Do Market-oriented Engendered Agriculture-health Interventions Affect Household Nutrition Outcomes: Evidence from an Orange-fleshed Sweetpotato Project in Rwanda.

The number of agricultural interventions promoting biofortified crops as a strategy to combat micronutrient malnutrition have increased significantly during the past decade. These interventions aim to improve the intake of key nutrients and sometimes other nutrition outcomes. In this study, we assess the impact of a market-oriented gender-sensitive agriculture-health project on household food consumption and food security. We use gender-disaggregated data from 842 sweetpotato farmers and a series of econometric techniques to assess the project's impact on food consumption household food security. The study finds unambiguous and strong impact of the project on both household food consumption and food security. Moreover, female-headed participant households benefitted much more from participation than did male-headed households. We further find that nonparticipant households would also have benefitted had they participated. The findings imply the importance of designing market-focused projects with a gender lens. They also imply that market-oriented agriculture-sensitive interventions do not necessarily harm the nutritional status of farm households.

Nutrition and food security impacts of quality seeds of biofortified orange-fleshed sweetpotato: Quasi-experimental evidence from Tanzania.

This study examined the nutrition and food security impacts of a project that was designed to improve availability of disease-free planting materials of biofortified orange-fleshed sweetpotato (OFSP) in rural Tanzania. Difference-in-difference and matching techniques were employed to estimate causal effects using panel data. Participation in the project increased agronomic and nutritional knowledge of households, raised uptake rate for OFSP varieties, and improved food security status. Effects on nutrition are, however, weak. These results suggest that timely access to quality seeds accompanied by a transfer of skills is important to reduce barriers to adoption of biofortified crops with resulting positive effects on the welfare of rural households. Adequate promotion of both agronomic and nutrition aspects of the technologies may enhance nutrition effects.

The dynamics of smallholder farmers' acquisition and distribution of sweetpotato vines in the Lake Victoria Zone Region, Tanzania.

This paper offers new insights into smallholder farmer's practices regarding acquisition and distribution of sweetpotato planting material in the Mwanza and Mara regions of Tanzania by examining three specific issues: (i) farmers' sources of planting material; (ii) factors that influence farmers' sourcing of planting materials outside their own farms and (iii) the types of transactions and social relations involved in farmers' acquisition and distribution of sweetpotato planting material. Data were collected using mixed methods, including a survey of 621 households across nine districts, semi-structured key informant interviews with 28 women sweetpotato farmers, and six focus group discussions. Findings show that farmers in the study area rely almost exclusively on informal seed systems, and that the majority (> 56%) produce their own planting material. Individual, household and community level factors influence farmers' acquisition of planting materials outside their own farms. The sources and mode of transaction related to acquisition/distribution of planting material are strongly influenced by the type of social relationship between the parties involved. Strong social ties facilitate the majority of local planting material acquisitions/distributions, and favor provision of locally available planting material as a gift/without payment.Weak social ties are primarily associated with the transaction modality of purchase/sale, and frequently help facilitate acquisition of new or exotic planting material. The findings provide entry points both for entities that seek to enhance small-scale farmers' access to improved, high quality sweetpotato germplasm, as well as broader efforts to strengthen research and development strategies for integrating formal and informal seed systems.

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya.

Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners' meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.

Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis.

BACKGROUND: Antenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya. METHODS: Data from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ2 test and Student's t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index. RESULTS: Among the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge. CONCLUSIONS: Substantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.