Enhanced Homestead Food Production Plus+ Program in the Lake Zone, Tanzania

Impact of the Evaluation of the Enhanced Homestead Food Production Program in Sengerema, and Ukerewe in the Lake Zone,Tanzania

The purpose of this study is to assess if the Enhanced Homestead Food Production Plus (EHFP+) Program implemented by HKI in Mwanza, Tanzania, enhances uptake of Micronutrient Powder (MNP) supplementation in children, helps maintaining reduced anemia levels among children after a blanket provision of MNP, and has an impact on child growth, infant and young child feeding (IYCF) practices, maternal knowledge related to health, nutrition, WASH and malaria prevention, food security and women's empowerment.

Study Overview

• Status: Completed
• Conditions: Anemia; Growth Retardation
• Intervention / Treatment: Other: EHFP+

Detailed Description

Since 1988, Helen Keller International's (HKI) flagship Homestead Food Production (HFP) program in Asia has helped communities establish technically-improved local food production systems by creating gardens yielding micronutrient-rich fruits and vegetables over expanded growing seasons, complemented by the improved rearing of poultry and livestock.

In 2010, HKI introduced an enhanced-HFP (E-HFP) model in Burkina Faso and included a strengthened nutrition education component; the Essential Nutrition Actions (ENA) framework. This E-HFP program was evaluated by IFPRI and yielded some encouraging results. With regards to nutritional outcomes, however, the primary finding was that, while the E-HFP program improved hemoglobin concentration-an indicator of iron status-the evaluation failed to note a significant impact of the program on improving children's growth. The primary explanation for the absence of a measurable improvement in children's growth was the lack of complementary health interventions that aim to specifically reduce children's disease burden, which, along with the lack of adequate food and care, is an underlying cause of undernutriton (UNICEF 1990).

Building on lessons learned from the Burkina Faso E-HFP program and a 2011 Tanzania HFP program, a new model, the Enhanced Homestead Food Production Plus (E-HFP+), was developed for Tanzania to improve the nutritional status of infants and young children. The new model strengthens the Behavior Change Communication (BCC) on malaria prevention, WASH, and gender components and enhances links with the health sector. The model will also test two new concepts:

1. to assess if the E-HFP+ program has the potential to maintain adequate levels of hemoglobin concentrations by increasing iron-rich food consumption and malaria prevention good practices.
2. to assess the effectiveness on anemia of using an existing agriculture-based platform to promote uptake and utilization of MNP.

The model involves both a set of production and nutrition interventions targeted to mothers and the provision of a curative treatment for moderate to severe anemia (Micronutrient Powder).

The main objective of the impact evaluation of the E-HFP+ program is therefore to assess whether the program:

• Maintains reduced anemia levels among pre-school aged children after a blanket provision of Micronutrient Powder (MNP)
• Improves child growth (measured by HAZ and WHZ)
• Improves infant and young child feeding (IYCF) practices and maternal knowledge on health and nutrition
• Is an appropriate delivery platform to enhance uptake and utilization of MNP supplementation in children

• Study Type: Interventional
• Enrollment (Actual): 2325
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Tanzania
  • Mwanza, Tanzania
    • National Institute for Medical Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 1 year (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• women living in the study area
• having one child aged 6-12 months of age

Exclusion Criteria:

• children with severe anemia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: EHFP+; Group receiving the intervention EHFP+, in addition to MNPs distribution for 2 months and malaria diagnosis and treatment for children enrolled, at baseline and after 12 months	Other: EHFP+; Enhanced-homestead food production program including home gardening and poultry rearing + WASH interventions + SBCC around the essential nutrition actions and WASH/malaria prevention with a gender component.
No Intervention: Control; MNPs distribution for 2 months and malaria diagnosis and treatment for children enrolled, at baseline and after 12 months

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anemia (g/dl and %)	Change in prevalence of anemia and hemoglobin concentration will be measured over the course of the program period.(at baseline, during follow-up after 3, 6 and 12 months and after 18 months at endline)	Measurements will be made for children aged 6 to 11 months at baseline and up to 3 months, 6 months, 12 months and 18 months (at endline), when the children are between the ages of 24 and 30 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Growth (Z-score and %)	Change in height-for-age Z-scores, weight-for-age Z-scores and weight-for-height Z-scores will be measured as well as the change in the prevalence of stunting (HAZ<-2), underweight (WAZ<-2) and wasting (WHZ<-2) over the course of the program period	Measurements will be made for children between the ages of 6 and 11 months of age at baseline and 18 months later, at endline, when the children are between the ages of 24 and 30 months
Biochemical markers	Change in plasmatic concentration of iron biomarkers (transferring receptors and ferritin; TfR and F), in concentration of vitamin A biomarkers (retinolbindingprotein; RBP) and inflammatory proteins (C-reactiveprotein and alpha-1 acidglycoprotein; CRP and AGP)	Baseline (June 2014), Follow-up1 (up to 3 months) and after 18 months at Endline
Dietary diversity (%)	Measured with a questionnaire using a qualitative 24h recall. Unit: Number of food group consumed and percentage of children having consumed 4 groups (upon 7) the previous day	Baseline (2014) and after 18 months at Endline
Food security (%)	Measured with a questionnaire to calculate the HFIAS score. Unit: percentage of household	Baseline (2014) and after 18 months at Endline (2016)
Women's empowerment (%)	Measured by questionnaire, using a decision-making module and a domestic violence module. Percentage of women over a calculated score.	Baseline (2014) and after 18 months at Endline (2016)
Maternal health and nutrition/WASH/malaria-related knowledge (%)	Using questionnaire on knowledge. Percentage of women giving adequate answer.	Baseline (2014) and after 18 months at Endline (2016)
IYCF/WASH/malaria practices (%)	Using questionnaire on practices. Percentage of women with adequate practices.	Baseline (2014) and after 18 months at Endline (2016)

Collaborators and Investigators

• Sponsor: International Food Policy Research Institute
• Collaborators: Helen Keller International; National Institute for Medical Research, Tanzania; Foreign Affairs, Trade and Development, Canada
• Investigators: Principal Investigator: Rahul Rawat, PhD, International Food Policy Research Institute; Principal Investigator: Erin Smith, Helen Keller International

Study record dates

Study Major Dates

• Study Start: June 1, 2014
• Primary Completion (Actual): March 1, 2016
• Study Completion (Actual): March 1, 2016

Study Registration Dates

• First Submitted: September 5, 2014
• First Submitted That Met QC Criteria: October 3, 2014
• First Posted (Estimate): October 8, 2014

Study Record Updates

• Last Update Posted (Estimate): September 19, 2016
• Last Update Submitted That Met QC Criteria: September 16, 2016
• Last Verified: September 1, 2015

More Information

Terms related to this study

• Other Study ID Numbers: EHFP+ TZ

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO