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)
- FAARM was featured in the June 2015 issue "Gesund & Krank" (Healthy & Sick) of Heidelberg University's research magazine Ruperto Carola: "Der stille Hunger. Nachhaltig gegen Mangelernährung" (Hidden hunger. Sustainable action against malnutrition). The article is in German, with a one-page English translation.
- HKI's Press Room featured an article on FAARM in June 2016: "Gardening: A Sustainable Solution for Malnutrition?".
- Presentation on FAARM on 6 June 2018 by Sabine Gabrysch at LSHTM's Centre for Evaluation (30 min.): watch here.
- FAARM featured in BMBF Newsletter in June 2019: Mangelernährung nachhaltig bekämpfen
- FAARM featured on BBC in December 2019: Can kitchen gardens combat climate change?
- Sabine Gabrysch presented FAARM at the Berlin Epidemiological Methods Colloquium (BEMC) on 2 June 2021 (45 min.): watch here.
Waid JL, Wendt AS, Kader A, Sobha S, Gabrysch S. Impact of a Homestead Food Production Program on Dietary Diversity: Seasonal and Annual Results from the Cluster-Randomized FAARM Trial in Sylhet, Bangladesh. J Nutr. 2023 Oct 21:S0022-3166(23)72668-0. doi: 10.1016/j.tjnut.2023.10.014.
Lambrecht NJ, Müller-Hauser AA, Sobhan S, Schmidt WP, Huda TMN, Waid JL, Wendt AS, Kader A, Gabrysch S. Effect of a Homestead Food Production Program on the Prevalence of Diarrhea and Acute Respiratory Infection in Children in Sylhet, Bangladesh: A Cluster-Randomized Controlled Trial. Am J Trop Med Hyg. 2023 Aug 14;109(4):945-956. doi: 10.4269/ajtmh.23-0152.
Wendt AS, Brintrup J, Waid JL, Kader A, Lambrecht NJ, Gabrysch S. Thalassemia and hemoglobinopathy prevalence in a community-based sample in Sylhet, Bangladesh. Orphanet J Rare Dis. 2023 Jul 19;18(1):192. doi: 10.1186/s13023-023-02821-3.
Lambrecht, N. J., Waid, J. L., Wendt, A. S., Sobhan, S., Kader, A., & Gabrysch, S. (2023). Impact of a Homestead Food Production program on poultry rearing and egg consumption: A cluster-randomized controlled trial in Bangladesh. Maternal & Child Nutrition, e13505. doi: 10.1111/mcn.13505
Kyei NNA, Waid JL, Ali N, Cramer B, Humpf HU, Gabrysch S (2023). Maternal exposure to multiple mycotoxins and adverse pregnancy outcomes: a prospective cohort study in rural Bangladesh. Arch Toxicol doi: 10.1007/s00204-023-03491-7
Waid JL, Wendt AS, Sinharoy S, Kader A, Gabrysch S. (2022): Impact of a homestead food production program on women's empowerment: Pro-WEAI results from the FAARM trial in Bangladesh. World Development, Volume 158, 106001. doi: 10.1016/j.worlddev.2022.106001.
Kyei NNA, Cramer B, Humpf H-U, Degen GH, Ali N, Gabrysch S. (2022): Assessment of multiple mycotoxin exposure and its association with food consumption: a human biomonitoring study in a pregnant cohort in rural Bangladesh. Archives of Toxicology, 96, 2123-2138. doi: 10.1007/s00204-022-03288-0.
Sobhan S, Müller-Hauser AA, Huda TMN, Waid JL, Gautam OP, Gon G, Wendt AS, Gabrysch S. (2022): Design, delivery, and determinants of uptake: findings from a food hygiene behavior change intervention in rural Bangladesh. BMC Public Health 22, 887. doi: 10.1186/s12889-022-13124-w.
Dupuis S, Hennink M, Wendt AS, Waid JL, Kalam MA, Gabrysch S, Sinharoy SS. (2022):Women’s empowerment through homestead food production in rural Bangladesh. BMC Public Health, 22, 134. doi: 10.1186/s12889-022-12524-2#.
Kyei NNA, Waid JL, Ali N, Gabrysch S. (2021): Awareness, Experience, and Knowledge of Farming Households in Rural Bangladesh Regarding Mold Contamination of Food Crops: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 18, 19, 10335. doi:10.3390/ijerph181910335.
Seiermann A, Alrahman H, Waid JL, Wendt AS, Sobhan S, Gabrysch S. (2021): Women’s fasting habits and dietary diversity during Ramadan in rural Bangladesh. Maternal and Child Nutrition. e13135. doi: 10.111/mcn.13135.
Sutradhar I, Jackson-deGraffenried M, Akter S, McMahon SA, Waid JL, Schmidt HP, Wendt AS, Gabrysch S. (2021): Introducing urine-enriched biochar-based fertilizer for vegetable production: Acceptability and results from rural Bangladesh. Environment, Development and Sustainability. doi: 10.1007/s10668-020-01194-y
Kyei NNA, Boakye D, Gabrysch S. (2020): Maternal mycotoxin exposure and adverse pregnancy outcomes: a systematic review. Mycotoxin Research. doi: 10.1007/s12550-019-00384-6.
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 and non-nutritional factors (P10-115-19). Current Developments in Nutrition, 3(S1):nzz034.P10-115-19.
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. doi: 10.1136/bmjopen-2019-031037.
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, Mueller 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.
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)
- Tarique Huda (icddr,b)
- Sheela Sinharoy (Emory)
- Thalia Sparling (LSHTM/Tufts)
- Jan Frank (Hohenheim)
- Abdul Kader (HKI Bangladesh)
Federal Ministry of Education and Research (BMBF)