{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:26:02Z","timestamp":1787199962684,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2019s 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\n                      <jats:italic>t<\/jats:italic>\n                      -tests, Chi-square tests, and analysis of covariance (ANCOVA) adjusting for baseline scores, child age, and household size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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: \u22120.89 vs. \u22121.51; F = 10.05,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002), weight-for-age z-scores (WAZ: 0.53 vs. 0.21; F = 12.6,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), and MDD (4.19 vs. 3.06; F = 79.6,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1873005","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:15:56Z","timestamp":1787199356000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeted gender equality approach to improving childhood nutritional status in Cross River State, Nigeria: a community-based quasi-experimental study"],"prefix":"10.3389","volume":"13","author":[{"given":"Regina Idu","family":"Ejemot-Nwadiaro","sequence":"first","affiliation":[{"name":"Directorate of Research, Innovation, Consultancy and Extension, Kampala International University","place":["Kampala, Uganda"]},{"name":"Department of Public Health, University of Calabar","place":["Calabar, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Libuo-Beshel","family":"Nji","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Calabar","place":["Calabar, Nigeria"]},{"name":"Department of Public Health and Community Medicine, Kampala International University in Tanzania","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Bassey","family":"Enyievi","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Calabar","place":["Calabar, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinenye Blessing","family":"Onyekwelu","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Calabar","place":["Calabar, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice-Joel Ugbe","family":"Ugbe","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Calabar","place":["Calabar, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okechukwu Paul-Chima","family":"Ugwu","sequence":"additional","affiliation":[{"name":"Department of Publication and Extension, Kampala International University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9734\/BJMMR\/2017\/30204","article-title":"A study of malnutrition-dependent factors among under-five children in Ekureku Community, Abi local government area of cross river state, Nigeria.","volume":"21","author":"Donatus","year":"2017","journal-title":"J Adv Med Med Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1186\/s12889-017-4420-7","article-title":"Prevalence and determinants of childhood mortality in Nigeria.","volume":"17","author":"Yaya","year":"2017","journal-title":"BMC Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1111\/jhn.12960","article-title":"Comparison of standardised milk-based, standardised non-milk based and hospital-based formulations on the anthropometric indices of under-fives with moderate acute malnutrition: A randomised clinical trial.","volume":"35","author":"Udoh","year":"2022","journal-title":"J Hum Nutr Diet"},{"key":"B4","volume-title":"IFAD, UNICEF, WFP, and WHOThe State of Food Security and Nutrition in the World 2024: Financing to End Hunger, Food Insecurity and Malnutrition in All Its Forms.","year":"2024"},{"key":"B5","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/S0140-6736(13)60996-4","article-title":"Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?","volume":"382","author":"Bhutta","year":"2013","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1017\/S1368980018002434","article-title":"Prevalence thresholds for wasting, overweight and stunting in children under 5 years.","volume":"22","author":"de Onis","year":"2019","journal-title":"Public Health Nutr"},{"key":"B7","unstructured":"Nutrition in Nigeria.\n          \n          2021"},{"key":"B8","volume-title":"Levels and Trends in Child Malnutrition: UNICEF-WHO-World Bank Group Joint Child Malnutrition Estimates, Key Findings of the 2023 Edition.","year":"2023"},{"key":"B9","volume-title":"National Population Commission (NPC), and ICF Nigeria Demographic and Health Survey 2023\u201324: Key Indicators Report.","year":"2024"},{"key":"B10","volume-title":"A Review of Gender-Transformative Approaches and Promising Practices in Health, Nutrition and HIV Programming in Africa: From Theory to Practice.","author":"Picard","year":"2022"},{"key":"B11","volume-title":"IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2023: Urbanization, Agrifood Systems Transformation and Healthy Diets across the Rural\u2013Urban Continuum.","year":"2023"},{"key":"B12","volume-title":"Effect of Women\u2019s Empowerment on Child Nutritional Status in India: A Secondary Analysis of Nationally Representative Household Survey Data (2019\u201321). DHS Working Papers No. 201.","author":"Rajan","year":"2024"},{"key":"B13","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1111\/agec.12171","article-title":"Gender inequalities in ownership and control of land in Africa: myth and reality.","volume":"46","author":"Doss","year":"2015","journal-title":"Agric Econ."},{"key":"B14","doi-asserted-by":"publisher","first-page":"100773","DOI":"10.1016\/j.ssmph.2021.100773","article-title":"Women\u2019s autonomy in household decision-making and safer sex negotiation in sub-Saharan Africa: an analysis of data from 27 demographic and health surveys.","volume":"14","author":"Seidu","year":"2021","journal-title":"SSM Popul Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1007\/s10995-021-03315-z","article-title":"A women\u2019s rights-based approach to reducing child mortality: data from 193 countries show that gender equality does affect under-five child mortality.","volume":"26","author":"Bagade","year":"2022","journal-title":"Matern Child Health J"},{"key":"B16","volume-title":"Women\u2019s Empowerment in Agriculture and Child Nutritional Outcomes in Rural Burkina Faso. AERC Policy Brief No. 770.","author":"Nikiema","year":"2021"},{"key":"B17","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.worlddev.2014.11.014","article-title":"Reducing child undernutrition: past drivers and priorities for the post-MDG era.","volume":"68","author":"Smith","year":"2015","journal-title":"World Dev."},{"key":"B18","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1111\/j.1651-2227.2007.00147.x","article-title":"Women\u2019s involvement in household decision-making and strengthening social capital-crucial factors for child survival in Ethiopia.","volume":"96","author":"Fantahun","year":"2007","journal-title":"Acta Paediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1080\/00220388.2015.1018904","article-title":"Women\u2019s empowerment mitigates the negative effects of low production diversity on maternal and child nutrition in Nepal.","volume":"51","author":"Malapit","year":"2015","journal-title":"J Dev Stud."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e002997","DOI":"10.1136\/bmjgh-2020-002997","article-title":"Gender-transformative programming with men and boys to improve sexual and reproductive health and rights: a systematic review of intervention studies.","volume":"5","author":"Ruane-McAteer","year":"2020","journal-title":"BMJ Glob Health"},{"key":"B21","doi-asserted-by":"crossref","DOI":"10.18235\/0003902","volume-title":"Effective Land Ownership, Female Empowerment, and Food Security: Evidence from Peru. IDB Working Paper Series No. 1298.","author":"Schling","year":"2021"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1605807","DOI":"10.3389\/ijph.2023.1605807","article-title":"Minimum dietary diversity among children aged 6-59 months in East Africa countries: a multilevel analysis.","volume":"68","author":"Raru","year":"2023","journal-title":"Int J Public Health"},{"key":"B23","volume-title":"Conceptual Framework on Maternal and Child Nutrition.","year":"2021"},{"key":"B24","volume-title":"A Guide to Biostatistics and Health Research Methods.","author":"Ejemot-Nwadiaro","year":"2009"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e12508","DOI":"10.1111\/mcn.12508","article-title":"Addressing barriers to maternal nutrition in low- and middle-income countries: a review of the evidence and programme implications.","volume":"14","author":"Kavle","year":"2018","journal-title":"Matern Child Nutr"},{"key":"B26","volume-title":"Women\u2019s Empowerment and Nutrition: An Evidence Review. IFPRI Discussion Paper No. 1294.","author":"van den Bold","year":"2013"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e98308","DOI":"10.1371\/journal.pone.0098308","article-title":"Poor nutrition status and associated feeding practices among HIV-positive children in a food secure region in Tanzania: a call for tailored nutrition training.","volume":"9","author":"Sunguya","year":"2014","journal-title":"PLoS One"},{"key":"B28","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.foodpol.2016.05.002","article-title":"Impact of agricultural interventions on the nutritional status in South Asia: A review.","volume":"62","author":"Pandey","year":"2016","journal-title":"Food Policy"},{"key":"B29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4324\/9781315564111-7","article-title":"Gender, agriculture and food security: where are we?","volume-title":"Transforming Gender and Food Security in the Global South","author":"Njuki","year":"2016"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2333794X19884827","DOI":"10.1177\/2333794X19884827","article-title":"An educational intervention to mothers improved the nutritional status of mexican children younger than 5 years old with mild to moderate malnutrition.","volume":"6","author":"S\u00e1nchez-Encalada","year":"2019","journal-title":"Glob Pediatr Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1080\/03670244.2016.1161617","article-title":"The effectiveness of nutrition education: applying the health belief model in child-feeding practices to use pulses for complementary feeding in Southern Ethiopia.","volume":"55","author":"Mulualem","year":"2016","journal-title":"Ecol Food Nutr"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1093\/jn\/134.10.2579","article-title":"Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys.","volume":"134","author":"Arimond","year":"2004","journal-title":"J Nutr"},{"key":"B33","doi-asserted-by":"publisher","first-page":"nzaa174","DOI":"10.1093\/cdn\/nzaa174","article-title":"An innovative grandmother-inclusive approach for addressing suboptimal infant and young child feeding practices in Sierra Leone.","volume":"4","author":"Aidam","year":"2020","journal-title":"Curr Dev Nutr"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.51745\/najfnr.7.16.1-12","article-title":"Nutrition education intervention on maternal knowledge and perception toward infant and young child feeding in Abakaliki metropolis.","volume":"7","author":"Edafioghor","year":"2023","journal-title":"North Afr J Food Nutr Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4236\/fns.2023.143013","article-title":"Effect of a nutrition education intervention on mothers\u2019 infant and young child feeding knowledge and practices in the peri-urban areas of Bobo-Dioulasso: before and after study.","volume":"14","author":"Hien","year":"2023","journal-title":"Food Nutr Sci."},{"key":"B36","doi-asserted-by":"publisher","first-page":"210287","DOI":"10.5402\/2013\/210287","article-title":"A nutrition education intervention to combat undernutrition: experience from a developing country.","volume":"2013","author":"Zahid Khan","year":"2013","journal-title":"ISRN Nutr"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1873005\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:16:03Z","timestamp":1787199363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1873005\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":36,"alternative-id":["10.3389\/fnut.2026.1873005"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1873005","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"1873005"}}