Enhanced Homestead Food Production Plus+ Program in the Lake Zone, Tanzania

Not Applicable

Completed

• Conditions: Growth Retardation; Anemia
• Interventions: Other: EHFP+

• Registration Number: NCT02259166
• Lead Sponsor: International Food Policy Research Institute

Brief Summary

The purpose of this study is to assess if the Enhanced Homestead Food Production Plus (EHFP+) Program implemented by HKI in Mwanza, Tanzania, enhances uptake of Micronutrient Powder (MNP) supplementation in children, helps maintaining reduced anemia levels among children after a blanket provision of MNP, and has an impact on child growth, infant and young child feeding (IYCF) practices, maternal knowledge related to health, nutrition, WASH and malaria prevention, food security and women's empowerment.

Detailed Description

Since 1988, Helen Keller International's (HKI) flagship Homestead Food Production (HFP) program in Asia has helped communities establish technically-improved local food production systems by creating gardens yielding micronutrient-rich fruits and vegetables over expanded growing seasons, complemented by the improved rearing of poultry and livestock.

In 2010, HKI introduced an enhanced-HFP (E-HFP) model in Burkina Faso and included a strengthened nutrition education component; the Essential Nutrition Actions (ENA) framework. This E-HFP program was evaluated by IFPRI and yielded some encouraging results. With regards to nutritional outcomes, however, the primary finding was that, while the E-HFP program improved hemoglobin concentration-an indicator of iron status-the evaluation failed to note a significant impact of the program on improving children's growth. The primary explanation for the absence of a measurable improvement in children's growth was the lack of complementary health interventions that aim to specifically reduce children's disease burden, which, along with the lack of adequate food and care, is an underlying cause of undernutriton (UNICEF 1990).

Building on lessons learned from the Burkina Faso E-HFP program and a 2011 Tanzania HFP program, a new model, the Enhanced Homestead Food Production Plus (E-HFP+), was developed for Tanzania to improve the nutritional status of infants and young children. The new model strengthens the Behavior Change Communication (BCC) on malaria prevention, WASH, and gender components and enhances links with the health sector. The model will also test two new concepts:

1. to assess if the E-HFP+ program has the potential to maintain adequate levels of hemoglobin concentrations by increasing iron-rich food consumption and malaria prevention good practices.

2. to assess the effectiveness on anemia of using an existing agriculture-based platform to promote uptake and utilization of MNP.

The model involves both a set of production and nutrition interventions targeted to mothers and the provision of a curative treatment for moderate to severe anemia (Micronutrient Powder).

The main objective of the impact evaluation of the E-HFP+ program is therefore to assess whether the program:

* Maintains reduced anemia levels among pre-school aged children after a blanket provision of Micronutrient Powder (MNP)

* Improves child growth (measured by HAZ and WHZ)

* Improves infant and young child feeding (IYCF) practices and maternal knowledge on health and nutrition

* Is an appropriate delivery platform to enhance uptake and utilization of MNP supplementation in children

Study Timeline

• Study Start: 2014-06
• Study First Submitted: 2014-09-05
• Study First Submitted QC: 2014-10-03
• Study First Posted: 2014-10-08
• Status Verified: 2015-09
• Primary Completion: 2016-03
• Study Completion: 2016-03
• Last Update Submitted: 2016-09-16
• Last Update Posted: 2016-09-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 2325

Inclusion Criteria

• women living in the study area
• having one child aged 6-12 months of age

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Exclusion Criteria

• children with severe anemia

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
EHFP+	EHFP+	Group receiving the intervention EHFP+, in addition to MNPs distribution for 2 months and malaria diagnosis and treatment for children enrolled, at baseline and after 12 months

Primary Outcome Measures

Name	Time	Method
Anemia (g/dl and %)	Measurements will be made for children aged 6 to 11 months at baseline and up to 3 months, 6 months, 12 months and 18 months (at endline), when the children are between the ages of 24 and 30 months	Change in prevalence of anemia and hemoglobin concentration will be measured over the course of the program period.(at baseline, during follow-up after 3, 6 and 12 months and after 18 months at endline)

Secondary Outcome Measures

Name	Time	Method
Growth (Z-score and %)	Measurements will be made for children between the ages of 6 and 11 months of age at baseline and 18 months later, at endline, when the children are between the ages of 24 and 30 months	Change in height-for-age Z-scores, weight-for-age Z-scores and weight-for-height Z-scores will be measured as well as the change in the prevalence of stunting (HAZ\<-2), underweight (WAZ\<-2) and wasting (WHZ\<-2) over the course of the program period
Women's empowerment (%)	Baseline (2014) and after 18 months at Endline (2016)	Measured by questionnaire, using a decision-making module and a domestic violence module. Percentage of women over a calculated score.
Biochemical markers	Baseline (June 2014), Follow-up1 (up to 3 months) and after 18 months at Endline	Change in plasmatic concentration of iron biomarkers (transferring receptors and ferritin; TfR and F), in concentration of vitamin A biomarkers (retinolbindingprotein; RBP) and inflammatory proteins (C-reactiveprotein and alpha-1 acidglycoprotein; CRP and AGP)
Dietary diversity (%)	Baseline (2014) and after 18 months at Endline	Measured with a questionnaire using a qualitative 24h recall. Unit: Number of food group consumed and percentage of children having consumed 4 groups (upon 7) the previous day
IYCF/WASH/malaria practices (%)	Baseline (2014) and after 18 months at Endline (2016)	Using questionnaire on practices. Percentage of women with adequate practices.
Food security (%)	Baseline (2014) and after 18 months at Endline (2016)	Measured with a questionnaire to calculate the HFIAS score. Unit: percentage of household
Maternal health and nutrition/WASH/malaria-related knowledge (%)	Baseline (2014) and after 18 months at Endline (2016)	Using questionnaire on knowledge. Percentage of women giving adequate answer.

Trial Locations

Locations (1)

National Institute for Medical Research; 🇹🇿 Mwanza, Tanzania