Mersha Girmay Ayana, Tariku Eshetu Zerihun, Boynito Wanzahun Godana, Woldeyohaness Meseret, Kebebe Tadese, Wodajo Birhanu, De Henauw Stefaan, Abbeddou Souheila
Food Science and Nutrition Research Department, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Public Health Nutrition, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
PLoS One. 2025 Apr 2;20(4):e0290524. doi: 10.1371/journal.pone.0290524. eCollection 2025.
Undernutrition reduction requires coordinated efforts across sectors to address its causes. A multisectoral approach is important in diagnosing the problem and identifying solutions that would be implemented across different sectors. The study aimed to explore the experience of health and agriculture extension workers in integrating nutrition-specific and nutrition-sensitive interventions provided to households with children under two years of age at community level.
A qualitative study was conducted in agrarian areas of Ethiopia following the completion of a multi-sectoral program that integrated health and agriculture interventions, in 2021. The program's goal was to reduce stunting and improve the dietary diversity of young children. In total, 28 key informant interviews were conducted with health- and agriculture-extension workers and mothers. A framework analysis approach was applied to manage and analyze data using NVivo version 12 software.
The study showed that joint health and agriculture interventions improved community knowledge on childcare and agricultural practices. The practice of farm gardening and cooking demonstrations were improved after the implementation of the program. Because of service integration, extension workers perceived an improved father's role in supporting mothers in childcaring and feeding nutritious diets to children and decreased severe cases of undernutrition. Integration of health and agriculture sectors for nutrition intervention was challenged by the high workload on extension workers, poor supervision and leadership commitment, lack of appropriate agricultural inputs, and absence of clarity on sector-specific roles. In some areas nutrition services are not owned by the health and agriculture sectors, and it was overlooked.
Integrating community-level platforms were key entry points to address undernutrition and promote key agriculture and health interventions. The joint implementation of health and agriculture services were effective in the reduction of wasting and improved the role of family members in supporting mothers. However, Integration of sectors were facing challenges in creating shared vision to improve nutrition status of children and women, distributing workload and equal commitment among sectors.
减少营养不良需要各部门协同努力以解决其成因。多部门方法对于诊断问题和确定将在不同部门实施的解决方案至关重要。该研究旨在探索卫生和农业推广工作者在社区层面为两岁以下儿童家庭整合特定营养和营养敏感型干预措施的经验。
2021年，在埃塞俄比亚农业地区完成一项整合卫生与农业干预措施的多部门项目后，开展了一项定性研究。该项目的目标是减少发育迟缓并改善幼儿的饮食多样性。总共对卫生和农业推广工作者以及母亲进行了28次关键 informant访谈。采用框架分析方法，使用NVivo 12软件管理和分析数据。
研究表明，卫生与农业联合干预提高了社区对儿童保育和农业实践的认识。项目实施后，农场园艺和烹饪示范的做法得到改善。由于服务整合，推广工作者认为父亲在支持母亲照顾孩子和为孩子提供营养饮食方面的作用有所改善，严重营养不良病例有所减少。卫生和农业部门整合营养干预面临着推广工作者工作量大、监督和领导承诺不足、缺乏适当的农业投入以及部门特定角色不明确等挑战。在一些地区，营养服务并非由卫生和农业部门主导，且被忽视。
整合社区层面的平台是解决营养不良和促进关键农业与卫生干预措施的关键切入点。卫生和农业服务的联合实施在减少消瘦方面有效，并改善了家庭成员在支持母亲方面的作用。然而，部门整合在为改善儿童和妇女营养状况创造共同愿景、分配工作量以及各部门平等承诺方面面临挑战。
