Effectiveness of integrated chicken production and nutrition-sensitive interventions on females' dietary diversity outcomes: a cluster-randomized controlled trial in rural Ethiopia.

BACKGROUND

Rural Ethiopian females have poor dietary diversity. Although nutrition-sensitive agriculture offers an opportunity for improving dietary diversity, evidence on effectiveness for females' nutrition outcomes remains limited.

OBJECTIVES

This study aims to evaluate the effectiveness of a chicken production intervention, with and without a nutrition behavior change component, on females' dietary diversity in rural Ethiopia.

METHODS

We conducted a 3-arm, cluster-randomized controlled trial among 2117 households in 60 villages across 4 regions of Ethiopia. Villages were randomly allocated to: 1) control receiving standard agricultural extension services; 2) African Chicken Genetic Gains (ACGG), providing 25 improved chickens and production support; or 3) ACGG plus Agriculture to Nutrition (ACGG+ATONU), combining chicken production with nutrition behavior change communication and home gardening. The primary outcome was 1-d Minimum Dietary Diversity for Women and Household Dietary Diversity Score (HDDS), assessed at baseline, midline (9 mo), and endline (18 mo). We used generalized linear mixed models accounting for cluster randomization to estimate intervention effects.

RESULTS

Among all cases, all 3 treatment arms showed upward trends in both females' and household dietary diversity. The ACGG+ATONU intervention showed no significant effects on females' dietary diversity outcomes (all P > 0.05), but improved household dietary diversity compared with ACGG alone [adjusted mean difference in HDDS: 0.37 food groups; 95% confidence interval (CI): 0.02, 0.71; P = 0.037] and control (adjusted mean difference in HDDS: 0.39 food groups; 95% CI: 0.01, 0.78; P = 0.045). ACGG+ATONU also increased household dietary diversity adequacy compared with control (adjusted risk difference: 0.06; 95% CI: 0.01, 0.11; P = 0.047). Mediation analysis revealed 3 key pathways: increased egg production, enhanced females' empowerment, and improved chicken management practices.

CONCLUSIONS

The integrated ACGG+ATONU intervention significantly improvs household dietary diversity but not females' individual dietary diversity, whereas chicken production alone (ACGG) shows no significant effects. These findings emphasize that nutrition-sensitive agricultural interventions in low-income settings require integrated behavior change components. This trial was registered at clinicaltrials.gov as NCT03152227 (https://clinicaltrials.gov/study/NCT03152227).