Date of Award

Spring 2022

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Edward A. Frongillo


Consumption of nutrients-rich foods like diverse vegetables, eggs, and meat throughout a year remains a challenge in low- and middle-income countries due to poor availability, accessibility, and affordability. One important way to overcome the challenge is to promote households’ own production of these foods and encourage individuals to consume. Improving household production of the foods necessitates understanding whether active participation and performance of frontline workers in the communities and performing improved production-related practices can translate into improved production of nutrients-rich foods. This study had two specific aims. The first aim was to examine demographic, socio-economic, and programmatic determinants of active participation and performance of village model farmers (VMFs), the frontline workers in the HFP program. The second aim was to investigate whether improved gardening and poultry-raising practices promoted in the communities were associated with improved household vegetable and poultry production.

To achieve these aims, two separate cross-sectional Suaahara-II, a multi-sectoral nutrition program, datasets were used. Information was collected from among 4,750 VMFs and 3,635 households from Suaahara-II. The active participation and performance of VMFs was defined as summed score of the number of four activities that they performed: registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Improved gardening and poultry-raising practices scores were created by summing improved gardening and poultry-raising activities practiced by the households. Vegetable production was assessed using: (i) vegetable production diversity score (0 to 5), generated by categorizing 35 vegetables produced into 5 groups and summing them: dark-green leafy vegetables, other vitamin A-rich vegetables, beans and pulses, roots and tubers, and other vegetables, and (ii) quantity produced (kg). Poultry production was assessed by counting the number of chickens and eggs produced in the households in the last month. Potential socio-economic and demographic determinants were identified a priori and adjusted for clustering. Ordinal regression models were used to examine the association between the potential determinants and active participation of the VMFs. Linear mixed-effects and left-censored regression models were used to examine the associations between the practices and production.

Higher levels of education, being a female community health volunteer, being from an upper caste household, and having received more additional trainings and inputs were associated with more active participation among the VMFs retained in the HFP program. Vegetable production diversity and quantity, egg, and chicken production were greater for those households performing a greater number of improved gardening and poultry raising practices, respectively. When designing large-scale nutrition-sensitive agriculture programs, providing trainings, but also inputs to the farming households to support their adoption of these improved practices will be critical for ensuring increased and more diverse household production of nutrients-rich foods.


© 2022, Shiva Bhandari