Targeted gender equality approach to improving childhood nutritional status in Cross River State, Nigeria: a community-based quasi-experimental study.

INTRODUCTION: Childhood undernutrition remains a critical public health problem globally, with the highest prevalence concentrated in rural, resource-constrained settings across sub-Saharan Africa. Gendered asymmetries in food access, resource control, and household decision-making substantially exacerbate nutritional disparities. This study assessed the effectiveness of a targeted gender equality intervention, delivered over a 16-week (approximately 4-month) period, on dietary diversity and nutritional outcomes in children under 5 years in Cross River State, Nigeria. METHODS: A community-based quasi-experimental study with a pre-test/post-test control group design was conducted, enrolling 200 child-caregiver pairs allocated equally to intervention and control groups drawn from two purposively selected, socio-demographically comparable Local Government Areas (LGAs). The intervention comprised nutrition education, women's empowerment sessions, and structured male partner engagement. Baseline and end-line (16-week) data on child anthropometry and minimum dietary diversity (MDD) were analyzed using independent t-tests, Chi-square tests, and analysis of covariance (ANCOVA) adjusting for baseline scores, child age, and household size. RESULTS: Stunting prevalence was approximately 36% in both groups at baseline. Over the 16-week study period, ANCOVA-adjusted marginal means at end-line revealed significantly greater improvements in the intervention group for height-for-age z-scores (HAZ: -0.89 vs. -1.51; F = 10.05, p = 0.002), weight-for-age z-scores (WAZ: 0.53 vs. 0.21; F = 12.6, p = 0.001), and MDD (4.19 vs. 3.06; F = 79.6, p < 0.001). Stunting prevalence fell from 36.5% to 23.5% in the intervention group over the study period, whilst rising from 34.2% to 50.6% in the control group. The proportion of children achieving adequate MDD increased from 41.2% to 78.8% in the intervention group across the 16 weeks, compared with 45.6% to 49.4% in the control group. CONCLUSION: A 16-week gender-transformative nutrition education and empowerment strategy significantly improved dietary diversity and anthropometric outcomes in children under 5 years. Integration of such approaches into national nutrition policy frameworks is warranted, with particular relevance to advancing Sustainable Development Goal targets on zero hunger, child health, and gender equality.