Women's Empowerment, Prevention of Malnutrition in Children under 2 Approach, and Agricultural Interventions Improved Household Dietary Diversity and Household Food Insecurity in South Kivu, DR Congo

Abstract

BackgroundFood insecurity remains a major factor contributing to poor nutritional status of many populations, but approaches to improving household food insecurity have not been widely evaluated, especially in severely food insecure settings.ObjectiveTo assess the effectiveness of a US Agency for International Development Office of Food for Peace‐funded multi‐year assistance program (Jenga Jamaa II) in improving indicators of household food security.MethodsThe study enrolled 1,820 households. The intervention groups were Women's Empowerment Groups (WEG), Prevention of Malnutrition in Children under 2 Approach (PM2A), Farmer Field Schools (FFS), and the Farmer to Farmer approach (F2F). The interventions were implemented by the Adventist Development and Relief Agency (ADRA) in Uvira and Fizi territories, South Kivu, DR Congo. The indicators assessed were Household Dietary Diversity Score (HDDS) (the number of food groups consumed by members of the household in the previous day, range 0–12), achieving Target Household Dietary Diversity (consumption of > 4 food groups the previous day), and Household Food Insecurity Access Scale (HFIAS) score (range 0–27, higher scores indicating greater food insecurity). An analysis of covariance (ANCOVA) approach was used to estimate differences between intervention groups and a control group at the end of the study, adjusting for baseline values of each indicator, geographic territory, and agricultural zone. The adjusted prevalence of achieving Target HDDS at the end of the study was estimated separately for each group, and compared to the control group using a doubly‐robust weighted least squares estimator approach.ResultsData were available from 1,479 (81.2%) households. Mean HDDS was significantly greater than the control group for three of the intervention groups: WEG (0.72, 95% CI: 0.36–1.08), PM2A (0.78, 95% CI: 0.43–1.13), and FFS (0.80, 95% CI: 0.45–1.15), p<0.001 for all. The adjusted difference in prevalence of achieving target HDDS compared to the control group was 14.9% for WEG (95% CI; 6.6–23.1%), 20.0% for PM2A (95% CI: 12.0–28.0%), and 20.2% for FFS (95% CI: 12.2–28.2%), p<0.001 for all. HFIAS score was lower for all intervention groups compared to the control group, indicating less food insecurity: WEG (−3.91, 95% CI: −4.85–−2.98), PM2A (−3.87, 95% CI: −4.78–−2.96), FFS (−4.39, 95% CI: −5.31–−3.48), and F2F (−1.83, 95% CI: −2.77– −0.89), p<0.001 for all.ConclusionWomen's Empowerment, PM2A, and Farmer Field School interventions had a significant effect on improving household dietary diversity and food security. The Farmer to Farmer approach was less effective compared to the other interventions but did reduce food insecurity compared to the control group.Support or Funding InformationThe parent study was funded by the Adventist Development and Relief Agency. This funding was made available through a USAID Office of Food for Peace Cooperative Agreement (AID‐FFP‐A‐11‐00006).