1.     Agriculture to Nutrition (ATONU) - Exploring Poultry-WASH-Nutrition Pathways in Ethiopia through Multiple Methodologies
July 10, 2017
Kathmandu, Nepal

2. Our Team Harvard T. H. Chan School of Public Health: Wafaie Fawzi
Ramya Ambikapathi*
Chelsey Canavan
Nilupa Gunaratna*
Isabel Madzorera
Ramadhani Noor
Simone Passarelli*
Food, Agriculture and Natural Resources Policy Analysis Network (FANRPAN):
Simbarashe Sibanda
Tshilidzi Madzivhandila
Bertha Munthali
Lindiwe Majele Sibanda
Addis Continental Institute of Public Health
Yemane Berhane
Semira Abdelmenan
Amare Worku

3. Overview
There has been conflicting evidence about the role of poultry in child growth
While some evidence shows positive associations between poultry ownership and growth, others show negative consequences of having chickens corralled in houses and the presence of animal feces (Headey & Hirvonen, 2016; Headey et al., 2017)
We are investigating the relationships between poultry and WASH practices and child nutrition and health outcomes using both quantitative and qualitative methods
Photo credit: Top-ILRI\Zerihun Sewunet; Bottom ILRI\Collins

4. Conceptual Framework Potential effect modifier Dietary diversity
Chicken management practices (corralling, sleeping in)
Exposure to contamination
Subclinical/clinical infection (inflammation, diarrhea, cough)
Maternal involvement in poultry care
Chicken Production
Nutritional status (growth, anemia)
Water and sanitation infrastructure; hygiene practices
Child involvement in poultry care
Demonstrates our line of thinking: we are evaluating potential positive impacts of ATONU, including increased intake of chicken meat and eggs, but also want to investigate whether there could also be negative consequences for nutrition through increased exposure to contamination vectors for infection, and what kind of chicken management practices (corralling, keeping chickens out of sleeping rooms) might alter these effects
IYCF practices
Potential effect modifier

5. Our Approach Research Questions Goals Methods
-How do children (6- 36 months), caregivers (men and women), and chickens interact? What are the roles of men and women caregivers?
-Does exposure to contamination from chickens hinder the potential for positive nutritional impacts?
Goals
-Describe empirically the relationship between food intake, contamination and child nutritional status
-Develop a conceptual framework to explain food intake, poultry interactions, and nutritional status
Methods
-Regression analysis of poultry and WASH indicators -Direct household observations
-Semi-structured interviews with men and women caregivers -Focus group discussions with men and women

6. Baseline WASH Characteristics
Indicator
% Households
Compound appearance is clean
50%
Child's hands are clean
81%
Woman's hands are clean
63%
Has improved water facility
84%
Has improved sanitation facility
30%
Has a handwashing station with soap
12%
Here is an example of some of the poultry and wash indicators we are looking to to evaluate poultry-wash-nutrition relationships
Compound/child/woman clean – general appearance (subjective, but standardized among data collectors during training) -> Alive and Thrive Bangladesh questionnaire
For hands, clean is neither dirty nor dusty
n=2117

7. Baseline Poultry Characteristics
Indicator
Mean / %
Has a poultry corral
78%
Poultry housing adjacent/connected to sleeping room
32%
Chickens slept in house last night
36%
Poultry entered the house yesterday
69%
Chickens observed immediately around house/compound
72%
Animal feces observed around house/compound
64%
n=2117

8. Households with more chickens: More corralling and less sleeping in homes
As the number of chickens owned increases, households are more likely to have a corral, and increasingly more likely to have an enclosed corral
Although households with more chickens are more likely to have chickens enter their houses, they are less likely to have them sleep in the house

9. Corralling and Poultry-related WASH
Only for acgg villages
Corralling reduced the risk of chickens sleeping in the house at night, of observing animal feces, of entering the house. On average, those with enclosed corrals have about 3 more chickens (12.4 vs. 9.5)
Derek Headey and Kalle Hirvonen– poultry sleeping in inversely assoc with child growth in Ethiopia (2016 PLoS)
n=1231

10. Poultry corrals are not associated with reduced roaming
*Only includes ACGG kebeles who have chickens
Responses limited to households that report having any chickens
-It is more common to have a corral in the two treatment arms (80%) compared to control (60%)
-And it is more common to have an enclosed corral in treatment arms (28-30% in acgg/atonu respectively, vs. 19% in control)
We do not see a difference between households letting chickens roam freely at night/during the day, and whether they have a corral. There is a slightly lower chance of allowing poultry to roam freely especially at night, with enclosed corrals (.4 vs. .3)
n=1231

11. Qualitative Study – Aims
The qualitative study aims:
to understand the relationship between food consumption and exposure to contamination from poultry among children
to conceptualize the pathways through which a father’s involvement and knowledge can affect a child’s nutritional outcomes.

12. Qualitative Study – Design & Methods
8 In-depth interviews with men
12 in-depth interviews with women
4 Focus Group Discussion with men & women (separately) in region 1 (control)
4 Focus Group Discussion with men & women (separately) in region 2 (ACGG + NSI)
Field:
Office:
Focus Group Discussion with the enumerators
3 hours of direct observation of
Chicken interactions
the study will focus on the regions Oromia and Amhara, where the majority of our sample population lives (754 and 606 participants respectively). Households for the qualitative interviews will be randomly sampled from ATONU trial’s three arms: One ATONU kebele (Nutrition sensitive agricultural interventions plus introduction of new chickens), one ACGG-only kebele (introduction of new chickens only) and one control kebele per each of two project regions with a total of 6 kebeles sampled.
we will sample a total of three households in each kebele across the three treatments in each region, for a total of 18 households. Within each region, we will select three kebeles (ensuring that the two treatment arms have already had their chickens for several months), and within each kebele, we will select three households: one with a child 6-18 months, one with a child months, and one woman headed household with a child age 6-36 months (who may have a child in either age group, since these households are not as common). In  addition, eight focus group discussion (four in control arms with two per men and two per women) will be held, and discussion will be based on common themes and practices identified in IDIs. At the end of the field collection, there will be an additional focus group discussion with the qualitative researchers.
 Not in agreement.
The dimensions of interest for the purposes of this research include: region, treatment status, age group (6-18 and months of age), and whether a household is woman-headed.
Sampling of participating households is purposive based on:
Region (Oromia and Amhara)
Treatment status (3 arms)
Age group of index child (6-18 and months of age)
Female- or male-headed household