Impact of nutrition-sensitive agricultural interventions on dietary diversity and selected nutritional outcomes among vulnerable populations in Ethiopia: a systematic review.

Abstract

Background: Malnutrition continues to be a significant public health issue in Ethiopia, disproportionately affecting children under five years of age, pregnant and lactating women, and low-income households. Nutrition-sensitive agricultural (NSA) interventions are agricultural strategies specifically designed to enhance nutrition by improving food availability, access, and dietary quality in a population. These interventions have been increasingly advocated to address the root causes of malnutrition. However, their effectiveness in enhancing dietary diversity and nutritional outcomes in Ethiopia has not yet been systematically assessed. This review aimed to evaluate the effects of NSA interventions on dietary diversity and nutritional status among vulnerable populations in Ethiopia.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify studies published between January 2015 and March 2025. Eligible studies included experimental, quasi-experimental, and observational (primarily cross-sectional) designs that evaluated NSA interventions and reported dietary and nutritional outcomes. Study selection, data extraction, and reporting were performed according to the PRISMA guidelines.

Results: In this review, ten studies were analyzed. Most of these studies indicated improvements in dietary diversity among women and children following NSA interventions, with statistically significant increases in dietary diversity scores or the proportion of households that achieved minimum dietary diversity. However, evidence regarding anthropometric outcomes in children remains inconsistent across studies. Integrated interventions that combine agriculture, nutrition education, and behavior change communication generally demonstrate stronger positive effects than single-component interventions. The magnitude of the impact varied based on the duration, intensity, and context of the intervention. Common challenges in implementation include limited infrastructure, weak market linkages, and resource constraints.

Conclusion: Although NSA interventions consistently enhance dietary diversity among vulnerable populations in Ethiopia, their impact on anthropometric nutritional outcomes remains uncertain. Although integrated, multi-sectoral approaches seem more promising, the overall strength of the evidence is limited by the heterogeneity of the studies included. Future interventions should focus on context-specific, long-term strategies and bolster the implementation systems to improve nutritional outcomes.