Can nutrition education mitigate the impacts of COVID‐19 on dietary quality? Cluster‐randomised controlled trial evidence in Myanmar's Central Dry Zone

Abstract

We evaluate the immediate impact of a nutrition and gender behaviour change communication on dietary quality in rural communities in Myanmar and assess whether the communication helped mitigate the effect of the COVID‐19 crisis on dietary quality. The intervention was designed and implemented as a cluster‐randomised controlled trial in which 15 villages received the intervention and 15 control villages did not. The intervention was implemented from June to October 2020. This paper provides an assessment of the intervention's impact on dietary quality based on the results of two phone surveys conducted in August and October 2020. Immediate impacts of the intervention indicate an improvement in women's dietary diversity scores by half a food group out of 10. At baseline, 44% of women were likely to have consumed inadequately diverse diets; results indicate that 6% ( p ‐value: 0.003, SE: 0.02) fewer sample women were likely to have consumed inadequately diverse diets. More women in treatment villages consumed pulses, nuts, eggs and Vitamin A‐rich foods daily than in control villages. In response to economic shocks related to COVID‐19, households in the treatment villages were less likely to reduce the quantity of meat and fish consumption than in control villages. The long‐term impacts of the intervention need to be continuously evaluated.

How Do Social and Behavioral Change Interventions Respond to Social Norms to Improve Women’s Diets in Low- and Middle-Income Countries? A Scoping Review

“…We summarized the range of social norms addressed in the articles by grouping norms into 2 categories: food-focused social norms and gender norms ( Table 1 ) [ [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] ]. These categories overlap, as all norms related to women’s diets may have a gendered element, by definition, with some directly related to food and others more related to expectations around women’s and men’s roles or food distribution within the household.…”

“…Gender norms includes those related to women’s roles and household decision making, intrahousehold food allocation, and ideals and expectations related to gender. Only one project targeted urban communities only; 16 were conducted in rural areas and 8 in both rural and urban areas ( Table 2 ) [ [32] , [33] , [34] , [35] , [36] , [37] , [38] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] ]. Almost all interventions were multipronged, with multiple household and community activities targeted to women and at least one reference group or influencer; these were most often delivered through the health sector ( Table 3 ) [ [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , 59 ].…”

COVID-19 preparedness and response in rural and remote areas: A scoping review

“…Dietary changes across countries were characterised by increased consumption of vegetables and staples (maize, rice, and bread), while consumption of meat, fish, fruit, oil, and sugar decreased [197,201]. Simple nutrition and gender messaging as part of behavioural change communication during COVID-19 improved dietary quality among women [202].…”

Immunomodulatory Role of Microelements in COVID-19 Outcome: a Relationship with Nutritional Status

“…As household income decreases, diets are likely to shift towards cheaper, more energy-dense and less micronutrient-dense foods. Promotion of an adequate and balanced diet could allow the consumer to experience food safety that favors better health and directly impacts the response of the immune system to infections [ 44 ].…”