Multisectoral behavior change intervention improves diet quality, but not food security, in rural Uganda

Abstract

Multi-sectoral interventions targeting nutrition have shown promise in low- and middle-income settings. A 1:1:1 multi-level cluster-randomized controlled trial assessed the impact of two 12-week social behavior change interventions called Nutrition Impact and Positive Practice (NIPP) and NIPP+. The NIPP intervention sought to improve participants’ food security, diet quality, and water, sanitation, and hygiene. The NIPP + intervention used additional nudges to improve agricultural practices. Nearly 900 households from 60 clusters in the Agago District of Uganda were randomized to one of three arms: Control, NIPP, and NIPP+. Impacts on maize yield, household food security, diet quality, and child anthropometry were assessed using generalized linear mixed models. Post-intervention, NIPP + children had 2 times increased odds of achieving a minimum acceptable diet (MAD) (OR = 2.04; 95% CI = 1.04, 3.99; p = 0.039) compared to control. One year post intervention, women in NIPP (OR = 2.27; 95% CI = 1.38, 3.74; p = 0.001) and NIPP+ (OR = 2.81; 95% CI = 1.71, 4.61; p < 0.000) had more than two times increased odds of achieving minimum dietary diversity (MDDW) compared to control, and children in NIPP + had a mean mid-upper arm circumference that was 0.217 cm higher (β = 0.217; 95% CI = 0.033, 0.402; p = 0.022) compared to control. We detected no significant effects on maize yield, household food security, or child dietary diversity. This study demonstrates the potential for the NIPP and NIPP + interventions to improve diet diversity, independent of improvements to either agricultural production or household food security.