Enhanced Homestead Food Production Plus+ Program in the Lake Zone, Tanzania
Condition: Anemia; Growth Retardation
Study type: Interventional

Summary: 
      The purpose of this study is to assess if the Enhanced Homestead Food Production Plus (EHFP+)
      Program implemented by HKI in Mwanza, Tanzania, enhances uptake of Micronutrient Powder (MNP)
      supplementation in children, helps maintaining reduced anemia levels among children after a
      blanket provision of MNP, and has an impact on child growth, infant and young child feeding
      (IYCF) practices, maternal knowledge related to health, nutrition, WASH and malaria
      prevention, food security and women's empowerment.
    

Detailed description: 
      Since 1988, Helen Keller International's (HKI) flagship Homestead Food Production (HFP)
      program in Asia has helped communities establish technically-improved local food production
      systems by creating gardens yielding micronutrient-rich fruits and vegetables over expanded
      growing seasons, complemented by the improved rearing of poultry and livestock.

      In 2010, HKI introduced an enhanced-HFP (E-HFP) model in Burkina Faso and included a
      strengthened nutrition education component; the Essential Nutrition Actions (ENA) framework.
      This E-HFP program was evaluated by IFPRI and yielded some encouraging results. With regards
      to nutritional outcomes, however, the primary finding was that, while the E-HFP program
      improved hemoglobin concentration-an indicator of iron status-the evaluation failed to note a
      significant impact of the program on improving children's growth. The primary explanation for
      the absence of a measurable improvement in children's growth was the lack of complementary
      health interventions that aim to specifically reduce children's disease burden, which, along
      with the lack of adequate food and care, is an underlying cause of undernutriton (UNICEF
      1990).

      Building on lessons learned from the Burkina Faso E-HFP program and a 2011 Tanzania HFP
      program, a new model, the Enhanced Homestead Food Production Plus (E-HFP+), was developed for
      Tanzania to improve the nutritional status of infants and young children. The new model
      strengthens the Behavior Change Communication (BCC) on malaria prevention, WASH, and gender
      components and enhances links with the health sector. The model will also test two new
      concepts:

        1. to assess if the E-HFP+ program has the potential to maintain adequate levels of
           hemoglobin concentrations by increasing iron-rich food consumption and malaria
           prevention good practices.

        2. to assess the effectiveness on anemia of using an existing agriculture-based platform to
           promote uptake and utilization of MNP.

      The model involves both a set of production and nutrition interventions targeted to mothers
      and the provision of a curative treatment for moderate to severe anemia (Micronutrient
      Powder).

      The main objective of the impact evaluation of the E-HFP+ program is therefore to assess
      whether the program:

        -  Maintains reduced anemia levels among pre-school aged children after a blanket provision
           of Micronutrient Powder (MNP)

        -  Improves child growth (measured by HAZ and WHZ)

        -  Improves infant and young child feeding (IYCF) practices and maternal knowledge on
           health and nutrition

        -  Is an appropriate delivery platform to enhance uptake and utilization of MNP
           supplementation in children
    

Intervention name(s): EHFP+
Intervention type(s): Other
Intervention description(s): Enhanced-homestead food production program including home gardening and poultry rearing + WASH interventions + SBCC around the essential nutrition actions and WASH/malaria prevention with a gender component.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention