randomly chosen as the sampling unit. For this project, 22 of the districts were included. The participants were 1,220 pregnant women who conceived after the intervention began. When their children were 2 to 13 months old, field staff collected information on household sociodemographic status and iodized salt intake, child stimulation, maternal depression symptoms, children's diet, anthropometry, urinary iodine concentration (UIC), hemoglobin, and mental development scores (Bayley III scales). Fewer mothers prepartum (28% vs. 41%,p< .05) and their children (13% vs. 20%,p< .05) were iodine deficient (UIC .05) compared with their controls. Iodized salt intake improved iodine status of both pregnant women and their children and also child cognitive development.

Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12‐month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother–child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention‐to‐treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length‐for‐age (LAZ)/height‐for‐age (HAZ), weight‐for‐age (WAZ), and weight‐for‐length (WLZ)/weight‐for‐height (WHZ) z‐scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0–32) at baseline and 29.8 ± 5.4 months (range: 13–48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random‐effects and mixed‐effects models and as‐treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high‐quality foods and nutrition education improve child nutrition.

Purpose: This study examined whether micro‐savings programs can improve young adolescent girls' financial knowledge, savings behaviors, and schooling outcomes in Ghana.Methods: We evaluated the short‐ and medium‐term effects of a randomized control trial in which a sub‐sample of over 1400 girls living in the Eastern Region of Ghana received financial literacy training and a micro‐savings account.Results: Girls in the intervention arm of the study initially exhibited higher levels of financial knowledge, planning, and savings, but some of these effects disappeared within two years. Nonetheless, girls with micro‐savings retained their greater knowledge of interest rates, had higher levels of savings, and were more likely to save for school. The effects on girls' educational enrollment was strongest in the second year.Conclusions: Our results suggest that even relatively young girls can manage micro‐savings accounts and that such programs, if sustained, can effectively build girls' financial and educational assets.