Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother-child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention-to-treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-for-age (LAZ)/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WLZ)/ weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0-32) at baseline and 29.8 ± 5.4 months (range: 13-48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition.

Background Little is known about how the level of program participation affects child nutrition in rural interventions. Objective This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Methods Nutrition Links was a cluster randomized controlled trial (Clinicaltrials.gov (NCT01985243)), which enrolled caregivers with children (< 12 months in 2014-15 and < 18 months in 2016-17). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale (very poor (1) to excellent (5)) for: i) meeting attendance, ii) egg productivity, iii) feed and poultry loan payment, iv) contributions during meetings, and v) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these five items in tertiles; 54 women who did not adopt the intervention were classified as “no participation”. Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category – 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Results Compared to the control category, only high participation was associated with egg consumption (aOR = 3.03, 95% CI [1.15, 7.94])). Both medium and high participation levels were associated with length-for-age Z-score (aβ = 0.44, 95% CI [0.16, 0.72] and 0.40, 95% CI [0.12, 0.67], respectively). Conclusion These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.

The costs of the multiple benefits of large-scale dam development are disproportionately borne by displaced people upstream and downstream riparian communities whose livelihood strategies have depended on the flood regime of rivers and resources in their natural surroundings. Downstream dam-affected populations are compelled to adapt to post-dam flood plain ecosystems in order to rebuild their livelihoods. However, they are usually confronted with many challenges due to limited local capacity, levels of vulnerability and impoverishment and, very often, inadequate and slow governmental and institutional support. In this paper, we examined the support of an international non-governmental organisation for four island communities of the Volta Delta in Ghana whose livelihoods were disrupted by the damming of the Volta River upstream at Akosombo, 80km from its mouth. The study was situated within the context of the sustainable livelihood analysis framework and the methodology adopted involved discussions and interviews with project beneficiaries and implementers. The study findings indicated that there were initial benefits from the livestock component of the project but that could not be sustained as the beneficiaries could not buy feed on regular basis. However, the communal agroforestry undertaken by the groups provided the impetus for establishment of individually-owned woodlots which are harvested for fuel. A key lesson from the project is that local leadership is crucial in the success of community livelihood support programmes. Also, adequate sensitization and education about the project along with re-orientation of peoples’ minds are essential ingredients for achieving acceptability of the project by local communities and ensuring project sustainability.

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Objectives Little is known about how level of participation affects nutrition outcomes in rural interventions. This study examined the association between participation level in a nutrition-sensitive agriculture intervention (NSA) and children's diet and anthropometric outcomes. Methods The Nutrition Links was a 2016–17 cluster RCT (clinicaltrials.gov NCT01985243) which enrolled caregivers with children < 18 mo in rural Ghana. Women in the intervention communities self-selected to receive poultry layers for egg production as part of a loan package, garden inputs, and nutrition education. Weekly meetings were used for education, for the staff to document egg production, and for the women to repay their loan and purchase feed. After endline, project participation was evaluated with a summative score that reflected 5 criteria: 1) egg productivity 2) timely and complete payment for feed and loan 3) meeting attendance 4) answering questions and making comments during the meetings and 5) attentiveness and helpfulness with the group. The field staff evaluated all criteria – from 1 (very poor) to 5 (excellent) – for each intervention woman who received poultry. Their participation was classified as high, medium, or low, based on tertiles. The participation of intervention women who never received poultry was ‘none’. Logistic and linear regressions tested the likelihood of consuming eggs and having a minimum diverse diet (MDD) and changes in anthropometric indices for the participation levels compared to those of the controls, who received standard-of-care services. Results In comparison to the control group, only a high participation level was significant for having a MDD (aOR  = 3.1, 95% CI [1.1, 8.8]). Both medium and high participation levels were associated with an increased likelihood in egg consumption (aOR = 2.1, 95% CI [1.0, 4.1]; aOR = 2.7, 95% CI [1.3, 5.4]), and length-for-age (LAZ)/height-for-age (HAZ) z-scores (β = 0.4, 95% CI [0.2, 0.6]; β = 0.4, 95% CI [0.2, 0.7]), and weight-for-age (WAZ) (β = 0.2, 95% CI [0.0, 0.4]; β = 0.2, 95% CI [0.0, 0.5]), respectively. Conclusions These results show the potential effect of NSA interventions and highlight the importance of facilitating high participation of beneficiaries. Funding Sources Global Affairs Canada, Heifer International, World Vision, McGill University, International Development Research Centre.