ASTUTE: Addressing Stunting in Tanzania Early (current)

Operations research on scaling up actions to prevent stunting in Tanzania

Click here for our printer-friendly research brief (IMA World Health. Scaling up Growth: Addressing Stunting in Tanzania Early (ASTUTE). Operations Research Brief. 2015.)

The Addressing Stunting in Tanzania Early (ASTUTE) Project led by IMA World Health aims to decrease stunting rates in 5 regions around Lake Victoria. Tanzania has achieved dramatic reductions in child mortality over the past 2 decades. However, with the third highest stunting rate in Africa, significant challenges of poor child growth and associated risks of mortality, cognitive deficits, poor school performance, and adult productivity persist. ASTUTE works closely with the Government of Tanzania on innovative approaches to support local government, community, and household actions promoting healthy growth and development of children. The Cornell team is conducting operations research, divided into four phases, to assess the factors that influence the design, implementation, and utilization of ASTUTE’s activities. The results will inform intervention efforts to build capacity of district governments, strengthen community-level implementation, and encourage supportive action at the household level to empower women and families with the time and resources needed to improve young child nutrition, health and development. Learn more about our four research phases below:

Phase 1 and Phase 2. Household trials: Exploring exclusive breastfeeding and complementary feeding practices

Women discuss recipes and feeding practices for their young children before preparing a range of enriched dishes [photo: Cynthia Matare]

We conducted Trials of Improved Practices (TIPs) to assess families’ willingness to try, use and sustain household strategies which increase the ability to practice optimal infant and young child feeding recommendations. We conducted a series of household visits with mothers and fathers, as well as focus group discussions with men, and recipe trials with mothers and children. We documented barriers and facilitators to practicing feeding recommendations, feasible strategies for how fathers and family members can support mothers to overcome feeding challenges, and locally available foods and complementary feeding recipes that were appropriate and acceptable to families. Learn about our findings below, shared at the American Society for Nutrition in June 2018

TIPs data collection was led by the research team pictured above, including Alindwa Bandio, Cynthia Matare, Winfrenda Edward, Aidan Kazoba, Prosper Ganyara, Nyamizi Njile, and Jane Siftan [photo: Aidan Kazoba].

Matare CR, Craig HC, Martin SL, Kayanda RA, Chapleau GM, Bezner-Kerr R, Dearden KA, Nnally LP, Dickin KL. Overcoming Perceptions of Colic and Increasing Support to Improve Exclusive Breastfeeding Practices in Tanzania: Household Trials with Mothers and Fathers. American Society for Nutrition. January 2018.

Click here for the EBF TIPs poster.

Martin SL, Matare CR, Kayanda RA, Owoputi I, Bezner-Kerr R, Dearden KA, Nnally L, Kazoba A, Dickin KL. Recommendations to Increase Children’s Dietary Diversity and Decrease Sugary Snacks were Acceptable and Feasible for Mothers and Fathers in Tanzania. American Society for Nutrition. January 2018.

Click here for the CF TIPs poster.

Matare CM, Craig HC, Martin SL, Kayanda RA, Chapleau GM, Bezner-Kerr R, Dearden KA, Nnally LP, Dickin KL. Barriers and Opportunities for Improved Exclusive Breastfeeding Practices in Tanzania: Household Trials with Mothers and Fathers. Food and Nutrition Bulletin. 2019.


Phase 3. Multi-sectoral nutrition (MSN) initiative: Assessing regional mentorship of council officers to strengthen MSN efforts

Regional Nutrition Officers use a sphere of influence framework to discuss outcomes, key influencers, and next steps in the Multi-sectoral Nutrition Initiative Study.

We are assessing the degree to which a mentorship approach impacts the ability of district officers in key sectors (e.g., health, agriculture, community development) to form strategic multi-sectoral partnerships and support the work and performance of frontline community health workers (CHWs). We will document how mentorship affects the knowledge, self-efficacy, collaboration, support, and communication and networking skills among key district officers in order to strengthen joint nutrition efforts across sectors. We will also examine the extent to which the mentoring approach is acceptable and feasible to mentors and mentees to identify tailored approaches and strategies to promote more broadly throughout Tanzania. See additional resources below:

Kayanda R, Nnally L, Dickin KL, Dearden K. Strengthening multi-sectoral nutrition capacities among council officers.

Workshop Report: Learning Exchange Workshop to Promote Multi-Sectoral Nutrition Capacity in Councils. 7-8 February 2018.

Workshop Toolkit: Learning Exchange Workshop to Promote Multi-Sectoral Nutrition Capacity in Councils. 7-8 February 2018.

Dickin KL, Klemm GC, Kayanda R, Kazoba A, McCann J, Frommer M, Lambert V, Martin S, Nnally L. Policy vs. Practice: Exploring a Mentoring Approach for Building Capacity to Implement Multi-sectoral Nutrition Policies in Tanzania. American Society for Nutrition. January 2019.

Phase 4. Implementation research study

We will assess the implementation of ASTUTE program outreach activities and document the acceptability and feasibility of community-level nutrition-specific and nutrition-sensitive interventions. We will explore the impact of community health workers (CHWs) on ASTUTE programming to strengthen the capacity of the frontline workforce to support families and motivate behavior change. We will use both quantitative and qualitative methods and will conducted this research in two phases. The first phase will focus on CHWs’ targeting of households and delivery of home visit messaging, and the second will explore household dynamics and program exposure in relation to practice of recommended nutrition behaviors.

Research team and Collaborators:

Implementation Study Phase A team

Implementation Study Phase B team








This research is led by principal investigators Katherine L. Dickin (Cornell University), Stephanie L. Martin (University of North Carolina at Chapel Hill), and Luitfrid Peter Nnally (Tanzania Food and Nutrition Centre). Cornell team members include Professor Rachel Bezner-Kerr, Gina Chapleau, Hope Craig, Cynthia Matare, and Ibukun Owoputi with undergraduate support from Juliet McCann,  Molly Frommer, Valencia Lambert, Emily Lasher, and Catherine Wambura. Rosemary Kayanda (IMA World Health) leads the research team from Mwanza, Tanzania.

Funding: This research is funded with UK aid from the UK government through the Department of International Development (DFID).