Nutritional Challenges in a Marginalized Workforce: Knowledge, Caloric Intake and BMI Among Tea Garden Workers in Sylhet, Bangladesh

INTRODUCTION

Nutrition is key to maintaining an active lifestyle and good health, which is best achieved through a varied, well-balanced diet that includes the right amounts from each food group [1]. Poor nutritional knowledge can lead to unhealthy dietary choices, with access to nutritious food and understanding of a healthy diet varying widely among different populations, especially in low-income communities [2]. Bangladesh has one of the oldest tea industries, with a long history, and it continues to be a key source of employment, contributing significantly to the organized labor force [3]. As of 2017, the annual report from the Bangladesh Tea Board indicated that 440,743 individuals, including workers and their families, lived in 159 tea gardens nationwide. Among them, 100,191 were permanent workers, comprising 48,611 men and 50,144 women [4]. Tea garden workers can be defined as individuals who are involved in the cultivation, harvesting, and then processing of tea leaves in a tea garden that is involved in tea plantation commercially [5]. The first commercial tea garden in what is now Bangladesh, and indeed one of the earliest in South Asia, was established in Malnichhara, Sylhet, in 1854 during the British colonial period [6]. The workers in this sector came from a variety of racial and ethnic backgrounds, as well as from different languages, cultures, and famine-stricken areas of India [7]. The majority of Bangladesh's tea is produced in four key districts—Sylhet, Moulvibazar, Habiganj, and Chittagong—with the largest portion cultivated in the northeastern Sylhet Division. This region experiences consistently heavy rainfall, creating an ideal climate for tea cultivation [6].

In Sylhet district, almost 74% of tea garden workers live below the poverty line [4]. Many are descendants of laborers brought by British colonial rulers, and they remain isolated in remote estates with limited access to health care, education, and nutritional resources. Therefore, tea garden workers, as a whole, lack access to fundamental human rights such as housing, nutrition, clothing, healthcare, education, and more [8]. With a daily wage of TK. 120 ($1.25), tea garden workers were the lowest-paid workers in the country until the end of 2022. However, following a protest demanding a 150% increase in pay, their daily wage increased to TK. 170 ($1.45) [4]. This sum is insufficient to cover basic needs, as it cannot even procure a liter of edible oil and coarse rice for their families in a day. Consequently, it becomes challenging for them to prioritize nutrition and meet other essential requirements with such limited income.

In order to achieve middle-income status and eradicate poverty, it is crucial to enhance labor productivity by ensuring proper wages and meeting the basic needs of tea garden workers.

Tea garden workers represent one of the most isolated and marginalized communities in Bangladesh. Historically disadvantaged and socioeconomically deprived, this group is often overlooked in national development programs and excluded from mainstream health and nutrition surveys. As a result, their specific health challenges—particularly those related to nutrition—remain largely undocumented in national health policy frameworks. National surveys such as the Bangladesh Demographic and Health Survey (BDHS) and the National Nutrition Services (NNS) frequently fail to disaggregate data for occupational subgroups like tea garden workers, leaving a significant evidence gap [9].

In the context of Bangladesh’s commitment to the Sustainable Development Goals (SDGs)—notably SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being)—it is imperative to address the needs of marginalized occupational groups to ensure that no one is left behind [10]. Given this background, a thorough investigation into the living conditions, dietary practices, and nutritional health of tea garden workers is essential. Assessing factors such as nutritional knowledge, daily caloric intake, and body mass index (BMI) can provide meaningful insights into their overall health and livelihood status.

Therefore, this study aims to evaluate the nutritional knowledge, daily calorie intake, and BMI of tea garden workers in the Sylhet district of Bangladesh. The findings will help uncover disparities in dietary practices and nutritional status, offering critical evidence for the formulation of inclusive public health interventions and occupational health policies.

METHODS

Study Area

A cross-sectional study was conducted between January and May 2023 on tea garden workers from four tea estates in Sylhet, Bangladesh (Malnicherra Tea Estate, Khadim Tea Estate, Burjan Tea Estate, and Cherragong Tea Estate). 

Sample Size Calculation

The sample size was determined using Cochran's sample size equation [11]:

Here, the minimum sample size is 384. However, 390 data was taken for analysis for increasing the study’s strength [12,13].   

Study Design and Data Collection 

The study employed a cross-sectional survey design, utilizing face-to-face interviews conducted from January to May 2023. Convenience sampling was utilized, resulting in an initial sample of 410 individuals. An equal number of participants were randomly selected from each of the four tea gardens to ensure balanced representation. After excluding incomplete responses, the final analysis involved 390 surveys. The survey tool was adapted from validated questionnaires [14–16] to assess BMI, nutritional knowledge, and daily caloric intake. A pilot test (n=20) evaluated clarity and acceptability, with revisions made based on feedback. The finalized questionnaire was reviewed by experts for relevance. Written informed consent, including study details and voluntary participation, was obtained from all participants. For illiterate respondents, consent was secured through local guardians and garden authorities. Inclusion criteria required participants to be adult (≥18 years) Bangladeshi tea workers willing to participate; minors and unwilling individuals were excluded. Trained research assistants ensured data accuracy and confidentiality throughout the study.

Measures

The questionnaire included informed consent and multiple sections (i.e., socio-demographic information, nutritional status, dietary knowledge, and calorie intake-related information) and was utilized to collect data during the interview periods.

Sociodemographic Information

Some questions related to socio-demographics were asked during the survey, including age (later categorized as young adults (18 to 39 years)/older adults (more than or equal to 40 years)), gender (male/female), marital status (married/unmarried), religion (Hindu/Muslim/Christian), education level (no formal education/primary/high school or above), monthly family income (<4000BDT/4000-4999BDT/≥50000BDT [BDT=Bangladeshi Taka]), and family type (nuclear/large).  

Body Mass Index (BMI)

For calculating BMI, anthropometric measurements were taken from the workers. In anthropometric, the worker’s height and weight were taken. Standing height was measured using precise scales (Detect-Medic, Detect Scales INC, USA) with an accuracy of 0.5 cm. Weight was measured barefoot and wearing lightweight clothing using a handheld scale with an accuracy of 0.5 kg. Then BMI was interpreted according to WHO’s standard BMI chart for adults [17].

Nutritional Knowledge

To measure workers nutritional knowledge, they were asked 10 diet- and nutrition-related questions, and their knowledge level was scored on a scale of 0-10 (Table 2). For every correct answer, point 1 was assigned, and for every incorrect answer, point 0 was assigned. The score was divided into three categories: poor knowledge with a score less than 50% {˂5}, moderate knowledge from 50% to 80% (5 to 8), and good knowledge more than 80% {˃8} [15,18].

Dietary Calorie Intake

To measure average daily calorie intake, a food frequency questionnaire was conducted, incorporating food items from 12 major food groups. Caloric intake is obtained from various food constituents, including cereals, meats, milk, eggs, pulses, oils, vegetables, fruits, and others. The nutrient composition of these food items was derived from WFP (1988) and USAID (2010) [19, 20]. During data collection, participants were asked to recall their food and beverage consumption frequency and amounts over the previous three months. The frequency and amount were recorded using the midpoint value of each category. To assess the responses, one month was considered equivalent to four weeks, and one week was defined as seven days. The intake frequency responses were then converted into times per day. For example, the range of 4-6 times per month was converted to five times per month and subsequently resolved to 1.25 (5/4 = 1.25) times per week and finally to 0.179 (1.25/7 = 0.179) times per day. The mean daily intake of each food (g) or drink (ml) was subsequently calculated through utilization of the following formula [21]:

 [Average daily intake = intake frequency (times) per day × intake amount per portion size × weight of the portion size] 

The total caloric requirement of the family members was determined through an assessment of the average Recommended Desired Intake (RDI) (kcal/capita/day) of food items, utilizing a rate of dietary needs equivalent to 2200 kcal/person/day [22]. The participants were then classified based on their caloric intake (per capita/day). Caloric levels were categorized into four groups: significantly below optimal (≤1800), below optimal (>1800-2122), optimal (>2122-2444), and above optimal (>2444) [19].

Statistical Analysis

Data analysis for this study was conducted using Microsoft Excel 2019 and IBM SPSS Statistics, Version 25.0 (Chicago, IL, USA). Microsoft Excel was utilized for data cleaning, editing, sorting, and coding. Subsequently, the Excel file was imported into SPSS software. Descriptive statistics, such as frequencies, percentages, means, and standard deviations, were calculated. Chi square test was performed to assess association between dependent and other variables.  The study also utilized binary logistics regression and multinomial logistics regression to measure the strength of association.  All statistical tests were considered significant at a 95% confidence interval, with a p-value less than 0.05.

Ethical Consideration

All procedures conducted in this study followed the guidelines for research involving human participants, including adherence to the Helsinki Declaration [23]. Informed written consent was obtained from each participant, clearly explaining the study's procedures, objectives, and the confidentiality of their information. Data were collected anonymously and analyses using numerical codes.       

RESULTS

The present sample included 390 participants with a mean age of 35.78 years (SD = 10.744) and an age range of 18–67 years. Table 1 shows the distribution of sociodemographic characteristics among the study participants. Most participants were young adults (n = 259, 66.4%), female (n = 227, 58.2%), married (n = 367, 94.1%), Hindu (n = 350, 89.7%), had no formal education (n = 179, 45.9%), had a monthly income ranging from 4000 to 4999 BDT (n = 345, 88.5%), and had a joint or large family structure (n = 199, 51). The study also revealed that the majority of the participants had a normal BMI level (n = 209, 53.6%), poor nutritional knowledge (n = 311, 79.7%) and were much below their optimal daily calorie intake level (n = 234, 60%).

This study found the mean BMI score of the study participants to be 19.64 (SD=3.27) and the mean nutritional knowledge score to be 3.65 (SD=1.216) out of 10. Table 2 presents the distribution of respondents' knowledge on nutrition (N=390). The findings reveal that overall nutritional knowledge among participants was limited. A significant majority incorrectly answered key questions related to balanced diet (83.6%), food group consumption (67.0% and 78.7% for most and least consumed groups, respectively), and recommended servings of fruits and vegetables per day (94.9%). Only 4.1% correctly identified the macronutrient with the highest caloric value, and just 9.2% knew that milk and dairy provide calcium and vitamin D. However, awareness was higher regarding the benefits of eating a variety of colorful vegetables (89.5%) and fiber-rich foods (87.4%). Moreover, 96.2% recognized the importance of breakfast in a healthy diet. Respondents' mean calorie intake per day was found to be 1795.58 (SD=852.75) kcal, which falls into the much below optimal (≤1800 kcal) category. These results suggest a need for targeted nutrition education to address prevalent knowledge gaps. 

The multinomial logistic regression analysis identified several factors significantly associated with BMI categories (Table 3). Young adults were less likely to be underweight compared to older adults (OR = 0.639, p = 0.046). Religion was significantly associated with being normal weight versus overweight/obese, with Hindus less likely to be overweight/obese compared to Muslims/Christians (OR = 0.309, p = 0.013). Monthly income also showed a significant association; participants with a monthly income of <4000 BDT were significantly more likely to be underweight (OR = 10.500, p = 0.009) and overweight/obese (OR = 12, p = 0.045) compared to being in the normal weight category, relative to those earning ≥5000. Education level was another significant factor, with individuals having no formal education being more likely to be overweight/obese compared to those with high school education (OR = 4.631, p =0.046). Knowledge level was significantly associated with being normal weight versus underweight, with those having poor knowledge more likely to be underweight (OR = 1.824, p = 0.033). 

The binary logistic regression analysis between nutritional knowledge level and other variables found education level to be significantly associated with nutritional knowledge (Table 4). The analysis found participants with no formal education were less likely to possess moderate nutritional knowledge compared to those with high school education (OR = 0.274, p =<0.001), and individuals with primary education were also less likely to have moderate nutritional knowledge compared to those with high school education (OR = 0.466, p = 0.018). 

Variables such as gender and family type were found to be significantly associated with daily calorie intake level in our multinomial logistic regression analysis (Table 5). The analysis revealed that male respondents were less likely to fall much below optimal daily calorie intake compared to female respondents (OR = 0.287, p = <0.001). The study also revealed that participants with small (nuclear) family types were 2.7 times more likely to fall into the optimal calorie intake level compared to those with large family types (OR = 2.788, p = 0.023). 

DISCUSSIONS

Increased nutritional knowledge has the ability to enhance the balance between the body’s calorie requirement and expenditure through altering eating habits [24]. Meal intake is thought to be influenced by the understanding of nutrition [25], and choosing healthier choices is influenced by knowledge provided to the people via schooling and nutritional advice [26]. Poor dietary intake causes multiple health issues. Protein and carb deficiencies in tea garden workers and their families lead to illnesses like coughing, fever, anemia, high blood pressure, and stomach and skin problems [27].

For a developing country, providing a sufficient amount of food regardless of culture, race, religion, wealth, and location is the greatest issue for all people [19], and this condition affects BMI category. This study found that sociodemographic factors like age, religion, income, education, and knowledge level affect BMI categories. Older adults were more likely to be underweight, aligning with prior research linking aging to lower BMI [28]. Malnourished workers notably suffer from anemia and other diseases, especially elderly workers [29, 30]. The results imply that socioeconomic variables, such as inadequate nutrition and educational attainment, make older individuals' nutritional problems worse [28, 31].

This study found overweight/obesity to be less common among Hindu workers than Muslims/Christians, reflecting socioeconomic factors affecting nutrition according to previous studies. Health disparities suggest an interaction between socioeconomic and religious influences on workers' health [29, 31, 32].

Workers earning less than 4000 BDT monthly were more likely to be underweight or overweight/obese, suggesting the impact of economic hardship on nutritional status [31]. Contrary to some studies, overweight/obesity was more common among those with no formal education, highlighting the role of education in nutrition awareness [33, 34].

The study found overweight/obesity was more common among individuals with no formal education, contradicting previous research linking obesity to higher education levels [31]. The lack of education that many tea garden workers have may make it difficult for them to comprehend nutrition and health [35]. Low education levels linked to overweight and underweight highlight the need for educational interventions to improve health and eating habits among tea garden workers [32].

Poor nutritional knowledge was associated with underweight status, reinforcing the link between health literacy and nutrition. High school-educated workers showed moderate knowledge, indicating a positive correlation between education and nutritional awareness [31]. Educational interventions could improve dietary behaviors among this population [31, 36]. Dietary awareness can be raised through educational initiatives, as high school graduates possess better nutrition knowledge than those with less education [37, 38].

This study found participants' mean calorie intake per day to be 1795.58 kcal, which is much less than the national average of 2393.0 kcal [22]. A strong link between gender and daily calorie intake was observed, with female workers consuming less than optimal levels, showing higher malnutrition rates [29]. This result can be linked to a number of issues, such as income disparities, because male workers tend to earn more than female workers, which prohibits women from accessing a healthy diet [37]. Workers from smaller families had better calorie intake, underscoring the influence of family size on food security and nutrition [31, 33].

Strengths and limitations of This Study

This study offers a novel and comprehensive look at nutritional knowledge, caloric intake, and BMI among impoverished tea garden workers in Sylhet, Bangladesh. However, several limitations exist. Convenience sampling may limit generalizability due to selection bias, while self-reported data are prone to recall and social desirability biases. The cross-sectional design prevents causal inference, and the absence of a comparison group and regional focus further constrain the findings. Future research should consider stratified random sampling, objective measures, and longitudinal designs for broader and more robust insights.

CONCLUSIONS

This study highlights significant disparities in BMI, nutritional knowledge, and daily caloric intake among tea garden workers in Sylhet, Bangladesh. Younger workers and those with higher income levels demonstrated better nutritional status, while older adults, individuals with lower incomes, and those lacking formal education were more prone to being underweight or overweight/obese. Poor nutritional knowledge was closely associated with underweight status, emphasizing the need for targeted educational interventions. Additionally, gender and family structure influenced daily calorie intake, with males and workers from smaller families more likely to achieve optimal intake. These findings underscore the importance of addressing educational and economic factors to improve the nutritional health of this vulnerable population.

ACKNOWLEDGEMENT

We extend our heartfelt gratitude to everyone who contributed to the successful completion of this research project. We are especially thankful to the tea garden workers and authorities for their valuable time and willingness to participate in our interviews, making data collection possible. Our sincere thanks also go to our project supervisor and faculty member of the Department, whose guidance and support were instrumental in carrying out this study.

FUNDING SOURCES

This research was conducted with self-funding. Therefore, any kind of financial support was not received for this study. 

CONFLICT OF INTEREST

The authors declare no conflict of interest. All aspects of this research were conducted impartially and independently. 

ETHICS STATEMENT

The study protocol was reviewed and approved by the Biosecurity, and Ethical Clearance Committee at Jahangirnagar University, Savar, Dhaka-1342, Bangladesh (Ref. No: BBEC, JU/M 2022/11 (95)). Participation was entirely voluntary, and respondents were assured of the confidentiality and anonymity of their information throughout the study.

References

• [1] 1. Uddin M, Sarker M, Mukta Z, Rana MM, Liza N. Assessment of rural women’s access to nutritional programs in Jamalpur district of rural Bangladesh: A comparative study between World Vision beneficiaries and non-beneficiaries. Int J Health Sci Res. 2021; 11:151-162.
• [2] 2. Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr. 2014;111(10):1713-1726.
• [3] 3. Ahmed S. Where no one has worked before: Innovations behind WaterAid’s WASH work in Bangladesh tea garden communities. Towar Incl WASH Shar Evid Exp from F A Ser 16 Case-Studies. 2012; 1:1-7.
• [4] 4. Begum N, Hashmi N, Ali M M. Current Scenario of Tea Garden Workers in Bangladesh: Time Demands to Stop the Zero-sum Game. Global Mainstream Journal of Business, Economics, Development & Project Management. 2022;1(4):1-9.
• [5] 5. Government of India. Plantations Labour Act, 1951. 1982; 1981:1-9.
• [6] 6. Islam MN, Al-Amin M. Life behind leaves: Capability, poverty and social vulnerability of tea garden workers in Bangladesh. Labor Hist. 2019;60(5):571-587.
• [7] 7. Al-Amin M, Parveen S. Social exclusion & poverty among tea garden workers in Bangladesh. Indian J Ind Relat. 2017; 53:21-36.
• [8] 8. Hossain M, Azad F, Rifat M, Siddique AB, Hasan G. Socio-economic status, dietary pattern and nutritional status of female workers of Fulchara Tea Garden in Moulvibazar district, Bangladesh. J Nutr Food Sci. 2017;7(4):10000644.
• [9] 9. National Strategy on Prevention and Control of Micronutrient Deficiencies, Bangladesh (2015–2024), 2017. https://www.unicef.org/bangladesh/media/4646/file/NMDCS%20Final.pdf%20.pdf]. Accessed March 2025.
• [10] 10. UNDP Bangladesh. (2020). Sustainable Development Goals: Progress Report 2020. https://info.undp.org/docs/pdc/Documents/BGD/SDGs-Bangladesh_Progress_Report%202020.pdf]. Accessed March 2025.
• [11] 11. Cochran WG. Sampling Techniques. 3rd ed. John Wiley & Sons Inc.; 1991:448.
• [12] 12. Siddique AB, Hasan M, Ahmed A, Rahman MH, Sikder MT. Youth’s climate consciousness: Unraveling the Dengue-climate connection in Bangladesh. Front Public Health. 2024; 12:1-12
• [13] 13. Siddique AB, Sujan SH, Ahmed S, et al. Knowledge, attitude, and practice regarding air pollution and health effects among general people: A multi-divisional cross-sectional study in Bangladesh. PLoS One. 2024;19(4): e0305075.
• [14] 14. Kana''an H, Saadeh R, Zruqait A, Alenezi M. Knowledge, attitude, and practice of healthy eating among public school teachers in Kuwait. J Public Health Res. 2021;11(2):2223.
• [15] 15. Bhuiyan FR, Barua JL, Kalam KA. Knowledge, attitude and practices regarding nutrition among adolescent girls in Dhaka city: A cross-sectional study. Curr Res Nutr Food Sci J. 2021; 10:1-9.
• [16] 16. Sharma S, Akhtar F, Singh RK, Mehra S. Dietary intakes, patterns, and determinants of children under 5 years from marginalized communities in Odisha: A cross-sectional study. Int J Health Sci Res. 2020; 10:315-325.
• [17] 17. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163.
• [18] 18. Rizwan AA, Huda M. Knowledge and attitude towards nutrition among pregnant women in rural areas of Dhaka city, Bangladesh. Int J Sci Bus. 2021;5(5):272-279.
• [19] 19. Jahan M, Sheikh B, Rahman M, et al. Tea Garden workers and their food security assessment. Int J Sci Res. 2022; 11(2):1231-1239.
• [20] 20. Ahmed JU, Mozahid MN, Dhar AR, et al. Food security and dietary diversity of tea workers of two tea gardens in greater Sylhet district of Bangladesh. GeoJournal. 2021; 86:1015-1027.
• [21] 21. Liu X, Wang X, Lin S, et al. Reproducibility and validity of a food frequency questionnaire for assessing dietary consumption via the dietary pattern method in a Chinese rural population. PLoS One. 2015;10(8): e0134627.
• [22] 22. Household Income and Expenditure Survey-2010. Bangladesh Bureau of Statistics, Ministry of Planning, Government of the People’s Republic of Bangladesh, Dhaka. 2010. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/554771468207262934/bangladesh-household-income-and-expenditure-survey-key-findings-and-results-2010. Accessed March 2025.
• [23] 23. World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001; 79:373-374.
• [24] 24. Shimokawa S. When does dietary knowledge matter to obesity and overweight prevention? Food Policy. 2013; 38:35-46.
• [25] 25. Bradette-Laplante M, Carbonneau É, Provencher V, et al. Development and validation of a nutrition knowledge questionnaire for a Canadian population. Public Health Nutr. 2017;20(7):1184-1192.
• [26] 26. Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science—Implications for current research, dietary guidelines, and food policy. BMJ. 2018;361: k2392.
• [27] 27. Sahoo D, Konwar K, Sahoo BK, Scholar MP. Health condition and health awareness among the tea garden laborers: A case study of a tea garden in Tinsukia district of Assam. IUP J Agric Econ. 2010; 7:50.
• [28] 28. Dasgupta P. Nutritional status and food environment of the elderly population residing in tea gardens of a block of Darjeeling district, West Bengal, India. J Indian Acad Geriatr. 2023;19.
• [29] 29. Yasmin S, Sau M, Patra M, et al. Poverty, undernutrition and morbidity: The untold story of tea-garden workers of Alipurduar district, West Bengal. J Family Med Prim Care. 2022; 11:2526-2531.
• [30] 30. Nath S, Das A, Datta S, Wankhar W. Malnutrition and anemia: A health burden among tea garden workers in West Tripura district, Tripura, India. Asian Pac J Health Sci. 2022;9(1):255-262.
• [31] 31. Mandal D, Bhattacherjee S, Biswas A, Samanta S. Determinants of malnutrition among the tea garden workers of Darjeeling district in 2021: An ordinal regression analysis. Int J Community Med Public Health. 2023;10(5):2132-2137.
• [32] 32. Gogoi N, Sumesh SS. We are just mazdoors! A decolonial ethnographic account of health inequalities, and inequities among tea garden laborers in Assam, India. New Solut. 2023;32(3):252-264.
• [33] 33. Bhattacharya D. Study on livelihood crisis and socio-economic condition of tea garden workers in Dooars of West Bengal. 2024; 6:1-16.
• [34] 34. Saha J, Acharjee D, Rahman M. A study to assess the socio-economic status of tea workers in selected tea estates of Sylhet district. J Bangladesh Agric Univ. 2017;15(2):297-300.
• [35] 35. Borkakoty B. Attitude of tea garden workers towards higher education of their children: An analytical study in Golaghat district of Assam. Int J Humanit Soc Sci Invention. 2024; 13:464-468.
• [36] 36. Mano PP, Sneha P. A study to assess the level of knowledge, attitude and practice regarding healthy lifestyle among garden workers. Int J Health Sci. 2023; 5:1-4.
• [37] 37. Raut S, Kc D, Singh DR, Dhungana RR, Pradhan PMS, Sunuwar DR. Effect of nutrition education intervention on nutrition knowledge, attitude, and diet quality among school-going adolescents: a quasi-experimental study. BMC Nutr. 2024 Feb 27;10(1):35.
• [38] 38. Nyhus Dhillon C, Vossenaar M, Weiligmann B, et al. A nutrition behavior change program moderately improves minimum diet diversity and handwashing behaviors among tea workers in Assam and Tamil Nadu, India. Food Nutr Bull. 2022; 43:037957212110707.