The Nutritional Impacts of Quality Protein Maize in Ethiopia

Tessema Masresha
Nilupa S. Gunaratna
Hugo De. Groote
Katherine Donata
Demissie Belayneh
Inge D. Brouwer
Tefera Belachew
Fieldwork by:
3,600 households with pregnant women and/or young children
2014 - 2016
Target group:
  • Children under five
  • Mothers and pregnant women
Outcome of interest:
  • Food security
  • Nutrition
  • Stunting
Intervention type:
  • Information
  • Improved seeds
AEA RCT registration number:

 Improved crop varieties have the potential to increase children’s nutrient intake and encourage growth. However, farming households do not always adopt new varieties and, even when they do, children do not always consume adequate amounts of protein. In Ethiopia, researchers are evaluating how encouraging households to grow a more nutritious maize variety and encouraging them to earmark the crop for children affects production, consumption, and childhood nutrition.

Policy issue

Globally, stunting (or low height for age) among children is the most prevalent form of undernutrition, and is associated with higher child mortality, poorer motor and cognitive development, health issues lasting into adulthood, and lower educational attainment and economic productivity. According to World Bank estimates, a one percent loss in adult height due to childhood stunting is associated with a 1.4 percent loss in economic productivity. 

Recent evidence has shown that protein intake is essential for biological processes that encourage growth. Multi-sectoral approaches to reduce undernutrition, such as nutrition sensitive agriculture, could be effective in addressing the underlying determinants of malnutrition, such as inadequate protein intake. 

Several efforts have been made to improve the protein content of staple foods, such as maize, through plant breeding efforts. These new protein rich varieties of maize, produced through plant breeding, are collectively referred to as “Quality Protein Maize” (QPM). Previous research in lab settings has shown that replacing conventional maize with QPM has led to improved growth among children. However, questions remain on QPM’s effectiveness in improving children’s nutritional outcomes in a natural setting.

Context of the evaluation

Stunting and malnutrition are prevalent among children in Ethiopia and 40 percent of all children under the age of 5 are stunted.  Not only can malnutrition affect a child’s own ability to grow, learn, and ultimately succeed, it can also take a toll on the larger economy. National estimates suggest that poor child nutrition comes at a cost of $4.7 billion per year, equivalent to 16.5 percent of Ethiopia’s GDP. Dietary quantity and quality are also poor among infants and young children in Ethiopia. Less than half of all children aged 6–23 months receive the minimum recommended number of meals and only 5 percent consume a sufficiently diversified diet. Diets of both children and adults in Ethiopia are heavily dependent on cereals and, in the last 20 years, maize has become a dominant food source. However, conventional maize is poor in protein content, necessitating a better source of protein in children’s diets. 

The Nutritious Maize for Ethiopia (NuME) Project develops, promotes, and disseminates a biofortified Quality Protein Maize (QPM) as an alternative to traditional varieties. NuME is a collaboration of the International Maize and Wheat Improvement Center (CIMMYT) with the Ethiopian Institute of Agricultural Research (EIAR), Sasakawa Global 2000, the Ethiopian Public Health Institute (EPHI), and other national and international partners.

When given the choice, what interventions can successfully encourage households to grow QPM and incorporate it into children’s diets? Furthermore, will the increased consumption of QPM lead to changes in protein intake, and in turn, to improved growth?

Details of the intervention

Researchers are conducting a randomized evaluation to test the impact of encouraging QPM adoption and consumption on child nutrition. The study is taking place in 12 Kebels (peasant associations, or administrative units comprising 500 to1000 households) in the Oromia and Amhara regions of Ethiopia. 

Out of 1779 households in the study, 1024 randomly selected eligible households were provided an adoption encouragement program. Out of these 1024 households, 511 randomly selected households were provided no further intervention, while the remaining 513 were provided a consumption encouragement program in addition to the adoption encouragement program.

Adoption encouragement: In the 1024 selected households, household heads were provided information about QPM and its benefits and about the vulnerability of children to undernutrition. The adoption  program component, which was meant to encourage households to adopt and produce QPM, was directed towards household heads, but children’s caregivers were invited to be present. After this discussion, farmers were offered the option to order up to three two-kilogram bags of QPM seed to plant on their own land. Since farmers may be more likely to adopt smaller quantities at first, researchers offered two kilograms of seed, since it would yield enough grain to bring about meaningful improvements in child nutrition over the course of 6 months (i.e. the consumption of at least 150 grams of grain per day, per child).

Consumption encouragement: In addition to adoption encouragement, household heads and caregivers for young children belonging to this group were offered a consumption encouragement program component.  This program component included guidance on the nutritional benefits of QPM for young children, the importance of keeping QPM separate from conventional maize to prevent dilution of the nutritional benefits, and tools to help them separate and ‘earmark’ QPM grain and flour for child consumption. While adoption and production of QPM is an important first step, this program component will help researchers understand if nudging families to feed their children QPM can further improve children’s nutrition. The 587 remaining households were offered neither program and formed the comparison group.

Researchers will test the impact of the programs on the growth of children, their protein status, and consumption of QPM. Additionally, researchers will also measure outcomes such as child stunting, malnutrition, underweight status, and total intake of protein. Questionnaires administered to children’s caregivers before and after program implementation will include questions on demographics; children’s diet, health, and growth perceptions; cooking practices and household food security; knowledge of nutrition and QPM; gender responsibilities; and bargaining.

Results and policy lessons

Study ongoing, results forthcoming.

Tessema, Masresha, Nilupa S. Gunaratna, Katherine Donato, Jessica L. Cohen, Margaret McConnell, Demissie Belayneh, Inge D. Brouwer, Tefera Belachew, and Hugo De Groote. "Translating the impact of quality protein maize into improved nutritional status for Ethiopian children: study protocol for a randomized controlled trial." BMC Nutr (2016) 2:54.