Nutrition-Sensitive Agriculture: A Systematic Review of Impact Pathways to Nutrition Outcomes

Abstract

The role of agriculture in reducing undernutrition is widely recognized, yet there is also consensus on the need to make the sector nutrition-sensitive. Evidence on the impact pathways from nutrition-sensitive agriculture (NSA) interventions, agricultural interventions with specific nutrition objectives, and actions detailing each temporal stage to reach nutrition outcomes is limited, however. We thus synthesized study results regarding impact of NSA interventions on nutrition outcomes relating to undernutrition, and constructed an impact pathway by mapping the evidence on each temporal stage from interventions to nutrition outcomes. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct and report our systematic review of studies on NSA interventions implemented in low- and lower-middle-income countries. Forty-three studies that met the inclusion criteria were extracted and synthesized across impact and pathways analyses. We carried out a thematic analysis of the effect of NSA interventions using evidence-based indicators and constructed the pathways by adopting a published framework on agriculture to nutrition pathways. Our findings reveal that NSA interventions can significantly improve dietary practices, and have the potential to enhance care practices and reduce occurrence of diseases, indicating their effectiveness in simultaneously addressing multiple determinants of undernutrition. However, NSA interventions have a lesser impact on nutritional status. NSA interventions lead to nutrition outcomes through 5 key pathways: food production, nutrition-related knowledge, agricultural income, women's empowerment, and strengthening of local institutions. We emphasize the need to carefully design, implement, and evaluate interventions with consideration for factors affecting impact pathways. Future research should focus on the effect of interventions combining multisector components, and pathways through non-food-production-related income, women's empowerment, strengthening of local institutions, food prices at intervention level, and expenditure on health care.

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

“…Most directly, livestock production may produce ASF that is consumed by the household, including children. The production pathway's influence on child nutrition varies widely, including by food item, market engagement, and other contextual factors ( 14 ). Socioeconomic status, cultural practices that limit or restrict ASF consumption, the capacity and/or opportunity for storage and preservation of ASF, community and household-level gender dynamics, and intra-household resource allocation are all factors that can affect individual ASF consumption ( 15 ).…”

Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi

“…One explicit step requires appropriate valuation of benefits arising from indicators that are more proximal to the intervention activities than indicators of nutrition status or income generation, for example, indicators related to dietary intake, like dietary diversity. The evidence on the positive effects of agriculture and nutrition interventions on this particular indicator is fairly well established (Sharma et al, 2021). Nevertheless, in this particular case, given that the intervention did reduce the prevalence of stunting, albeit not in the primary reference age group for the trial, this study suggests that the approach of integrating nutrition-sensitive agriculture promotion into communitybased ECD centers may be as economically efficient as other proven nutrition-specific interventions.…”

What Influences the Implementation and Sustainability of Nutrition-Sensitive Agriculture Interventions? A Case Study from Southern Bangladesh

“…This can be achieved through nutrition-sensitive agriculture (NSA) which incorporates nutrition objectives and actions in agricultural interventions [4,5]. The NSA interventions have the potential to address multiple determinants at multiple levels [6]. NSA is considered a promising approach to address inadequate diet and malnutrition in low and lower-middle-income countries.…”

“…Past studies have highlighted the need to consider relevant contextual factors during the design and implementation of interventions [6,7]. Investigating such contextual factors is crucial because of the highly complicated nature of NSA, as it integrates multiple interrelated and complex components at different levels.…”

“…Therefore, it is evident that the agriculture and food system in the country has not fulfilled adequate production diversity. Even though production diversity could increase, translating it into consumption within the local food system is linked to, besides agricultural production, multiple aspects such as nutrition-related knowledge and education, income, empowerment of women, and strengthened local institutions [6]. As a result, the government of Bangladesh has prioritized an integrated response to addressing food insecurity and malnutrition [24].…”