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Abstract
Introduction Chronic undernutrition affects over 150 million children worldwide and has serious consequences. The causes are complex and include insufficient dietary diversity and poor hygiene practices. Systematic reviews of nutrition-sensitive agricultural interventions concluded that while these hold promise, there is insufficient evidence for their impact on child growth. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) project is a 1:1 cluster-randomised trial aiming to evaluate the impact of a Homestead Food Production (HFP) programme implemented by Helen Keller International on women’s and children’s undernutrition.
Methods and analysis The HFP intervention comprises training of women’s groups and asset distribution to support year-round home gardening, poultry rearing and improved nutrition and hygiene practices. Formal trainings are supplemented by behaviour change communication during household visits, and facilitated links between producer groups and market actors. The FAARM trial will examine if and how this complex intervention reduces undernutrition. In 2015, FAARM enrolled married women and their children (0–3 years) in 96 rural settlements of Habiganj district in Sylhet division, Bangladesh. Covariate-constrained randomisation was used to assign 48 settlements to receive a 3-year HFP intervention, with the other 48 acting as controls, targeting over 2700 women. To study impact pathways, a surveillance system collects data on all participants every 2 months. In late 2019, children 0–3 years of age (born during the intervention period) will be surveyed, thus capturing impact during the critical first 1000 days of life. Children’s length/height-for-age z-scores will be compared between intervention and control arms using mixed-effects linear regression. Secondary outcomes include women’s and children’s micronutrient status, dietary intake, dietary diversity and other indicators of child growth, development and morbidity.
Ethics and dissemination Ethical approval was received in Bangladesh and Germany. Results will be disseminated through peer-reviewed publications and presentations in Bangladesh and internationally.
Trial registration number NCT02505711; Pre-results.
- nutrition
- community child health
- public health
- epidemiology
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Footnotes
Contributors SG conceptualised the study initially, then jointly with JLW. SG, JLW and TMS selected the study site. SG, JLW, ASW, TMS and AAM developed and oversaw surveys, monitoring and surveillance systems. All authors contributed to the development, review and finalisation of this study protocol manuscript.
Funding The FAARM trial is primarily supported by the German Ministry for Education and Research (BMBF) (grant number: 01ER1201). Additional funding for the surveillance programme and other project components comes from the Nutrition Embedding Evaluation Programme (NEEP) funded by the UK Department for International Development (DFID) (grant number: DFI.1836-705713-PRE), the Food and Business Applied Research Fund (ARF) of the Dutch Ministry of Foreign Affairs (grant number: W08.270.334), the Thrasher Research Fund (grant number: 13751), and the Alexander von Humboldt Foundation (grant number: 3.1-1163387). Further support through charitable donations to HKI for the implementation of the HFP programme is provided by the Carrefour social responsibility programme and the Best in Brands social marketing programme.
Disclaimer The content of this publication is solely the responsibility of the authors. Funding organisations did not have a role in the study design, hiring or training of staff, intervention delivery, data collection, analysis or interpretation of data.
Competing interests None declared.
Ethics approval The full FAARM trial protocol was positively reviewed by Heidelberg University in Germany (Reference: S-121/2014). The trial protocol without biological sample collection was approved by the James P. Grant School of Public Health, BRAC University (IRB Registration: IRB00003441) and the blood sampling by the Bangladesh Medical Research Council (Reference: BMRC/NREC/2013-2016/844). The food hygiene intervention and evaluation protocol including stool sampling and blood sampling at endline was approved by Heidelberg University (Reference: S-606/2017) and icddr,b (Reference: PR-17126). Any protocol changes are reported to the respective ethical boards for approval.
Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.
Patient consent for publication Not required.
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