Lessons from using cluster-randomized evaluations to build evidence on large-scale nutrition behavior change interventions

Menon, Purnima; Ruel, Marie T.; Nguyen, Phuong Hong; Kim, Sunny S.; Lapping, Karin; Frongillo, Edward A.; Alayón, Silvia

doi:10.1016/j.worlddev.2019.104816

Cited by 15 publications

(7 citation statements)

References 12 publications

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“…Personal or group-based BCC interventions have been widely used to improve maternal and child nutrition in LMICs, but the evidence is limited to these groups, and little information is available on their cost-effectiveness, scalability, and ease of adaptation either to other demographic groups or for shaping demand for nutritious foods. One notable initiative, the Alive and Thrive Program led by FHI360, successfully implemented holistic social BCC (SBCC) strategies-combining interpersonal communication, mass-media, and community mobilization approaches-in a range of LMICs (Kim et al, 2018;Kim et al, 2019;Kim et al, 2016;Menon et al, 2020;Nguyen et al, 2017a;Nguyen et al, 2017b;Rawat et al, 2015). The program improved maternal breastfeeding and complementary feeding practices; impacts were greater among mothers who were exposed to all three strategies, although this was also more costly (Menon et al, 2020).…”

Section: Behavior Change Communication (Bcc) Interventionsmentioning

confidence: 99%

“…One notable initiative, the Alive and Thrive Program led by FHI360, successfully implemented holistic social BCC (SBCC) strategies-combining interpersonal communication, mass-media, and community mobilization approaches-in a range of LMICs (Kim et al, 2018;Kim et al, 2019;Kim et al, 2016;Menon et al, 2020;Nguyen et al, 2017a;Nguyen et al, 2017b;Rawat et al, 2015). The program improved maternal breastfeeding and complementary feeding practices; impacts were greater among mothers who were exposed to all three strategies, although this was also more costly (Menon et al, 2020). The SBCC strategies used in Alive and Thrive focused on maternal and child nutrition, but the approach could be expanded to promote healthy diets and lifestyles for other household members, including providing advice on improving dietary quality to reduce risks of overconsumption of harmful foods.…”

Section: Behavior Change Communication (Bcc) Interventionsmentioning

confidence: 99%

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Understanding the demand for “protective foods” in East Africa: An economic analysis with policy recommendations

Headey¹,

Ecker²,

Comstock³

et al. 2021

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Suboptimal diets are a major risk factor for avoidable death and disease in low-and middle-income countries.n Evidence shows that some foods or food components (e.g., processed red meat, saturated fat, salt, sugar) significantly elevate the risk of noncommunicable diseases and mortality, while others protect health (e.g., vegetables, fruits, pulses, nuts/seeds, fish, whole grains-referred to in this document as "protective foods") n We used household surveys to compare dietary patterns in Ethiopia, Kenya, Tanzania, and Uganda to the EAT-Lancet healthy reference diet and to quantify and explain consumption gaps for nutritious foods.n Compared to the EAT-Lancet healthy reference diet, consumption gaps for pulses and nuts/seeds, vegetables, and fruits are large for both poor and rich consumers in rural and urban areas in the four countries studied, while consumption gaps for meat, fish, and eggs and dairy foods are much larger for lower income groups.n Food expenditures of most households in these four countries are far too low to allow consumption of the healthy reference diet; animal-source foods and vegetables are the largest cost components of food expenditures, although quantities consumed of both food groups are much lower than the EAT-Lancet healthy reference diet.n Income elasticities of demand for pulses and nuts/seeds and vegetables are often low or moderate, suggesting weak consumer preference for these foods, while income elasticities for fruits and animal-source foods are relatively high.n Income growth alone will not solve dietary problems in East Africa; in addition to supply-side interventions to improve affordability, special interventions are required to increase consumer demand for underappreciated protective (nutritious) foods such as pulses and nuts/seeds and vegetables. Are average diets in East Africa meeting the intake levels of the EAT-Lancet healthy reference diet?The EAT-Lancet healthy reference diet includes a balanced mix of vegetables, fruits, pulses, nuts/seeds, dairy foods, and (white or red) meat, fish, and eggs, and allows only a third of total calories to come from starchy staples and very limited quantities of added fats and sugars. Figure 1 reports average calorie consumption amounts and composition by main food groups for the populations in four East African countries and compares these averages to the midpoints of the possible calorie intake ranges of the healthy reference diet. 2 Note that the food groupings used here are driven by the datasets used, which combine into single groups pulses and nuts and meat, fish, and eggs, respectively.The contrast between the actual diets of consumers in these four LMICs and the EAT-Lancet healthy reference diet is stark. Many people are consuming far too many calories from starchy staples, which account for 59%-77% of total calories consumed at home, on average. These nutrient-poor but caloriedense diets may explain why all four countries still have high rates of preschooler stunting (>30%) and rapidly rising rates of adult overweight and...

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Section: Behavior Change Communication (Bcc) Interventionsmentioning

confidence: 99%

Section: Behavior Change Communication (Bcc) Interventionsmentioning

confidence: 99%

Understanding the demand for “protective foods” in East Africa: An economic analysis with policy recommendations

Headey¹,

Ecker²,

Comstock³

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Promoting a healthy diet and optimal infant and child feeding practices through contextualized SBC interventions is another avenue to improve dietary quality and eventual health outcomes. The influence of targeted SBC approaches on diets and expenditures is mixed [19], however, some programs have shown success [20]. A key component of successful interventions is a deep understanding of the community in which the SBC intervention is taking place, and inclusion of local perspectives and beliefs [21].…”

Section: Background and Rationalementioning

confidence: 99%

A randomised controlled trial to test the effects of fish aggregating devices and SBC activities promoting fish consumption in Timor-Leste: A study protocol

Tilley

Byrd

Pincus

et al. 2021

Preprint

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Timor-Leste is one of the world's most malnourished nations where micronutrient-deficient diets are a contributing factor to the prevalence of child stunting, currently estimated to be 45.6% of children under five. Fish are an important source of micronutrients and one that may assist the country's predominantly rural population of agriculturalists to exit poverty and malnutrition. However, a small national fishing fleet producing low catch volumes place fish out of reach of most inland and upland populations where it is needed most. Fish consumption is very low in rural areas compared to coastal, regional, and global averages. This trial is a one-year, cluster-randomized, partially masked, controlled trial among families living in rural, inland Timor-Leste. This trial aims to test and compare the effects of two treatments, alone and in combination, on the frequency and volume of household fish consumption in upland areas as a proxy for improved dietary diversity and micronutrient intake. Treatment 1 is the installation of nearshore, moored fish aggregating devices (FADs) to improve catch rates with existing fishing gears. Treatment 2 is social and behaviour change (SBC) activities to promote fish consumption. Villages in inland communities will be randomized to receive treatment 1, treatment 2, both treatments, or neither treatment. Some households with one child under five will be recruited, and data will be collected at baseline (prior to the rollout of the treatments) and endline. Our study will determine the impact of an improved supply of fish, along with nutrition-oriented SBC activities, on the fish purchasing and consumption practices of rural, inland households. Findings from this study are urgently needed by small island developing states in order to make policy and investment decisions on how best to improve households' diets using locally available, nutrient-dense foods such as fish. Investments such as these are needed to break the cycle of malnutrition.

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“…Promoting a healthy diet and optimal infant and child feeding practices through contextualized social behaviour change (SBC) interventions is another avenue to improve dietary quality and eventual health outcomes. The influence of targeted SBC approaches on diets and expenditures is mixed [17,18], however, some programs have shown success [19]. A key component of successful interventions is a deep understanding of the community in which the SBC intervention is taking place, and inclusion of local perspectives and beliefs [20].…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial to test the effects of fish aggregating devices (FADs) and SBC activities promoting fish consumption in Timor-Leste: A study protocol

et al. 2022

View full text Add to dashboard Cite

Timor-Leste is one of the world’s most malnourished nations where micronutrient-deficient diets are a contributing factor to the prevalence of child stunting, currently estimated to be 45.6% of children under five. Fish are an important source of nutrients and one that may assist the country’s predominantly rural population of agriculturalists to exit poverty and malnutrition. However, a small national fishing fleet producing low catch volumes places fish out of reach of most inland and upland populations where it is needed most. Fish consumption is very low in rural, inland areas compared to coastal, regional, and global averages. This study is a one-year, partially masked, cluster-randomized controlled trial among families living in rural, inland Timor-Leste. We aim to test and compare the effects of two treatments, alone and in combination, on the frequency and volume of household fish consumption in rural, inland areas as a proxy for improved dietary diversity and micronutrient intake. Treatment 1 is the installation of nearshore, moored fish aggregating devices (FADs) to improve catch rates with existing fishing gears. Treatment 2 is a social and behaviour change (SBC) activity to promote fish consumption. Villages in inland communities will be randomized to receive treatment 1, treatment 2, both treatments, or neither treatment. Data will be collected at baseline (prior to the rollout of the treatments) and endline. Our study will determine the impact of an improved supply of fish, along with nutrition-oriented SBC activities, on the fish purchasing and consumption practices of rural, inland households. Findings from this study are urgently needed by Small Island Developing States to guide policy and investment decisions on how best to improve households’ diets using locally available, nutrient-dense foods such as fish. Investments such as these are needed to break the cycle of malnutrition. This trial is registered at clinicaltrials.gov (NCT04729829). Trial registration: Trial registered at clinicaltrials.gov Identifier: NCT04729829.

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Lessons from using cluster-randomized evaluations to build evidence on large-scale nutrition behavior change interventions

Cited by 15 publications

References 12 publications

Understanding the demand for “protective foods” in East Africa: An economic analysis with policy recommendations

Understanding the demand for “protective foods” in East Africa: An economic analysis with policy recommendations

A randomised controlled trial to test the effects of fish aggregating devices and SBC activities promoting fish consumption in Timor-Leste: A study protocol

A randomised controlled trial to test the effects of fish aggregating devices (FADs) and SBC activities promoting fish consumption in Timor-Leste: A study protocol

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