berber kramer - anh academy

Cooking Contests for Healthier Recipes:Impacts on Nutrition Knowledge and Behaviors in Bangladesh

Berber Kramer, International Food Policy Research Institute (IFPRI)

ANH Symposium 2017, July 11-13, Kathmandu

Background

Improving incomes alone is not enough to improve nutrition outcomes

I Per capita income growth rates of 5.5% reduce stunting by 1% pointper year (Headey, 2012)

I Better nutrition will require programs that improve nutrition knowledgeand habits

Many income interventions add low-cost nutrition messaging (information),but studies on whether information can improve diets are rare.

I For IYCF, messaging can have positive effects on dietary outcomes(Dewey and Adu-Afarwuah 2008, Imdad et al. 2011, Lassi et al. 2013)

I Small compared with food fortification (de Brauw et al. 2015) andcampaigns with home visits, livestock transfers etc. (Olney et al. 2015)

Successful programs provide experience, using a mixture of methods toreinforce messages (Sarassat, et al. 2015, Murray, et al. 2015).

I Cooking contests could encourage learning by doing at a low cost

Berber Kramer (IFPRI) Cooking Contests for Healthier Recipes ANH Symposium 2017 2 / 15

Research questions

1 Does nutrition education improve nutrition knowledge and does thistranslate into improved household diets?

2 Do cooking contests, designed to encourage learning by doing, haveadditional impacts on nutrition knowledge?

3 Do cooking contests help translate improvements in nutrition knowledge intobetter household diets?

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Intervention

Partners: Banchte Shekha and GAIN in Trishal, Bangladesh

Targeted 1,080 young women in 45 paras

Data: Baseline and endline for 900 targeted women, and - ifavailable - a non-targeted family member

Targeted women were invited to participate in two events:

1 Nutrition training, providing information on dietary diversity, micronutrientsand the functions they serve, as well as WASH.

I Nutrition knowledge tested at baseline, after training, and at endline.I Participants were assigned to teams.

2 Cooking contests in which teams prepared a recipe that was scored in termsof taste, nutrition and WASH (learn by doing).

I Organized after nutrition training but 2+ weeks before endline.I Organized in 30 randomly selected paras.

Berber Kramer (IFPRI) Cooking Contests for Healthier Recipes ANH Symposium 2017 5 / 15

Intervention

Partners: Banchte Shekha and GAIN in Trishal, Bangladesh

Targeted 1,080 young women in 45 paras

Data: Baseline and endline for 900 targeted women, and - ifavailable - a non-targeted family member

Targeted women were invited to participate in two events:

1 Nutrition training, providing information on dietary diversity, micronutrientsand the functions they serve, as well as WASH.

I Nutrition knowledge tested at baseline, after training, and at endline.I Participants were assigned to teams.

2 Cooking contests in which teams prepared a recipe that was scored in termsof taste, nutrition and WASH (learn by doing).

I Organized after nutrition training but 2+ weeks before endline.I Organized in 30 randomly selected paras.

Berber Kramer (IFPRI) Cooking Contests for Healthier Recipes ANH Symposium 2017 5 / 15

Evaluation methods

1 Nutrition training (information) in all paras: Knowledge gains for targetedvs. non-targeted respondents (quasi-experimental control group)

I Difference-in-difference estimator for effect of nutrition training(Post × Targeted)

2 Cooking contests (experience) in 30 randomly selected paras. Remaining15 paras received nutrition training only (experimental control group).

I ANCOVA estimator: differences in endline outcomes in the contest vs.control group, controlling for baseline levels (Contest)

I Difference-in-difference estimator for effect of cooking contests(Post × Contest)

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Evaluation methods

1 Nutrition training (information) in all paras: Knowledge gains for targetedvs. non-targeted respondents (quasi-experimental control group)

I Difference-in-difference estimator for effect of nutrition training(Post × Targeted)

2 Cooking contests (experience) in 30 randomly selected paras. Remaining15 paras received nutrition training only (experimental control group).

I ANCOVA estimator: differences in endline outcomes in the contest vs.control group, controlling for baseline levels (Contest)

I Difference-in-difference estimator for effect of cooking contests(Post × Contest)

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Measuring nutrition knowledge on tablets

Which of the following foods contains IRON?

Which of the following foods PREVENTS ANEMIA?

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Which of the following foods contains IRON?

Which of the following foods PREVENTS ANEMIA?

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Knowledge scores

Knowledge test included 20 items in total; this presentation will focus on 10items covered in training

Average score: 59.8% (random benchmark: 33%), and faster answers aremore likely to be correct

Salience: Assign faster correct answers a higher weight than slower correctanswers

This time-adjusted score reveals more variation in nutrition knowledge test,allowing us to estimate program effects with increased precision

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RESULTS

Knowledge improves more for targeted than for non-targeted respondents

Note: Coefficients and 95% confidence intervals from a linear regression with household fixed effects, controlling for respondent

characteristics, enumerator effects and re-test effects.

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Cooking contests improve knowledge sharing but not knowledge

Note: Coefficients and 95% confidence intervals from regressions estimating the effect of cooking contests using an ANCOVA

and difference-in-difference estimator.

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No effects of cooking contests on dietary outcomes

Note: Coefficients and 95% confidence intervals from linear regressions with household fixed effects, controlling for enumerator

effects and survey wave.

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Knowledge sharing, not knowledge itself, translates into better diets

Note: Coefficients and 95% confidence intervals from linear regressions with household fixed effects, controlling for enumerator,

post, postXcontest, WASH score, empowerment score.

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Conclusion

To make income-enhancing programs more nutrition sensitive, we oftenconsider adding low-cost nutrition messaging

We find that providing information improves nutrition knowledge, but thisdoes not translate into improved diets

Reinforcing the training through cooking contests improves sharing ofknowledge, but not knowledge or diets

As stand-alone intervention, messaging appears penny-wise, pound-foolish -raising questions around impacts within broader programs

More intensive programs that foster knowledge sharing - potentially withininterventions along agricultural value chain - may have stronger impacts

Perhaps not the nutrition messaging, but the provision of resources, accessto foods and social networks are driving impacts in other evaluations.

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Thank you!

Questions? b.kramer@cgiar.org

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