Food and Agricultural Approaches to Reducing Malnutrition (FAARM)

This study tests the hypothesis that integrated agriculture, nutrition and hygiene interventions can reduce undernutrition when children benefit in their crucial first 1000 days.

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About the project

Full title: Reducing young child undernutrition through an integrated agricultural project with women’s groups: A cluster-randomised trial in rural Bangladesh

An estimated 150 million children worldwide suffer from chronic undernutrition which leads to compromised physical and cognitive development and prevents them from reaching their full potential. Nutrition-sensitive agricultural interventions that aim to increase dietary diversity, empower women and include an educational behaviour change component focused on nutrition and hygiene are a promising and sustainable approach to addressing undernutrition. However, evidence on the impact of such complex interventions is still scarce due to a lack of rigorous long-term evaluations (e.g. Masset et al.).

This study tests the hypothesis that integrated agriculture, nutrition and hygiene interventions can reduce undernutrition when children benefit in their crucial first 1000 days. We conduct an impact evaluation of a Homestead Food Production (HFP) program implemented by Helen Keller International in Bangladesh. The HFP program trains women’s groups in vegetable and fruit gardening, poultry rearing, hygiene, child care and nutrition. Furthermore, we assess the program impact pathways to discern how any impact is achieved. 

The study design is a cluster-randomized controlled field trial in two sub-districts of Habiganj District, Sylhet Division, Bangladesh, including 2700 young women in 96 settlements. After the baseline survey in 2015, settlements were randomized into 48 intervention and 48 control settlements. Women in the intervention settlements received training and support in Homestead Food Production over three years. A surveillance system collected data on pregnancies, births, child development, nutrition and infections as well as pathway indicators. In 2019, we conducted the endline survey to assess the nutritional status of the women and their children below 3 years of age and compare between intervention and control.

The main outcomes of interest are stunting (primary outcome: length-for-age), wasting, anaemia, micronutrient deficiencies, early child development, infection prevalence and dietary intake in children under age 3, intra-uterine growth retardation, as well as underweight and micronutrient deficiencies in the women. To better understand how well and through which pathways the program is working, we collected data on the implementation of the various project components and on pathway indicators including food production, income, food security, health service use, women’s empowerment, feeding and hygiene practices.

FAARM was awarded the 2018 “Preis für mutige Wissenschaft” (Award for bold research) of the State of Baden-Württemberg: Press release (in German, with details about FAARM in the linked PDF at the bottom of the page).

Outreach

Publications

Wendt AS, Sparling TM, Waid JL, Mueller AA, Gabrysch S. (2019): Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh. BMJ Open, 9(7):e031037.

Sparling TM, Waid JL, Wendt AS, Gabrysch S. (2020): Depression among women of reproductive age in rural Bangladesh is linked to food security, diets and nutrition. Public Health Nutrition, 23(4):660-73

Wendt A, Waid J, Gabrysch S. (2019): Etiology of anemia among women and children in rural Bangladesh: an assessment of nutritional an non-nutritional factors (P10-115-19). Current Developments in Nutrition, 3(S1):nzz034.P10-115-19

Wendt AS, Waid JL, Gabrysch S. (2019): Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh. Current Developments in Nutrition, 3(10):nzz093

Gabrysch S, Waid, JL, Wendt AS, Müller AA, Kader A, Gosh U. (2018): Nutritional effects of flooding due to unseasonably early monsoon rainfall in Bangladesh: a cross-sectional study in an ongoing cluster-randomised trial. The Lancet Planetary Health, 2(S1):S3, doi: 10.1016/S2542-5196(18)30088-3

Wendt A, Waid J, Gabrysch S. (2017): The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh. UNSCN News, 42: 149-50

Lorenz E, Gabrysch S. (2017): Covariate-constrained randomization routine for achieving baseline balance in cluster-randomized trials, The Stata Journal, 17(2):503-510

Sinharoy S, Waid JL, Haardörfer R, Wendt A, Gabrysch S*, Yount KM*. (2017): Women’s dietary diversity in rural Bangladesh: Pathways through women’s empowerment. Maternal & Child Nutrition, 14(1). doi:10.1111/mcn.12489. (* equal contribution)

Project team

External collaborators

  • Tarique Huda (icddr,b)
  • Sheela Sinharoy (Emory)
  • Thalia Sparling (LSHTM/Tufts)
  • Jan Frank (Hohenheim)
  • Abdul Kader (HKI Bangladesh)

Main funder

Federal Ministry of Education and Research (BMBF)