Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households.Les carences en micronutriments représentent un grave problème de santé publique chez les femmes et les enfants au Bangladesh, au Cambodge, au Népal et aux Philippines. Helen Keller International met en œuvre dans ces pays un programme de production alimentaire en exploitations familiales (homestead food production - HFP) associé à une éducation à l'alimentation afin d’augmenter et de garantir la disponibilité et la consommation d'aliments riches en micronutriments tout au long de l'année dans les foyers pauvres, et plus particulièrement chez les femmes et les enfants. Entre 2003 et 2007, le programme HFP a été mis en œuvre dans environ 30 000 foyers de ces quatre pays. Les données fournies par les échantillons représentatifs utilisés pour l'évaluation de ce programme mettent en évidence les bénéfices qu'il représente pour les familles. Ces données sont le résultat des entretiens conduits avec des familles appartenant à des villages participant au programme HFP, ainsi qu’avec des familles de contrôle dans des villages non concernés par le programme. Des analyses de l’hémoglobine ont été réalisées sur des échantillons sanguins prélevés avant et après la mise en œuvre du programme sur environ 1 000 enfants âgés de 6 à 59 mois et environ 1 200 femmes (non enceintes). L’évaluation du programme HFP a montré qu’il avait amélioré significativement la diversification alimentaire. Les données combinées des quatre pays montrent une amélioration de la consommation de produits d’origine animale chez les familles du programme. La consommation de foie est passée de 24 % à 46 %, et le nombre médian d’œufs consommés par semaine et par famille est passé de 2 à 5. La vente des produits issus du programme HFP a également amélioré les revenus de ces foyers. La prévalence de l’anémie chez les enfants participant au programme a diminué dans tous les pays. Cette diminution n'était cependant significative qu'au Bangladesh et aux Philippines. Bien que, dans trois pays, la prévalence de l’anémie ait également diminué chez les familles de contrôle, la différence était plus grande chez les familles participant au programme en comparaison avec les familles de contrôle.La malnutrición en micronutrientes es un problema de salud pública serio entre las mujeres y los niños en Bangladesh, Camboya, Nepal y Filipinas. En estos países Helen Keller International ha implementado programas de producción de alimentos en casa (PAC), conjuntamente con una educación en nutrición, para aumentar y asegurar la disponibilidad y el consumo todo el año de alimentos ricos en micronutrientes en hogares desfavorecidos, en particular entre las mujeres y los niños. Entre 2003 y 2007, el programa PAC fue aplicado en unos 30.000 hogares en estos cuatro países. Los datos obtenidos de las muestras representativas tomadas para la evaluación de los programas PAC en dichos países mostraron los beneficios del programa para los hogares. Los datos fueron recogidos a través de entrevistas con hogares en los pueblos en los que se aplicó el programa PAC y con hogares de control en pueblos sin el programa PAC. Antes y después de la implementación del programa, se tomaron muestras de sangre de unos 1000 niños entre 6 y 59 meses de edad y de unas 1200 mujeres no embarazadas; dichas muestras fueron analizadas para ver la hemoglobina. El estudio revela que el programa PAC mejoró de manera significativa la diversificación en la dieta. Los datos combinados de los cuatro países mostraron una mejoría en el consumo de alimentos de origen animal entre los hogares afiliados al programa, con un aumento del consumo de hígado de 24 % al comienzo a 46 % al final, y un aumento de 2 a 5 del número medio de huevos consumidos por familia y por semana. La venta de productos PAC también mejoró los ingresos del hogar. La prevalencia de anemia en los niños de hogares afiliados al programa disminuyó en todos los países; sin embargo, la disminución sólo fue significativa en Bangladesh y Filipinas. Aunque la prevalencia de anemia también disminuyó entre los hogares de control en tres países, la magnitud del cambio fue mayor en hogares del programa que en hogares de control

Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households.Les carences en micronutriments représentent un grave problème de santé publique chez les femmes et les enfants au Bangladesh, au Cambodge, au Népal et aux Philippines. Helen Keller International met en œuvre dans ces pays un programme de production alimentaire en exploitations familiales (homestead food production - HFP) associé à une éducation à l'alimentation afin d’augmenter et de garantir la disponibilité et la consommation d'aliments riches en micronutriments tout au long de l'année dans les foyers pauvres, et plus particulièrement chez les femmes et les enfants. Entre 2003 et 2007, le programme HFP a été mis en œuvre dans environ 30 000 foyers de ces quatre pays. Les données fournies par les échantillons représentatifs utilisés pour l'évaluation de ce programme mettent en évidence les bénéfices qu'il représente pour les familles. Ces données sont le résultat des entretiens conduits avec des familles appartenant à des villages participant au programme HFP, ainsi qu’avec des familles de contrôle dans des villages non concernés par le programme. Des analyses de l’hémoglobine ont été réalisées sur des échantillons sanguins prélevés avant et après la mise en œuvre du programme sur environ 1 000 enfants âgés de 6 à 59 mois et environ 1 200 femmes (non enceintes). L’évaluation du programme HFP a montré qu’il avait amélioré significativement la diversification alimentaire. Les données combinées des quatre pays montrent une amélioration de la consommation de produits d’origine animale chez les familles du programme. La consommation de foie est passée de 24 % à 46 %, et le nombre médian d’œufs consommés par semaine et par famille est passé de 2 à 5. La vente des produits issus du programme HFP a également amélioré les revenus de ces foyers. La prévalence de l’anémie chez les enfants participant au programme a diminué dans tous les pays. Cette diminution n'était cependant significative qu'au Bangladesh et aux Philippines. Bien que, dans trois pays, la prévalence de l’anémie ait également diminué chez les familles de contrôle, la différence était plus grande chez les familles participant au programme en comparaison avec les familles de contrôle.La malnutrición en micronutrientes es un problema de salud pública serio entre las mujeres y los niños en Bangladesh, Camboya, Nepal y Filipinas. En estos países Helen Keller International ha implementado programas de producción de alimentos en casa (PAC), conjuntamente con una educación en nutrición, para aumentar y asegurar la disponibilidad y el consumo todo el año de alimentos ricos en micronutrientes en hogares desfavorecidos, en particular entre las mujeres y los niños. Entre 2003 y 2007, el programa PAC fue aplicado en unos 30.000 hogares en estos cuatro países. Los datos obtenidos de las muestras representativas tomadas para la evaluación de los programas PAC en dichos países mostraron los beneficios del programa para los hogares. Los datos fueron recogidos a través de entrevistas con hogares en los pueblos en los que se aplicó el programa PAC y con hogares de control en pueblos sin el programa PAC. Antes y después de la implementación del programa, se tomaron muestras de sangre de unos 1000 niños entre 6 y 59 meses de edad y de unas 1200 mujeres no embarazadas; dichas muestras fueron analizadas para ver la hemoglobina. El estudio revela que el programa PAC mejoró de manera significativa la diversificación en la dieta. Los datos combinados de los cuatro países mostraron una mejoría en el consumo de alimentos de origen animal entre los hogares afiliados al programa, con un aumento del consumo de hígado de 24 % al comienzo a 46 % al final, y un aumento de 2 a 5 del número medio de huevos consumidos por familia y por semana. La venta de productos PAC también mejoró los ingresos del hogar. La prevalencia de anemia en los niños de hogares afiliados al programa disminuyó en todos los países; sin embargo, la disminución sólo fue significativa en Bangladesh y Filipinas. Aunque la prevalencia de anemia también disminuyó entre los hogares de control en tres países, la magnitud del cambio fue mayor en hogares del programa que en hogares de control

Homestead food production model contributes to improved household food security and nutrition status of young children and women in poor populations

Micronutrient malnutrition is a serious public health problem among women and children in Bangladesh, Cambodia, Nepal and the Philippines. Helen Keller International has been implementing homestead food production (HFP) programs (coupled with nutrition education) in these countries to increase and ensure year-round availability and intake of micronutrient-rich foods in poor households, particularly among women and children.  Between 2003 and 2007, the HFP program was implemented among ~30,000 households in these four countries. Data collected from representative samples taken for evaluations of HFP programs in these countries illustrated the benefit of the program for households. Data were collected through interviews with households in villages that had the HFP program and from control households in non-HFP program villages. Blood samples collected from ~1000 children aged 6-59 months and ~1200 non-pregnant women before and after program implementation were analyzed for hemoglobin. The review showed that the HFP program significantly improved dietary diversification. The combined data from all four countries showed improved animal food consumption among program households, with liver consumption increasing from 24% at baseline to 46% at endline and the median number of eggs consumed by families per week increasing from 2 to 5.  The sale of HFP products also improved household income. Anemia prevalence among children in program households decreased in all the countries; however, the decrease was only significant in Bangladesh and the Philippines.  Although anemia prevalence also decreased among control households in three countries, the magnitude of change was higher in program households compared with control households

Comparing two simplified questionnaire‐based methods with 24‐h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines

Abstract Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24‐h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire‐based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7‐day semiquantitative food frequency questionnaire [SQ‐FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7‐day SQ‐FFQ and compared the results against 24HRs. The participants included children 12−18 months (n = 123) and their mothers 18−49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ‐FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ‐FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual‐level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research

Filipino Children with High Usual Vitamin A Intakes and Exposure to Multiple Sources of Vitamin A Have Elevated Total Body Stores of Vitamin A But Do Not Show Clear Evidence of Vitamin A Toxicity

BackgroundYoung children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS).ObjectivesTBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined.MethodsChildren 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group.ResultsMean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity.ConclusionsIn this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339

Comparing two simplified questionnaire‐based methods with 24‐h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines

Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research