Introduction: To date, most food-based nutrition interventions have not considered food production practices, particularly the use of synthetic chemicals. This study aimed to evaluate the impact of a multi-component food-based nutrition intervention involving homestead food production, nutrition counselling, cooking demonstrations, and crop planning exercises, and employing agroecological production practices (herein ‘nutrition-sensitive agroecology program’), on dietary diversity, nutritional status, and child development in Andhra Pradesh, India. Methods: A cross-sectional assessment was conducted in 2021-2022 of 50 intervention villages where the nutrition-sensitive agroecology program had been implemented since 2018 and 79 control villages where only the agroecology program had been implemented. Data on self-reported dietary intake, caregiver-reported early child development, anthropometric measurements, and hemoglobin concentrations were collected using standardized procedures by trained Nutrition Farming Fellows, who were also responsible for implementing the program. Results: A sample of 3,511 households (1,121 intervention and 2,390 control) participated in the survey. Dietary diversity scores (DDS) among women and men were mean (SD) 6.53 (±1.62) and 6.16 (±1.65), respectively, in intervention villages and 5.81 (±1.58) and 5.39 (±1.61), respectively, in control villages (p<0.01). DDS among children 6-24 months of age in intervention and control villages was 2.99 (±1.52) and 2.73 (±1.62), respectively (p<0.01). Children <2 years of age were less likely to be anemic in intervention versus control villages (59% versus 69%, p<0.01). Children 18-35 months age in intervention villages had higher child development scores than children in control villages (all p<0.05). Conclusion: Nutrition-sensitive agroecological programs may be effective in improving diets, nutrition, and child development in rural India.

LD, VK, VJ, VC and SY were affiliates of the government organization responsible for implementing the program evaluated in this study.

YB, LB, NSV, PP and LMJ were supported by the Medical Research Council/UK Research and Innovation (grant number MR/T044527/1). AR was supported by a DBT/Wellcome Trust India Alliance Fellowship (grant number IA/CPHE/20/1/505272).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Public Health Foundation of India Institutional Ethics Committee (Protocol number: TRC-IEC 488/22) and the Harvard T.H. Chan School of Public Health Institutional Review Board (Protocol number: IRB22-0220) approved the study

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data underlying the results presented in the study are available upon reasonable request to Lakshmi Durga (lakshmidurgaryss@gmail.com).