Abstract
Background: Rice predominate diets are common in Bangladesh, leading to widespread nutritional deficiencies. Objective: The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial in rural Sylhet, Bangladesh, evaluated a homestead food production intervention implemented 2015-2018 through Helen Keller International, aiming to improve child growth (ClinicalTrials.gov ID: NCT025-05711). We estimate the impact on women's and children's dietary diversity, a secondary trial objective. Methods: We calculated dietary diversity for women and children using standard measures from data collected throughout the trial (2015-2020). Our analysis included 28,282 observations of 2,701 women (out of 2,705 enrolled) and 17,445 observations of their 3,257 children (aged 6-37 months) in 96 settlements, 48 of which received the intervention. We estimated the intervention's impact on dietary diversity using multilevel regression, controlling for seasonality, baseline dietary diversity, and clustering by settlement and repeated measures. Results: Dietary diversity scores and the proportion of women and children classified as consuming minimally diverse diets varied greatly by season, peaking in May/June with 5.3 food groups for women (out of ten) and 3.8 food groups for children (out of seven). Over the entire intervention and post78 intervention period, women's and children's odds of consuming a minimally diverse diet nearly doubled (OR 1.8, p<0.001, for both). This benefit was barely present in the first year of the intervention, increased in the second, and peaked in the last intervention year (OR 2.4 for women, OR 2.5 for children, both p<0.001) before settling at around double the odds in post-intervention years (p<0.001). Dietary improvement was observed throughout the 82 year for both women and children and driven through incremental increases in nearly all food groups. Conclusions: The nutrition-sensitive agriculture intervention successfully increased dietary diversity in women and children, and these impacts persisted after the project closed, including during the COVID-19 lockdown period.
