Homestead food production (HFP) programmes improve the availability of vegetables by providing training in growing nutrient-dense crops. In rural Tanzania, most foods consumed are carbohydrate-rich staples with low micronutrient concentrations. This cluster-randomized controlled trial investigated whether women growing home gardens have higher dietary diversity, household food security or probability of consuming nutrient-rich food groups than women in a control group. We enrolled 1,006 women of reproductive age in 10 villages in Pwani Region in eastern Tanzania, split between intervention (INT) and control (CON) groups. INT received (a) agricultural training and inputs to promote HFP and dietary diversity and (b) nutrition and public health counselling from agricultural extension workers and community health workers. CON received standard services provided by agriculture and health workers. Results were analysed using linear regression models with propensity weighting adjusting for individual-level confounders and differential loss to follow up. Women in INT consumed 0.50 (95% CI [0.20, 0.80], p = 0.001) more food groups per day than women in CON. Women in INT were also 14 percentage points (95% CI [6, 22], p = 0.001) more likely to consume at least five food groups per day, and INT households were 6 percentage points (95% CI [−13, 0], p = 0.059) less likely to experience moderate-to-severe food insecurity compared with CON. This home gardening intervention had positive effects on diet quality and food security after 1 year. Future

Background: Agriculture can influence diets through consumption of home-produced foods or increased purchasing power derived from sale of agricultural commodities. Objective: This article explores cross-sectional relationships between agricultural diversification and dietary diversity (a proxy for micronutrient adequacy) among women of reproductive age in rural Tanzania. Methods: Dietary diversity was measured using the women’s minimum dietary diversity score indicator. Data were analyzed from the baseline survey of a cluster randomized control trial in Rufiji, Tanzania. One woman of reproductive age was randomly surveyed from each eligible household, totaling 1006 individuals. Generalized linear mixed-effects models were used to estimate the relationship between agricultural indicators and dietary diversity. Results: Median dietary diversity score for women was 3.00 (interquartile range: 2-3). Approximately 73% of households grew at least 1 crop in the previous year. Women’s dietary diversity score was positively associated with cropping diversity ( P for trend = .04), ownership of livestock (adjusted coefficient: 0.30; 95% confidence interval [CI]: 0.08-0.44; P = .005), cash crop production (adjusted coefficient: 0.22; 95% CI: 0.03-0.41; P = .02), and production of pulses (adjusted coefficient: 0.50; 95% CI: 0.27-0.74; P < .0001) and other vegetables (adjusted coefficient: 0.64; 95% CI: 0.11-1.17; P = .02). Conclusions: Average dietary diversity is well below the recommended 5 food groups per day, a widely used indicator of micronutrient adequacy. Since the majority of households participate in agriculture, the efforts to promote agricultural diversification and/or specialization and sale of agricultural goods may positively influence dietary diversity and associated health and nutrition outcomes.

Objective: To examine the prevalence of and factors associated with different forms of household-level double-burden of malnutrition (DBM) in Ethiopia. Design: We defined DBM using anthropometric measures for adult overweight (body mass index (BMI) ≥25 kg/m2), child stunting (height-for-age Z-score <-2 SD) and overweight (weight-for-height Z-score ≥2 SD). We considered 16 biological, environmental, behavioural, and socio-demographic factors. Their association with DBM forms was assessed using generalized linear models. Setting: We used data from two cross-sectional studies in an urban (Addis Ababa, January-February 2018), and rural setting (Kersa District, June-September 2019). Participants: 592 urban and 862 rural households with an adult man, adult woman, and child <5 years. Results: In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9% (95% CI 7-12%)). Duration of residence in Addis Ababa (adjusted odds ratio (aOR) 1.03 (95% CI 1.00-1.06)), Orthodox Christianity (aOR 1.97 (95% CI 1.01-3.85)), and household size (aOR 1.24 (95% CI 1.01-1.54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11% (95% CI 9-14%)). Housing quality (aOR 0.33 (95% CI 0.20-0.53)), household wealth (aOR 1.92 (95% CI 1.18-3.11), and sanitation (aOR 2.08 (95% CI 1.07-4.04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor. Conclusions: DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic, and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.

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Background: Nutrition-sensitive interventions such as homestead production of diverse, nutrient-rich foods, coupled with behavior change communication, may have positive effects on the nutritional status and health of rural households engaged in agriculture, particularly among women and young children. Engagement of agriculture and health extension workers in these communities may be an effective way of delivering nutrition-sensitive interventions given the dearth of trained health care providers in many developing countries. This study aims to assess the effects of integrated homestead food production, food consumption and women's empowerment interventions using a multi-sectoral approach on women's and child's health and nutrition. Methods: This is a cluster-randomized community-based prospective study set in Rufiji district, a rural area in Eastern Tanzania. Ten randomly selected villages within the Rufiji Health and Demographic Surveillance Site (HDSS) in Eastern-Tanzania were paired and randomly assigned to the intervention or control arm. The Rufiji HDSS dataset was used to randomly sample households with women of reproductive age and children 6-36 months. The intervention includes provision of small agricultural inputs, garden training support, and nutrition and health counseling. This is delivered by community health workers and agriculture extension workers through home visits and farmer field schools. There are three time points for data collection: baseline, midline, and endline. Primary outcomes are women's and children's dietary diversity, maternal and child anemia status and growth (child stunting, child wasting, women's BMI, and women and child hemoglobin). Discussion: This integrated agriculture and nutrition intervention among rural farming households is a simple and innovative solution that may contribute to the reduction of undernutrition and disease burden among women and children in developing countries. Engaging already existing workforce in the community may facilitate sustainability of the intervention package. Trial registration: ClinicalTrials.gov NCT03311698, Retrospectively registered on October 17, 2017.