Cambodia's homestead food production program increased household production and consumption of micronutrient-rich foods and maternal and child intake (or frequency of intake) of some of these foods. Weaknesses in the evaluation design (e.g., lack of comparability between groups at baseline, failure to control for self-selection of households into the intervention, and collection of baseline and endline data during different seasons) prevent drawing firm conclusions about the program impacts. Analysis of impact pathways also shows that household-level benefits from the program did not translate into significant improvements in maternal and child health and nutrition. A careful redesign and rigorous assessment of the program using a program theory framework would help unleash its true potential to improve maternal and child health and nutrition outcomes.

This paper assesses the additional benefits of a homestead gardening program designed to control vitamin A deficiency in Bangladesh. In February and March 2002, data were collected on the food security and social status of women from 2,160 households of active and former participants in the gardening program and from control groups in order to assess the impact and sustainability of the program. The proportions of active and former-participant households that gardened year-round were fivefold and threefold, respectively, higher than that of the control group (78% and 50% vs. 15%). In a three-month period, the households of active participants produced a median of 135 kg and consumed a median of 85 kg of vegetables, while the control households produced a median of 46 kg and consumed a median of 38 kg (p and consumed a median of 38 kg (p and consumed a median of 38 kg (< .001). About 64% of the active-participant households generated a median garden income of 347 taka (US$1 = 51 taka), which was spent mainly on food, and 25% of the control households generated 200 taka in the same period (p generated 200 taka in the same period (p generated 200 taka in the same period (< .001). The garden production and income levels of formerly participating households three years after withdrawal of program support were much higher than those of the control households, illustrating the sustainability of the program and its ability to increase household food security. Significantly more women in active-and former-participant households than in control households perceived that they had increased their economic contribution to their households since the time the program was launched in their subdistricts (> 85% vs. 52%). Similar results were found for the level of influence gained by women on household decision-making. These results highlight the multiple benefits that homestead gardening programs can bring and demonstrate that these benefits should be considered when selecting nutritional and development approaches targeting poor households.

Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

To evaluate the effectiveness of Sprinkles alongside infant and young child feeding (IYCF) education compared with IYCF education alone on anemia, deficiencies in iron, vitamin A, and zinc, and growth in Cambodian infants.Design: Cluster-randomized effectiveness study.Setting: Cambodian rural health district.Participants: Among 3112 infants aged 6 months, a random subsample (n = 1350) was surveyed at baseline and 6-month intervals to age 24 months.Intervention: Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months.Main Outcome Measures: Prevalence of anemia; iron, vitamin A, and zinc deficiencies; and growth via biomarkers and anthropometry.Results: Anemia prevalence (hemoglobin level Ͻ11.0 g/dL [to convert to grams per liter, multiply by 10.0]) was reduced in the intervention arm compared with the control arm by 20.6% at 12 months (95% CI, 9.4-30.2; P = .001), and the prevalence of moderate anemia (hemoglobin level Ͻ10.0 g/dL) was reduced by 27.1% (95% CI, 21.0-31.8; PϽ .001). At 12 and 18 months, iron deficiency prevalence was reduced by 23.5% (95% CI, 15.6-29.1; PϽ.001) and 11.6% (95% CI, 2.6-17.9; P=.02), respectively. The mean serum zinc concentration was increased at 12 months (2.88 µg/dL [to convert to micromoles per liter, multiply by 0.153]; 95% CI, 0.26-5.42; P =.03). There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time.Conclusions: Sprinkles reduced anemia and iron deficiency and increased the mean serum zinc concentration in Cambodian infants. Anemia and zinc effects did not persist beyond the intervention period.

Micronutrient malnutrition affects more than 20 million children and women (at least 50% of this population) in Bangladesh. The diets of more than 85% of women and children in Bangladesh are inadequate in essential micronutrients such as vitamin A, largely because adequate amounts of foods containing these micronutrients are not available, or the household purchasing power for these foods is inadequate. In Bangladesh and many other developing countries, large-scale programmes are needed to make a significant impact on this overwhelming malnutrition problem. There has been limited experience and success in expanding small-scale pilot programmes into large-scale, community-based programmes. This paper describes the development and expansion of the Bangladesh homestead gardening programme, which has successfully increased the availability and consumption of vitamin A-rich foods. The programme, implemented by Helen Keller International through partnerships with local non-governmental organizations, encourages improvements in existing gardening practices, such as promotion of year-round gardening and increased varieties of fruits and vegetables. We present our experience with the targeted programme beneficiaries, but we have observed that neighbouring households also benefit from the programme. Although this spillover effect amplifies the benefit, it also makes an evaluation of the impact more difficult. The lessons learned during the development and expansion of this community-based programme are presented. There is a need for an innovative pilot programme, strong collaborative partnerships with local organizations, and continuous monitoring and evaluation of programme experiences. The expansion has occurred with a high degree

Efforts to improve household food security are important as a means of promoting maternal nutritional status; however, additional research is needed to better understand the role of other factors that are driving the burden of child undernutrition in Cambodia.

Malnutrition is a serious public health problem in Asia. Since 2003 Helen Keller International (HKI) has been implementing homestead food production (HFP) programmes to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households of Asia. The aim of this paper is to review the impact of HFP programmes and identify lessons learned for adaptation, replication and potential scale-up. Impact evaluation data collected on a representative sample (10 to 20 percent of ~30,000 households in HFP programme and comparison (non-HFP programme) villages in Bangladesh, Cambodia, Nepal and the Philippines were reviewed. Information assessed included household garden practices, dietary intake, income and prevalence of anaemia and night-blindness among children (6-59 months) and non-pregnant women. A review of the implementation process was also undertaken. The HFP programme improved household garden practices, food production, consumption and dietary diversity. The number of crop varieties consumed was significantly increased from a range of 2-3 to 8-9 between baseline and endline among programmeme households. The change in proportion of households consuming eggs and/or liver was higher among programme (24 percent to 46 percent) than comparison (12 percent to 18 percent) households. The median income earned from selling surplus HFP produce increased from US$1 to 7 in all programmes. Anaemia prevalence was lower among children in the programme households at endline compared to baseline, however, the decrease was only significant in Bangladesh (63.9 percent to 45.2 percent), and the Philippines (42.9 percent to 16.6 percent). The HFP programme improved household garden practices, consumption, dietary diversity and income as well as reduced anaemia among preschool children.

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