Effectiveness of Integrated Chicken Production and Nutrition-Sensitive Interventions on Women's Dietary Diversity Outcomes: A Cluster-Randomized Controlled Trial in Rural Ethiopia.

BACKGROUND: Rural Ethiopian women have poor dietary diversity. While nutrition-sensitive agriculture offers an opportunity for improving dietary diversity, evidence on effectiveness for women's nutrition outcomes remains limited. OBJECTIVE: To evaluate the effectiveness of a chicken production intervention, with and without a nutrition behavior change component, on women's dietary diversity in rural Ethiopia. METHODS: We conducted a three-arm, cluster-randomized controlled trial among 2,117 households in 60 villages across four regions of Ethiopia. Villages were randomly allocated to: (1) control receiving standard agricultural extension services; (2) African Chicken Genetic Gains (ACGG), providing 25 improved chickens and production support; or (3) ACGG plus Agriculture to Nutrition (ACGG+ATONU), combining chicken production with nutrition behavior change communication and home gardening. The primary outcome was 1-day Minimum Dietary Diversity for Women (MDD-W) and Household Dietary Diversity Score (HDDS), assessed at baseline, midline (9 months), and endline (18 months). We used generalized linear mixed models accounting for cluster randomization to estimate intervention effects. RESULTS: Among all cases, all three treatment arms showed upward trends in both women's and household dietary diversity. The ACGG+ATONU intervention showed no significant effects on women's dietary diversity outcomes (all P>0.05), but improved household dietary diversity compared with ACGG alone (adjusted mean difference in HDDS: 0.37 food groups; 95% confidence interval (CI): 0.02 to 0.71; P=0.037) and control (adjusted mean difference in HDDS: 0.39 food groups; 95% CI: 0.01 to 0.78; P=0.045). ACGG+ATONU also increased household dietary diversity adequacy versus control (adjusted risk difference: 0.06; 95% CI: 0.01 to 0.11; P=0.047). Mediation analysis revealed three key pathways: increased egg production, enhanced women's empowerment, and improved chicken management practices. CONCLUSIONS: The integrated ACGG+ATONU intervention significantly improved household dietary diversity but not women's individual dietary diversity, whereas chicken production alone (ACGG) showed no significant effects. These findings emphasize that nutrition-sensitive agricultural interventions in low-income settings require integrated behavior change components. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03152227; registered at https://clinicaltrials.gov/study/NCT03152227.