Impact of a Homestead Food Production Program on Dietary Diversity: Seasonal and Annual Results from the FAARM Trial in Sylhet, Bangladesh

Abstract

ObjectivesWe examine the impact of a nutrition-sensitive agricultural program on the dietary diversity of women and children enrolled in the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Habiganj, Sylhet, Bangladesh. The homestead food production intervention, implemented by Helen Keller International, began in mid-2015 and ended in December 2018. MethodsWe use four data sources: 1) baseline data (all women and their youngest child, March-May 2015); 2) surveillance data (every two months - all children 6–18m and a rotating random third of women and children 19–37m, September 2015-August 2019); 3) endline data (all women and children 6–23m, September 2019-February 2020); 4) phone survey during the COVID-19 lockdown (a random two-thirds of women, May-June 2020). We calculated dietary diversity for women (MDDW-10) and children (WHO IYCF). Our analysis included 24,931 observations of 2,701 women and 17,445 observations of 2,162 children (6–37m). We estimate the impact of the intervention on dietary diversity using multi-level regression, controlling for clustering by settlement and repeated measures. ResultsDietary diversity scores and the proportion of women and children classified as consuming adequate diets varied greatly over the year, peaking in May/June with 5.3 food groups for women (out of ten) and 3.8 food groups for children (out of seven). Over all program years, intervention women had 1.8 higher odds of consuming an adequate diet compared to control women (p < 0.001). However, this benefit varied from 1.3 in the first year of the intervention (p = 0.015) to 2.3 in the last year (p < 0.001), before falling to around 1.9 in the post-intervention years (p < 0.001). We saw a nearly identical pattern in children. Dietary improvement was driven through incremental increases in nearly all food groups. ConclusionsThe intervention successfully increased dietary diversity in women and children, and these impacts persisted after the project closed, including during the COVID-19 lockdown period. Funding SourcesThe German Ministry for Education and Research (BMBF) is the primary funder for the FAARM trial. The U.K. Department for International Development (DFID) supported the design of the surveillance system.