Homestead Agriculture and Nutrition Project
Condition: Diet Modification; Health Behavior
Study type: Interventional

Summary: 
      HANU is an evaluation of the effects of an integrated, gender-focused nutrition-sensitive
      intervention on the nutrition and health of young children and women of reproductive age in
      rural Tanzania.
    

Detailed description: 
      HANU aims to develop, implement, and evaluate nutrition-sensitive interventions among rural
      smallholder households in Rufiji Tanzania with the goal of improving the nutritional status
      and health of young children and women of reproductive age. Specifically, HANU will engage
      agricultural extension workers (AEWs) and community health workers (CHWs) to provide an
      integrated homestead food production, nutrition counselling, and public health intervention.

      Households receiving the intervention will receive (1) Interventions to promote homestead
      food production, increase agricultural production and food diversity, (2) nutritional
      counselling, including locally adapted instructions on the mix and quantity of food suitable
      for children of ages 6-24 months, and (3) a health-focused intervention, including
      information on micronutrient supplementation, integrated management of child illnesses, and
      prevention and management of child malnutrition with a focus on the first 1,000 days. The
      intervention will include information on cultivation of nutrient-rich crop varieties, best
      practices for home gardening, safe water, sanitation, and hygiene practices (WASH),
      breastfeeding and complementary feeding, dietary intake and nutrition, and other basic public
      health messages. There are two delivery mechanisms for the intervention: farmer field schools
      and households visits. Household visits are conducted approximately bimonthly separately by
      AEWs and CHWs. Field schools are held approximately bimonthly and attended by both AEWs and
      CHWs. Households enrolled in the intervention will also receive agricultural inputs such as
      seeds, fertilizer, and watering cans.

      Through this package of interventions, HANU aims to address the three primary pathways of
      impacting nutrition through agriculture: gender, income, and consumption. The interventions
      are designed to increase women's input into decision making over crop production and food
      consumption, child feeding, use of income, WASH practices, knowledge of nutrition and healthy
      diets; and home gardening skills. It also aims to address market barriers to homestead food
      production through connecting participants with agricultural services and helping to generate
      income through crop production.

      The effects of the intervention will be evaluated through a cluster-randomized study design.
      Ten villages will be randomly selected and paired based on location, proximity to water, and
      population size. One village in each pair will be randomly assigned to receive the
      intervention (total of five villages) and one to the control group (total of five villages).
      Approximately 500 households in each arm will be screened, consented, and enrolled. Data will
      be collected by trained interviewers using surveys administered with electronic tablets at
      three time points, once at baseline, once 12 months after intervention implementation, and
      once approximately 36 months after intervention implementation. Anthropometric measurements
      of women and young children will be taken at three time points. Hemoglobin for women and
      young children will be measured among a subset of the study population at three time points.

      Qualitative methods will be used to explore barriers to adopting the behaviors promoted
      through the intervention. One focus group discussion with study participants in each
      intervention village will be conducted to explore participant experiences with the
      interventions including key challenges. Eight key informant interviews will further assess
      sustainability aspects of the intervention.

      It is possible that the adoption of home gardening practices and other positive nutrition and
      health behaviors could spillover to neighboring households. Therefore this study will also
      assess potential spillover effects of the intervention. In each intervention village,
      households that did not receive the intervention will be enrolled to assess potential
      spillover effects of the intervention through the use of a quantitative survey. Approximately
      450 households will be enrolled and data will be collected at two time points 12 months after
      intervention implementation and 36 months after intervention implementation. One focus group
      discussion in each intervention village among households that did not receive the
      intervention will be conducted to further explore spillover effects.
    

Intervention name(s): Nutrition-sensitive intervention
Intervention type(s): Behavioral
Intervention description(s): Nutrition-sensitive intervention using behavior change communication on home gardening, diet, nutrition, WASH, and women's empowerment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention