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 conducted the baseline survey. 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 these 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).

Keywords: haemoglobin; iron; nutrition‐sensitive agriculture; vitamin A; zinc.

Figure 1

Trial profile as CONSORT flow diagram. The flowchart depicts how we arrived at the final analytic samples for the micronutrient status of women and children enrolled in the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Sylhet, Bangladesh. ^aThe baseline and endline surveys consisted of several modules. The depicted numbers reflect those women and eligible children reached in the anthropometry/blood collection module (September‐December 2019). ^bMeasures included iron (serum ferritin and soluble transferrin receptor), vitamin A (retinol binding protein), and inflammation (C‐reactive protein, alpha‐1‐acid glycoprotein). ^cThe eligibility period for children was defined as those born after 1 September 2016 and before or on 22 December 2023, as all blood collection ended on this day. ^dLater endline survey modules captured additional births that occurred after the blood collection module was complete. ^eBlood was collected into serum and EDTA vials. In some cases, not all vials could be filled, which prevented either haemoglobin (EDTA vials) or micronutrient (serum vials) measurement. EDTA: Ethylenediaminetetraacetic acid.