Browsing by Author "Mtinda, Elias"

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Food security mediates the decrease in women's depressive symptoms in a participatory nutrition-sensitive agroecology intervention in rural Tanzania.
(Cambridge University Press 2021, 2021-03-12) Cetrone, Hollyn; Santoso, Marianne; Bezner Kerr, Rachel; Petito, Lucia; Blacker, Lauren; Nonga, Theresia; Martin, Haikael; Kassim, Neema; Mtinda, Elias; Young, Sera
Objective: To investigate if food security mediated the impact of a nutrition-sensitive agroecology intervention on women’s depressive symptoms. Design: We used annual longitudinal data (4 time points) from a cluster-randomized effectiveness trial of a participatory nutrition-sensitive agroecology intervention, the Singida Nutrition and Agroecology Project (SNAP-Tz). Structural equation modelling estimation of total, natural direct, and natural indirect effects was used to investigate food security’s role in the intervention’s impact on women’s risk of probable depression (CES-D > 17) across three years. Setting: Rural Singida, Tanzania. Participants: 548 food insecure, married, smallholder women farmers with children < 1-year-old at baseline. Results: At baseline, one third of the women in each group had probable depression (Control: 32.0%, Intervention: 31.9%, p difference=0.97). The intervention lowered odds of probable depression by 43% (OR=0.57, 95% CI: 0.43-0.70). Differences in food insecurity explained approximately 10 percentage points of the effects of the intervention on odds of probable depression (OR = 0.90, 95% CI: 0.83-0.95). Conclusions: This is the first evidence of the strong, positive effect that lowering food insecurity has on reducing women’s depressive symptoms. Nutrition-sensitive agricultural interventions can have broader impacts than previously demonstrated, i.e., improvements in mental health, and changes in food security play an important causal role in this pathway. As such, these data suggest participatory nutrition-sensitive agroecology interventions have the potential to be an accessible method of improving women’s wellbeing in farming communities.
Household food insecurity and gender inequity is associated with high prevalence of maternal depression amongst female farmers with young children in rural Tanzania
(The Federation of American Societies for Experimental Biology, 2018-10-03) Blacker, Lauren; Santoso, Marianne; Harnett, Laura; Kassim, Neema; Mollay, Clara; Martin, Haikael; Mtinda, Elias; Kalonga, Esther; Mtei, Kelvin; Kalonga, Joseph; Bezner, Rachel; Young, Sera
There is growing recognition of the importance of maternal mental health for the well-being of both mothers and children. In addition to being of importance to public health concern on its own right, maternal depression could impede women's capacity to provide quality care to their children. However, the covariates of maternal depression, especially in low-resource settings, are not well-understood. In particular, the role of gender equity in maternal depression needs further investigation. Therefore, we sought to understand covariates associated with maternal depression in a rural farming community in Tanzania. We hypothesized that greater food insecurity and gender inequity in a household would be positively correlated with maternal depression. The Singida Nutrition and Agroecology Project (SNAP-Tz) is a participatory agroecology and nutrition intervention with rural farmers with children <1 y in Singida, Tanzania. As part of the baseline assessment in February 2016, women from the 587 participating households were asked about a range of socio-demographic, agricultural, health, and nutrition topics. The Center for Epidemiologic Studies Depression Scale (CES-D, range: 0–65) was used to measure maternal depression. The Household Food Insecurity Access Scale (HFIAS, range: 0–27) was used to measure household food insecurity. Gender equity was indicated by a summed score of husband's help with household chores (range: 0–7), women's (dis)satisfaction with leisure time, and women's experience with domestic violence. Social support was measured using the Perceived Social Support scale (PSS, range:0–40). Multivariate linear regression models of depression were then built using backwards stepwise elimination and include village fixed effects. Standard error estimates considered clustering at the village level. CESD scores indicated probable depression (CES-D≥17) among 69.2% of women. Probable major depression (CES-D≥26) was indicated for 42.5% women. The mean HFIAS of 14.0 (sd: 7.9) suggested that food insecurity was also very common. In multivariate models of depression, food insecurity score was positively and strongly correlated with maternal depression score (β=0.62, p=0.000). Having experienced domestic violence was positively associated with increased maternal depression score (β=4.29, p=0.004). Greater help from husband and satisfaction with amount of leisure time were negatively correlated with maternal depression score (β=−0.65, p=0.011 and β=−3.00, p=0.000, respectively). In sum, the prevalence of maternal depression is very high in Singida, Tanzania. While some covariates were not modifiable, several important ones were, including food insecurity, unbalanced household division of task, and domestic violence. Causality should be further explored, but these data suggest important and novel domains in which to intervene to improve maternal mental health.
A Mixed Methods Exploration of the Role of Participation in a Nutrition-Sensitive Agroecology Intervention in Rural Tanzania
(Elsevier, 2023-06) Santoso, Marianne; Petrie, Halle; Kerr, Rachel; Lane, Charlotte; Kassim, Neema; Martin, Haikael; Mtinda, Elias; Lupafya, Esther; Young, Sera
Background: Participation is key to the successful implementation of nutrition-related interventions, but it has been relatively overlooked. Objective: We sought to describe participation intensity among smallholder farmers in a randomized nutrition-sensitive agroecology study in rural Tanzania. We explored the association between baseline characteristics and overall participation intensity (quantitatively at the individual level and qualitatively at the group level), the association of participation intensity with 2 process indicators, and the association between participation intensity and key study outcomes. Methods: Data came from 7 rounds of surveys with 295 women and 267 men across 29 months and 2 rounds of semi-structured interviews with the 20 “mentor farmers” who delivered the intervention. Participation intensity was based on the number of months of attendance at village-level project meetings or household visits (range: 0–29). Multivariable models of participation were built. Results: Women and men participated for 17.5 7.2 and 13.6 8.3 months, respectively. Participation intensity followed 1 latent tra- jectory: initially low, with a sharp increase after month 7, and plateaued after the first year. At baseline, higher participation intensity was associated with older age, higher education, level of women’s empowerment, being in the middle quintile of wealth, and qualitatively, village residence. Higher participation intensity was associated with 2 process indicators – better recall of topics discussed during meetings and greater knowledge about key agroecological methods. High participation intensity was positively associated with increased use of sustainable agricultural practices among all participants, and among women, with husband’s involvement in household tasks and child’s dietary diversity score. Conclusions: Participation intensity covaried with key study outcomes, suggesting the value of increased attention to implementation in nutrition-related programs for providing insights into drivers of impact. We hope that investigations of participation, including participation intensity, will become more widespread so that intervention impacts, or lack thereof, can be better understood.
A Nutrition-Sensitive Agroecology Intervention in Rural Tanzania Increases Children's Dietary Diversity and Household Food Security But Does Not Change Child Anthropometry: Results from a Cluster-Randomized Trial.
(Oxford University Press, 2021-05-11) Santoso, Marianne V; Bezner Kerr, Rachel N; Kassim, Neema; Martin, Haikael; Mtinda, Elias; Njau, Peter; Mtei, Kelvin; Hoddinott, John; Young, Sera L
Background There are urgent calls for the transformation of agriculture and food systems to address human and planetary health issues. Nutrition-sensitive agriculture and agroecology promise interconnected solutions to these challenges, but evidence of their impact has been limited. Objectives In a cluster-randomized trial (NCT02761876), we examined whether a nutrition-sensitive agroecology intervention in rural Tanzania could improve children's dietary diversity. Secondary outcomes were food insecurity and child anthropometry. We also posited that such an intervention would improve sustainable agricultural practices (e.g., agrobiodiversity, intercropping), women's empowerment (e.g., participation in decision making, time use), and women's well-being (e.g., dietary diversity, depression). Methods Food-insecure smallholder farmers with children aged <1 y from 20 villages in Singida, Tanzania, were invited to participate. Villages were paired and publicly randomized; control villages received the intervention after 2 y. One man and 1 woman “mentor farmer” were elected from each intervention village to lead their peers in agroecological learning on topics including legume intensification, nutrition, and women's empowerment. Impact was estimated using longitudinal difference-in-differences fixed-effects regression analyses. Results A total of 591 households (intervention: n = 296; control: n = 295) were enrolled; 90.0% were retained to study end. After 2 growing seasons, the intervention improved children's dietary diversity score by 0.57 food groups (out of 7; P < 0.01), and the percentage of children achieving minimum dietary diversity (≥4 food groups) increased by 9.9 percentage points during the postharvest season. The intervention significantly reduced household food insecurity but had no significant impact on child anthropometry. The intervention also improved a range of sustainable agriculture, women's empowerment, and women's well-being outcomes. Conclusions The magnitude of the intervention's impacts was similar to or larger than that of other nutrition-sensitive interventions that provided more substantial inputs but were not agroecologically focused. These data suggest the untapped potential for nutrition-sensitive agroecological approaches to achieve human health while promoting sustainable agricultural practices.
A Participatory Agroecological Intervention Reduces Women’s Risk of Probable Depression Through Improvements in Food Security in Singida, Tanzania
(Elsevier, 2020-06) Cetrone, Hollyn; Santoso, Marianne; Petito, Lucia; Bezner-Kerr, Rachel; Blacker, Lauren; Kassim, Neema; Mtinda, Elias; Martin, Haikael; Young, Sera
In 2015, depressive disorders led to over 50 million disability-adjusted life years lost globally, with more than 80% occurring in low- and middle-income countries. Depressive disorders are also risk factors of a number of adverse maternal and child health outcomes. To our knowledge, the Singida Nutrition and Agroecology Project (SNAP-Tz), is the first nutrition-sensitive agriculture (NSA) intervention identified to improve women’s probable depression (2020). Food security has been posited to play an important role in the relationship between NSA interventions and depression, yet causal factors have not yet been analyzed quantitatively. Therefore, we investigated food security’s mediating role on this impact.
Predictors of Program Participation in a Nutrition-Sensitive Agroecological Intervention in Singida, Tanzania
(Oxford University Press, 2020-06) Santoso, Marianne; Bezner-Kerr, Rachel; Kassim, Neema; Mtinda, Elias; Martin, Haikael; Hoddinott, John; Young, Sera
Objectives Nutrition-sensitive agricultural interventions are theorized to improve child’s diet through asset provision and program participation. Although some programs measure participation, predictors of participation are understudied. We therefore investigated predictors of men’s and women’s program participation in Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876). Methods In SNAP-Tz, ‘mentor farmers’ led their peers (smallholder farmers with children < 1 year at baseline) in learning about agroecology, nutrition, and gender equity through meetings and household visits. At baseline, we collected data on demographics, Household Food Insecurity Access Scale (0–27), men’s involvement in 7 household tasks (0–7), and Abbreviated Women’s Empowerment in Agriculture Index (AWEAI). Participating men (n = 262) and women (n = 283) were asked to recall their program participation biannually. Predictors of high participation, defined as attendance in ≥60% participant meetings and household visits, were identified using multiple logistic regressions, controlling for clustering at the village level. Results Only 59% and 37% of women and men, respectively, had high participation. Women’s high participation was associated with their spouse’s participation (OR = 4.23, P < 0.01), greater food insecurity (OR = 1.03, P = 0.03), years of education (OR = 1.13, P = 0.02), and being empowered (OR = 5.88, P < 0.01). Men’s high participation was associated with their spouse’s participation (OR = 4.22, P < 0.01), greater food insecurity (OR = 2.23, P = 0.01), involvement in household tasks (OR = 1.25, P = 0.04), and age (OR = 1.03, P < 0.01). Conclusions Associations between an individual’s and their spouse’s participation indicate the importance of spousal dynamics. The association between participation and baseline gender equity (i.e., women’s empowerment, men’s involvement in household tasks) highlights the challenges of gender programming in nutrition-sensitive interventions. Analysis of program participation was simple and revealed valuable lessons for program implementation and design; more programs should therefore analyze participation.
Production Diversity Is Not Associated with Women’s Dietary Diversity After Controlling for Wealth and Participation in an Agriculture Intervention in Tanzania
(Oxford University Press, 2019-06) Guo, Mianzhao; Santoso, Marianne; Bezner-Kerr, Rachel; Kassim, Neema; Martin, Haikael; Mtinda, Elias
Objectives Farm production diversity has long thought to be a primary driver of dietary diversity. Few studies have explored the drivers of dietary diversity among women, who are often vulnerable to sub-optimal diets. We therefore investigated how production diversity affects women’s dietary diversity in smallholder farming communities in rural Tanzania. Specifically, we hypothesized that women in households with greater farm production diversity would have higher dietary diversity. Methods Female farmers (n = 462) were surveyed on agricultural practices in 2018 and their diet in the subsequent harvest season as a part of the Singida Nutrition and Agroecology Project (SNAP-Tz). SNAP-Tz is a cluster randomized effectiveness trial of a participatory agroecology and nutrition intervention. We estimated the impact of production diversity (crop species richness, range: 1–10) on women’s dietary diversity (Minimum Dietary Diversity for Women, range: 1–10) using linear regression analysis with Stata15, controlling for geographic clustering and other known covariates of women’s dietary diversity. Results Farm production diversity was positively associated with women’s dietary diversity after controlling for household size, age, and women’s occupation (b = 0.15, P < 0.01). However, this association was not significant (b = 0.068, P = 0.18) after additionally controlling for household wealth and participation in the intervention. Conclusions Contrary to our hypothesis, women living in households with higher production diversity did not have more diverse diets when controlling for other covariates of dietary diversity, i.e., household wealth and participation in the participatory agroecology intervention. Modifiable determinants of women’s dietary diversity are an important area for future exploration. Comparing and contrasting the role of production diversity here to that in other settings will be fruitful.
Production Diversity, Men’s Help with Household Tasks, & Lower Women’s Depression Mediate Impact of an Agriculture Intervention on Child’s Dietary Diversity in Tanzania (FS01-06-19)
(Elsevier, 2019-06-01) Santoso, Marianne; Bezner, Rachel; Kassim, Neema; Martin, Haikael; Mtinda, Elias; Mtei, Kelvin; Young, Sera
Production diversity and women’s empowerment are two ways by which nutrition-sensitive agriculture interventions are thought to improve children’s diet, but, few empirical studies have tested these pathways. We therefore investigated the impact of the Singida Nutrition and Agroecology Project (SNAP-Tz; NCT02761876) on child’s dietary diversity, as well as the mediating role of production diversity and women’s empowerment on that relationship.