Showing papers by "Esi K Colecraft published in 2022"

Growing and Learning Together in Fostering Multisectoral Participation for Sustaining Interventions: Lessons from 3 Successive Integrated Multidisciplinary Interventions in Rural Ghana

Abstract: ABSTRACT 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 2 decades, 3 integrated agriculture, livelihood, 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 are presented on the efforts to garner multisectoral participation to sustain these interventions. 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.

Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District

Abstract: ABSTRACT Background Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana. Objectives Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243). Methods A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates. Results Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women. Conclusions Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members. The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy.

A behavior change communication intervention, but not livelihood interventions, improves diet diversity and animal-source food consumption among Ghanaian women

Abstract: Background Women of reproductive age (WRA), especially in sub-Saharan Africa, are vulnerable to micronutrient deficiencies driven largely by poor quality diets. Intervening into food value chains, on which many households in low- and middle-income countries depend for their livelihood, may be a promising approach to improving diets in these contexts. Objective In this pilot-scale randomized trial, we evaluated whether a multisectoral, food value chain intervention improved the diet diversity and the consumption of animal-source foods (ASFs) among WRA in Ghana. Design Twelve fish-smoking communities in two regions of Ghana with 296 eligible women were randomly assigned to one of three 9-month treatment arms: 1) behavior change communication (BCC) to promote improved diet quality through twice-weekly audio messages and bi-weekly peer-to-peer learning sessions; 2) BCC with microcredit to increase women’s incomes; or 3) BCC with provision of new smoke-oven technology. We assessed baseline-endline and between-treatment arm differences using a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, and 7-day frequency of ASF consumption. Results Among 118 participants (39 in both treatment arm 1 and treatment arm 3, and 40 in treatment arm 2, with no participant refusals), DDS increased from a mean (SD) of 4.0 (1.3) at baseline to 5.1 (0.9) at endline (P-value < 0.0001). The proportion of women achieving the MDD-W indicator nearly doubled from baseline (35.6%) to endline (69.5%) (P-value < 0.0001). Frequency of ASF consumption similarly increased for meat and poultry (2.7 (4.1) to 4.7 (5.3); P-value < 0.0001) and eggs (1.5 (3.1) to 2.3 (4.9); P-value = 0.02). Few differences in these outcomes were observed among treatment arms. Conclusions A BCC intervention improved diet diversity and consumption of ASFs among participants. However, neither a group-based microcredit nor improved smoke oven intervention, both of which increased women’s income, led to additional dietary improvements.

Collective Empowerment and Influential Group Membership Matter for Household Food Security

Abstract: Abstract Objectives Reducing the gender gap in empowerment within households is associated with indicators of improved diet. This study developed a household-level empowerment measure and then examined its association with food security. Methods This analysis used baseline data from a nutrition-sensitive agriculture intervention in rural Ghana (ClinicalTrials.gov NCT03869853). Only 198 of the 330 households with complete paired empowerment data for one female and one male were included. The household empowerment measure was constructed in two stages. First, the individual empowerment score was assessed using the project-level Women's Empowerment in Agriculture Index (pro-WEAI) with its 12 indicators (e.g., influential group membership, access to financial services). Participants were classified as empowered (≥75%, 9 out of 12 indicators) or disempowered (<75%). Then, the household was categorized as empowered (both members empowered; 50.5%), semi-empowered (only one member empowered; 34.9%) or disempowered (both members not empowered; 14.6%). Two of the pro-WEAI indicators were assessed also at the household level using the same technique. Food security was assessed with the 15-item Latin American and Caribbean Food Security Scale; a binary variable was created: food secure (0), food insecure (FIS; >0). Cluster-adjusted logistic regression models examined the relationship between FIS and household empowerment. Results Over half (58%) of households were FIS. Empowered compared to disempowered households had a lower odds of being FIS (aOR = 0.50, 95% CI [0.29, 0.86]). The model for influential group membership showed that empowered were less likely than disempowered households to be FIS (aOR = 0.27, 95% CI [0.13, 0.58]) while the model for access to financial services showed the opposite (aOR = 3.15, 95% CI [1.80, 5.51]). Conclusions These results highlight the complexity of empowerment measures and support empowerment approaches that target different members of the household. Funding Sources The Canadian Queen Elizabeth II Diamond Jubilee Scholarships (QES) is managed through a unique partnership of Universities Canada, RHF, CFC, and Canadian universities. The QES-AS is made possible with financial support from IDRC and SSHRC.