Abstract
Childhood malnutrition is a nationally-recognized problem in Tajikistan. In 2017, 6% of children under 5 years were wasted and 18% were stunted. Through the Tajikistan Health and Nutrition Activity (THNA), funded by the U.S. Agency for International Development's Feed the Future, IntraHealth International trained 1,370 volunteer community health workers (CHWs) and 500 community agricultural workers (CAWs) in 500 rural communities to improve nutrition among children and pregnant and breastfeeding women. CHWs and CAWs mutually encourage health behavior change, reinforce better agricultural practices, and promote maternal and child health and nutritious diets through household visits, community events, and peer support groups. CHWs refer children with malnutrition and diarrhea and pregnant women who are not registered for antenatal care to health facilities. THNA supported CHWs/CAWs through peer learning, refresher trainings, supportive supervision, and quarterly material incentives. We observed gains in knowledge, attitudes, and practices across health; nutrition; water, sanitation, and hygiene (WASH); and agriculture in target communities. From 2016 to 2019, we observed statistically significant (P<.05) improvements in children receiving a minimum acceptable diet; children with diarrhea receiving more liquids; women making 4 or more antenatal care visits; women reporting improved WASH; and farmers demonstrating improved agricultural practices. A February 2020 screening of 94.6% of children under 5 years in target communities found the prevalence of children with signs of wasting at 2.2%. Partnerships between CHWs, CAWs, and rural health workers facilitated these results. Paired agricultural and health interventions proved successful in improving nutrition of children and may be applicable in other contexts. Although effective in delivering interventions, CHWs/CAWs experience attrition, need motivation, and require intensive support. Assuming responsibility for this community-based volunteer workforce presents a major challenge for Tajikistan's national and local governments.