Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets.

Smallholder farmers dependent on rain-fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross-sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non-consecutive quantitative 24-hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty-five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes (r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two-block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = -0.007, SE = 0.003, P = 0.027, 95% CI [-0.013, -0.001] ŋ2  = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.

Participatory farm diversification and nutrition education increase dietary diversity in Western Kenya.

Our study assessed the effectiveness of a community-based participatory approach in increasing micronutrient adequacy of diets of women and young children through agricultural activities and nutrition education in Vihiga County, Western Kenya. Outcome indicators include the mean dietary diversity score (DDS), the percentage of women and children reaching minimum dietary diversity (MDD), and micronutrient adequacy (mean adequacy ratio). The project consisted of(a) a diagnostic survey covering agrobiodiversity and nutrition, (b) participatory development of activities to improve nutrition, (c) a baseline survey covering dietary intakes, (d) participatory implementation of the developed activities, and (e) an endline survey covering dietary intakes. The diagnostic survey was conducted in 10 sublocations of Vihiga County, which were pair-matched and split into five intervention and five control sublocations. The intervention sublocations developed activities towards improving nutrition. Before implementation, a baseline survey collected the dietary intake data of 330 women-child pairs in the intervention and control sublocations. To support the activities, communities received agriculture and nutrition training. After 1 year of implementation, an endline survey collected dietary intake data from 444 women-child pairs in the intervention and control sublocations. Impact was assessed using the difference-in-difference technique. Highly significant positive impacts on children's mean DDS (treatment effect = 0.7, p < 0.001) and on the share of children reaching MDD (treatment effect = 0.2, p < 0.001) were shown. Higher dietary diversity can be explained by the development of subsistence and income-generating pathways and increased nutrition knowledge. Participatory farm diversification and nutrition education were shown to significantly increase dietary diversity of young children in Western Kenya.

Can common dietary assessment methods be better designed to capture the nutritional contribution of neglected, forest, and wild foods to diets?

Food systems are the primary cause of biodiversity loss globally. Biodiversity and specifically, the role that wild, forest and neglected and underutilised species (NUS) foods might play in diet quality is gaining increased attention. The narrow focus on producing affordable staples for dietary energy has contributed to largely homogenous and unhealthy diets. To date, evidence to quantify the nutritional contribution of these biodiverse foods is limited. A scoping review was conducted to document the methods used to quantify the contribution of wild, forest and NUS foods. We found 37 relevant articles from 22 different countries, mainly from Africa (45%), the Americas (19%), and Asia (10%). There were 114 different classifications used for the foods, 73% of these were specifically related to wild or forest foods. Most dietary assessments were completed using a single day qualitative or quantitative 24 h open recall (n = 23), or a food frequency questionnaire (n = 12). There were 18 different diet related indicators used, mainly nutrient adequacy (n = 9) and dietary diversity scores (n = 9). Often, no specific nutritionally validated diet metric was used. There were 16 studies that presented results (semi) quantitatively to measure the contribution of wild, forest or NUS foods to dietary intakes. Of these, 38% were aggregated together with broader classifications of 'traditional' or 'local' foods, without definitions provided meaning it was not possible to determine if or to what extend wild, forest of NUS foods were included (or not). In almost all studies there was insufficient detail on the magnitude of the associations between wild, forest or NUS foods and dietary energy or nutrient intakes or the (qualitative) diet recall methodologies that were used inhibited the quantification of the contribution of these foods to diets. A set of six recommendations are put forward to strengthen the evidence on the contribution of wild, NUS, and forest foods to human diets.

Pathways to Diverse Diets-a Retrospective Analysis of a Participatory Nutrition-Sensitive Project in Kenya.

BACKGROUND: There is a current need for better understanding the impact of nutrition-sensitive agriculture interventions. This study is based on a community-based participatory project that diversified diets of women and children by making use of local food biodiversity. This retrospective impact pathway analysis aims at explaining why and how impact was reached. OBJECTIVES: This study aimed to understand how a nutrition-sensitive agriculture project improved people's diets by analyzing the pathways from agriculture to nutrition. It also aimed to test theoretical pathways by comparing the documented pathways with those from a widely used framework from the literature. METHODS: A qualitative study was conducted in 2019 through 10 semistructured focus group discussions with community members engaging in the project and 5 key informant interviews with local authorities that worked with these communities during the project. Summative content analysis was used to identify pathways through which the project affected diets of beneficiaries. The defined pathways were compared with the pathways of the widely used Tackling the Agriculture-Nutrition Disconnect in India (TANDI) framework from the literature. RESULTS: Out of the agriculture-nutrition pathways that are presented in the literature, 3 were found in the responses: 1) food from own production; 2) income from sale of foods produced; and 3) women's empowerment through access to and control over resources. In addition, 5 other pathways were identified and indicated spillover effects from the intervention to the control participants, increased nutrition knowledge, improved health, savings, and empowerment and harmony in the household. CONCLUSIONS: Pathway analysis in nutrition-sensitive agriculture can provide valuable understanding on how and why dietary improvements have been achieved in an intervention. The approach can hence be instrumental in addressing the current demand within the field on understanding the progress and impact of interventions. Pathway analysis also helps to address knowledge gaps regarding theoretical frameworks, as in the present study, concerning women empowerment pathways.

The Impact of Local Agrobiodiversity and Food Interventions on Cost, Nutritional Adequacy, and Affordability of Women and Children's Diet in Northern Kenya: A Modeling Exercise.

Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily ($0.5 to $1.2) for children between 6 and 23 months and 173 to 305 KES ($1.8 to $2.9) for women. Addition of the three wild vegetables resulted in cost reductions between 30 and 71% as well as making up for iron and zinc gaps. The micronutrient powder had an insignificant effect on diet cost and filling nutrient gaps. Edible wild plant species, specifically wild vegetables, can reduce diet costs in considerable proportions while filling nutrient gaps year-round. However, affordability of a nutritious diet remains a major challenge in Turkana County, irrespective of the wealth group.

Exploring agrobiodiversity for nutrition: Household on-farm agrobiodiversity is associated with improved quality of diet of young children in Vihiga, Kenya.

Due to their limited access to the external productive inputs and the dependency on rain-fed agricultural production, small scale farmers in sub-Saharan Africa have continued to face undernutrition despite the significant advancements in agriculture. They however often live in areas endowed with high agrobiodiversity which could contribute, if explored, to improved diets and nutrition. Few studies have linked the contribution of agrobiodiversity to the micronutrient adequacy of the diets of young children among smallholder farmers. The study explored this relationship and contributes to the growing body of literature linking agrobiodiversity to nutrition of young children. Two cross-sectional surveys were conducted as part of baseline assessment for an intervention study, one in the lean and a second in the plenty season in Vihiga county, Kenya. Household level interviews were administered to 634 households with children 12-23 months. Agrobiodiversity was defined as the number of crop species cultivated or harvested from the wild and the number of livestock maintained by the household across two agricultural seasons. Dietary data were collected using two-non-consecutive quantitative 24-hour recalls and analyzed using Lucille software. Diet quality was assessed using dietary diversity score based on seven food groups and mean probability of micronutrient adequacy computed for eleven micronutrients. A total of 80 species were maintained or harvested from the wild by the households. Mean household species richness was 9.9 ± 4.3. One in every four children did not meet the minimum dietary diversity score. The average mean probability of micronutrient adequacy was 68.11 ± 16.08 in plenty season compared to 56.37± 19.5% in the lean season. Iron, zinc and calcium were most limiting micronutrients in the diet, with less than 30% average probability of adequacy in both seasons. Household agrobiodiversity was positively associated with both dietary diversity score (r = 0.09, p = 0.029) and micronutrient adequacy (r = 0.15, p<0.000) in the pooled sample. One unit increase in species diversity was associated with 12.7% improvement in micronutrient adequacy. Despite the rich agrobiodiversity in the study area the diets were low in diversity and there is an unrealized opportunity to improve micronutrient intake through greater promotion and consumption of locally available agrobiodiversity.