The EHFP intervention improved anemia among children aged 12 to 48 months and their mothers in Baitadi District of Nepal. The intervention also reduced underweight among these women, but had no impact on child growth, in this district.
Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year‐round availability and intake of diverse micronutrient‐rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non‐RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long‐term exposure to targeted multi‐sectoral solutions and rigorous evaluation to optimize impact.
Global recommendations on strategies to improve infant feeding, care and nutrition are clear; however, there is limited literature that explains methods for tailoring these recommendations to the local context where programmes are implemented. This paper aims to: (1) highlight the individual, cultural and environmental factors revealed by formative research to affect infant and young child feeding and care practices in Baitadi district of Far Western Nepal; and (2) outline how both quantitative and qualitative research methods were used to design a context-specific behaviour change strategy to improve child nutrition. Quantitative data on 750 children aged 12-23 months and their families were collected via surveys administered to mothers. The participants were selected using a multistage cluster sampling technique. The survey asked about knowledge, attitude and behaviours relating to infant and young child feeding. Qualitative data on breastfeeding and complementary feeding beliefs and practices were also collected from a separate sample via focus group discussions with mothers, and key informant interviews with mothers-in-law and husbands. Key findings revealed gaps in knowledge among many informants resulting in suboptimal infant and young child feeding practices - particularly with relation to duration of exclusive breastfeeding and dietary diversity of complementary foods. The findings from this research were then incorporated into a context-specific nutrition behaviour change communication strategy.
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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