The process of developing a nutrition sensitive agriculture intervention a multi site experience

The process of developing a nutrition sensitive agriculture intervention a multi site experience tài liệu, giáo án, bài...

Food Sec DOI 10.1007/s12571-016-0625-3 ORIGINAL PAPER The process of developing a nutrition-sensitive agriculture intervention: a multi-site experience Peter R Berti & Rachelle E Desrochers & Hoi Pham Van & An Lê Văn & Tung Duc Ngo & Ky Hoang The & Nga Le Thi & Prasit Wangpakapattanawong 5,6 Received: September 2015 / Accepted: 10 October 2016 # Springer Science+Business Media Dordrecht and International Society for Plant Pathology 2016 Abstract Nutrition-sensitive agriculture (NSA) interventions are of increasing interest to those working in global health and nutrition However NSA is a broad concept, and there are numerous candidate NSA interventions that could be implemented in any given setting While most agriculture interventions can be made Bnutrition-sensitive^, there are few guidelines for helping to decide what agriculture component should be tried in an NSA intervention Based on previous models, we developed a framework with explicit questions about community factors (agricultural production, diets, power and gender), project Electronic supplementary material The online version of this article (doi:10.1007/s12571-016-0625-3) contains supplementary material, which is available to authorized users * Prasit Wangpakapattanawong prasitwang@yahoo.com HealthBridge, 1004-One Nicholas Street, Ottawa, Canada Center for Agricultural Research and Ecological Studies, Vietnam National University of Agriculture, Hanoi, Vietnam Hue University of Agriculture and Forestry, 102 Phung Hung, Hue, Vietnam HealthBridge, Suite 202 & 203, E4 Building, Diplomatic Compound, No Dang Van Ngu Str., Dong Da Dist, Hanoi, Vietnam Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand World Agroforestry Centre (ICRAF) c/o Knowledge Support Center for the Greater Mekong Sub-region (KSC-GMS), Faculty of Social Sciences, Chiang Mai University, P.O Box 267, CMU Post Office, Chiang Mai 50202, Thailand factors (team capacity, budget, timelines) and external factors that helped our team of agriculture scientists, nutritionists and local officials identify NSA interventions that may be feasibly implemented with a reasonable chance of having positive agricultural and nutritional impacts We applied this framework to two settings in upland Vietnam, and one setting in upland Thailand From an initial list of nineteen interventions that have been tried elsewhere, or may reasonably be expected to be appropriate for NSA, five or six candidate interventions were chosen per site Based on the criteria, three to four interventions were selected per site and are being implemented Poultry rearing and home gardening were selected in each site They and the other selected interventions, hold promise for capitalizing on underused agricultural potential to improve diets, while working with (or improving) existing gender relationships and power structures The process for identifying NSA interventions was thorough and identified reasonable candidates, but it was very time consuming Further efforts should focus on streamlining the process, so that promising and appropriate NSA interventions can be identified quickly and reliably Keywords Nutrition-sensitive agriculture Vietnam Thailand Food security Introduction The potential and real contributions of agriculture to the health and nutrition of low and middle income country farmers is of increasing interest to development donors, practitioners and researchers through Berti P.R et al what has been termed Bnutrition-sensitive agriculture^ (NSA) Instead of considering agriculture solely as an economic activity, NSA is concerned with the broad relationship between food production and the health of the farmer and the farm family Their relationship may be expressed in terms of pathways that lead from agriculture to improved nutrition (Herforth and Harris 2014; Headey et al 2011; Kadiyala et al 2014) These include: a household’s own crop and animal production to consumption of its own produced food; increased household income (through increased production or beneficial agricultural policies) allowing increased purchasing of food and/or health care; adjustment of women’s workload to allow for improved child care and/or maternal nutritional status; and improved women’s status and ability to control allocation of resources for food, health and care These relationships are theoretical and the amount of supporting evidence for each pathway is variable but generally limited There were eight reviews of the impact of agriculture interventions on nutrition outcomes carried out between 2001 and 2013, summarized in Webb and Kennedy (2014), but these reviews included only as few as 13 and at most 52 separate studies, and collectively they drew on about 100 separate studies This is a small number of studies from which to draw globally applicable lessons The studies cover different agricultural foci in various climatic, topographic and geopolitical environments, with various ethnic groups and covering different age groups All the reviews conclude that more research is needed to better understand the relationship between agricultural interventions and nutrition and to be able to design NSA interventions with a high probability of having a positive health outcome Fortunately, much more research is ongoing now – a recent review of the research landscape indicated that there were 151 ongoing NSA studies (Turner et al 2013), and probably many more that were not captured in that review With all this interest, it is worthwhile considering how to select a specific NSA intervention to implement in a given situation Guidelines from the FAO direct the user on aspects of situation appraisal to plan NSA, to define program objectives, to select target groups, to choose interventions and implementation modalities (FAO 2015) The focus here is on the development of a framework specifically for choosing which NSA(s) to trial In our case, this meant choosing an agriculture intervention that the agriculture scientists (HPV, ALV, PW, plus other local team members) thought may be successful from a production point of view, and the nutritionists (PRB, NLT, plus other local team members) thought could be made Bnutrition-sensitive^ and have a positive impact on nutrition outcomes The authors represent teams from agriculture departments in two Vietnamese universities, and a biology department in a Thai university, as well as scientists from a health-focused international NGO Funding from the International Development Research Centre (IDRC), Canada from March 2013 to February 2016 supported carrying out research on NSA interventions in three research sites (one for each of the university teams), but the specifics of the interventions were not pre-defined A preliminary step for the research teams was to decide which intervention, or interventions, should be trialled at each site The Vietnamese and Thai research teams did not have prior experience with explicit NSA interventions and some care was needed to select appropriate interventions to implement at these sites The purpose of the paper is to describe our methods of determining suitable NSAs to test, and suggest ways forward for other researchers and programme designers in a similar situation Based on previous models, we developed a framework with explicit questions about community factors (agricultural production, diets, local power structure and gender), project factors (team capacity, budget, timelines) and external factors that helped our team of agriculture scientists, nutritionists and local officials identify NSA interventions that may feasibly be implemented with a reasonable chance of having positive agricultural and nutritional impacts Note that we did not carry out a comprehensive needs assessment to identify the single best strategy for poverty alleviation or health improvement – perhaps a water and sanitation intervention, or a maternal health services intervention would have a greater impact Rather, our research mandate was to identify and test NSA interventions and monitor the nutrition impact of the intervention, accepting that while there are risks in NSA interventions (Dury et al 2015), they can have positive health benefits when well done (Berti et al 2004; Webb and Kennedy 2014) Study setting Malnutrition (General Statistical Office of Vietnam 2011; National Statistical Office of Thailand 2013) and food security remain serious problems in both Vietnam (as determined using household food insecurity access score (Humphries et al 2015) or whether households produce enough staple crop (FAO 2004) and Thailand as determined by access to adequate resources (Isvilanonda and Bunyasiri 2009), particularly amongst ethnic minorities living in remote, upland areas (Government of Vietnam Socialist Republic 2005; Limnirankul et al 2015) The national prevalence of underweight and stunting is 11.7 % and 22.7 %, The process of developing a nutrition-sensitive agriculture Map The three study sites, Mae Chaem, Yen Chau, and A Luoi are shown in orange on the right hand panel respectively, in Vietnam and 9.2 % and 16.3 %, respectively, in Thailand Rates in both countries are higher in the poverty-stricken highland-minority communities (General Statistical Office of Vietnam 2011; National Statistical Office of Thailand 2013) The current study was carried out in three locations: Mae Chaem district of Chiang Mai province in northern Thailand (with Lua and Karen ethnic groups), district of Hue province in central Vietnam (with Cotu, Taoi, Paco, Van Kieu and Kinh ethnic groups), and Yen Chau district of Son La province in north Vietnam (with Kinh, Thai, Kho Mu, and H’mong ethnic groups) (see Map 1) Specific villages were selected based on accessibility by the research team, perceived potential for change, and representativeness of major ethnic groups The three sites have broadly similar climates, with temperatures hitting lows of 15 to 20 °C in December and highs of 25 to 35 °C in May through July, and the rainfalls ranging from close to mm in December to as much as 250 to 300 mm in August in Yen Chau and Mae C h a e m , o r 0 m m i n A L u o i i n O c t o b e r Agriculture practiced in these communities is predominantly subsistence agriculture (or semi-subsistence in the case of Yen Chau district in northern Vietnam with 60 % of farmers producing their own rice and nearly all producing their own vegetables) There is a need in all three locations to identify longterm, sustainable solutions to increase local food availability in these vulnerable areas With existing high rates of malnutrition, their food security is threatened further by transitions taking place in the local farming systems Traditionally, farmers in highland areas (more than 600 m above sea level) have practiced Bshifting agriculture^, also known as swidden or slash-and-burn agriculture The burning of the trees by farmers provides a nutrient-rich layer of ash that allows for a season or two of high levels of crop production Farmers would then move to new areas to repeat the cycle, while the burnt area was left to regenerate (Rambo and Cuc 1996; Wangpakapattanawonga et al 2010) There is now intense pressure to transition away from shifting agriculture in both Vietnam (where it is now illegal) and northern Thailand as alternative methods of farming are now being sought because there is insufficient land for the number of people farming to leave land fallow long enough to regenerate (Sikor and Nguyen 2011; Thomas et al 2004) There is tension between farmers’ needs for high levels of production in the short term, which makes increasing levels of agriculture inputs (especially synthetic pesticides and fertilizers) attractive to the farmers, and the longer term degradation of the environment caused by this industrialization of agriculture (Dung et al 2008; Tuan et al 2014) Methods Development of framework to guide selecting NSA We developed a framework for assessing the Community, Project, and External factors listed in the introduction In order to develop the framework, we drew on existing descriptions of the pathways between agriculture and nutrition (Headey et al 2011; Herforth and Harris 2014), and drew on our experience in previous community development projects, nutrition research, agriculture research, and integrated nutrition-agriculture research projects This led to the framework in Box 1, which consists of a series of questions for assessing the Community, Project, and External factors Berti P.R et al Box Factors taken into consideration when deciding on the nature of nutrition-sensitive agriculture interventions In choosing the NSA interventions, guided by the framework in Box 1, the user can then select from a list of potential interventions that have been shown in other settings to be successful at improving nutrition outcomes, or that could be reasoned to potentially improve nutrition A list of interventions the authors considered is shown in Table Application of the framework to guide selecting NSA Given budget and timing limitations, the site PIs (HPV, ALV, PW) estimated they could test, at most, four interventions per site In other words, they had sufficient time and resources to introduce four distinct NSAs to participating communities, provide adequate training and requisite materials for the families to start the intervention, and allow it to continue for at least one growing season The application of the framework, therefore, helped to reduce the candidate interventions from the 19 listed in Table to only four To collect the information required to answer the questions in Box 1, we used qualitative and quantitative methods to conduct a situational assessment characterizing the nutritional situation, local farming practices and the relationships between food production, availability and consumption, as well as the conditioning factors (e.g gender dynamics, market infrastructure, natural resources, including local wild foods) that promote (or impede) healthy diets Questions regarding Community Factors were answered through formative research involving household surveys, in-depth interviews and focus group discussions targeting different ethnic groups at the study sites External Factors were assessed through key informant interviews with district and sub-district/commune officials The project teams answered the questions about Project Factors The process of developing a nutrition-sensitive agriculture Table Agriculture interventions we considered for testing in integrated NSA interventions Animal-source food production Horticulture and consumption Large animal husbandry – for meat and milk Small animal husbandry – for meat Poultry rearing – for meat and eggs Fish farming Insect farming Field crops Rice (System of Rice Intensification, known as SRI) Legumes and intercropping Infrastructure Improved irrigation system Fish pond improvement Fruit trees (various types) teleconferencing, to all the authors The authors questioned the site leaders and asked them to defend their decisions, and when all the questions were satisfactorily addressed, the decisions on the NSA selections were endorsed Research ethics review Home gardening of various vegetables Home gardening of pumpkins School gardens of various vegetables Perennial vegetables Market development Local markets for fruit, vegetables, meat and eggs, and preserved foods Export markets Behaviour Time management changes to reduce women’s workload Nutrition promotion and education aimed at breastfeeding practices, complementary feeding, young child feeding, diet of pregnant and breastfeeding women, or diet of whole family Sloping land protection Data were collected during October 2013 and January 2014 Specifically: (a) In household surveys: parents or caregivers of children under years old were randomly selected to be interviewed using a standardized questionnaire; (b) Individuals from surveyed households were purposively sampled to take part in in-depth interviews to more fully characterize agricultural production and opportunities at the household level; (c) Focus group discussions were held with men and women who had children under years; (d) Key informant interviews were conducted with commune/sub-district leaders, agriculture staff, healthcare staff and school nurses and with district agriculture and health officials The focus of this paper is not the data gathering process and quantitative results, but rather how the results were interpreted and used, with respect to Box Therefore, details of the methods and the survey results are in the Supplementary Materials section The leaders of each of the three research sites used the results of the data collection to answer the questions in Box and to guide their preliminary selection of the NSAs to be trialled Their results and preliminary NSA selections were presented to local partners, and then, through The research was approved by the Ethical Review Board for Biomedical Research, Hanoi School of Public Health, and Human Experimentation Committee Research Institute for Health Sciences, Chiang Mai University Permission was also granted by the community via the local community leaders Before conducting the interviews, the purpose of the data collection was explained to the respondents, the confidentiality of their responses was assured, and their informed and voluntary consent was sought Agreement to participate was granted orally (in Vietnam) or in writing (in Thailand) Results Development of framework to guide selecting NSA Through a series of team meetings and discussions, the authors developed and refined the questions, leading to the framework shown in Box 1, including, as planned, questions related to community factors, project factors and external factors In the development of the framework we recognized that the process would work best if we split the process into two steps (1) Characterized the site in terms of agricultural production, and food and nutrition to identify basic needs and potentials, and considered project factors that would present limits or provide opportunities at each site Then the observations and interpretations would suggest a number of candidate interventions drawing from the options in Table (2) Assess the suitability of each of the candidate interventions according to the various Community, Project, and External factors laid out in Box Application of the framework to guide selecting NSA The first step of characterizing agricultural production, food and nutrition, and considering project factors suggested a number of possible interventions for each site (Box 2a, b and c) Five or six NSA interventions were considered in detail for each site, with 11 different interventions considered across the three sites For A Luoi, the site team chose the candidate interventions Poultry, Fishponds, Home gardens, Beans and inter-cropping, and Infant and child feeding For Yen Chau, they selected the candidate interventions Poultry, Pumpkins, Home gardens, Rice, School gardens, and Sloping land crop diversification For Mae Chaem, the site team chose the candidate interventions Poultry, Food preservation, Home gardening, Infant and child feeding, and Improving water Berti P.R et al systems In all cases, the candidate interventions were selected because the local teams saw that they could meet the Box 2a Characteristics of A Luoi, in relation to Box production and nutrition needs within the time and resource constraints of the project The process of developing a nutrition-sensitive agriculture Box 2b Characteristics of Yen Chau, in relation to Box Berti P.R et al Box 2c Characteristics of Mae Chaem, in relation to Box The process of developing a nutrition-sensitive agriculture Box 3a Evaluation of candidate interventions in A Luoi district Berti P.R et al Box 3b Evaluation of candidate interventions in Yen Chau The process of developing a nutrition-sensitive agriculture Box 3c Evaluation of candidate interventions in Mae Chaem Berti P.R et al The site teams then assessed the suitability of each of the candidate interventions according to various social, project, and external factors from Box There was marked heterogeneity within and between sites regarding current cropping and animal husbandry practices, decision-making about farming and feeding, food security, and dietary practices All three sites had the same time constraints to carrying out the interventions (about 18 months, due to funding deadlines), which limited potential interventions to annual crops or small animals, and precluded working on major infrastructure or legislative changes or market development In some cases the implications of the answers were clear cut and easily applicable For example, in A Luoi, poultry were regarded favourably because women would be involved in the raising of the poultry and be able to feed eggs to their children In other cases, the implications were less clear For example, increased income through agricultural production and market access for farmers are two of the pathways through which farming households can improve diet and health (Herforth and Harris 2014) However, the site teams (the scientists and local officials) felt that increasing emphasis on the markets would move farmers from food crops to non-food crops, which provide variable and uncertain returns, and thus threaten local food security Local officials report that growing non-food crops for market (rubber, acacia, cassava, and maize for cattle) have increased cash incomes but not improved household diets Market development was therefore eliminated from consideration at the current time, but if production were to increase and households became more food secure, improving market access may be an appropriate next step to helping farmers move out of poverty The selection of three or four of the candidate interventions, and rejection of other interventions, varied by site, based on contextual factors While all the interventions were thought by the site teams and the international teams to have the potential to be successful, some of them were perceived to be more promising candidates, and given the self-imposed maximum of four interventions to test per site, less promising interventions were discarded: For A Luoi, fish ponds would likely result in increased work load for women, and were rejected largely for this reason Similarly, the bean intervention would require a great deal of extra work and, if women were involved, it would take them away from childcare Thus in A Luoi, the team chose small scale poultry rearing and home gardening, as well as training on infant and child feeding, which would all be expected to lead to improved diets without compromising child care For Yen Chau, there were no clear reasons to reject any of the candidates Having to narrow the candidates down, it was reasoned that some pumpkin cultivation could be incorporated within home gardening, and the school was thought to be a less promising site for gardening than the home Rice intensification was selected, anticipating that it would be popular with farmers and local officials, and knowing that while men would most of the work, women usually control the sale of the surplus and could be anticipated to use the proceeds for the family Increasing production on sloping land was also selected, as it was expected to be carried out by the men while providing increased nutritious foods from underused lands Poultry rearing would require some work by women, but would have minimal impact on childcare since it would be close to home, while producing nutrient-rich food For Mae Chaem, there was some consideration of working on improving water systems While desirable, it would probably stretch the timelines and budget of the project Food preservation may be a good intervention, but it was rejected as it was deemed to have less potential for positive impact on health and food security and it was decided that it would be better to focus on food production (poultry and home gardening) and infant and child feeding practices These assessments were made by the local teams and, after presentation to the entire international team through teleconferences, the decisions were endorsed by all the team members In summary, four of the selected interventions involved annual vegetables or legumes (Home gardens in all three sites, and Improved bean production) All three sites included poultry rearing Two of the three sites also decided to include training on infant and child feeding, although this is perhaps not strictly a separate NSA intervention The two other selected interventions included one conventional agriculture intervention involving staple crops (Rice intensification, focusing on utilization of young seedlings, lowering planting density and fewer plants), and one unconventional intervention, focusing on diversification into perennial vegetable and fruit crops on underused sloping lands Most of the interventions fit within existing gender roles, and no need was felt to try and change these roles The exception was childcare and feeding, where the sites would work to increase male involvement in order to reduce maternal workloads In all cases, in all the research sites, following selection of the intervention from the team, the suggested interventions were presented to local officials and participating households, and endorsement of the selected NSA interventions was obtained with no further modifications Discussion In this paper, we describe the process of using a framework to select NSA interventions to implement The framework presented here may be most useful to others as a supplement to The process of developing a nutrition-sensitive agriculture existing FAO guidelines (FAO 2015), which provide overall guidance on the entire NSA program cycle, whereas our framework focuses almost exclusively on choosing which agricultural intervention should be trialed Other frameworks use a Bpathways^ approach, identifying the three pathways from which agriculture can contribute to improved nutrition outcomes (Food Production, Agricultural Income, and Women’s Empowerment pathways (Herforth and Harris 2014)) and then seek to move participants along one or more of the pathways Following our framework, we examined community needs and potential and then considered various possible barriers and enablers for realizing the potential One novel barrier/enabler that we considered, albeit briefly, was Bpower^ - considering the nature of local power structures and whether they would be supportive of the intervention – a factor that is often overlooked in development planning (Green 2012) There is no gold standard for assessing whether the framework Bworked^ Perhaps at the end of the project, if the selected NSAs have been shown to be successful (feasible, favoured by the farmers, and with positive dietary impacts), then we may conclude that the framework did not steer us in a wrong direction However, there were two key weaknesses to be considered Some of the intervention selections were made following in-depth, multi-layered discussions among the research team, local officials and community members While the discussions were in part prompted by working through the framework, the discussions are not easily summarized, they would be difficult to replicate, and we are not able to provide guidelines on how to carry out these discussion For example, there is nothing in Box 3b that would lead an outside observer to choose home gardens over pumpkin cultivation, yet this was the result of detailed discussions Pumpkins are commonly grown, often intercropped with maize They are mainly used as animal feed and are not included in the families’ diets In Yen Chau fewer than 20 % of children ate Vitamin A-rich foods in the previous 24 h and so increased consumption of pumpkins would provide a beneficial increase in vitamin A intake The Yen Chau research team included an agronomist, sociologist, and nutritionist and they discussed training local households in pumpkin processing (e.g., powder, jam, syrup, etc.) with local agricultural and nutrition officials as a means to increase pumpkin consumption However, this would be new to the farmers and there would be numerous constraints such as the time required for pumpkin processing, additional ingredients for pumpkin processing that were not available locally, lack of infrastructure for processing and storing pumpkins Considering all of this, the team decided not to work on pumpkin production and processing Other possible interventions were never even considered, as they were eliminated for what are obvious reasons for locals An example of this is insect farming, which would not be accepted by the farmers in Vietnam Similar nuanced discussions were held around every candidate intervention Such supplementary knowledge, not captured in the framework, is an important part of the overall process Another aspect of the nuanced discussions involved in the decision-making and not adequately captured is explicit weighting to account for the varying potential for nutritional impact of different interventions For example, there is increasing evidence of the positive nutritional impact of animal-source food interventions (e.g., (Hoddinott et al 2015; L Iannotti et al 2013; L L Iannotti et al 2014), and the biology behind the impact is self-evident, as animal-source foods are nutrient-dense with small amounts providing large proportions of requirements (Murphy and Allen 2003) On the other hand, cereal-based interventions have much less evidence supporting their effectiveness (Arimond et al 2011) This weighting is included in the decision-making, but not captured in the framework It took many months and hundreds of person-hours of work to use the framework Given the relatively short time available to carry out the project, the NSAs had to be selected before the evaluation presented here was fully completed Frameworks with a lighter burden would be more easily implemented The NSAs selected through this evaluation may not be different from those that would be selected with a much lighter and less formal approach We thus see a continuum of methods for choosing NSAs a On the intense end of the continuum, programmes would collect and analyse at least as much data as we collected and summarized (see Supplementary Materials), if not more The process could begin even further upstream with a full community health assessment and livelihoods analysis, if the programmers were not pre-committed to working on NSAs and had a year or more for planning and assessment b At the lighter end of the continuum, a one-hour meeting of a small team of agronomists, nutritionists and health workers familiar with the setting could select a few candidate interventions A community participatory workshop would narrow the list down further, Berti P.R et al filtering out culturally or otherwise inappropriate interventions For example, poultry rearing and home gardening are existing, appreciated practices with increasing evidence supporting their effectiveness in addressing malnutrition In our current research sites, we could have quickly settled on poultry and home gardening with meetings lasting only a few hours The very best interventions may not necessarily have been identified but we could be reasonably confident that they would, at worst, be useful Whether practitioners tend towards the heavy or light end of the continuum will depend on their familiarity with local needs, possibilities and culture, and resources available for their assessment A third weakness, not specific to the framework, but to NSAs in general, is that from the outset, our intention was to identify and test NSA interventions, without first evaluating the need for improved food production and diet in the study communities relative to other possible areas of intervention While we had no doubt that production and diet could be improved, there were and are certainly other needs in the communities, and they may be of higher priority to the community members We acknowledge this overall weakness, while also recognizing this is generally how development research takes place – agriculture scientists conduct agriculture research, nutrition scientists conduct nutrition research, health services scientists conduct health services research, and so on, without first fully appreciating community needs and priorities Despite these weaknesses, there is value in laying out the specific strengths and weaknesses of candidate interventions, and being intentional in NSA selection Some of the factors, such as potential impact on breastfeeding, are not often considered by agronomists Seasonality and gender roles in food production are not often considered by health workers Power (within households, within communities, and at a higher level) is not regularly considered in development programs of any kind Explicitly enumerating the various strengths and weaknesses of candidate interventions, as is done through the application of Box 1, helps the agriculture and health fields communicate, understand one another, and appreciate the importance of integration for effective nutrition-sensitive agriculture NSA interventions are of increasing interest to those working in global health and nutrition and the guidelines developed and tested here can help implementers to decide what agriculture component may be feasibly implemented with a reasonable chance of having positive agricultural and nutritional impacts Acknowledgments The research was carried out with the aid of a grant from the International Development Research Centre, Ottawa, Canada We acknowledge the contributions of: Lisa Macdonald (HealthBridge) in managing the project: the Thai team, including Palika Champrasert, Surachet Jina Keaw, Tanawit Wongsur, Natjan Chairat, and Anantika Ratnamhin of ICRAF Thailand Office, and Sakda Pruenglampoo, and Posri Leelapat of Research Institute for Health Sciences, Chiang Mai University; the collaboration of researchers of the Center for Agriculture, Forestry Research and Development of Hue University of Agriculture and Forestry The paper benefitted greatly from reviews from the Senior Editor and two anonymous reviews Compliance with ethical standards Conflict of interest statement All authors declare that there are no conflicts of interest References Arimond, M., Hawkes, C., Ruel, M., Sifri, Z., Berti, P., LeRoy, J., et al (2011) Agricultural interventions and nutrition: lessons from the past and new evidence In B Thompson & L Amoroso (Eds.), Combating micronutrient deficiencies: food-based approaches (pp 41–75) Rome: Food and Agriculture Organization/CABI International Berti, P R., Krasevec, J., & FitzGerald, S (2004) A review of the effectiveness of agriculture interventions in improving nutrition 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has experience in many field surveys employing direct data capture, having provided technical support for several large-scale household surveys; and has collaborated on operational research for the malaria program in Togo She also provides support for research within the context of HealthBridge’s Livable Cities program in Asia Pham Van Hoi is a lecturer on agroecology and environmental sciences at Vietnam National University of Agriculture He completed his PhD on Environmental Sociology at Wa g e n i n g e n U R , t h e Netherlands in 2010 He has been co-PI and researcher in a number of international projects on sustainable agricultural and rural sociology His publications focus on environmental governance practices in the agricultural sector in Vietnam Berti P.R et al Lê Văn An Prof An finished a BSc degree in animal production from Agricultural University No.2, Ha Bac, Vietnam, in 1983 and a MSc degree in livestock production system from the Swedish Un iversity of Agriculture Sciences in 1999 He finished his PhD degree in animal science at the same University in 2004 and is now the Rector of Hue University of Agriculture and Forestry Agric Ngo Tung Duc Mr Ngo Tung Duc finished his Ph.D degree in natural resource management from Kyoto University, Japan in 2011, MSc degree in agricultural systems from Chiang Mai University, Thailand in 2005, and BSc degree in forestry from Hue University of A g r i c u l t u r e a n d F o r e s t r y, Vietnam in 1998 He has vast experience in natural resource management and livelihood of local people in upland areas, as well as social forestry He is now the Head of the Post-graduate Training Department, Hue University of Agriculture and Forestry Hoang The Ky is working at HealthBridge Vietnam (HBV) on the Nutrition and Food Security project (or From Field to Fork project) in the highlands of Vietnam and Thailand He is responsible for assisting the Research Coordinator with implementation of the project In particular, he is responsible for coordinating project training and workshops, leading nutrition training, and providing nutrition technical support to project partners He coordinates and follows up on the progress of project implementation Besides, he is working on a nutrition initiative through cooperative research between HealthBridge and Bioversity International under the CGIAR Research Program on Humid Tropics to assess the potential of diverse local foods and improve diet quality and diversity, especially for women of reproductive age and for children between 23 and 12 months in Vietnam Ky graduated from Hanoi School of Public Health (HSPH) with a Masters degree in June 2012 From July 2008 - May 2013, he worked for World Vision International in Vietnam in technical support for health and nutrition In this period, he successfully conducted models of nutrition (such as: PD/ HEARTH; nutrition clubs, green vegetable garden…) for minority groups (H’mong, Thai, Muong …) in Northern provinces (Hoa Binh, Dien Bien…) From August 2010 to August 2011, he worked for CHILILAB of HSPH, a research centre for public health and population in the Hanoi office as a researcher and field coordinator Nga Le Thi Dr Le Thi Nga, a medical doctor with more than 20 years’ experience in public health and research, is Deputy Country Director at HealthBridge Vietnam Before joining HBV, Dr Le worked at various organizations, including PAT H / U S , P a t h f i n d e r International, Vietnam-Australia Malaria Control Project, Save the Children/US, and the National Institute of Nutrition Her experience is in operational research, TB prevention, reproductive health, maternal and child health, immunizations, nutrition, malaria, HIV/AIDS, public-private partnerships and health systems strengthening Dr Le’s expertise is in operational research and epidemiology; program design, public-private partnership, management; training and capacity building; information, education and communication (IEC), and monitoring and evaluation (M&E) Dr Le was granted the Master Degree of International Research Bioethics by Monash University, Australia; Master Degree of Public Health by the University of Queensland, Australia; and Medical Doctor by the Hanoi Medical University Dr Wangpakapattanawong’s research interest is forest ecology He graduated with a Ph.D in Forest Sciences from the University of British Columbia (UBC) in 2001 While his B.Sc in Biology is from C h i a n g M a i U n i v e r s i t y, Thailand, where he has been working since finishing his UBC degree, and his M.Sc in Botany is from Iowa State University, USA At CMU, he teaches ecology and biodiversity for undergraduate and graduate students in Biology, Environmental Science, and Biodiversity and Ethnobiology He began his research career with research on tropical forest restoration (http://www forru.org) Having been working for more than 12 years at CMU as an assistant professor, his research interests have broadened to include several topics that relate to forest ecology, for example, carbon sequestration in forest restoration, ecology of figs, and ethnoecology In addition, he also works as a part-time visiting scientist/country representative of the Thailand Office of World Agroforestry Center (ICRAF) overseeing research projects on land tenure, land-use changes, and agricultural-system management and human nutrition  ... Chairat, and Anantika Ratnamhin of ICRAF Thailand Office, and Sakda Pruenglampoo, and Posri Leelapat of Research Institute for Health Sciences, Chiang Mai University; the collaboration of researchers... Ottawa, Canada We acknowledge the contributions of: Lisa Macdonald (HealthBridge) in managing the project: the Thai team, including Palika Champrasert, Surachet Jina Keaw, Tanawit Wongsur, Natjan... commune/sub-district leaders, agriculture staff, healthcare staff and school nurses and with district agriculture and health officials The focus of this paper is not the data gathering process and quantitative