ASTUTE: Addressing Stunting in Tanzania Early (current)

Operations research on scaling up actions to prevent stunting in Tanzania

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

Recipe trials: Women discuss acceptable ways to improve the nutritional quality of foods fed to young children by cooking and tasting recipes made with local ingredients [photo: 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 (left to right) Alindwa Bandio, Cynthia Matare, Winfrenda Edward, Aidan Kazoba, Prosper Ganyara, Nyamizi Njile, and Jane Siftan [photo: Kazoba]

Poster presentations

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. Nutrition 2018 (American Society for Nutrition), Boston, Massachusetts. January 2018. Click here for the 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. Nutrition 2018 (American Society for Nutrition), Boston, Massachusetts. January 2018. Click here for the poster.

Oral presentation

Martin SL, Matare CR, Kayanda RA, Riggle KR, Owoputi I, Bezner Kerr R, Dearden KA, Nnally LP, Dickin KL. Increasing family support for recommended complementary feeding practices in Tanzania. Annual Meeting of the Society for Applied Anthropology, Philadelphia, Pennsylvania, April 2018.

Manuscript

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. May 2019.

Phase 3. Multisectoral nutrition (MSN) initiative: Strengthening multisectoral nutrition capacities among district officers

Regional Nutrition Officers use a sphere of influence framework to discuss expected outcomes, key influencers, and next steps in the Multisectoral Nutrition Initiative Study. [photo: Dickin]

We assessed the degree to which mentoring and multisectoral “action team” approaches impact the ability of district officers in key sectors (e.g., health, agriculture, community development) to form strategic multisectoral partnerships and support the work and performance of frontline implementation staff. We documented how these low cost approaches affect the knowledge, self-efficacy, collaboration, support, and networking skills among key district officers in order to strengthen joint nutrition efforts across sectors. We also examined barriers and facilitators to each approach and the extent to which the approaches were acceptable and feasible to mentors and mentees to identify tailored methods and strategies to promote more broadly throughout Tanzania.

Briefs

Research Study Brief. Strengthening multisectoral nutrition capacities among council officers. December 2017

Knowledge-for-Action Brief. Council multisectoral “action teams” enhance coordination for nutrition activities. July 2019.

Workshop tools

Workshop Report. Learning exchange workshop to promote multisectoral nutrition capacity in councils. 7-8 February 2018.

Workshop Toolkit. Learning exchange workshop to promote multisectoral nutrition capacity in councils. 7-8 February 2018.

Poster presentations

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. Nutrition 2019 (American Society for Nutrition), Baltimore, Maryland. 8-11 June 2019. Click here for the poster.

Dickin KL, Klemm GC, Kayanda R, Kazoba A, McCann J, Frommer M, Lambert V, Martin S, Nnally L. Exploring mentoring as a novel strategy to support implementation of national nutrition policies through multi-sectoral coordination in Tanzania. Qualitative Evaluation (QE) Symposium, Brasilia, Brazil. 9-11 October 2019.

Oral presentation

Kayanda RA, Klemm GC, Kazoba A, McCann J, Nnally LP, Dickin KL. Multi-sectoral “action teams” help district officers implement nutrition policies and strengthen coordination across sectors for nutrition in Tanzania. Federation of African Nutrition Societies (FANUS), Kigali, Rwanda. 26 August 2019. Click here for the slides.

Dissemination in Study Sites

We created sample Regional data profiles on the nutrition situation in each region using DHS data, to provide ideas to Regional Nutrition Officers on how multisectoral action teams can use data to set goals and advocate for nutrition priorities. Click here for the profiles.

We shared preliminary results of key themes with participants and regional and district leaders of participating sites to elicit feedback and recommendations as a way to improve the accuracy and validity of the findings and implications for programs. Click here for the slides.

Phase 4. Implementation research study

We assessed the implementation of ASTUTE program outreach activities and document the acceptability and feasibility of community-level nutrition-specific and nutrition-sensitive interventions. We explored 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 used both quantitative and qualitative methods and conducted this research in two phases. The first phase focused on CHWs’ targeting of households and delivery of home visit messaging, and the second explored household dynamics and program exposure in relation to practice of recommended nutrition behaviors.

Implementation Study Team, Fall 2018

Implementation Study Team, Spring 2019

 

 

 

 

 

 

 

Oral presentation

Owoputi I, Kayanda RA, Bezner Kerr R, Dearden KA, Martin SL, Nnally LP, Dickin KL. He said, she said: Using pile sort methods to explore differences in decision-making and resource allocation for food, agriculture, and other costs among couples in Tanzania. Annual Agriculture, Nutrition and Health (ANH) Academy Week, Hyderabad, India, June 2019.

Research team and collaborators

This research was 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) lead 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).