Program Participation Intensity and Children's Nutritional Status: Evidence from a Randomized Control Trial in Mozambique. HarvestPlus Working Paper 16

Agricultural interventions are thought to have the potential to improve nutrition, but little rigorous evidence is available about programs that link the two. In this paper, we study impacts of an integrated agricultural and nutritional biofortification project, the REU in Mozambique. We first provide evidence on dietary impacts of the program and then examine impacts of the program by participation intensity. Using OLS and IV techniques, we find that more intense participation in both project components led to larger impacts. The results therefore have important implications for refining the design of future projects attempting to link agricultural and nutrition interventions. ∗ Alan de Brauw is a Senior Research Fellow, International Food Policy Research Institute, 2033 K Street NW, Washington, DC 20006; Patrick Eozenou is an Economist at the World Bank; and Mourad Moursi is a Research Fellow at HarvestPlus. We want to thank Mary Arimond, Howarth Bouis, Dan Gilligan, Christine Hotz, Ricardo Labarta, Cornelia Loechl, Jan Low, J.V. Meenakshi, and Bernardino Munhaua for contributions to the field work that were essential to this manuscript, and four anonymous reviewers whose comments have improved the manuscript. Please direct correspondence to Alan de Brauw at a.debrauw@cgiar.org or at the address listed above. All remaining errors are our responsibility. Program Participation Intensity and Children's Nutritional Status: Evidence from a Randomized Control Trial in Mozambique Agricultural interventions are thought to have the potential to improve nutrition, but very little rigorous evidence is available about programs that link the two. A recent review of the existing scientific literature indicated that two main factors contributed to the continued uncertainty about the strength of the link between agriculture and nutrition. First, agricultural interventions are rarely designed with the explicit goal of improving nutrition. And even when improving nutrition is an explicit goal of an agricultural intervention, the evaluation of the impact on nutritional indicators is often flawed. Such evaluations are rarely randomized, they tend to lack controls for the effects of confounding factors, or they lack statistical power to detect expected effects (Masset et al., 2012). 1 The recent Reaching End Users (REU) project in Mozambique and Uganda aimed to promote the adoption and consumption of vitamin A biofortified orange flesh sweet potato (OSP). The REU was implemented in Mozambique between 2006 and 2009 and integrated agricultural, nutritional, and market level components. The impacts of the REU were assessed with a prospective, cluster randomized control study addressing many of the methodological weaknesses found in previous similar studies. The study found that vitamin A intakes increased and vitamin A deficiency levels decreased among target populations in both Mozambique and Uganda, and serum retinol levels increased among moderately deficient children in Uganda (Hotz et al., 2012a; Hotz et al., 2012b). Previous research on the REU in both Mozambique and Uganda both demonstrates that the project had impacts on average vitamin A intakes (Hotz et al., 2012a ; Hotz et al., 2012b) and that average impacts on adoption and vitamin A intakes appear to have largely resulted from the agricultural component of the intervention (de Brauw et al., 2013). However, as with many interventions, we know the average effects, but we do not know much about how much the intensity of participation mattered for impacts to occur. As with many interventions, in the REU farmers (or, more properly, members of farm households) could choose their intensity of participation in the project, which might have made those households more or less successful at growing OSP and feeding OSP to target populations. In this paper, we estimate the average impacts of the REU and several outcomes related to children's nutritional status in Mozambique, going beyond the impacts estimated in Hotz et al. (2012a). The outcomes we primarily study can be categorized as measures of both narrow and