Effects of integrated Nutrition Education approaches on Production and Consumption of Orange-fleshed Sweetpotatoes in Homa Bay County, Kenya

Abstract

Malnutrition is still a big menace in sub-Saharan Africa as approximately 48 percent of children below five years and 20 percent of pregnant-age women suffer from the effects of Vitamin A deficiency (VAD); night blindness, increased child morbidity and mortality. Biofortified staples have been promoted widely in the region as a sustainable way of addressing the undernutrition problem. Recent studies have shown that these foods can contribute to the fight against malnutrition, and are accepted by young children. However, the existing initiatives used in promoting the vitamin A biofortified orange-fleshed sweetpotato (OFSP) have borne fruits, whose impacts have seldom been felt beyond the borders of the direct beneficiaries and the active periods of the projects. Nevertheless, the potential role of simultaneous nutrition education dissemination to preschool children and their caregivers on the continued production and consumption of fresh biofortified food remain much less understood. Thus, the main objective of this study was to assess the effects of disseminating nutrition education to preschool children and their caregivers on the production and consumption of OFSP. The objectives of the study were to assess the effects of integrated nutrition education approaches on; i) the caregivers‟ knowledge, attitude and practices (KAP) around OFSP; ii) the caregivers‟ likelihood to replant OFSP after phase-out of the free vines dissemination projects; and iii) the consumption of OFSP among preschool children. The study was guided by the random utility theory and employed a randomized controlled trial approach. Participants were selected through a multistage sampling technique. The first stage gave a purposive sample of 15 villages that had no prior interaction with OFSP promotion projects in the Ndhiwa and Rangwe Sub-counties of Homa Bay County. The second stage involved using proportionate to size sampling and simple random sampling techniques to choose 431 preschooler-caregiver pairs who participated in preliminary activities of the study - cooking demonstrations and dissemination of free vines. The 15 villages were randomized into four groups (one control and three treatment groups) and all participants in the groups were assigned the respective interventions. The treatments involved the issuance of nutrition education; i) to preschool children alone via OFSPbranded exercise books, class posters, and poems; ii) to caregivers alone by sending bulk nutrition education messages to their phones; and iii) to both the preschooler and the caregiver simultaneously using the same methods in other treatment arms. Baseline and follow-up survey data were collected using structured questionnaires. Also, a dietary diversity register was used to collect data on the preschoolers‟ consumption of OFSP during school days. The effects of the treatments were elicited by estimation of the generalized linear regression model (GLM), special regressor method (SRM), and the zero-inflated Poisson (ZIP) regression model in line with the three hypotheses, respectively. The results show that only the multiple-channel oriented nutrition education gave significant improvements in all the dimensions of the caregivers‟ knowledge of OFSP. It also improved the likelihood of the caregivers to retain the OFSP on their farms significantly while the singlechannel approaches failed to provide any significant improvements. Further, both the single and multiple-channel oriented nutrition education approaches increased the number of days on which the preschool children were fed on the OFSP roots. Overall, the magnitude of the effect of OFSP nutrition education interventions was significantly improved by delivering the nutrition education through multiple channels and ensuring higher rates of reception of the assigned interventions by the target group. Accordingly, the study concludes that the integration of complementary nutrition education interventions, delivered through the Early Childhood Development (ECD) platforms, can enhance the supply of and demand for nutritious crops such as OFSP in the menus of malnutrition high risk groups to improve food and nutrition security. The study recommends that agriculture-nutrition education interventions should consider both preschoolers‟ learning materials and the caregivers‟ mobile phones as effective platforms for nudging the caregivers to adopt the biofortified staples sustainably.