Abstract
ABSTRACTBackgroundFood-assisted maternal and child health and nutrition programs are a widely used approach to address undernutrition. Little is known about the effects of these programs’ combined household and individual food rations on household and individual food consumption. Tubaramure in Burundi targeted women and children during the first 1000 d of life, and included: 1) food rations (corn-soy blend and micronutrient-fortified vegetable oil); 2) health services strengthening and promotion of their use; and 3) behavior change communication on nutrition, hygiene, and health practices.ObjectivesThe objectives were: 1) to assess Tubaramure’s impact on household food consumption and food security, maternal dietary diversity, and infant and young child feeding practices; 2) to explore the role of the food rations; and 3) assess 6–8 mo impacts around 8 mo after the end of the program.MethodsWe used a 4-arm cluster-randomized controlled repeated cross-sectional design (11,906 observations). The treatment arms received the same food ration but differed in the ration timing and duration: 1) the first 1000 d; 2) from pregnancy through 17.9 mo of age; or 3) from birth through 23.9 mo of age.Results Tubaramure significantly (P < 0.05) improved the percentage of food secure households [from 4.5 to 7.3 percentage points (pp)], and increased household energy consumption (from 17% to 20%) and micronutrient consumption. The program had a positive effect on maternal dietary diversity (+0.4 food groups, P < 0.05) and increased the proportion of children aged 6–23.9 mo consuming ≥4 food groups (from 8.0 to 9.6 pp, P < 0.05). The effects on many outcomes were attributable to the food rations. Postprogram effects (P < 0.05) were found on household food security, maternal dietary diversity, and younger sibling's complementary feeding practices.ConclusionsPrograms such as Tubaramure have the potential to improve food security and household and individual energy and micronutrient consumption in severely resource-constrained populations, as seen in rural Burundi. This trial was registered at clinicaltrials.gov as NCT01072279.
Highlights
Food-assisted maternal and child health and nutrition (FAMCHN) programs are a widely used strategy in low- and middle-income countries to address problems of hunger, food insecurity, and undernutrition [1–3]
FA-MCHN programs such as those implemented by the U.S Agency for International Development (USAID)’s Office of Food for Peace (FFP) generally include the distribution of micronutrient-fortified food commodities typically composed of a household ration and an individual ration
Tubaramure, a FA-MCHN program in Burundi, improved household food security, led to an increase in household energy consumption of up to 20%, increased the energy from fruit consumption, and had a positive effect on household micronutrient consumption
Summary
Food-assisted maternal and child health and nutrition (FAMCHN) programs are a widely used strategy in low- and middle-income countries to address problems of hunger, food insecurity, and undernutrition [1–3] These programs increasingly target mothers and children during the first 1000 d of life (from pregnancy through to the child’s second birthday) [4]. Conclusions: Programs such as Tubaramure have the potential to improve food security and household and individual energy and micronutrient consumption in severely resource-constrained populations, as seen in rural Burundi. This trial was registered at clinicaltrials.gov as NCT01072279.
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