An integrated agriculture and nutrition program in Burkina Faso has positive intrahousehold spillover effects on maternal and child nutritional status, but no sustained longterm improvements in household welfare
Authors: Bliznashka Lilia , Olney Deanna K , Ruel Marie T , Rawat Rahul , Becquey Elodie , Birba Ousmane 
Published: June 2021

BackgroundIntegrated agriculture and nutrition programs have been shown to increase production and consumption of micronutrient‐rich foods. However, current evidence about their effectiveness in improving maternal and child nutritional status is limited. Recent results from a cluster‐randomized controlled trial (RCT) of Hellen Keller International's (HKI) enhanced homestead food production (EHFP) program in Burkina Faso showed significant positive impacts both on agricultural production and on reducing the prevalence of diarrhea, wasting and anemia among children and of underweight among their mothers over the 2 y program period (2010–2012). Yet, little is known about the sustainability and intra‐household spillover of impacts on household, maternal and child outcomes from this and similar types of programs.MethodsWe examined the sustained household impacts and intra‐household spillover effects on maternal and child outcomes of the EHFP program 2 y after it ended (2014). We used data from the original RCT (baseline and endline) from a sub‐sample of households (EHFP beneficiaries: n = 197; control: n = 118) who were also included in the baseline sample of a follow‐on program started in 2014. Both programs targeted children under 12 mo of age. We therefore have data from 2010, 2012 and 2014 on a longitudinal sample of 315 households (~20% of the original EHFP sample of 1767 households), and a cross‐sectional sample of mothers and children 0–12 mo in those households. Difference‐in‐differences (DID) impact estimates were used to assess the impacts on household, mother and child outcomes.FindingsWe found statistically significant (P<0.05) positive intra‐household spillover effects on children born into households that participated in the EHFP program compared to those that did not. Our findings show positive program effects on children's weight‐for‐height Z‐score (DID: 0.45 standard deviations (SD); P=0.05) and prevalence of wasting (DID: −10.8 percentage points (pp); P = 0.04). In addition, we found positive spillover effects on mothers’ body mass index (BMI) (DID: 0.51 kg/m2; P = 0.04) and prevalence of underweight (DID: −14.6 pp; P = 0.00). However, we found no evidence of intra‐household spillover effects on children's anemia or diarrhea. We also found no sustained impacts on household outcomes such as assets and livestock ownership, household dietary diversity and food security.ConclusionTwo years after the end of HKI's EHFP program, we found positive intrahousehold spillover impacts on mothers’ and children's nutritional status, indicating the long‐ term potential of the EHFP program, and similar types of home gardening programs, to improve maternal and child nutrition outcomes. However, our results also highlight the difficulty in sustaining household‐level impacts in the absence of input supply and program activities. More rigorous evaluations are necessary to further understand the mid‐ and long‐term sustainability and spillover effects of integrated agriculture and nutrition programs on maternal and child nutrition outcomes.Support or Funding InformationFunding was provided by USAID/OFDA through HKI, DFATD and CGIAR Research Program on A4NH led by IFPRI.