Pathways from integrated agriculture and health-based interventions to nutrition: a case from Southern Bangladesh.

Objective: We aimed to analyse the effects of nutrition-sensitive agriculture (NSA) interventions on nutrition, examine the pathways within a project cycle and explore the pathways 3 years after the end of the funding period.

Design: We employed a sequential mixed-methods design using (1) secondary quantitative data and (2) primary qualitative data. The quantitative data were analysed using the Mann-Whitney test, independent sample t test and binary logistic regression. The qualitative data were analysed thematically.

Setting: This research used the case of the Integrated Agriculture and Health Based Interventions project.

Participants: The quantitative data comprised 4825 households. The qualitative data included forty-six participants (twenty-eight beneficiaries and eighteen implementers) from two focus group discussions (n 15) and thirty-one semi-structured interviews.

Results: NSA interventions reduced child underweight and improved household and women's dietary diversity scores, breastfeeding practices, handwashing and access to Fe-folic acid during pregnancy. Pregnant and lactating women's minimum dietary diversity increased, while children's minimum dietary diversity reduced. Key pathways to nutrition during project implementation were food production, nutrition-related knowledge and strengthening local institutions. Sustainability of knowledge was mostly evident, followed by food production, while the strengthening of local institutions was less evident.

Conclusions: Key pathways to outcomes during the project implementation were food production, nutrition-related knowledge and strengthening local institutions, as these were the main focus of the project. Income and women's empowerment pathways could be more effective if intentionally integrated. We reiterate the need to enhance children's dietary diversity, strengthen income-expenditure and women empowerment pathways, sustain livestock production and strengthen local institutions.