Outcomes of Co-Designed, Place-Based Nutrition Interventions on the Nutritional Status of Women and Young Children in Rural North-Eastern Ghana: A Cluster-Randomized Controlled Trial

Abstract Background Maternal and child undernutrition remains a major public health challenge in rural North-Eastern Ghana, where food insecurity, anaemia, and acute malnutrition are widespread, and conventional top-down nutrition programmes have shown limited effectiveness and sustainability. Objective We evaluated the effectiveness of a co-designed, place-based nutrition intervention on the nutritional status of women of reproductive age and young children in rural North-Eastern Ghana. Methods We conducted a mixed-method, cluster-randomized controlled trial across ten communities, randomizing 248 mother-child pairs (124 per group) to intervention or control. A formative baseline survey and co-design phase (June–October 2023) preceded a six-month intervention (November 2023-May 2024) comprising culturally tailored nutrition education, community engagement, and women’s empowerment activities. Baseline and end line assessments captured anthropometric, haemoglobin, dietary, and food security data. Of 248 pairs enrolled, 211 (109 intervention; 102 control) completed end line assessment (15% attrition). Non-parametric tests evaluated within and between group changes. Results The intervention group showed statistically significant reductions in child wasting (27.4% to 12.8%, p = 0.01) and underweight prevalence (26.6% to 15.6%, p = 0.04) compared with controls. Child anaemia prevalence fell from 71.0% to 22.0% (p < 0.001), and maternal anaemia declined from 41.1% to 27.5% (p < 0.001). Haemoglobin levels rose significantly in children (median 10.2 g/dL to 12.0 g/dL, p < 0.001) and mothers (11.25 g/dL to 13.10 g/dL, p < 0.001) in the intervention group. No significant changes were detected in maternal BMI or child stunting. Conclusions Co-designed, place-based nutrition interventions can meaningfully improve acute malnutrition and anaemia among vulnerable rural populations. Scaling up the components driving this improvement, Community Nutrition Volunteer-led education and household counselling, promotion of micronutrient-rich local foods, and women’s economic-empowerment groups, within existing health and community systems could extend these benefits to similar settings. Trial registration The trial was registered retrospectively with the Pan African Clinical Trial Registry, (PACTR202412697952932) on 23 December 2024, https//pactr.samrc.ac.za.