Nutrition Outcomes of Under-five Children of Smallholder Farm Households: Do Higher Commercialization Levels Lead to Better Nutritional Status?

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Study Justification:
– The study aimed to investigate the nutritional status of under-five children in farm households.
– It focused on the relationship between the level of commercialization in these households and the nutritional outcomes of the children.
– The study fills a gap in the existing literature by examining the specific factors that contribute to the nutritional status of children in farm households.
Highlights:
– The study found that 42.9% of the children were stunted, 7.9% were underweight, and 3.6% were wasted.
– The highest level of stunting was observed in households with zero commercialization, but some higher commercialization households also had increased levels of stunting.
– The study identified several factors that influenced the nutritional status of the children, including child’s age, farm size, access to electricity, healthcare, and commercialization variables.
– The results showed weak positive and negative relationships between commercialization levels and children’s nutrition outcomes.
Recommendations:
– The study recommends implementing maternal nutrition-sensitive education interventions to improve the nutrition knowledge of mothers.
– It also suggests providing infrastructure that enhances increased farm production and promotes healthy living among farm households.
Key Role Players:
– Researchers and experts in nutrition and child development
– Government agencies responsible for health and agriculture
– Non-governmental organizations (NGOs) working in the field of nutrition and rural development
– Community leaders and local authorities
Cost Items for Planning Recommendations:
– Development and implementation of nutrition education programs
– Training and capacity building for healthcare providers and community health workers
– Infrastructure development, such as improved access to electricity and clean water
– Support for agricultural initiatives and farm productivity improvement
– Monitoring and evaluation of the implemented interventions
Please note that the cost items provided are general categories and may vary depending on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized primary data from 352 farm households with 140 under-five children, which provides a solid foundation for the findings. The use of the WHO Anthro software to analyze anthropometric indices adds credibility to the results. Additionally, the study employed a logit regression model to examine the drivers of under-five children’s nutritional status. However, the abstract does not provide information on the sampling method used to select the farm households, which could affect the generalizability of the findings. To improve the strength of the evidence, the authors should provide more details on the sampling procedure and ensure that the study sample is representative of the target population. Additionally, including information on the reliability and validity of the data collection instruments would enhance the rigor of the study.

The study investigated the nutritional status of under-five children of farm households. The study utilized primary data from 352 farm households with 140 under-five children. Household crop commercialization index (CCI) was used to estimate cassava farm household crop sale ratio and categorize the households into four commercialization levels while WHO Anthro software was employed to analyze under-five children anthropometric indices such as weight-for-age z-score (WAZ), height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Logit regression model (LRM) was used to examine the drivers of under-five children’s nutritional status of farm households. The study found that 42.9%, 7.9% and 3.6% of the children are stunted, underweight and wasted respectively. The highest stunting level was recorded in zero level households (CCI 1). Although, some higher CCI households (medium-high and very-high level) recorded increased percent of stunted children. This revealed that being a member of low or high-level commercialization households may not guarantee better nutritional status of young children of farm households. The results of LRM indicated that the predictors of children nutritional status were child’s age, farm size, access to electricity, healthcare and commercialization variables. Moreover, weak positive and negative relationships exist between CCI and children’s nutrition outcomes as measured by the z-scores. The study recommended maternal nutrition-sensitive education intervention that can improve nutrition knowledge of mothers and provision of infrastructure that enhance increased farm production and promote healthy living among farm households.

The study was carried out in Ogun and Oyo states (South-West) of Nigeria. However, Nigeria is located in West Africa within the land mass of 923,768 square kilometer with latitude 10° 00ˡ N and 8° and 00ˡ E (Maps of World, 2021). It is a multi-ethnic nation where Igbo, Hausa and Yoruba are regarded as the most common ethnic groups. South-West is one of the six geo-political zones in Nigeria. There are 6 states in South-West. Agriculture is regarded as the major occupation of about 70% of the rural population (Lawal & Samuel, 2010; Otekunrin et al., 2021b). This study utilized primary data which was collected through multi-stage sampling procedure. Firstly, two (2) from six (6) cassava producing States in the Southwestern Nigeria was randomly selected. Secondly, the selection of five (5) Local Government area (LGAs) from Oyo State and three LGAs from Ogun state giving a total of eight (8) LGAs in the two states. In stage 3, 24 villages from the 8 LGAs was selected while the fourth stage included the selection of 16 cassava farming households resulting in 384 farm households. The data were gathered using structured questionnaire which include; the household socioeconomic factors, nutrition, child-centred factors, expenditure on food and other salient household and child-centred issues. Thirty-two of the questionnaires were unusable after data cleaning. In the 352 farm households, there were 140 under 5-year members. However, anthropometric measurements such as age of child, gender, height and weight were measured and recorded. These measurement details were used in obtaining malnutrition indices such WAZ, HAZ and WHZ. The CCI levels of cassava farm households in the study areas were estimated, while making use of Crop Commercialization Index (CCI) by Strasberg et al., 1999; Carletto et al., 2017 and Otekunrin et al., 2019b; Otekunrin et al., 2022a, b which is expressed as: We have as the household in year j. Using this method, agricultural commercialization can be expressed as a continuum spanning complete subsistence () to full commercialization (). Using this this method, cassava farm households were grouped on the basis of their cassava commercialization levels. From non-participant farm household which are grouped as (i) zero commercialization households (CCI = 0%) to participating households which are classified into; (ii) low commercialization (CCI=1–49%) (iii) medium-high commercialization (CCI = 50–75%) and (iv) very-high commercialization (CCI = > 75%) levels (Otekunrin, 2021b; Otekunrin & Otekunrin, 2021b). Anthropometry is a human body measurements that are mainly used to obtain important nutrition details concerning a sample or population (Babatunde et al., 2011). Past farm household studies have applied anthropometric data to under 5-year children in Nigeria (Babatunde et al., 2011; Ogunnaike et al., 2020; Adeyonu et al., 2022; Ashagidigbi et al., 2022). The anthropometric measurements are used in obtaining indices such as HAZ, WAZ and WHZ (Babatunde et al., 2011; Slavchevska, 2015; Fadare et al., 2019; Bhargava et al., 2020; Otekunrin,2021b ). Empirical studies on anthropometric measurements (using WHO Anthro software) of under 5-year members of rural farm households are scarce. The anthropometric measurements for under-five were measured using stunting (HAZ), wasting (WHZ) and underweight (WAZ). The anthropometric indices of under-five members of cassava farm households were obtained for this study using WHO Anthro software. These are stunting, wasting and underweight. However, children (> 5years) having HAZ < -2 Standard Deviation (SD) and < -3SD compared to 2007 WHO reference were classified as stunted and severe stunting, WAZ < -2SD and < -3SD referred to as underweight and severe underweight while WHZ < -2SD and < -3SD referred to as wasting and severe wasting respectively (WHO, 1995, 1997; de Onis et al., 2007; Babatunde et al., 2011; Slavchevska, 2015; Bhargava et al., 2020). The drivers of under 5-year children’s malnutrition (stunting, wasting and underweight) of farm households were analyzed using LRM as expressed in Eq.(2) below. However, the regressand (dependent variables) are the malnutrition status of the children members of the farm households and are presented in separate regression models. In each case, one (1) is for malnourished child and zero (0) otherwise (i.e. stunted = 1, 0 otherwise; wasted = 1, 0 otherwise; and underweight = 1 and 0 otherwise) as expressed as a function of a vector of explanatory variables assumed to affect the malnutrition of farm under 5-year children. This indicated that in each case, the parameter estimate indicates the likelihood that a child will be malnourished. However, the positive sign on the parameters shows high-level of malnutrition while the negative sign reveals low-level of malnutrition (Babatunde et al., 2011). The explanatory variables included in the model are; child age, child gender, age of mother, education level of mothers, household size, farm size, household head educational level, farm income, non-farm income, food expenditure, mothers’ access to nutrition training, healthcare access, toilet access, access to electricity, piped water access and crop sold ratio. Following Gujarati & Porter 2009 and Otekunrin et al., 2022a, b, the logit regression model is expressed as: Where denotes the probability of a child being stunted, wasted and/or underweight, are the parameter estimates of the explanatory variables, the represent the explanatory variables and are the stochastic error terms.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide pregnant women and new mothers with access to important health information, reminders for prenatal and postnatal care appointments, and personalized nutrition and exercise recommendations.

2. Telemedicine Services: Implement telemedicine services that allow pregnant women in rural areas to consult with healthcare professionals remotely, reducing the need for travel and improving access to prenatal care.

3. Community Health Workers: Train and deploy community health workers to provide education and support to pregnant women and new mothers in underserved areas. These workers can offer guidance on nutrition, breastfeeding, and postpartum care, as well as facilitate referrals to healthcare facilities when needed.

4. Maternal Health Vouchers: Introduce voucher programs that provide pregnant women with financial assistance to cover the costs of prenatal care, delivery, and postnatal care. This can help reduce financial barriers and improve access to essential maternal health services.

5. Maternal Health Clinics: Establish dedicated maternal health clinics in underserved areas, staffed by skilled healthcare professionals who specialize in prenatal and postnatal care. These clinics can provide comprehensive services, including antenatal check-ups, vaccinations, and counseling.

6. Transportation Support: Develop transportation initiatives that provide pregnant women with reliable and affordable transportation options to healthcare facilities. This can include partnerships with local transport providers or the use of community-based transportation services.

7. Maternal Health Education Programs: Implement targeted education programs that focus on improving maternal nutrition, hygiene practices, and overall health during pregnancy. These programs can be delivered through community workshops, radio broadcasts, or mobile applications.

8. Maternity Waiting Homes: Establish maternity waiting homes near healthcare facilities, where pregnant women from remote areas can stay in the weeks leading up to their due date. This ensures that they have timely access to skilled birth attendants and emergency obstetric care.

9. Public-Private Partnerships: Foster collaborations between government agencies, non-profit organizations, and private sector entities to improve access to maternal health services. This can involve leveraging private sector resources and expertise to expand healthcare infrastructure and service delivery in underserved areas.

10. Health Financing Innovations: Explore innovative financing mechanisms, such as microinsurance or community-based health financing schemes, to make maternal health services more affordable and accessible to low-income women.

It’s important to note that the specific context and needs of the target population should be considered when implementing these innovations.
AI Innovations Description
Based on the study’s findings and recommendations, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Develop a mobile application or online platform that provides maternal nutrition-sensitive education and resources for mothers in rural farm households. This platform should include interactive modules and videos that educate mothers on the importance of nutrition for themselves and their children, as well as practical tips on how to improve their family’s nutrition. The platform should also provide information on local agricultural practices and resources to help mothers increase farm production and access nutritious foods. Additionally, the platform should connect mothers to healthcare services by providing information on nearby healthcare facilities, scheduling appointments, and offering telemedicine consultations. This innovation would address the identified drivers of under-five children’s malnutrition, such as maternal nutrition knowledge and access to healthcare, while leveraging technology to reach a wider audience in rural areas.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile health applications that provide pregnant women with access to information, resources, and support for prenatal care, nutrition, and postnatal care. These apps can also facilitate communication between pregnant women and healthcare providers, allowing for remote consultations and monitoring.

2. Community Health Workers: Train and deploy community health workers (CHWs) to provide maternal health education, screenings, and referrals in underserved areas. CHWs can bridge the gap between healthcare facilities and communities, ensuring that pregnant women receive the necessary care and support.

3. Telemedicine Services: Establish telemedicine services that enable pregnant women to consult with healthcare providers remotely. This can be particularly beneficial for women in rural or remote areas who may have limited access to healthcare facilities.

4. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with financial assistance to access maternal health services. These vouchers can cover the cost of prenatal care, delivery, and postnatal care, making healthcare more affordable and accessible.

5. Transportation Support: Develop transportation initiatives that address the challenges of reaching healthcare facilities. This can include providing transportation vouchers or arranging transportation services for pregnant women in remote areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group that will be impacted by the recommendations, such as pregnant women in a particular region or community.

2. Collect baseline data: Gather data on the current access to maternal health services, including the number of pregnant women receiving prenatal care, the distance to healthcare facilities, and any existing barriers to access.

3. Develop a simulation model: Create a simulation model that incorporates the potential impact of the recommendations on access to maternal health. This model should consider factors such as the number of women reached through mHealth solutions, the number of CHWs deployed, the utilization of telemedicine services, and the uptake of maternal health vouchers.

4. Input data and parameters: Input the collected baseline data and parameters into the simulation model. This includes information on the target population, the implementation of the recommendations, and any assumptions or constraints.

5. Run simulations: Run multiple simulations using different scenarios and assumptions to assess the potential impact of the recommendations on improving access to maternal health. This can involve varying factors such as the coverage of mHealth solutions, the number of CHWs deployed, or the utilization rates of telemedicine services.

6. Analyze results: Analyze the simulation results to determine the projected changes in access to maternal health services. This can include metrics such as the increase in the number of pregnant women receiving prenatal care, the reduction in travel distance to healthcare facilities, or the improvement in healthcare utilization rates.

7. Validate and refine the model: Validate the simulation model by comparing the projected results with real-world data or expert opinions. Refine the model based on feedback and make adjustments as necessary.

8. Communicate findings: Present the findings of the simulation analysis, including the projected impact of the recommendations on improving access to maternal health. This information can be used to inform decision-making, resource allocation, and policy development to enhance maternal health services.

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