Examining the role of women’s engagement in khat production on child nutritional outcomes using longitudinal data in East Oromia, Ethiopia

In eastern Ethiopia, production of khat has increased in recent years, with significant implications for women in khat production and sale. Women have long been engaged in agricultural production in the region, yet the implications of the shift from food crop production to khat/cash crop production on degree and manner of women’s engagement in agriculture and any related changes in nutrition are largely unstudied. Using longitudinal data collected from December 2020 to June 2022 in Haramaya woreda, East Hararghe Zone, Ethiopia, this study aimed to explore the relationship between women’s engagement in khat production and child nutritional outcomes, and to test whether an increase/decrease in women’s engagement in khat production over time was associated with a change in child nutritional outcomes. Primary outcome variables were child length-for-age z-score (LAZ), child weight-for-age z-score (WAZ), child weight-for-length z-score (WLZ), and child minimum dietary diversity (MDD). Mixed effect models using backward stepwise regression were conducted to assess the relationship between women’s engagement in khat production, child nutrition outcomes, and a set of covariates, including women’s empowerment. No relationship was found between women’s engagement in khat production at baseline and child LAZ, WAZ, or WLZ; however, women’s empowerment was positively associated with child LAZ (β = 0.513, p = 0.004) and child WAZ (β = 0.456, p = 0.010) in this model. Women’s high engagement in khat production over time (first year of child’s life) was negatively associated with child LAZ (β = −0.731, p = 0.033) when compared to those who had low engagement over the same time period; women’s empowerment was positively associated with child LAZ (β = 0.693, p < 0.001) in this model. The findings from this study point to a potentially important dynamic between sustained high levels of women’s engagement in khat production and poor child growth outcomes; and contribute to a growing literature linking women’s empowerment in agriculture to improved child growth outcomes. Further research is needed to better understand the relationship between women’s engagement in khat production and women’s empowerment in agriculture. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is funded by the United States Agency for International Development Bureau for Food Security under Agreement #AID-OAA-L-15-00003 as part of Feed the Future Innovation Lab for Livestock Systems, and by the Bill & Melinda Gates Foundation OPP#1175487. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Any opinions, findings, conclusions, or recommendations expressed here are those of the authors alone. Research reported in this publication was supported by the University of Florida Clinical and Translational Science Institute, which was supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. ### Author Declarations 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 Institutional Review Board of the University of Florida Internal Review Board gave ethical approval for this work (IRB201903141). The Institutional Health Research Ethics Committee of Haramaya University (COHMS/1010/3796/20) gave ethical approach for this work. The Ethiopia National Research Ethics Review Committee (SM/14.1/1059/20) gave ethical approval for this work. Written informed consent was obtained from all participating households (husband and wife) using a form in the local language (Afaan Oromo). 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. 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