Evaluating interventions to improve child nutrition in Eastern Democratic Republic of Congo.

OBJECTIVE: The prevention of malnutrition in children under two approach (PM2A), women's empowerment and agricultural interventions have not been widely evaluated in relation to child diet and nutrition outcomes. The present study evaluated the effectiveness of PM2A, women's empowerment groups (WEG), farmer field schools (FFS) and farmer-to-farmer training (F2F). DESIGN: Community-matched quasi-experimental design; outcome measures included children's dietary diversity, stunting and underweight. SETTING: Communities in South Kivu, Democratic Republic of the Congo.ParticipantsA total of 1312 children from 1113 households. RESULTS: Achievement of minimum dietary diversity ranged from 22·9 to 39·7 % and was significantly greater in the PM2A and FFS groups (P<0·05 for both comparisons). Fewer than 7·6 and 5·8 % of children in any group met minimum meal frequency and acceptable diet targets; only the PM2A group differed significantly from controls (P<0·05 for both comparisons). The endline stunting prevalence ranged from 54·7 % (PM2A) to 69·1 % (F2F) and underweight prevalence from 22·3 % (FFS) to 34·4 % (F2F). No significant differences were found between intervention groups and controls for nutrition measures; however, lower prevalences of stunting (PM2A, -4 %) and underweight (PM2A and FFS, -7 %) suggest potential impact on nutrition outcomes. CONCLUSIONS: Children in the PM2A and FFS groups had better child diet measures and nutrition outcomes with the best results among PM2A beneficiaries. Interventions that address multiple aspects nutrition education, health, ration provision and income generation may be more effective in improving child diet and nutrition in resource-poor settings than stand-alone approaches.

Food Security and Nutrition Outcomes of Farmer Field Schools in Eastern Democratic Republic of the Congo.

BACKGROUND: Food and nutrition security in eastern Democratic Republic of the Congo are threatened by political instability and chronic poverty. The Jenga Jamaa II project, implemented between 2011 and 2016 in South Kivu Province, aimed to improve household food security and child nutritional status using various intervention strategies, including farmer field school (FFS) programs. OBJECTIVE: To characterize the changes in agricultural production techniques, household food security, and child nutritional status associated with participation in FFS programs. METHODS: We used a community-matched design to select FFS intervention and control households from 3 health zones in which the project was operating. Data on food security (Household Dietary Diversity Score [HDDS] and Household Food Insecurity Access Scale [HFIAS]) and child anthropometry were collected semiannually for 3.5 years in both groups. Additional data on agricultural practices were collected annually in the FFS group only. Focus groups with FFS staff and beneficiaries were conducted in the final project year. Statistical analyses included basic descriptive statistics such as paired t tests and analysis of covariance; regression models using a bootstrap were applied to generate P values and confidence intervals while accounting for differences between groups. RESULTS: The study enrolled 388 FFS beneficiaries and their households in the intervention group and 324 non-FFS households in the control group. FFS participants reported increasing the number of different agricultural techniques they used by an average of 2.7 techniques over the project period, from 5.1 in 2013 to 7.9 in 2016 (P<.001). The mean HDDS and HFIAS improved more in the FFS group than in the control group (mean difference between intervention and control for HDDS was 0.9 points and for HFIAS was -4.6 points; P<.001). However, the prevalence of child stunting (60.2% intervention vs. 58.8% control) and underweight (22.3% intervention vs. 29.8% control) were similar in both groups at endline (P>.05). CONCLUSION: Although FFS participants diversified their agricultural production strategies and experienced improvements in household food security, there was not a positive impact on child nutritional status. In this food-insecure context, improvements in agricultural production alone are unlikely to significantly change child nutritional status-a health outcome with a complex, multilevel causal chain.