Nutrition Information, Market Access Both Key in Improving Children's Diets

Reducing stunting and wasting in children under five years of age and improving children’s micronutrient status have become widely recognized as important development goals. Undernutrition in the first few years of life can have significant long-term effects, including fewer years of schooling, lower cognitive skills, and even lower income in adulthood.

A working paper from the Ethiopia Strategy Support Program (ESSP) (supported by IFPRI , EDRI , and the CGIAR PIM research program ) identifies caregivers’ knowledge about nutrition as one of the most important factors determining children’s nutritional status in developing countries. The paper cites two studies that found that mothers in Ethiopia often do not feed their young children vegetables or meats because they believe these products are too difficult for young children to digest. Interventions to increase caregivers’ understanding of proper childhood nutrition can go a long way toward improving child feeding practices, but what if caregivers lack actual access to nutritious foods? In the end, being more knowledgeable about their children’s nutritional needs may not help parents if they cannot get the foods to meet those needs due to physical or economic constraints (or both).

The ESSP paper examines this link between improved nutritional knowledge and market access in Ethiopia and finds that children’s diets do, in fact, improve when their caregivers have better nutritional knowledge – but only when those households are located in areas with good market access. Improving nutritional knowledge in remote areas was found to have no impact on children’s diets.

The study collected information regarding the diets of pre-school children, their mothers’ knowledge regarding good feeding and nutrition practices, and market access using household surveys in the Alefa woreda in northwestern Ethiopia. While agro-climatic conditions are similar throughout the district, transportation costs vary widely over a relatively short distance. This allowed researchers to assess the effect of these varying costs on households facing similar physical terrain and climate conditions. The study area began in the market town of Atsedemariam; this town is connected to a major urban area by a gravel road that is passable year-round. Households were then surveyed along a series of seven sub-districts along the route from Atsedemariam. Transport costs included the cost of renting a donkey for a round-trip to Atsedemariam, the cost of transporting 100 kilograms of agricultural goods to the market, and the imputed value of a farmer’s travel time (based on median harvest-period wages).

Mothers were surveyed regarding whether their children consumed any of the following foods during the previous day: grains, roots, and tubers (such as barley, maize, teff, and wheat); legumes and nuts; dairy products (milk, yogurt, cheese); meat, poultry, or fish; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Children’s diets were scored in a range from zero to seven.

Because households’ nutrition knowledge cannot be directly observed, the study asked respondents if they agreed or disagreed with seven statements about appropriate infant and young child feeding practices. [1] Household responses were then reduced into one index using a principal components analysis, with the end variable representing each household’s nutrition knowledge expressed in units of Z-scores, with a score of 0 indicating better nutrition knowledge.  To account for the possibility that nutrition knowledge is not exogeneous, the authors also estimate using an instrumental variable approach to test their findings.

The results found that improving a household’s nutrition knowledge from an average score of 0.00 to the highest score of 1.42 increased the number of food groups children consumed from 3.08 food groups to 4.1 food groups; this increase means that the households would satisfy World Health Organization recommendations of consuming a minimum of four food groups per day.

However, these results only hold true for households with relatively good market access. For households closer to the market town, improving nutrition knowledge by one standard deviation increases children’s dietary diversity by 1.5 food groups. For more remote households with less access to the market town, improvements in household nutrition knowledge do not appear to increase children’s dietary diversity.

These findings have several policy implications. The authors suggest that in order to improve diets, Ethiopian policymakers need to focus on both ends of the spectrum – access to nutritious food and knowledge regarding nutritious food. The former will require more well-integrated markets and improved rural infrastructure, in addition to diversification of more remote households’ own agricultural production to include more nutritious crops.

[1] Taken from Alive & Thrive, 2014.