Lessons from implementation and process monitoring of the FAARM trial in Bangladesh

Transcription

1 Lessons from implementation and process monitoring of the FAARM trial in Bangladesh FAARM = Food and Agricultural Approaches to Reducing Malnutrition Thalia Sparling, Jillian Waid, Amanda Wendt, Simone Jacobs, Tarique Huda & Sabine Gabrysch Institute of Public Health Heidelberg University

2 Undernutrition Bangladesh 35% of children <5 years stunted Micronutrient deficiencies Diets: mainly rice à Dietary diversification Source: Sebastian Kern

3 Research gap Home gardening programs ü Can increase vegetable production ü Can improve dietary diversity Ø Can reduce stunting??? Source: Thalia Sparling Systematic reviews (Masset et al. 2012, Webb Girard et al. 2012) Studies too small, too short-term, no rigorous methodology Difficult to conduct complex intervention studies à Lack of evidence for impact on stunting

4 Research project title Reducing young child undernutrition through an integrated agricultural project with women's groups: A cluster-randomised trial in rural Bangladesh Outcome Intervention Study design Setting

5

6 FAARM intervention: Homestead Food Production (HFP) program by Helen Keller International (HKI) Home gardening Poultry rearing Nutrition education Women's groups HFP Hygiene promotion Marketing training Child care education Health education

7 Homestead Food Production Helen Keller International (HKI) + local NGO Women s groups: 1 model farmer and ~15 participants Year-round home gardens: fruits and vegetables Poultry production, marketing training Nutrition, hygiene and health education Photo source: Thalia Sparling

8 FAARM study aims 1. Evaluate whether an integrated agriculture, nutrition and hygiene program with women's groups can reduce undernutrition in a rural low-income setting when children benefit in their crucial first 1000 days. Primary outcome: Length-for-age Z-score (90% power to detect a 0.22 Z-score difference if ICC=0.03) 2. Assess program impact pathways to discern how any impact is achieved (or why not).

9

10 FAARM project site

11 FAARM cluster-randomized trial Timeline: (4 years) 96 villages: 48 intervention + 48 control Participants: 2700 women < 30 years Their children < 3 years (born during trial)

12 Data collection 1. Formative research: June 2014 January Baseline survey: March May Monitoring & Process evaluation: Surveillance (births, diarrhea, diets): Endline survey: Planned 2019 Data collection with tablets: Software ONA / ODK Collect (

13 Implementation process monitoring 1. Routine program activity monitoring Training attendance, topics covered, assets distributed Quality monitoring of trainings by HKI supervisors 2. Rolling program output & outcome monitoring Garden and poultry rearing activity and productivity Knowledge change 3. Process evaluation Qualitative interviews with implementation staff and participants

14 FAARM surveillance system 1. Bimonthly visits of all 2700 enrolled women Track last menstrual period and pregnancies Dietary diversity of women and children Diarrhea and ARI of children in last 7 days Add-on questions (e.g. maternal depression) 2. Dietary intake: Subsample of 864 households Annual revisits (replication in one-third), 24h recall 3. Birth visit (within 72 hours) Birth weight, length and head circumference Care-seeking for delivery

15 Results slides Not sharing yet as unpublished

16 Thanks to the FAARM team Implementation team Amin Uddin, Shirin Afroz, Zillur Rahman, Basana Marma, Md. Wali-Ul Islam, Helen Keller International & VARD team Core research team Amanda Wendt, Thalia Sparling, Simone Jacobs, Philipp Zanger, Andreas Deckert, Nicholas Kyei, Shafinaz Sobhan, Andrea Seiermann, Gabriele Stieglbauer, Heidelberg Institute of Public Health Jillian Waid, Abdul Kader & team, Helen Keller International Malabika Sarker & team, JPGSPH at BRAC University Tarique Huda, ICDDR,B Collaboration partners Irmgard Jordan, University of Gießen Katja Kehlenbeck, Rhine-Waal University of Applied Sciences Sheela Sinharoy, Emory University; Hans-Peter Schmidt, Ithaka Institute for carbon strategies; Jody Harris, Om Prasad Gautam, Martin Maier,

17 FAARM Funding German Federal Ministry of Education and Research (BMBF): Epidemiology Junior Scientist Group Duration: September 2013 August 2019 Add-on studies: DFID: NEEP, LANSA Dutch Ministry of Foreign Affairs: ARF IFPRI: GAAP2 Humboldt Foundation, Thrasher Research Fund, CGIAR ISPC, Foundation fiat panis Additional funding to HKI for implementation: Carrefour Foundation, Best-in-brands, TFWA-Care

18 FAARM: Further information

19 Thank you!