Scale up of Enhanced Homestead Food Production for Improved Household Food Security and Nutrition in Cambodia
试验速览
- 阶段
- 不适用
- 入组人数
- 1,318
- 试验地点
- 2
- 主要终点
- Difference in mean intake of vitamin A
研究概览
简要总结
This project is a delayed pragmatic delayed-intervention cluster randomized control study in a subset of households (n=600) enrolled in a larger scale up program of enhanced homestead food production (EHFP) in Cambodia. The trial is designed to evaluate the impact of EHFP (home gardens only; home garden and fishponds; home gardens and poultry) versus control group on dietary intake of women and youngest child, household food security, income, and production throughout the agricultural cycle. Following administration of the baseline survey 300 households will be randomized to the EHFP package of their choosing (Intervention Group) for two years. The other 300 households will not receive any intervention during the first year and will act as the control group; data will be collected monthly on production and income generated from gardening (and other homestead food production activities) and at two points throughout the year 24-hour dietary recall data will be collected from the women head of the household (aged 15-49y) and the youngest child between the ages of 6 - 59 months. After one year, the control group will be offered the intervention (EHFP package of their choice) fully subsidized and the project team will collect identical data on intervention group for one year as described for the control group.
详细描述
Cambodia's economy has improved remarkably in the last decade, yet 80% of households experience some form of poverty, and 20% are severely impoverished. Food insecurity and its sequelae remain a problem, especially among rural farmers. As a solution Helen Keller International (HKI) implements a Enhanced Homestead Food Production (EHFP) model in Cambodia. EHFP, focusing on women farmers, fosters year-round environmentally sustainable production of nutrient-rich fruits, vegetables and animal-source foods. The program provides initial farming inputs coupled with technical assistance, nutrition education, and training on marketing and gender equity.
In 2012, HKI together with the University of British Columbia (UBC), conducted a 22-month randomized control trial of EHFP, known as 'Fish on Farms'. Using HKI's approach, 900 women farmers were randomized to three groups: 1) plant-based EHFP; 2) EHFP plus fishponds; or 3) a control. Remarkably, in less than two years working with women farmers, Fish on Farms established 300 fishponds and 600 gardens. In the fishponds, small nutrient-rich fish were raised for household consumption and larger fish were raised for consumption or sale. After two years, households in both EHFP arms saw improvements in food production, income generation, food security, dietary diversity, and dietary intake of certain micronutrients relative to the control. However, the randomized-control trial (RCT) approach did have a number of issues, and gaps that need to be addressed were identified. Attrition was high, perhaps in part because of better opportunities for women, but also because women were not given a choice in the type of HFP activity to participate in. Further, the project provided many inputs for free so the women were not as invested as they might have otherwise been. Other issues identified were a lack of market access for sale of produce and fish, gender inequities, and a need to better capture the seasonality of food production and consumption at the household level.
Building on lessons learned from the pilot study (Fish on Farms), this pragmatic delayed-intervention cluster randomized control study includes rigorous monitoring of production throughout the agricultural cycle as well as multiple 24-hour dietary recalls with improved methodology and frequency to better capture dietary intake. Women are self-selecting to participate, and are provided access to micro-credit institutions or other cost-sharing options so that women have a greater financial stake in EHFP leading to more successful farmers. Participants will also able to select from more EHFP options that include home gardens, poultry and fish.
The ultimate goal of the program is to provide evidence of an integrated model of EHFP that has scalability and sustainability to improve the livelihoods of Cambodians and possibly the larger region.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 6 Months 至 59 Months(Child)
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Women of reproductive age (15-49 y)
- •Child aged 6 - 59 months
- •Demonstrate a willingness to cost-share on EHFP inputs
- •Have suitable land for Enhanced Homestead Food Production activities
排除标准
- •Not meeting the above inclusion criteria
结局指标
主要结局
Difference in mean intake of vitamin A
时间窗: Measurements will be made for women of reproductive age aand the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later
Sample size was calculated to detect a difference in zinc and vitamin A intake between any two groups, with 80% power and alpha of 0.05, assuming a 30% attrition. Measured by 24 hour dietary recall surveys with repeat recalls on a sub-set of the sample in order to adjust for intra-individual variations in intake and provide an estimate of usual intake.
Difference in mean intake of zinc
时间窗: Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later
Sample size was calculated to detect a difference in zinc and vitamin A intake between any two groups, with 80% power and alpha of 0.05, assuming a 30% attrition. Measured by 24 hour dietary recall surveys with repeat recalls on a sub-set of the sample in order to adjust for intra-individual variations in intake and provide an estimate of usual intake.
次要结局
- Difference in mean protein intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- Difference in mean riboflavin intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- Difference in mean thiamin intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- Incremental net monetary benefit(Monthly for 1 year)
- Difference in mean energy intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- Women's empowerment / gender equity(Baseline (2016) through to study completion, on average 2 years)
- Difference in mean iron intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- WASH practices(Baseline (2016) through to study completion, on average 2 years)
- Difference in mean fat intake(Measurements will be made for women of reproductive age and the youngest child in the household (> 6 mo < 60 mo) at baseline and ~ 7 months later)
- Household food security(Baseline (2016) through to study completion, on average 2 years)
研究者
Tim Green
Principle Investigator
University of British Columbia
