Ludwig-Borycz Elizabeth F, Wilson Mark L, Colecraft Esi K, Jones Andrew D
Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Food Nutr Res. 2022 Jul 27;66. doi: 10.29219/fnr.v66.7570. eCollection 2022.
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.
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.
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.
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 (-value < 0.0001). The proportion of women achieving the MDD-W indicator nearly doubled from baseline (35.6%) to endline (69.5%) (-value < 0.0001). Frequency of ASF consumption similarly increased for meat and poultry (2.7 (4.1) to 4.7 (5.3); -value < 0.0001) and eggs (1.5 (3.1) to 2.3 (4.9); -value = 0.02). Few differences in these outcomes were observed among treatment arms.
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.
育龄妇女，尤其是撒哈拉以南非洲地区的育龄妇女，极易因饮食质量差而出现微量营养素缺乏的情况。干预食物价值链（许多低收入和中等收入国家的家庭依靠其维持生计）可能是改善这些地区饮食的一种有前景的方法。
在这项试点规模的随机试验中，我们评估了多部门食物价值链干预措施是否能改善加纳育龄妇女的饮食多样性以及动物源食物（ASF）的摄入量。
在加纳两个地区的12个烟熏鱼社区中，296名符合条件的妇女被随机分配到三个为期9个月的治疗组之一：1）行为改变沟通（BCC），通过每周两次的音频信息和每两周一次的同伴学习课程来促进改善饮食质量；2）BCC与小额信贷相结合，以增加妇女收入；或3）BCC与提供新的烟熏炉技术相结合。我们使用10种食物组的饮食多样性评分（DDS）、妇女最低饮食多样性（MDD-W）指标以及7天内ASF的消费频率来评估基线至终点以及各治疗组之间的差异。
在118名参与者中（治疗组1和治疗组3各39名，治疗组2为40名，无参与者拒绝），DDS从基线时的平均（标准差）4.0（1.3）增加到终点时的5.1（0.9）（P值<0.0001）。达到MDD-W指标的妇女比例从基线时的35.6%几乎翻倍至终点时的69.5%（P值<0.0001）。肉类和家禽的ASF消费频率同样增加（从2.7（4.1）增加到4.7（5.3）；P值<0.0001），鸡蛋的消费频率也增加（从1.5（3.1）增加到2.3（4.9）；P值=0.02）。各治疗组在这些结果上几乎没有差异。
BCC干预改善了参与者的饮食多样性和ASF的摄入量。然而，基于群体的小额信贷和改进的烟熏炉干预（两者都增加了妇女收入）均未带来额外的饮食改善。
