*3.5. Major Changes in Household Knowledge*

The statistical significance of knowledge of the households in the four CSVs was assessed by McNemar's test (Table 6). Statements 1 and 8 relate to the understanding of the basic idea of nutrition, and the role of nutritious food in achieving a healthy body and longer life. The analysis revealed that only TKM CSV exhibited a significant improvement in the respondents' understanding of nutrition and nutritious food, while the other CSVs showed a poor understanding of these topics in 2020.


**Table 6.** Proportion of respondents who agree on the knowledge statements related to household nutrition in four CSVs.

*(a) The statements used for HH knowledge were as follows.*

*1. Nutrition is about food preparation and malnourished children. 2. Anemia or lack of iron makes the child intelligent. 3. Fish, meat and eggs give a person energy. 4. Green and leafy vegetables are rich in Vitamins A, C and iron.*

*7. Flies and other insects that come into contact with food may cause diseases to humans and also spoil the food.*

*5. Vegetables and fruits help the person prevent diseases and infections. 6. Personal hygiene and cleanliness helps prevent diseases and infections. 8. Nutritious food is important for humans to be healthy and achieve*

*longer life.*

*9. Parasitic worms contribute to malnutrition of children 10. Iron is important to the body as it helps in delivering oxygen to all parts of the body.*

*growth of humans.*

*11. Green and leafy vegetables as well as brightly colored vegetables such as squash are good sources of Vitamin A for good eye sight and for growth and development. 12. Carbohydrates and fats are considered foods for growth.*

*13. Rice, corn, potatoes and peanut oil are important sources of energy for people. 14. Beans, groundnuts and meats are sources of protein needed for the*

*15. A good meal must contain food from three groups—energy foods, growth foods and protective foods.*

*(b) A positive statement ideally shall have move agree responses and a negative statement shall have less agree responses*

*(c) McNemar's test was conducted to determine whether there was a significant difference in the proportion (increase or decrease) over time. If p-value < 0.05, then the proportion was statistically significant at 5%. If p-value < 0.01, then the proportion was statistically significant at 1%. Note: "No responses" were excluded from the analysis.*

> This suggests a need for more careful messaging and awareness building on what nutrition is, and why it is important.

> Statements 2, 4, 10, 12 and 15 relate to the basic understanding of topics such as food groups, vitamins, minerals and anemia. Overall, there remains a lack of understanding of what anemia is (statement 2) and why it is important for ensuring nutrition in the households. While there was a lack of understanding of anemia, the Htee Pu and Ma Sein CSVs indicated some improvements in their understanding of the role of iron for a healthy body. However, overall, it is indicative that the concept of anemia and the role of iron are not well-understood across the four CSVs.

> For the food groups (statements 4, 12 and 15), only Htee Pu and Ma Sein showed a significant improvement in their understanding of the three basic food groups. However, in the case of understanding carbohydrates and fats, there was no overall improvement in the respondents' understanding of these food groups. Only the Htee Pu CSV showed a significant improvement in understanding the important role of green and leafy vegetables as sources of vitamins A and C and iron.

> Statements 5 and 11 relate to the role of vegetables and fruits in preventing disease and infection, and their dietary importance. All four CSVs indicated significant improvements in statement 5 (that vegetables and fruits prevent disease and infection) but only Ma Sein CSV indicated a significant improvement in understanding that green and leafy vegetables are important parts of the diet.

> Statements 6, 7 and 9 relate to the importance of hygiene and cleanliness in addressing malnutrition. TKM CSV showed a significant improvement in understanding the important

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role of personal hygiene and cleanliness. Saktha CSV showed significant improvements in understanding the link of parasitic worms to malnutrition.

Overall, the Htee Pu and Ma Sein CSVs demonstrated the greatest number of improvements in their understanding of the food groups, the important role of fruits and vegetables in the diet and knowledge about vitamins and minerals.
