Increasing production diversity and diet quality through agriculture, gender, and nutrition linkages: A cluster-randomized controlled trial in Bangladesh

A growing body of evidence indicates that agricultural development programs can potentially improve production diversity and diet quality of poor rural households; however, less is known about which aspects of program design are effective in diverse contexts and feasible to implement at scale. We address this issue through an evaluation of the Agriculture, Gender, and Nutrition Linkages (ANGeL) project. ANGeL is a randomized controlled trial testing what combination of trainings focused on agricultural production, nutrition behavior change communication, and gender sensitization were most effective in improving production diversity and diet quality among rural farm households in Bangladesh. We find that trainings focused on agriculture improved production diversity in terms of greater production of fruits and vegetables grown on the homestead, eggs, dairy, and fish; adding trainings on nutrition and gender did not significantly change these impacts. Trainings focused on both agriculture and nutrition showed the largest impacts on diet quality, with evidence indicating that households in this arm also significantly increased consumption out of homestead production for fruits and vegetables, eggs, dairy, and fish. Findings indicate that agricultural training that promotes production of diverse, high-value, nutrient-rich foods can increase production diversity, and this can improve diet quality, but diet quality impacts are larger when agricultural training is combined with nutrition training. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality

Trends and Inequities in food, energy, protein, fat, and carbohydrate intakes in rural Bangladesh

Background: Tracking dietary changes can inform strategies to improve nutrition, yet there is limited evidence on food consumption patterns and how disparities in food and nutrient intakes have changed in Bangladesh. Objectives: We assessed trends and adequacies in energy and macronutrient intakes and evaluated changes in inequities by age group, sex, and expenditure quintile. Methods: We used panel data from the 2011 and 2018 Bangladesh Integrated Household Survey (n = 20,339 and 19,818 household members aged ≥2 y, respectively). Dietary intakes were collected using 24-h recall and food-weighing methods. Changes in energy and macronutrient intakes were assessed using generalized linear models and adjusted Wald tests. Inequities in outcomes were examined by age group, sex, and expenditure quintile using the Slope Index of Inequality and Concentration Index. Results: Between 2011 and 2018, dietary diversity improved across sex and age groups (30–46% in children, 60–65% in adolescents, 37–87% in adults), but diets remain imbalanced with ∼70% of energy coming from carbohydrates. There were declines in intakes of energy (3–8%), protein (3–9%), and carbohydrate (9–16%) for all age groups (except children aged 2–5 y), but an increase in fat intake (57–68% in children and 22–40% in adults). Insufficient intake remained high for protein (>50% among adults) and fat (>80%), whereas excessive carbohydrate intake was >70%. Insufficient energy, protein, and fat intakes, and excessive carbohydrate intakes, were more prevalent among poor households across survey years. Inequity gaps decreased for insufficient energy intake in most age groups, remained stable for insufficient protein intake, and increased for insufficient fat and excessive carbohydrate intakes. Conclusions: Despite improvements in dietary diversity, diets remain imbalanced and inequities in insufficient energy, protein, and fat intakes persist. Our findings call for coherent sets of policies and investments toward a well-functioning food system and social protection to promote healthier, more equitable diets in rural Bangladesh

Increasing production diversity and diet quality: Evidence from Bangladesh

In the context of rural Bangladesh, we assess whether agriculture training alone, nutrition behavior communication change (BCC) alone, combined agriculture training and nutrition BCC, or agriculture training and nutrition BCC combined with gender sensitization improve: (a) production diversity, either on household fields or through crop, livestock, or aquaculture activities carried out near the family homestead; and (b) diet diversity and the quality of household diets. All treatment arms were implemented by government employees. Implementation quality was high. No treatment increased production diversification of crops grown on fields. Treatment arms with agricultural training did increase the number of different crops grown in homestead gardens and the likelihood of any egg, dairy, or fish production but the magnitudes of these effect sizes were small. All agricultural treatment arms had, in percentage terms, large effects on measures of levels of homestead production. However, because baseline levels of production were low, the magnitude of these changes in absolute terms was modest. Nearly all treatment arms improved measures of food consumption and diet with the largest effects found when nutrition and agriculture training were combined. Relative to treatments combining agriculture and nutrition training, we find no significant impact of adding the gender sensitization on our measures of production diversity or diet quality. Interventions that combine agricultural training and nutrition BCC can improve both production diversity and diet quality, but they are not a panacea. They can, however, contribute toward better diets of rural households