Agricultural productivity is linked to children’s nutritional status: evidence from small-scale cocoa production systems in Côte d’Ivoire

Child undernutrition remains an important public health problem in low- and middle-income countries. Rates of undernutrition are often disproportionally high in rural populations that primarily rely on small-scale agriculture for their livelihoods. We aimed to assess the relationship between agricultural income and child nutritional status in a rural setting of Côte d’Ivoire. In 2022, we collected anthropometric data from 2,472 cocoa-farming households living in the Taabo Health and Demographic Surveillance System in the south-central part of Côte d’Ivoire. Nine hundred and fifty-three households had 1,157 children aged 2–5 years and were included in the analysis. We divided households into agricultural productivity quintiles and compared child nutritional outcomes across these groups using regression analysis. Agricultural productivity and income varied widely in the study population. Households in the top quintile earned, on average, USD 6,041 per year, as compared to less than half in the bottom quintile (USD 2,755). We observed substantial child growth faltering across the entire income range. Compared to children in the lowest income quintile, their peers in the highest quintile had 0.27 standard deviation (SD) higher height-for-age z -scores [95% confidence interval (CI): (0.01, 0.54)] and 57% lower odds of stunting [OR = 0.42, (0.23, 0.80)]. Similarly, weight-for-age z -scores were 0.21 SD higher [(0.00, 0.42)], and the odds of being underweight were 62% lower [OR = 0.38, (0.14, 0.98)]. Underweight gradually decreased in the 4 months after the main cocoa harvests income. Our findings suggest that increasing small-scale cocoa farming productivity is not only contributing to households’ financial well-being and nutritional diversity, but also to reducing child undernutrition.