Impacts of a Homestead Food Production Intervention on Anaemia and Micronutrient Deficiencies Among Women and Children in Rural Bangladesh: A Cluster-Randomized Controlled Trial.

Abstract

Micronutrient deficiencies affect over half of young children and two-thirds of reproductive-aged women worldwide. Nutrition-sensitive agriculture interventions have the potential to increase nutrient-dense food intake and thus improve micronutrient status. We evaluated the impact of a homestead food production (HFP) programme on micronutrient status and anaemia of women and their children (registered secondary outcomes) in the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial, additionally assessing its impact on inflammation. We conducted a 1:1 parallel two-arm cluster-randomized controlled trial in Sylhet, Bangladesh, with 96 clusters. The 3-year HFP intervention included gardening, poultry, nutrition, and hygiene components. In 2015, we enrolled 2705 women and their children up to 3 years of age, and in 2019, we evaluated impacts on anaemia, iron, vitamin A, zinc and inflammation status through blood measures of women (aged 19-44 years) and their 6- to 37-month-old children, using multilevel regression. Anaemia was common (nonpregnant women: 20%, pregnant women: 35%, children: 16%), while iron deficiency was rare among nonpregnant women (3%), 12% among pregnant women and 20% among children. Vitamin A deficiency ranged from 1% to 5%, and zinc deficiency was very common (nonpregnant women: 43%, pregnant women: 69%, children: 25%). We found no evidence of an intervention impact on micronutrient status, anaemia or inflammation among the 2483 women and 930 children measured. The moderate improvements in dietary intake achieved by the intervention were thus not sufficient, and more substantial hygiene improvements and targeted dietary changes may be needed to improve micronutrient status. This trial was registered at Clinicaltrials.gov (NCT02505711).