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Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations - lessons learned from scaling-up programs in Asia (Bangladesh, Cambodia, Nepal and Philippines)

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Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children. Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples (10 to 20% of program households and a similar number of control households) taken for evaluations of HFP programs in these countries were reviewed to illustrate the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that participation in the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline (p
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Homestead food production model contributes to improved household food security and
nutrition status of young children and women in poor populations - lessons learned from
scaling-up programs in Asia (Bangladesh, Cambodia, Nepal and Philippines)
A. Talukder
1,5
, N.J. Haselow
5
, A.K. Osei
5
, E. Villate
4
, D. Reario
4
, H. Kroeun
1
, L.
SokHoing
1
, A. Uddin
2
, S Dhungel
3
, V. Quinn
6
Affiliations
1
Helen Keller International, Cambodia
²Helen Keller International, Bangladesh
3
Helen Keller International, Nepal
4
Helen Keller International, Philippines
5
Helen Keller International, Asia-Pacific Regional Office, Phnom Penh, Cambodia
6
Helen Keller International, Washington D C, USA
This project was funded by Oxfam Novib in Bangladesh and Nepal, USAID and CIDA in
Cambodia, and Monsanto in Philippines
Abstract
Micronutrient malnutrition is a serious public health problem among women and children in
Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been
implementing homestead food production (HFP) programs (coupled with nutrition education) in
these countries to increase and ensure year-round availability and intake of micronutrient-rich
foods in poor households, particularly among women and children. Between 2003 and 2007, the
HFP program was implemented among ~30,000 households in these four countries. Data
collected from representative samples (10 to 20% of program households and a similar number
of control households) taken for evaluations of HFP programs in these countries were reviewed
to illustrate the benefit of the program for households. Data were collected through interviews
with households in villages that had the HFP program and from control households in non-HFP
program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200
non-pregnant women before and after program implementation were analyzed for hemoglobin.
The review showed that participation in the HFP program significantly improved dietary
diversification. The combined data from all four countries showed improved animal food
consumption among program households, with liver consumption increasing from 24% at
baseline to 46% at endline (p<0.001) and the median number of eggs consumed by families per
week increasing from 2 to 5. The sale of HFP products also improved household income,
although the average income gained was variable across countries. Anemia prevalence among
children in program households decreased in all the countries, however, the decrease was only
significant in Bangladesh (63.9 at baseline and 45.2% at endline, P<0.001), and the Philippines
(42.9 at baseline and 16.6% at endline, P<0.001). Although anemia prevalence also decreased
among control households in three of the countries, the magnitude of change was higher in
program households compared to control households.
1
1. Introduction
There is substantial evidence that malnutrition, particularly micronutrient deficiencies, is a
contributing factor in up to 35% of mortality in children less than 5 years of age and growing
body of evidence exist that malnutrition plays a similar role in maternal mortality (1). At least
one half of preschool-aged children and pregnant women in Bangladesh, Cambodia, Nepal and
the Philippines are affected by micronutrient malnutrition, including deficiencies of vitamin A
and iron (2-5). These deficiencies are also common among older children, adolescents and non-
pregnant women. Micronutrient deficiencies are highly prevalent in these countries because the
typical diet consists of mainly cereals and lacks the optimal diversity and quality to meet the
nutrient needs of most people. Infants and young children are particularly at risk of
micronutrient deficiencies because of their high nutritional needs relative to energy intake and
the frequent episodes of infection (including sub-clinical infection) at this age which often results
in reduced appetite, decreased nutrient absorption, and increased loss of nutrients from the body.
Besides its effect on childhood mortality, malnutrition during early life often leads to stunted
growth in children who survive (6), and there may also be irreversible sequelae from
micronutrient deficiencies that affect brain development and other functional outcomes.
Micronutrient malnutrition has serious implications on the development of countries due to its
long-term impact on health, cognitive function, and work productivity.
The recent increase in global food prices has substantially raised overall poverty and has pushed
more people into malnutrition. The food price crisis is thought to have moved over 100 million
people back into poverty in 2008 and erased four years of the global progress towards the
achievement of the first Millennium Development Goal (MDG), which is the reduction of
extreme poverty and hunger by 2015 (7). The Food and Agriculture Organization of the United
Nations (FAO) estimates that the number of hungry people in the world increased by 50 million
people in 2008 as a result of the high global food prices and for the first time in the last century,
the estimated number of hungry people in the world is more than 1 billion (8). As a result of the
food crises, many households have been forced to adopt harmful coping strategies for survival,
such as cutting back on food consumption, replacing micronutrient-rich foods with staple foods,
selling household and agricultural assets, and increased borrowing putting many households in
financial debt. These actions have long-term negative consequences for nutrition, health, child
development and food security (9). Women and children, who have special nutritional needs, are
particularly at risk with negative implications on maternal health and well being and on the
survival, growth and development of children (10, 11).
Conventional approaches to address micronutrient malnutrition in deficient populations are
supplementation, food fortification, nutrition education and dietary diversification strategies
(including agricultural interventions). Of these approaches, dietary diversification strategies are
considered more sustainable because these are often community based and have the advantage of
being economically feasible and culturally acceptable compared to the other methods for
improving micronutrient status (12). Dietary diversification approaches for ensuring better
micronutrient status of household members involves improving dietary intake by having a
sufficient, affordable and diverse supply of micronutrient-rich foods throughout the year, and
providing information to households to ensure these foods are consumed in adequate amounts,
particularly among the most vulnerable household members. Inadequate dietary intake is the
main cause of micronutrient deficiencies and thus it seems logical that food and agriculture
activities, ideally in conjunction with nutrition education, could contribute to improved
2
micronutrient status (13). Food-based approaches, particularly the ones that involve agricultural
interventions, can also contribute to poverty reduction in a variety of ways, which in turn also
adds to improving nutritional status (11, 15, 16). Increasing availability and consumption of
micronutrient-rich foods through a household’s own production is considered a sustainable
approach because the process empowers women and households to take ultimate responsibility
over the quality of their diet through their own production of nutrient-rich foods and educated
consumption choices
(14). Until recently, projects that encourage households’ own production
of food have focused on home gardens that often promote the production of plant source foods
only. While plant foods are important sources of micronutrients, particularly vitamin A, it is now
well known that the bioavailability of vitamin A and other micronutrients from plants is lower
than originally thought (17). Therefore, it is crucial to increase the consumption of animal foods,
which are known to be rich sources of bioavailable vitamins and minerals, among micronutrient
deficient populations. For this reason, Helen Keller International (HKI) initiated pilot projects in
Bangladesh, Cambodia, Nepal and Philippines to integrate animal husbandry and nutrition
education into an on-going home gardening program to enhance the intake of bioavailable
micronutrients by household members. This integrated approach is referred to as homestead food
production (HFP).
Helen Keller International’s homestead food production model
HKI has been implementing homestead food production programs in several countries in Asia
since the early 1990s. The program which was initiated as a pilot project in Bangladesh is
currently one of the major HKI interventions in Bangladesh, Cambodia, Nepal and Philippines.
The HFP program enables year-round availability of nutritious foods for participating
households. The main objectives of the program are to 1) increase diversity and year-round
production of fruits and vegetables by participating households; 2) increase the year round
production of meat, poultry and eggs by participating households; 3) improve consumption of
fruits and vegetables and animal source foods by members of households involved in the
program, through increased production and nutrition-related education, and 3) improve health
and nutrition outcomes of women and children in participating households. The HFP model
achieves these objectives by encouraging households to establish household gardens and animal
husbandry (mainly rearing poultry); and by conducting nutrition education to inform optimal
intra-household nutrition and feeding practices. HFP also generates additional income for
household members through the sale of surplus food products from the home gardens and/or
animal husbandry. This income can be used to purchase other micronutrient-rich food items, and
pay for household expenses such as health care and children’s education needs (18)
In most poor households in rural areas of South and Southeast Asia, home gardening is already a
common practice, however, the gardens and gardening practices are sub-optimal and do not offer
adequate nutritious year round products. Under the HFP model, household gardens are classified
into three categories: “traditional”, “improved” and “developed”. Traditional gardens are
seasonal and are often maintained on scattered plots with a few traditional fruits and vegetables
such as pumpkins and gourds. This type of home garden is usually practiced by most households
in Asia, especially when there is no external assistance for improved agricultural practices.
Improved gardens are gardens maintained on fixed plots that produce more varieties of fruits and
vegetables than the traditional gardens, but only during certain times of the year. Developed
gardens are maintained on fixed plots and produce a wide variety of fruits and vegetables that are
available throughout the year (i.e. year-round). HKI’s HFP model encourages, promotes and
3
assists households to establish the developed type of garden which yields a wide variety of fruits
and vegetables on a year-round basis together with animal husbandry.
The HFP model targets women from poor households as the primary beneficiaries, placing
farming inputs, knowledge and skills in their hands. The model works by providing technical
assistance, training, agricultural supplies and management support through local non-
governmental organizations (NGOs) partners to support primarily women farmers from poor
households. In establishing the HFP model, HKI first works with the local NGO partners to
establish Village Model Farms (VMFs) in the target communities. These VMFs supply the seeds,
seedlings, saplings and chicks to participating households for their year round food production.
The VMFs also serve as a focal point for community support, demonstrating agricultural
methods and providing practical training and inputs for production by targeted households. The
owner of the VMF also coordinates and supports the women’s group of household
producers/farmers, and helps link them to additional health and agriculture services as well as
markets.
As stated above, the first HFP pilot project was initiated by HKI in Bangladesh 20 years ago and
since then the model has been refined and scaled up throughout the country and also adapted to
the local contexts in Cambodia, Nepal and the Philippines. Altogether, the program has reached
over one million households, representing about 5.5 million beneficiaries, particularly women
and children, in these countries. The HFP programs reviewed for this report were implemented
with HKI support for at least three years before the program evaluations were conducted.
2. Methodology
Between 2003 and 2007, the HFP program was implemented among ~30,000 households in
various project sites across Bangladesh, Cambodia, Nepal and the Philippines. Data collected
from representative samples (10 to 20% of program households and a similar number of control
households) taken for evaluations of HFP programs in these countries were reviewed to illustrate
the benefit of the program for households. In these evaluations, randomly selected households
from villages that participated in the HFP program were identified as ‘program’ households.
‘Control’ households were sampled from different villages that did not participate in the HFP
program but had similar demographic profiles as the program villages. The program households
received training, and inputs for homestead food production as well as nutrition education from
HKI through trained personnel of a local NGO partners.
In all the countries involved in this review, cross-sectional data were collected from the program
and control households before the start of the HFP program (baseline) and after a period of the
programs implementation (endline). Baseline data were collected in 2003 and endline surveys
took place between 2006-2007, after 3-4 years of the HFP program implementation, the length of
which varied slightly by country (Table 1). In each country (except Cambodia), the baseline and
endline surveys were conducted around the same time of the year to reduce normal seasonality
production influences. The changes in outcome variables of interest between the baseline and
endline surveys were compared between the program and control communities in each country in
order to determine the impact of the HFP projects.
4
Table 1. Dates of baseline and endline data collection for HFP program evaluations in
Bangladesh, Cambodia, Nepal and Philippines
Date of baseline survey Date of endline survey
Bangladesh July 2003 June 2005
Cambodia October 2005 May 2007
Nepal May 2003 May 2006
Philippines April 2005 July 2007
In all countries, a similar, but slightly contextually adapted precoded, structured questionnaire
was used to collect data through interviews on household food production such as the diversity
(number and varieties) of vegetable and fruits produced from the home garden and the number of
eggs produced from the poultry in the house; household food consumption including the number
of different varieties of fruits and vegetables consumed by household members and the
consumption of animal foods like eggs and liver by household members in the week before the
survey; household income and the income generated from sale of HFP products in the month
preceding the survey and the utilization of such income; and household socio-economic
indicators, including decision-making process and power among household members. It is worth
noting that other information on household characteristics was collected during these surveys but
we have only mentioned the ones that are relevant for this review. Weight, height and mid upper
arm circumference of children and the mid-upper arm circumference of their non-pregnant
mothers were measured in all the countries.
In a sub-sample of household in all four countries, blood samples were collected to assess change
in anemia status. A finger prick of blood was collected by trained staff from ~1000 children
aged 6-59 months and ~1200 non-pregnant women before and after program implementation for
measurement of hemoglobin using a HemoCue
TM
analyzer. The sample included ~ 125 children
aged 6-59 months and ~200 non-pregnant women from each of the program and control
households in each country. Blood samples were collected only for children and not mothers in
the Philippines survey because children were considered the primary focus of anemia assessment
for the impact evaluation in this country. Anemia was defined as hemoglobin <110 g/L for
children aged 6-59 months, and hemoglobin <120 g/L for non-pregnant women.
Vitamin A intake was assessed among sub-samples by using the 24-hour vitamin A semi-
quantitative food frequency questionnaire developed by HKI’s (19). In addition to the impact
evaluation surveys presented in this review for the HFP programs, we also used secondary data
from the second national vitamin A survey conducted in Bangladesh in 1999 to assess the impact
of home gardening and poultry production on nightblindness prevalence in children.
All the respondents were informed about the purpose of the survey and verbal and written
consent was received from all before their participation. The confidentiality of all information
released by respondents was assured. Ethical approval for the studies was granted by the
National Ethics Committee in all four countries.
Country specific data was analyzed separately using the Statistical Package for Social Science
(SPSS). For each of the four countries, proportions and means of key outcome variables of
interest were used to describe the data collected from the baseline and endline surveys. Within
each of the program and control groups, comparisons were made on each outcome indicator
5
between the baseline and endline surveys to assess if these parameters changed significantly over
time. The program and control groups were then compared on such changes to assess the impact
of the program. Country specific program evaluation results have been presented in various
reports and bulletins (20, 21, 22, 23). For most of the results presented in this review, we did not
pool the raw data and re-analyze it, but rather reviewed the findings presented in the various
reports and bulletins and presented these findings to illustrate the impact of the HFP program.
However, in cases where the raw data from the different countries was available for a particular
indicator, the raw data was re-analyzed separately for each country and also pooled together and
re-analyzed to verify and clarify the findings obtained from the already published reports and
bulletins.
3. Results
3.1 Changes in vegetable production and consumption
Figure 1 presents the consolidated findings from the endline evaluation surveys in Bangladesh
and Cambodia HFP program villages on the number of vegetable varieties being produced, the
volume of production in the two months prior to the survey and the frequency of vegetable
consumption by children in the week before the survey for the different types of home gardens
(traditional, improved and developed garden types) in these communities. The data show that
the number of varieties of vegetables and the volume being produced was highest among
households that practiced the developed gardening, which is promoted by HKI in its HFP
program, compared to households that practiced the improved and traditional types of garden.
The number of varieties of vegetable produced and the volume produced from home garden was
three and four times respectively higher in developed gardens than traditional gardens. The
diversity of vegetable consumption by young children was only four types of vegetables eaten
when households practiced traditional gardening compared to thirteen types of vegetables eaten
when households practiced the developed gardening. Frequency of consumption of vegetables
by children was also 1.6 times higher among children in households that have developed gardens
relative to traditional gardens. The high dietary diversity among children from households that
practiced developed gardens was also associated with increased consumption of vitamin A rich
foods. More children in households with developed gardens consumed vitamin A-rich foods,
such as green leafy vegetables and yellow fruits, more frequently than children in households
without a garden or with a traditional garden.
6
Figure 1. Type of garden related to production and consumption of vegetables in Bangladesh and
Cambodia at endline.
4.5
8
3
4
3
5
13
45.5
10
19.5
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
No Traditional Improved Developed
Garden Type
cons(d/wk)var(n)
0
5
10
15
20
25
30
35
40
45
50
Production(kg)
child veg cons (d/wk) No of varieties Production (kg)
As shown in figure 2 below, the type of gardens grown by households that have home gardens
changed significantly (p<0.05) between baseline and endline surveys for both the program and
control households in Cambodia. The presence of developed gardens, with diverse varieties of
vegetables, was very low in both program and control areas at baseline. However, at the endline
evaluation, a significantly greater proportion of households in the program area were practicing
developed gardening compared to the control households. As mentioned earlier, HKIs HFP
program promotes the developed garden type. Therefore this increase suggests that the HFP
program resulted in more households practicing the developed garden type.
Figure 2. Changes in type of household gardens practiced by households in Cambodia between
baseline and endline (2003-2007).
7
3.2. Impact on animal food consumption
The findings from pooled data of the surveys in Bangladesh and Cambodia showed that
consumption of chicken liver increased from 24% to 46% from baseline to endline in program
households. Egg consumption by household members, as well as by mothers and children, also
increased significantly in the program households. (p<0.05) (Table 1).
Table 2. Consumption of chicken liver and eggs in Bangladesh and Cambodia at baseline and
endline surveys of the HFP program (2003-2007)
Baseline survey Endline survey
% N % N
Households that consumed
chicken liver in the 7 days
before the survey
24
720
46
720
Median # eggs consumed in 7
days before the survey:
Household
Mothers
Children
2
1
1
720
254
266
5
1.5
2
720
402
407
3.3 Income earned from Homestead Food Production and its utilization
Evaluation findings from Bangladesh and Cambodia showed a significant improvement in
household income from sale of products from home gardens and animal husbandry between the
baseline and endline surveys in the HFP program communities. Evaluation findings from
Bangladesh showed that household’s bi-monthly earnings from sale of vegetables and fruits
obtained from the home gardens increased from an average of US$0.62 at baseline to US$1.25 at
endline. The average income from sale of eggs and poultry also increased from US$1.62 to
US$2.16 between these surveys. The average increase in income earned by households from the
sale of HFP garden products between baseline and endline was much higher in Cambodia than
Bangladesh. On average, Cambodian households earned US$3.75 at baseline which increased to
US$17.50 at endline from the sale of vegetables and fruits from home gardens. There was only a
small increase of income earned by households in Cambodia from the sale of poultry products
(US$9 at baseline to US$9.75 at endline). It is worth noting that at both the baseline and endline
surveys, Cambodian households earned more from sale of HFP products than Bangladesh
households.
Most households in both countries used the income earned from sale of HFP products to
purchase additional food for the household (Table 3). Up to 92% of households in Cambodia
and 70% of households in Bangladesh used the income earned from sale of home garden produce
to purchase food. Also over 80% of households in Cambodia and close to half of households in
Bangladesh (46%) spent the income obtained from selling animal products obtained from the
homestead food production to purchase other foods (Table 3). Significant proportions of
households in Bangladesh also used the income earned from sale of HFP products on other
important household expenditures such as education, including materials and clothing for school
8
and investing in income generating activities of the household such as reinvesting in the HFP to
purchase seeds, seedlings, saplings, and chicks or to invest in other income generating activities.
Review of the survey results from Bangladesh, Cambodia and Nepal showed that for almost
three-quarters (73%) of households in HFP villages in these countries, the majority of homestead
food production activities, including deciding what type of garden practice to use at the
homestead, were managed by women (28). This suggests that women were the likely decision-
makers regarding the use of the income earned by selling garden produce.
Table 3. Proportion of households in Bangladesh and Cambodia that spent income earned by
selling garden produce, poultry and egg on various items at endline.
Household
Commodities
Bangladesh* (in last 2
months)
Cambodia (in last 1 month)
% household
spending
income from
selling home
garden
products on:
% household
spending
income from
selling egg
and poultry
on:
% household
spending
income from
selling home
garden
products on:
% household
spending
income from
selling egg
and poultry
on:
Food 70 46 92 82
Education 30 26 1 3
Productive/Reinvestment 22 25 1 3
Clothes 14 22 0 3
Saving 11 24 0 0
Medicine 8 0 2 6
Housing 1 3 0 0
Amusement 1 2 0 0
Social activities 0 1 1 2
Other 0 0 3 1
* Multiple responses allowed
3.4 Impact on anemia prevalence among children aged 6-59 months
Anemia prevalence among children 6-59 months of age decreased in program households in all
the four countries after the projects’ implementation (figure 3). However, the decrease in anemia
prevalence among children was significant only in Bangladesh [63.9 at baseline vs. 45.2% at
endline (P<0.001)] and the Philippines [42.9 at baseline vs.16.6% at endline (P<0.001)]. Among
control households, anemia prevalence among children remained unchanged in Nepal, decreased
slightly in Cambodia, but showed significant decreases in Bangladesh and Philippines (figure 3).
However, in all four countries, the magnitude of decrease in anemia prevalence among children
was higher in program households compared to the control households, although the inter-group
difference was not statistically significant.
9
Figure 3. Anemia prevalence among children aged 6-59 months from HFP program and control
households in Bangladesh, Cambodia, Nepal and Philippines at baseline and endline (2003-
2006).
64
45
66
50
65
57
64
65
78
70
72
70
43
17
59
31
0
10
20
30
40
50
60
70
80
90
Target Control Target Control Target Control Target Control
Bangladesh Nepal Cambodia Philippines
Baseline
Endline
3.5 Impact on anemia prevalence among non-pregnant mothers of children aged 6-59
months
In communities that received the HFP program, anemia prevalence among non-pregnant mothers
of children aged 6-59 months decreased by a magnitude of 26% (p=0.009) and 12% (p=0.075) in
Nepal and Bangladesh respectively. However, anemia prevalence among non-pregnant mothers
of the children in the control communities remained relatively unchanged in both countries
(figure 4). There was no significant change in anemia prevalence among non-pregnant mothers
in both the HFP program and control communities in Cambodia (figure 4).
Figure 4. Anemia prevalence among non-pregnant mothers of children aged 6-59 months in HFP
program and control households in Bangladesh, Cambodia and Nepal at baseline and endline
(2003-2006).
51.4
51.6
58
51.5
60
51.8
40.851.9
42.9
45
62.9
50.8
0
10
20
30
40
50
60
70
Target Control Target Control Target Control
Bangladesh Nepal Cambodia
Baseline
Endline
10
3.6 Impact on night blindness among children less than five years of age
HKI re-asserted the importance of HFP in the control of night blindness based on the findings of
the last national vitamin A survey in rural Bangladesh (20). The study showed that among
children aged 12-59 months who had not received a vitamin A capsule (VAC) in the six months
before the survey, the prevalence of night blindness (clinical vitamin A deficiency) was
significantly lower in households with a garden and/or poultry than households without a garden
and poultry (figure 5). However, among children who received a VAC, no such difference was
found, which seems to indicate that the large-dose VAC overshadowed any additional impact of
the diet.
Figure 5. Prevalence of night blindness (XN) among children aged 12-59 months who had not
received a VAC, by home garden and poultry ownership (n=4296), National Vitamin A Survey,
Bangladesh, 1999.
0
0.5
1
1.5
2
2.5
3
3.5
No HG, No Poultry Poultry HG HG & Poultry
Prevalence of XN (%)
4. Discussion
Review of results from the evaluations of HKI’s HFP programs in Bangladesh, Cambodia, Nepal
and Philippines showed that the program increased food diversity both in terms of production
and consumption of vegetables among beneficiary households. The HFP program also improved
consumption of animal products like chicken liver and eggs by household members, particularly
women and children. Such increased diversity in vegetable and animal food consumption is
important to ensure adequate intake of essential vitamins and minerals for optimal growth and
development, because eggs and liver are good sources of micronutrients and increasing dietary
diversity is shown to improve micronutrient intake (16). This was evident in reduction in anemia
among children and their non-pregnant mothers and reduction in nightblindness among children
in some of the countries studied. Insufficient dietary intake of iron is believed to be the main
cause of anemia in most developing countries. Although these impact evaluations did not study
the impact of HFP on dietary iron intake or iron status, we believe improved intake of dietary
iron and other micronutrients such as vitamin A, as a result of the HFP program might have
contributed to the reduction in anemia prevalence.
In rural areas of all the countries in the study, food from homestead food production, including
vegetables, fruits and poultry, are often the only source of micronutrients in the family diet (20).
The production of fruits, vegetables, eggs and meat provides the rural households with access to
11
the nutrients required that otherwise may not be readily available or within their economic
means. Equally important, surplus HFP produce can be sold, generating additional income for
the family. The nutrition education component of the HFP program promotes nutritionally-
informed food purchasing and consumption choices and our findings show that the majority of
households use this additional income to buy supplementary food items, such as meat, fish and
cooking oil, thereby further increasing the diversification of the family’s diet (24). The income
is also used to cover other essential household expenses and to invest in productive assets,
including reinvesting in HFP. More recently, HKI has found that this investment in productive
assets helps families to cope during times of economic difficulty or natural disaster (24).
As seen by the reduction of night blindness (a clinical sign of vitamin A deficiency) among
children living in households with gardens and/or poutry, HFP type programs also can have a
positive effect on vitamin A status. HFP has been shown to be an important way to improve the
intake of vitamin A- and other micronutrient-rich foods in all HFP programs, particularly in poor
households in countries like Bangladesh, Nepal, Cambodia and Philippines. Among the ways by
which HFP increases the consumption of micronutrient-rich foods and contributes to improved
micronutrient status are the following:
By increasing the number of varieties of micronutrient rich fruits and vegetables, and animal-
source foods available year-round, the consumption of these foods becomes consistent
throughout the year
By coupling HFP with targeted nutrition education, nutrition practices are improved,
particularly for women and young children.
By providing additional income through the sale of surplus HFP produce, families can have
extra resources to purchase additional high quality foods.
5. Conclusion and recommendations
HKI’s HFP programs in Asia improved household food security by increasing the year round
availability and diversity of micronutrient-rich foods at the household level, by informing
optimal nutrition behaviors through nutrition education, and by improving the economic
resources of the participating families. Through targeting women as HFP manager, HFP
programs empowered women, giving them more control over resources and income generated
from the HFP program. Such control over HFP resources and income enhances women’s
participation in household decision-making. This also has a positive impact on overall
household spending, food preparation, food choices and intra-household food allocation as well
as care-seeking behavior of the women (25).
The program also appears to have a positive impact on nutritional status of women and children.
HFP was shown to have an impact on reducing night blindness among children, although
additional studies that assess impact of the program on serum vitamin A levels would strengthen
and further define the effect. The program’s impact on anemia reduction among children aged 6-
59 months and non-pregnant women (mothers of these children) looks promising although
results were not consistent across all four countries. Such varied results across countries might
be due to the slight variation in the design of the impact evaluation and the differences in
etiology of anemia among these groups in the different countries. Thus, a more tightly control
study design may be necessary to evaluate the impact of HFP on anemia. It also suggests, that
among young children in particular, additional interventions that are based on sound knowledge
12
of contextual factors associated with anemia may be needed to adequately reduce anemia among
this population.
The HFP program results presented in this review are encouraging. The program’s contribution
to overall household food consumption and improved micronutrient status, however, can be
maximized by implementing the HFP program in coordination with other interventions for
combating micronutrient deficiencies such as deworming, vitamin A supplementation and home
fortification with micronutrient powders. The program can also be improved by choosing foods
with higher vitamin A content for home gardening and by improving the nutrition education
component to promote consumption of animal products, use of extra income to purchase
nutritious foods as well as improving bioavailability of vitamins and minerals through ensuring
adequate fat intake (22). Key essential nutrition actions, using behavior change communication
techniques, targeted at mothers and children under two years of age, should be incorporated as an
integral part of the strategy in order to more effectively promote optimal nutrition practices to
maximize the food availability. As shown by the results of this review, homestead food
production has the potential to increase micronutrient intake and improve the health and
nutritional status of nutritionally at-risk women and children through various pathways including
increased household production for the families own consumption, increased income from the
sale of products and improved social status of women through greater control over resources (23,
26, 27)
The integration of HFP into other types of development programs should be explored and
encouraged as a way to scale up the HFP model more quickly. For instance, HFP can
complement programs aimed at improving gender equality through its positive effect on
women’s empowerment and increased control of household resources. In addition, the HFP
model, which promotes developed gardening with targeted nutrition education, should be
introduced into agriculture programs that promote home gardening and livestock to better ensure
that available food translates into increased consumption and also into improved nutrition among
vulnerable household members. The HFP model can also be used to target specific vulnerable
groups, such as households with people living with HIV/AIDS because such households require
additional food and have added healthcare costs, which put further demands on their limited
resources
1
.
HKI’s HFP program has been proven to be successful in four Asia-Pacific countries in
improving the availability, production and consumption of micronutrient-rich foods through
poultry raising, animal husbandry, and home gardening, coupled with nutrition education.
Lessons learned from these evaluations and monitoring results have been used to expand and
improve the HFP program over time, and most recently to integrate ENA into the model.
Nevertheless, additional data is needed to better understand the impact of the HFP program on
the health and nutritional status of women and children. Moreover, there is a need for improved
documentation of program activities and standardization of tools and procedures for monitoring
and evaluation across all countries with the program to ensure better comparison of programs
across countries. This will also allow data from different countries to be pulled together easily
for the kind of analysis presented in this review. Studies are being designed to look more closely
at the program, including evaluations of the program impact pathways to improve program
delivery.
1
HKI included households with PLWHA in its HFP program in Cambodia and is evaluating the program.
13
HFP is a strategy that has shown positive results in poor countries for improved household food
consumption, decreased prevalence of anemia among children in some countries, increased
household income, and potential empowering of women. Due to these multiple benefits of the
program, HFP could conceivably contribute to the achievement of the MDGs including those for
poverty reduction, promotion of gender equity and women’s empowerment, reduction of child
mortality and improvement of maternal health. For these reasons, it is important that the HFP
program is expanded to other areas in these countries and implemented in more countries where
micronutrient deficiencies are a public health problem.
6. References
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28. Abstract presented on ‘Large and Small-Scale Food Based Programmes For Boosting
Production and Consumption of Vegetables’ in the ‘ International Conference on
Vegetbale (ICV)’ on November 11-14, 2002, Bangalore, India
... Helen Keller International's (HKI) Homestead Food Production (HFP) programmes: With objectives such as increasing DD and reducing MNDs, the HKI has been running its HFP programmes coupled with nutrition education in many Asian countries since the 1990s 123 . In one of its major interventions, HKI implemented HFP (which integrated animal husbandry and nutrition education with ongoing home gardening) among around 30,000 households of Bangladesh, Cambodia, Nepal and the Philippines between 2003 and 2007 123 . ...
... Helen Keller International's (HKI) Homestead Food Production (HFP) programmes: With objectives such as increasing DD and reducing MNDs, the HKI has been running its HFP programmes coupled with nutrition education in many Asian countries since the 1990s 123 . In one of its major interventions, HKI implemented HFP (which integrated animal husbandry and nutrition education with ongoing home gardening) among around 30,000 households of Bangladesh, Cambodia, Nepal and the Philippines between 2003 and 2007 123 . Evaluation of the programme showed a significant improvement in DD, a decline in anaemia, better nutrition status and improved income among intervention households compared to their own baseline data as well as those households that were not covered under the programme 123 . ...
... In one of its major interventions, HKI implemented HFP (which integrated animal husbandry and nutrition education with ongoing home gardening) among around 30,000 households of Bangladesh, Cambodia, Nepal and the Philippines between 2003 and 2007 123 . Evaluation of the programme showed a significant improvement in DD, a decline in anaemia, better nutrition status and improved income among intervention households compared to their own baseline data as well as those households that were not covered under the programme 123 . Experiences of HKI's HFP clearly demonstrates the importance of DD, which is linked with better nutritional status as also a lower prevalence of MNDs. ...
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The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a longterm and sustainable strategy to address population-based MNDs.
... Of the 145 records included, 24 reported results from interventions that investigated the impact of a livestock intervention on ASF consumption and/or dietary intake of children and/or households. Of the nine studies that measured child ASF consumption, a significant increase in child ASF consumption from baseline to endline was reported in one study (54); significant increases in child ASF consumption among intervention compared to control households were reported in five studies (55)(56)(57)(58)(59); two studies found no significant differences (60,61); and one study did not report significance (62). Of the 4 studies that reported child dietary intake data, significant increases in child dietary diversity among intervention compared to control households were reported in two studies (57,61), a marginally statistically significant greater increase in children's minimum dietary diversity among intervention compared to control households was reported in one study (63), and no significant difference in child intake of foods groups among intervention compared to control households was reported in one study (60). ...
... Of the livestock intervention studies, 19 reported dietary data at the household level, 12 of which reported ASF consumption data at the household level. Of these 12 studies, significant increases in household ASF consumption from baseline to endline were reported in two studies (64,65); significant increases in household ASF consumption among intervention compared to control households were reported in four studies (58,59,66,67); no significant increases in household ASF consumption among intervention compared to control households were reported in three studies (68)(69)(70); and significance was not reported in three studies (61,71,72). Of the 19 studies that measured household dietary diversity, significant differences were reported in three studies (58,61,73); a marginally statistically significant greater increase among intervention compared to control households was reported in one study (63); and no significant differences were reported in three studies (67,74,75). ...
... Of these 12 studies, significant increases in household ASF consumption from baseline to endline were reported in two studies (64,65); significant increases in household ASF consumption among intervention compared to control households were reported in four studies (58,59,66,67); no significant increases in household ASF consumption among intervention compared to control households were reported in three studies (68)(69)(70); and significance was not reported in three studies (61,71,72). Of the 19 studies that measured household dietary diversity, significant differences were reported in three studies (58,61,73); a marginally statistically significant greater increase among intervention compared to control households was reported in one study (63); and no significant differences were reported in three studies (67,74,75). Furthermore, of these 19 studies, one study reported a significantly lower percentage of food insecure households among intervention compared to control households (76); one study reported a significant improvement in food security among intervention compared to control households (77); one study reported a significant increase in household consumption of green, leafy vegetables and yellow/orange fruit among intervention compared to control households (61); and one study found no significant differences in household energy intake among intervention compared to control households (54). ...
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Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.
... The study proved that HFP could increase their nutritional intake and give additional income to the family. The review from the HFP program proved that dietary diversification including animal food consumption, and anemia among children decreased after the intervention [30]. In four Asia-Pacific nations, the HFP program is successful in increasing the availability, production, and consumption of micronutrient-rich foods including poultry growing, animal husbandry, and domestic gardening, along with nutrition education [30]. ...
... The review from the HFP program proved that dietary diversification including animal food consumption, and anemia among children decreased after the intervention [30]. In four Asia-Pacific nations, the HFP program is successful in increasing the availability, production, and consumption of micronutrient-rich foods including poultry growing, animal husbandry, and domestic gardening, along with nutrition education [30]. Therefore, it could be implemented in the vulnerable population which needs more income, while they still have a nutritional problem. ...
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... Implementing homestead food production (HFP) programs from 2003 to 2007 significantly decreased anemia prevalence among children (from 42.9 to 16.6%). HFP products also improved young children's food security, nutrition status, and household income, significantly reducing the prevalence of anemia among children in the Philippines [22]. Moreover, political commitment measured by the Hunger and Nutrition Commitment Index (HANCI), was moderate [15]. ...
... The program had a positive impact on the nutritional status of children and significantly improved dietary diversification. Moreover, the sale of HFP products improved household income and decreased anemia prevalence among children [22]. ...
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... Home gardening creates avenue to cultivate various ranges of crops. Hence, home gardening entails the cultivation of herbs, vegetables, fruits, and shrubs mainly for personal consumption at home (Algert et al., 2016;Galhena et al., 2013;Talukder et al., 2010). Some home gardeners go as far as rearing animals on a portion of their garden (Raymond et al., 2019). ...
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... While looking at the results by type of ASFs, it was revealed that organ meat and small fish consumption increased by 18 percentage points, followed by eggs and other meats (16 and 15 percentage points, respectively) from 2017 to 2020. This strategy also aligned with other studies that found ownership of poultry and livestock is associated with young child consumption of animal-source foods in Bangladesh (Choudhury & Headey, 2018;Talukder et al., 2010), Ethiopia (Kim et al., 2019a), Tanzania (Bundala et al., 2020;Kim et al., 2019) increasing access through income generation and availability in nearby points of sale, can form a holistic approach, which enables feeding animal-source foods to children 8-23 months. ...
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... Furthermore, the consumption of green and leafy vegetables, roots and tubers, and other vegetables by intervention household increased drastically from 61.4, 48, 54 to 97.6, 95.0 and 88.1 respectively after establishing vegetable nutrition gardens Rethi et al. [22] noticed the same results that 76.2 percent women have started consuming vegetables on the daily basis to fulfill the nutritional requirements after introducing horticulture interventions. A Study conducted by Talukder et al. [23] that with establishment of nutrition garden volume and variety of vegetables produce inclined to three to four times approximately and same results have been found in our study. Akrofi et al. [24] reported the contribution of food items from the vegetable nutrition garden to the dietary diversity score (DDS-6.8) ...
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... Studies have found that even smallholder farming households typically rely on purchased food to increase the diversity, stability and quality of diets (Gelli et al., 2020;Headey et al., 2019;Koppmair et al., 2016;Sibhatu and Qaim, 2018b). Similarly, analyses of programs focused on increasing households' own production of nutrient-dense foods have sometimes found positive effects on dietary diversity and other measures of nutrition, but also demonstrated a clear mediating role of household access to markets (Fraval et al., 2020;Jones, 2017;Kumar et al., 2015;Lehmann-Uschner and Kraehnert, 2016;Leroy and Frongillo, 2007;Masset et al., 2012;Romeo et al., 2016;Ruel et al., 2018;Sibhatu and Qaim, 2017, 2018a, 2018bTalukder et al., 2010;van den Bold et al., 2013;Wood et al., 2013). Markets are particularly important complements for households that rely on nonfarm earnings to meet their food needs, but even most smallholder farmers are net buyers of food, including in rural Malawi (Dorward et al., 2004;Headey, 2016;Ivanic and Martin, 2014). ...
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A growing literature uses least-cost diets to evaluate how effectively a food system supports access to nutritious foods. We identify the cost of meeting nutrient requirements for whole households in rural Malawi from and the nutrient-level drivers thereof. From 2013 to 2017, we can identify a household least-cost diet only 60% of the time with an average cost of $2.32/person/day (2011 US$ PPP). We illustrate that larger households have more diverse nutrient needs and face a higher cost for 1000 calories of a sufficiently nutrient dense diet. Shadow price analysis shows riboflavin to be the costliest nutrient in the market. We use policy scenarios to understand what drives the infeasibility and high cost. Simulating the impact of selenium soil biofortification of maize results in a feasible diet 94% of the time at half the cost ($1.22/person/day on average) and eliminates the shadow price of copper. This is explained by insufficient selenium from sources low in copper such that under baseline conditions it is impossible to get enough selenium without too much copper. Even when feasible, to avoid copper, more higher cost foods enter the diet than would be otherwise needed to meet remaining nutrient requirements. Other value chain scenarios to increase the availability and lower the cost of nutrient-dense foods did not meaningfully change the diet cost results. Of direct relevance to Malawi, this study demonstrates more broadly how least-cost diet methods can be used to assess barriers to accessing an adequate diet and the potential impacts of policy options.
... В рамках программы производства пищевых продуктов в домохозяйствах организации "Хелен Келлер Интернэшнл", реализуемой в сочетании с ориентированными на женщин информационными мероприятиями, посвященными изменению поведения, регулярно собираются данные об их воздействии на положение в отношении микроэлементов и антропометрические показатели женщин и детей. В Бангладеш и Филиппинах рост объемов потребления ПЖП, особенно яиц, привел к снижению распространенности анемии среди детей (Talukder et al., 2010). В Буркина-Фасо, благодаря росту объемов производства фруктов и овощей, в том числе богатых витамином А, а также повышению разнообразия рациона питания, снизились масштабы анемии (а также истощения и диареи) у детей младшего возраста. ...
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The article emphasizes that Ukraine, as an active exporter of agri-food products and agricultural raw materials to the European market, needs to take into account the new EU approach to categorization of products based on their sustainability indicators. The European Commission will formulate a legislative proposal on the framework of a sustainable food system, and general requirements for sustainable foods, and their certification and labeling according to sustainability indicators by the end of 2023. Based on the presently available EU documents (first of all, the Farm to Fork Strategy) the author generalizes the main principles and requirements for sustainable foods that will become standard for all foods placed on the EU market in accordance with public interests. It is substantiated that the quite new for Ukraine concept of "sustainable agri-food product" has a broader content than the concept of "eco-friendly product" or "organic product", as environmental friendliness is just one of the characteristics of sustainability, along with the climatic and social ones. The main differences between sustainable and eco-friendly/organic products are systematized. A prominent place in the article is given to the climate criterion of sustainability, in particular, the reduction of greenhouse gas emissions in the production and supply of agricultural food (carbon footprint), which meets the target of decarbonization and achieving climate neutrality in Europe. In the context of creating a harmonized EU methodology for food sustainability, the author considers the content and components of the ecological footprint (land area used for production and utilization, water resources, carbon dioxide emissions, and food miles). The article provides global experience of voluntary certification of food sustainability, and national programs for certification of food sustainability, in particular soybeans in the USA and Canada, which testifies to the growing differentiation of the food market and a tendency towards official certification and labeling of sustainable foods. The author highlights the challenges for Ukrainian exports to the EU under the increasing requirements for the sustainability of agri-food products. In particular, high levels of greenhouse gas emissions from crops (corn and oilseeds) may lead to restrictions on their exports as raw materials for biofuel production. Tracking of chemical pesticide and antimicrobial residues in exported products is expected to be tightened, as the use of these hazardous substances in the EU should be reduced by 50% by 2030. The revealed asymmetry of the spread of the concept of "sustainable foods" between foreign (quite common) and domestic (almost absent) scientific and journalistic sources may indicate that domestic farmers might not be prepared for a timely reorientation to production and export to the EU of sustainable agri-food products. It is obvious that the better off countries will be those who manage to modernize their national agri-food systems in advance in the context of ensuring product sustainability.
Thesis
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