Agricultural Interventions, Caregiver Perceptions, and Child Growth in Rural Ethiopia

Abstract

Despite recent global progress in reducing child mortality, child growth faltering remains widespread. Child stunting—defined as a child’s height-for-age z-score that is more than two standard deviations below a healthy population’s median—affects more than 150 million children under five years old worldwide, and many millions more fail to achieve their full linear growth potential. Nearly 50 million children under five suffer from wasting, or being too thin for their height. Undernutrition in early childhood is associated with long-term consequences for cognitive development, economic earnings, increased morbidity and mortality from infections, a higher risk of chronic disease later in life, and adverse birth outcomes for women. To address the widespread burden of child undernutrition, it is unlikely that nutrition-specific interventions will be sufficient. Thus, effective nutrition-sensitive interventions—which address the underlying determinants of fetal and child nutrition and development—are urgently needed. In three manuscripts, this dissertation explores the role of agricultural interventions and caregiver perceptions in child nutrition and growth in rural Ethiopia—a context where more than 40% of children are stunted and 7% are wasted. Paper 1 analyzes primary and intermediary outcomes pertaining to child nutrition, health, and water, sanitation, and hygiene (WASH) from a cluster-randomized trial promoting chicken production as a nutrition-sensitive agricultural approach, showing benefits of the intervention for anthropometry, diets, health, production, and women’s empowerment. Paper 2 uses quantitative household survey data, direct observations, and qualitative in-depth interviews to understand how chicken production influences the WASH environment for households. The results highlight the high degree and multiple sources of contamination from animals to which young children are exposed in this context, and provide insight into the woman caregivers’ beliefs and barriers related to chicken management practices. Lastly, Paper 3 quantitatively analyzes woman caregivers’ perceptions of their child’s linear growth using household survey data, finding that caregivers systematically overestimate their child’s height-for-age relative to other children in the village. Together, these three papers provide evidence of effective approaches for nutrition-sensitive agriculture and WASH, and contribute to knowledge about woman caregivers’ roles and beliefs related to child undernutrition in rural Ethiopia. We hope that the findings presented in this dissertation not only contribute to the evidence base for Ethiopia, but that they also provide instructive case studies for other low- and middle-income countries aiming to improve child nutrition.