Impact of an enhanced homestead food production program on household food production and dietary intake of women aged 15-49 years and children aged 6-59 months: a pragmatic delayed cluster randomized control trial protocol
Keywords:Enhanced homestead food production, Nutrition, Pragmatic delayed cluster randomized controlled trial, Cambodia
Background: Undernutrition remains a public health problem in Cambodia. To address this, Helen Keller International has implemented an enhanced homestead food production (EHFP) program that provides agricultural inputs and, nutrition, hygiene, and gender empowerment training. This research evaluates the impact of EHFP on dietary intake of women and children and, household food production.
Methods: This two-year pragmatic delayed cluster randomized controlled trial will be conducted in 600 households in Kampot, Cambodia. Half the households will be randomly assigned to the intervention group and administered the EHFP program immediately. The remaining households (control) will be delayed for one year after which they will receive EHFP. In year one in the control group and year two in the intervention group, household data on food production and income generation will be collected using monthly surveys and, dietary data will be collected using 24-hour recalls from women 15-49 years and children 6-59 months twice during the year. Primary outcomes are differences between the treatment groups in mean intake of zinc and vitamin A among women and children. Secondary outcomes are differences between the treatment groups for other key nutrients and the incremental net monetary benefit of EHFP. Additional outcomes including household food security, women’s empowerment, and hygiene practices from larger project data will also be assessed.
Conclusions: The results of this trial will assess the impact of EHFP on household food production and the dietary intake of women and children.
International Food Policy Research Institute. 2012 Global Hunger Index. The challenge of hunger: ensuring sustainable food security under land, water, and energy stresses. IFPRI - Issue Br. 2012;(70):1-67.
Olney DK, Talukder A, Iannotti LL, Ruel MT, Quinn V. Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food Nutr Bull. 2009;30:355-69.
Olney DK, Vicheka S, Kro M, Chakriya C, Kroeun H, SokHoing L, et al. Using program impact pathways to understand and improve program delivery, utilization, and potential for impact of Helen Keller International's homestead food production program in Cambodia. Food Nutr Bull. 2013;34:169-84.
Council for Agricultural and Rural Development. National Strategy for Food Security and Nutrition 2014-2018: Cambodia, 2014. Available at: http://ali-sea.org/aliseaonlinelibrary-dashboard/get/file/ Strategic-Framework-for-Food-Security-and-Nutrition-in-Cambodia-2014-2018-SFFSN-Cambodia.pdf. Accessed on 12 April 2017.
National Institute of Statistics. Cambodia Demographic and Health Survey 2014. Phnom Penh, Cambodia and Rockville, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF International; 2015.
Verbowski VC. The effect of plant-based homestead food production with and without small-scale aquaculture on dietary intake of women farmers and their children in Prey Veng, Cambodia (Unpublished Master’s Thesis). The University of British Columbia, Vancouver, BC, Canada; 2015.
Michaux KD. Gap Analysis Report, Fish on Farms. Phnom Penh, Cambodia: University of British Columbia; 2015.
Lakzadeh P. Economic evaluation of a novel homestead food production program in rural Cambodia (Unpublished Master’s Thesis). The University of British Columbia, Vancouver, BC, Canada; 2016.
Krist AH, Glenn BA, Glasgow RE, Balasubramanian BA, Chambers DA, Fernandez ME, et al. Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project. Implement Sci. 2013;8(1):73.
Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, et al. A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62(5):464-75.
World Health Organisation, WHO: Maternal I, Health C. Essential Nutrition Actions- Improving maternal, newborn, infant and young child health and nutrition. Geneva WHO. 2013: 144.
Hillenbrand E, Lindsey D, Ridolfi R, Von Kotze A. Nurturing Connections: Adapted for Homestead Food Production and Nutrition. New York, NY: Helen Keller International; 2015.
Ford I, Norrie J. Pragmatic Trials. N Engl J Med. 2016;375(5):454-463.
Gibson RS, Ferguson EL. An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. Washington, D.C.: HarvestPlus and Int Food Policy Res Institute. 2008.
Institute of Medicine (IOM). DRI Dietary Reference Intakes: Applications in Dietary Assessment. Vol Available.;2000. doi:doi: 10.17226/9956.
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, D.C.: National Academies Press; 2001.
Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for measurement of household food access: indicator guide (v.3). FHI 360/FANTA, Washington, DC; 2007.
International Food Policy Research Institute. Women’s Empowerment in Agriculture Index. Washington: IFPRI; 2012.
UNICEF. Strategy for improved nutrition of children and women in developing countries. New York: UNICEF; 1990.
Wren H, Chambers L. Breastfeeding in Cambodia: mother knowledge, attitudes and practices. World Health Popul. 2011;13:17-29.
Pandey VL, Mahendra Dev S, Jayachandran U. Impact of agricultural interventions on the nutritional status in South Asia: A review. Food Policy. 2016;62:28-40.