title: Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia.
abstract: Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children's dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric measurements were taken. A difference-in-differences model was applied. The sample comprised 743 households with children ≥6 months of age at baseline and 921 at impact. After 1 year of NE, 69 % of the intervention households reported to have participated in the NE. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3·6 and 3·9, respectively). In particular, the consumption of pro-vitamin A-rich foods and other fruits and vegetables increased. No treatment effects on height-for-age Z-scores could be shown. NE led to improvements in children's diets. For effects on growth, it is assumed that longer NE activities are required to achieve sustainable behaviour change of age-appropriate infant feeding.
authors.affiliation: 1Justus Liebig University Giessen,Wilhelmstr 20,35392 Giessen,Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Reinbott
authors.affiliation: 1Justus Liebig University Giessen,Wilhelmstr 20,35392 Giessen,Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Schelling
authors.affiliation: 1Justus Liebig University Giessen,Wilhelmstr 20,35392 Giessen,Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Kuchenbecker
authors.affiliation: 2Food and Agriculture Organization of the United Nations,Nutrition Education and Consumer Awareness Group (ESNE),Nutrition Division (ESN),Viale delle Terme di Caracalla,00153,Rome,Italy.
authors.forename: Theresa
authors.initials: T
authors.lastname: Jeremias
authors.affiliation: 3Food and Agriculture Organization of the United Nations (FAO),No. 5, Street 370, Boeung Keng Kang I,12302 Phnom Penh,Cambodia.
authors.forename: Iean
authors.initials: I
authors.lastname: Russell
authors.affiliation: 4National Maternal and Child Health Center,No. 31A, Rue de France (Street 47),12202 Phnom Penh,Cambodia.
authors.forename: Ou
authors.initials: O
authors.lastname: Kevanna
authors.affiliation: 1Justus Liebig University Giessen,Wilhelmstr 20,35392 Giessen,Germany.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Krawinkel
authors.affiliation: 1Justus Liebig University Giessen,Wilhelmstr 20,35392 Giessen,Germany.
authors.forename: Irmgard
authors.initials: I
authors.lastname: Jordan
mesh_terms: D000383:Agriculture / Q000193:education / Q000639:trends; D002160:Cambodia; D017028:Caregivers; D002657:Child Development; D053198:Child Nutrition Sciences / Q000193:education; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy / Q000208:ethnology; D005191:Family Characteristics / Q000208:ethnology; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D006266:Health Education; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000208:ethnology; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology; D015995:Prevalence; D012423:Rural Health / Q000208:ethnology; D014480:United Nations
keywords:  CDDS child dietary diversity score;  CNP community nutrition promoter;  DiD difference-in-differences;  HAZ height-for-age Z-scores;  HH household;  IYCF infant and young child feeding practices;  MALIS improving market linkages for smallholder farmers;  NGO non-governmental organisation; Child dietary diversity; Community-based nutrition; Nutrition education; Stunting