Behavioural insights to support increased consumption of quality protein maize by young children: a cluster randomised trial in Ethiopia

Abstract

IntroductionBiofortified crops have tremendous potential to improve child nutrition. We tested whether complementing the distribution of quality protein maize (QPM) with a package of interventions informed by behavioural insights could support greater consumption of QPM by young children and translate into improved growth.MethodsWe conducted a cluster-randomised trial in Oromia, Ethiopia. Clusters of households with a child between 6 and 35 months were randomised into an arm receiving QPM seed only (320 households, 203 clusters) or an arm receiving QPM seed and a child consumption targeting intervention (290 households, 183 clusters). The intervention package included tools to help caregivers keep QPM separate from conventional maize and to earmark QPM specifically for child consumption, as well as encouragement regarding cooking QPM specifically for young children. We analysed the impact of the intervention on food storage, cooking and consumption behaviours and on anthropometric measures (weight-for-age, height-for-age z scores).ResultsThe consumption targeting intervention increased the probability of child consumption of QPM in the past week by 17.3 percentage points (pp) (95% CI 9.4 pp to 25.1 pp; p<0.01), increased the probability that QPM flour was stored separately from conventional maize by 46.5 pp (95% CI 38.3 pp to 54.7 pp; p<0.01) and increased the probability that caregivers cooked QPM specifically for young children in the past week by 14.4 pp (95% CI 7.9 pp to 20.9 pp; p<0.01). These effects persisted, but were attenuated, 10 months postintervention. No significant effects on anthropometric outcomes were found.ConclusionsEnhancing the distribution of new, biofortified crop varieties with a consumption targeting campaign can change storage, cooking and consumption behaviours. However, these improved behaviours did not translate into increased growth in this setting.Trial registration numberNCT02710760 and AEARCTR0000786.

Innovations, nudging interventions and food and nutrition security : Evidence from experimental and quasi-experimental studies in Ethiopia

“…In addition, our results contribute to the growing literature that demonstrates the utility of using nudging interventions to influence people's food choices (Bucher et al, 2016;Hollands et al, 2017;Lehner et al, 2015;Lycett et al, 2017). Our results are also consistent with the findings that knowledge about the social norms with regard to a new technology affects people's behaviour and that this, in turn, affects the decision to adopt the new technology (Bandiera and Rasul, 2006;BenYishay and Mobarak, 2019;Donato et al, 2020;Krishnan and Patnam, 2014).…”

“…The effects of the treatments on farmers' wtp for biofortified yellow maize seed can be The effect is significant and consistent with a recent study conducted in Ethiopia, which showed a positive effect of nutrition messaging in changing consumption behaviours (Donato et al, 2020). The result is also consistent with a study conducted in Kenya and Uganda that also showed that availing nutrition information increases consumers' wtp for improved porridge flour (Chege et al, 2019).…”

“…The social norm treatment involved informing participants that consumption of foods prepared from nutritionally enhanced maize is both common and socially desirable among their peers. Studies have demonstrated that behaviourally informed interventions induce substantial behaviour change in rural settings with regard to adopting pro-poor technologies (Benhassine et al, 2015;Donato et al, 2020;Hummel and Maedche, 2019) and influencing people's food choices (Bucher et al, 2016;Lehner et al, 2015;Lycett et al, 2017). More importantly, studies show that knowledge about what others who are close to the target population are doing can be leveraged to promote new technologies (Bandiera and Rasul, 2006;BenYishay and Mobarak, 2019;Krishnan and Patnam, 2014).…”

“…We also study the impact of two interventions: nutrition and normative messaging. Provision of nutrition information can effectively stimulate healthy consumption by altering the information set on which people base their decision, though the evidence is relatively sparse for low and middle-income countries (Bonaccio et al, 2013;Chege et al, 2019;Donato et al, 2020;Miller and Cassady, 2015;Shimokawa, 2013). Similarly, social norm treatments have been effectively used to nudge consumers towards healthier choices (Bucher et al, 2016;Higgs et al, 2019;Lehner et al, 2015;Lycett et al, 2017).…”

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

“…Full-text eligibility checks of the remaining 52 articles excluded 29 studies. The reasons for exclusion of studies included: 4 studies were duplicates, [42][43][44] 1 study was cross-sectional, 45 2 studies used qualitative evaluation, 46 47 10 studies were abstracts, [48][49][50][51][52][53][54][55][56][57] 4 studies were based on the design and implementation of interventions, [58][59][60][61] 5 studies did not measure IYCF outcomes, [62][63][64][65][66][67][68][69][70] and 3 studies were based on interventions designed for different target groups [71][72][73] (figure 1). Among the 23 included studies, 14 were quasiexperimental studies, [74][75][76][77][78][79][80][81][82][83][84][85][86][87] while the remaining 9 were cluster randomised trials.…”