Food and Agricultural Approaches to Reducing Malnutrition
- Conditions
- Malnutrition
- Interventions
- Behavioral: Homestead Food Production program
- Registration Number
- NCT02505711
- Lead Sponsor
- Sabine Gabrysch
- Brief Summary
The aim of this study is to evaluate the potential of reducing young child undernutrition in low-income countries through an integrated program that trains women's groups in agriculture, nutrition, child care and hygiene.
- Detailed Description
An estimated 165 million children worldwide suffer from chronic undernutrition which leads to compromised physical and cognitive development and prevents them from reaching their full potential. Nutrition-sensitive agricultural interventions that aim to increase dietary diversity, empower women and include an educational behaviour change component focused on nutrition and hygiene are a promising and sustainable approach to addressing undernutrition. However, evidence on the impact of such interventions is still scarce due to a lack of rigorous long-term evaluations.
This study will test the hypothesis that integrated agriculture, nutrition and hygiene interventions can reduce undernutrition when children benefit in their crucial first 1000 days. The investigators will conduct an impact evaluation of Helen Keller International's Homestead Food Production program in Bangladesh that trains women's groups in vegetable and fruit gardening, poultry rearing, hygiene, child care and nutrition. Furthermore, the investigators will assess the program impact pathway to discern how any impact is achieved (through improved food production, income, food security, health service use, female empowerment, feeding and hygiene practices).
The study design is a cluster-randomized controlled field trial in two sub-districts of Habiganj District, Sylhet Division, Bangladesh, including 2700 young women in 96 settlements. After the baseline survey in 2015, settlements will be randomized into 48 intervention and 48 control settlements. Women in the intervention settlements will receive training and support in Homestead Food Production during the following four years. A surveillance system will collect data on pregnancies, births, child development, nutrition and infections as well as pathway indicators. In 2019, the investigators will conduct the endline survey to assess the nutritional status of the 2700 women and their then approximately 1500 children below 3 years of age and compare between intervention and control.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 2705
For settlements:
- Located in selected unions of Habiganj District, Sylhet Division, North East Bangladesh
- Minimum distance to adjacent settlement at least 400 m
- Judged to be suitable for Homestead Food Production program by the NGO HKI Bangladesh (dry land year-round, at least 10 women eligible and interested)
For women:
- Married and aged 30 years or less at enumeration
- Woman's husband stays overnight in household at least once a year
- Access to at least 1 decimal of land, ideally 0.25 decimal near the house
For children:
- Biological child of a participant woman
- Aged 0-35 months at survey start or surveillance visit
For women:
- Lack of interest in participating in a gardening program
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Homestead Food Production Homestead Food Production program Enrolled in Homestead Food Production program from 2015 to 2019, 48 clusters, approx. 1350 women and 750 children
- Primary Outcome Measures
Name Time Method Linear growth in children below 3 years of age Measured 50 months after randomization (endline survey 2019) Length/height-for-age Z-score
- Secondary Outcome Measures
Name Time Method Intrauterine growth retardation: head size Measured within 3 days of birth, 15-57 months after randomization Head circumference-for-gestational-age
Linear growth in children aged 6-30 months Measured 50 months after randomization Length/height-for-age Z-score
Intrauterine growth retardation: length Measured within 3 days of birth, 15-57 months after randomization Length-for-gestational-age
Head circumference in children below 3 years of age Measured 50 months after randomization Head circumference-for-age Z-score
Underweight in women Measured 50 months after randomization Body Mass Index (BMI, non-pregnant women), mid-upper-arm circumference (MUAC, pregnant women)
Micronutrients: Vitamin A deficiency in women and in children below 3 years of age Measured 50 months after randomization Retinol-binding protein, corrected for inflammation (CRP, AGP)
Micronutrients: Iron deficiency in women and in children below 3 years of age Measured 50 months after randomization Ferritin and soluble transferrin receptor, corrected for inflammation (CRP, AGP)
Diarrhea in children below 3 years of age Measured every 2 months, 6-50 months after randomization Period and point prevalence of diarrhea
Dietary adequacy in women and children below 3 years of age Measured every 2 months, 6-50 months after randomization Mean probability of adequate micronutrient intake (MPA)
Dietary diversity in women and children below 3 years of age Measured every 2 months, 6-50 months after randomization Individual dietary diversity score, breastfeeding behaviors
Fecal contamination of complementary food for children 6-18 months of age Measured 36 months after randomization Log-transformed counts of total coliforms and E. coli in complementary food samples
Intrauterine growth retardation: small-for-gestational age Measured within 3 days of birth, 15-57 months after randomization Weight-for-gestational-age adjusted for time since birth
Anemia in women and children below 3 years of age Measured 50 months after randomization Hemoglobin concentration
Wasting in children below 3 years of age Measured 50 months after randomization Weight-for-length/height Z-score
Gestational weight gain Measured every 2 months during pregnancy, 6-57 months after randomization Gestational weight gain Z-score
Micronutrients: Zinc deficiency in women and in children below 3 years of age Measured 50 months after randomization Serum zinc, corrected for inflammation (CRP, AGP)
Acute respiratory infection in children below 3 years of age Measured every 2 months, 6-50 months after randomization Period prevalence of acute respiratory infection
Enteropathy in children below 18 months of age Measured 36 and 50 months after randomization Biomarkers: faecal myeloperoxidase, faecal α1-antitrypsin, faecal neopterin, serum C-reactive protein, serum α-1-acid glycoprotein
Food hygiene behaviour in mothers of children aged 6-18 months Measured 36 months after randomization Hygiene score from structured observation of mothers
Early child development (adapted WHO milestones) Measured at appropriate ages for milestones, 6-50 months after randomization Gross and fine motor, cognitive, personal-social and communication skills