The impact and implementation of an mHealth intervention to improve infant and young child feeding in Senegal: IIMAANJE protocol for a cluster randomized control trial.

Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions-the use of mobile phones to transmit health-related information or direct care-to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thies, Fatick, Diourbel) with 488 mother, father and children (6-23 months) triads. The intervention included 8 scripted messages, that underwent cognitive testing prior to the intervention implementation, and 8 unscripted messages from positive deviants. One voice message and one text message were sent each week to members of our experimental group for a 16-week period. The impact of the intervention was assessed through a household survey, 24-h dietary recall, and hemoglobin measurements before and after the intervention implementation. The primary outcomes were minimal acceptable diet (MAD) and anemia. We also included a total of 54 participants in nine focus groups held with mothers and fathers and semi-structured interviews with Badienou Gox (i.e., community health workers) (n = 6) and national partners and program implementers (n = 6) to examine the intervention implementation process. The study was registered prior to data collection on Clinicaltrials.gov (Identifier: NCT05374837).

An evaluation of nutrition, culinary, and production interventions using African indigenous vegetables on nutrition security among smallholder farmers in Western Kenya.

Introduction: Nutrition security continues to worsen in sub-Saharan Africa. Current research is limited on how seasonality may influence the impact of nutrition, culinary, and production interventions on food security, diet quality, and consumption of African Indigenous Vegetables (AIV); a culturally accepted source of micro-and-macronutrients that are easily produced due to their adaptation to the local environment. The objective of this study was to evaluate the programmatic impact of AIV interventions on nutrition security among smallholder farmers. Methods: In a randomized control trial, five target counties in Western Kenya were randomly assigned to one of four treatments: (1) control; (2) production intervention (PI); (3) nutrition and culinary intervention (NCI); and (4) NCI and PI (NCI/PI). After the counties were randomly assigned to a treatment, 503 smallholder farmers (18-65 years) were selected from participatory farmer groups. The PI consisted of five agricultural production modules delivered between 2016 and 2019. The NCI was delivered twice: (1) household nutrition education (2017) and (2) community culinary training (2019). The NCI/PI included communities receiving both interventions at these time periods. Baseline and endline surveys were administered to all participants once in October 2016 (harvest season) and to all available participants (n = 250) once in June to July 2019 (dry season), respectively. The impact evaluation was analyzed by Household Hunger Scale (HHS), Women's Dietary Diversity Score (WDDS), AIV consumption frequency, and AIV market availability. Statistical tests included descriptive statistics (means and frequencies), paired t-test, McNemar's test, Wilcoxon Signed-Rank test, ANOVA test with Tukey post hoc, and χ2 test. Open-ended questions were aggregated, and responses were selected based on relevancy and thoroughness of the response to provide context to the quantitative data. A value of p < 0.05 was used to denote statistical significance. Results: There was an overall decrease in WDDS, HHS, and consumption frequency between baseline and endline attributed to seasonal differences. Despite this, post-intervention, households that received NCI/PI had a higher WDDS relative to the control: WDDS 5.1 ± 1.8 vs. 4.2 ± 1.5, p = 0.035. In addition, between baseline and endline, there was an overall increase in the percentage of respondents that reported an adequate supply of key AIVs, particularly for households that received PI. Furthermore, seasonal effects caused a reported shift in the primary location for purchasing AIVs from the village to the town market. There was no reported difference in HHS. While "diet awareness" significantly influenced diet quality among the NCI treatment group, "production" was reported to have the greatest influence on diet quality among all intervention groups. Discussion: The findings revealed that coupled nutrition, culinary, and production interventions could create a protective effect against seasonal fluctuations in the availability and affordability of AIV as evidenced by a higher WDDs. Conclusion and Recommendations: These findings suggest that future programming and policy should focus on promoting the availability, accessibility, acceptability, and affordability of improved agronomic practices and germplasm for both smallholder farmers with particular emphasis on AIV varieties that contain high levels of micro-and macronutrients, improved agronomic characteristics (e.g., delayed flowering, multiple harvests, higher yields, and disease resistance), and are aligned with the communities' cultural preferences. In addition, agricultural training and extension services should incorporate nutrition and culinary interventions that emphasize the importance of farmers prioritizing harvests for their household consumption.

Leveraging Nutrient-Rich Traditional Foods to Improve Diets among Indigenous Populations in India: Value Chain Analysis of Finger Millet and Kionaar Leaves.

Many indigenous foods are nutrient-rich but are often underutilized even among populations at high risk of malnutrition. The aims of this study were to conduct value chain analysis of one cultivated crop (finger millet among the Munda tribe) and one wild green leafy vegetable (Koinaar leaves among the Sauria Paharia tribe) of two Indigenous communities in Jharkhand state, India and to identify entry points for interventions aimed at supporting production and consumption. Semi-structured interviews were conducted with stakeholders among each tribal group and transcripts were open coded and organized based on key themes across the steps of the value chain for each food independently. Improved storage techniques and infrastructure, machinery for processing and improved cooking fuel would help reduce barriers across the finger millet supply chain related to postharvest losses, processing labor and safety concerns related to cooking. For Koinaar leaves, improving drying techniques to increase consumption across seasons and providing training and support to increase opportunities for selling leaves in local markets, where participants mentioned potential language barriers, could strengthen the supply chain. Improving extension services and focusing beyond production has potential to improve the production and consumption of both nutrient-rich crops among Indigenous communities in India.

The Influence of Food Environments on Food Security Resilience during the COVID-19 Pandemic: An Examination of Urban and Rural Difference in Kenya.

Hunger and food insecurity has worsened due to the COVID-19 pandemic. The types of food environments (e.g., natural/built) that people can access may improve household resilience to food-system shocks. This paper examines (1) urban and rural differences in the perceived influence of the COVID-19 pandemic on agricultural, livelihoods, food environment attributes, diets; and (2) whether access to different food environments was associated with food security. A two-part telephonic survey (COVID-19 Surveillance Community Action Network Food Systems Tool and Household Food Insecurity Access Scale) was conducted in Western Kenya (n = 173) and an informal settlement in Nairobi (n = 144) in January/February 2021. Limitations on the acquisition of farm inputs and movement restrictions had an adverse impact on agriculture and food sales. Urban residents reported a more significant impact on livelihoods (97% vs. 87%, p < 0.001), with day laborers being the most impacted. Rural respondents reported access to significantly more food environments and lower food insecurity. Multiple linear regression analysis revealed that younger respondents, ≤1 income source, had more difficulty acquiring food, decreased access to cultivated environments, and increased access to informal markets were predictors for higher food insecurity. These data indicate that access to specific types of food environments may improve household resilience.

Strengthening Vegetable Production and Consumption in a Kenyan Informal Settlement: A Feasibility and Preliminary Impact Assessment of a Sack Garden Intervention.

Background: Over 85% of Kibera's population, an informal settlement in Nairobi, Kenya, is food insecure. Nutrition-sensitive agriculture interventions, such as sack gardens, have the potential to diversify diets-in turn, improving household food security and diet quality. Furthermore, the sale of extra vegetables may provide an income for program participants. Objectives: The aim of this paper was to conduct a feasibility assessment and preliminary impact assessment of a nutrition-sensitive urban agriculture intervention that used sack gardens for women in Kibera. Methods: Women, from a women's empowerment program, in Kibera (n = 36; n = 21 full program participants, n = 11 withdrawn, n = 4 new members) were engaged in a sack garden intervention in June 2018. A mixed-method approach was used to assess the feasibility and preliminary impact of the program. Qualitative semi-structured interviews (n = 25; n = 18 full program participants, n = 5 withdrawn, n = 2 new members), administered at the end of the pilot phase (March 2019), identified barriers and facilitators (e.g., preferences, inputs, group dynamics) to the production, consumption, and sale of self-produced vegetables. Quantitative surveys (n = 21 full program participants), administered in June 2018 and March 2019, were conducted to evaluate preliminary intervention impact on food security and diet quality through analysis of the Household Hunger Scale (HHS) and Minimum Dietary Diversity for Women (MDD-W). Results: Key barriers included insufficient inputs and group work difficulties, particularly around communication. Facilitators included positive intervention feedback, social bonds and teamwork, participants' self-sufficiency, and preference for sack garden vegetables over market vegetables. Post-intervention, participants reported reduced household food insecurity. Recommendations for program scale-up include investment in additional inputs, a water-collection/irrigation system, additional training, and placing sack gardens closer to women's homes to reduce time constraints. Conclusions: This study suggests that sack gardens may provide partial solutions to improve diet quality; however, further research is needed to assess any impact on household income.

Drivers of food choice among women living in informal settlements in Nairobi, Kenya.

Suboptimal diets drive the multiple burdens of malnutrition among women living in informal settlements. Women's food choices have important implications for their health, as well as that of their families. The purpose of this study was to examine how food choice decisions might differ across different age groups of women living in informal settlements in Nairobi, Kenya. Using in-depth interviews which incorporated a free-listing task, we determined the factors influencing food choice decisions in women in two informal settlements, Kibera and Mukuru. Among women in all age groups, we found income and food price to be the most salient factors influencing food choice decisions. Differences across age groups regarding food choice considerations included individual preference and quality being more salient factors amongst younger women while household preferences were more salient among older women. Women also reported making trade-offs between food affordability and other factors including time and nutrition, which led to sub-optimal diets. Our findings suggest that interventions in these settings may need to be tailored to specific age groups. Additionally, interventions may need to target both individual factors and the external food environment to help women overcome the trade-offs they often find themselves making in food choice decisions.

Descriptive aroma profiles of fresh sweet basil cultivars (Ocimum spp.): Relationship to volatile chemical composition.

Few studies have linked sensory descriptions of the aroma profiles of fresh, sweet basil varieties with their volatile chemistry. Using a recently developed lexicon for fresh basil, a descriptive panel characterized the aroma profiles of seven basil varieties. Chemical analysis of fresh basil leaves was performed using GC-MS headspace analysis. Analysis of variance probed for differences in the sensory attributes among varieties and principal component analysis (PCA) related the sensory profiles to volatile chemical composition. Three commercial specialty basils, "Queenette Thai" (QT), "Sweet-Dani" (SD) lemon basil, and MC-9 (cinnamon basil) had strong anise, lemon, and cinnamon-like aromas, respectively. These basils were distinguished from breeding lines of traditional Italian sweet basils where SB-22, CB-1, and CB-39 exhibited strong anise-like aroma and SB-17 had strong "general spice" aromas, characteristic of a warm spice blend. The PCA accounted for 58.7% of the variation in the data and characterized the samples in two dimensions: general spice-citrus and cinnamon-like-anise. There was a strong correspondence between the sensory attributes and volatile chemical composition. SD associated with lemon aroma and citral content; QT, CB-1, and CB-39 associated with anise aroma and methyl chavicol; and MC-9 associated with the cinnamon-like aroma, methyl cinnamate. SB-17 and SB-22 associated with general spice aroma and were in close proximity to the spice-like volatiles, 1,8 cineole, and eugenol, associated with clove aroma. We constructed precise sensory/chemical profiles for fresh basil aroma that can be used to guide breeding programs for variety improvement to meet consumer expectations or market demand. PRACTICAL APPLICATION: Sweet basil aroma is due to a complex array of several aromatic volatile compounds. The presence, concentration, and the particular ratios in which these aroma compounds accumulate significantly impact the sensory attributes. Understanding aroma profiles for fresh basil have practical applications in product development, procurement, food preparation, ethnic cuisine, and processing. Plant genetics and breeding of aroma profiles can be used and incorporated in plant improvement programs.