Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia

Moss, Cami; Bekele, Tesfaye Hailu; Salasibew, Mihretab; Sturgess, Joanna; Ayana, Girmay; Kuche, Desalegn; Eshetu, Solomon; Abera, Andinet; Allen, Elizabeth; Dangour, Alan D.

doi:10.1136/bmjopen-2018-022028

Cited by 29 publications

(47 citation statements)

References 16 publications

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“…The proportion of dietary diversity among children aged 6-23 months under the program was also higher than those of EDHS 2016(14%),the systemic review in Ethiopia(23.25%) [18], Sinana district, Ethiopia (13%) [18],Dabat district (17%) [11],and Kemba district (23.3%) [30]. The difference might be that the study area (Yilimana Denssa district) was under SURE program where HEW/AEW gave supportive training and counseling to mothers regarding the preparation of complementary foods [17]. SURE covered districts were 2.5 times more likely to have adequate dietary diversity than the uncovered once.…”

Section: Discussionmentioning

confidence: 86%

“…The rate of adequate dietary diversity was by far lower than the national target (40%) stated in the National Nutrition Program (NNP2020). This difference might be due to the fact that SURE program is a government-led multi-sectoral intervention that aims to integrate the work of the health and agriculture sectors to improve child feeding through behavior change communication [17].This behavior change intervention also provides an opportunity for complementary feeding, nutrition counseling to mother to improve the intake of adequate dietary diversity by enhancing the existing Community-Based Nutrition (CBN) programs. The proportion of adequate dietary diversity among children who lived in SURE covered districts was 33.4%.…”

Section: Discussionmentioning

confidence: 99%

“…This program has been implemented in 150 districts on 1.5 million stunted children living in the agrarian districts of Oromia, Amhara, SNNP and Tigray regions with the aim of reducing stunting to 26% by 2020 and improving complementary feeding and dietary diversity. It provided nutrition education using the behavior change communication (BCC) approaches [17].The project has such three main components as enhancing community-based nutrition (CBN) to address inadequate complementary feeding, improving household dietary diversity through IYCF and familiarizing nutrition-sensitive agriculture.…”

Section: Introductionmentioning

confidence: 99%

“…Existing empirical evidence is mainly found in the northern, western, and other parts of Ethiopia. However, only limited studies compared the dietary diversity and associated factors among SURE project covered and uncovered district mothers of children 6-23 month of age in West Gojjam zone [17]. Therefore, this study aimed to compare the proportions of dietary diversity among SURE program covered and uncovered districts and identify factors associated with dietary diversity among young children aged 6-23 months.…”

Section: Introductionmentioning

confidence: 99%

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Sustainable under nutrition reduction program and dietary diversity among children’s aged 6–23 months, Northwest Ethiopia: Comparative cross-sectional study

Worku

Gonete

Muhammad

et al. 2020

Int J Equity Health

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Introduction: Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6-23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6-23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6-23 months in districts covered and not covered by SURE program in West Gojjam zone. Methods: A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score. Result: The overall proportion of adequate dietary diversity among children aged 6-23 months was 29.9% (95% CI: 27.0-33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0-38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI: 1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity. Conclusion: The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sustainable under nutrition reduction program and dietary diversity among children’s aged 6–23 months, Northwest Ethiopia: Comparative cross-sectional study

Worku

Gonete

Muhammad

et al. 2020

Int J Equity Health

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“…This study analyses data from the SURE baseline survey completed in May–July 2016 and comprising 1,848 children 6–23 months of age in 36 intervention districts (Oromia: n = 18; Amhara: n = 8; Tigray: n = 4; and SNNP: n = 6) and 36 comparison districts selected by region in equal proportion. Complete details are available in the SURE evaluation study protocol (Moss et al, ).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with dietary diversity and length‐for‐age z‐score in rural Ethiopian children aged 6–23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation

Kuche

Moss

Eshetu

et al. 2019

Maternal & Child Nutrition

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Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership.LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Drivers of stunting reduction in Peru: a country case study

Conway

Akseer

Subedi³

et al. 2020

The American Journal of Clinical Nutrition

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Background Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. Objectives We aimed to study factors and key enablers of child stunting reduction in Peru from 2000–2016. Methods Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca–Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. Results The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. Conclusions Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.

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Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia

Cited by 29 publications

References 16 publications

Sustainable under nutrition reduction program and dietary diversity among children’s aged 6–23 months, Northwest Ethiopia: Comparative cross-sectional study

Sustainable under nutrition reduction program and dietary diversity among children’s aged 6–23 months, Northwest Ethiopia: Comparative cross-sectional study

Factors associated with dietary diversity and length‐for‐age z‐score in rural Ethiopian children aged 6–23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation

Drivers of stunting reduction in Peru: a country case study

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