Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia
Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia
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DOI：
10.1177/156482650903000407
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发表时间：
2009-12-01
影响因子：
1.9
通讯作者：
Quinn, Victoria
中科院分区：
文献类型：
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作者：
Olney, Deanna K.;Talukder, Aminuzzaman;Quinn, Victoria
背景宅基地粮食生产方案有可能通过多种途径改善孕产妇和儿童的健康和营养。评价柬埔寨宅基地粮食生产计划对家庭生产和消费富含微量营养素的食物以及对孕产妇和儿童健康和营养（富含微量营养素的食物摄入量、人体测量、血红蛋白和贫血患病率）的影响;并评估对孕产妇和儿童健康和营养的影响途径。两个横截面调查（基线和底线）被用来评估干预（n = 300）和控制（n = 200）家庭之间的差异，使用t检验和卡方检验。使用终点数据和多变量分析，我们研究了该计划对孕产妇和儿童健康和营养的影响途径。干预组和对照组家庭的社会人口学特征在基线时相似，但更多的干预组家庭拥有动物，从宅基地粮食生产中获得收入，并生产和消费富含微量营养素的食物。最终，这些差异有所扩大，更多的干预家庭生产和消费更多的蔬菜，饮食多样性更高，5岁以下儿童发烧的患病率更低。在干预组中，更多的儿童食用更多的鸡蛋，更多的母亲比对照组更频繁地食用富含微量营养素的食物。在产妇和儿童健康和营养方面，两组之间没有其他差异。家庭生产更多的水果和蔬菜与家庭饮食多样性有关，而家庭饮食多样性又与母亲和儿童的饮食多样性有关。膳食多样性与其他母婴健康和营养结果无关。柬埔寨宅基地粮食生产方案增加了家庭生产和消费富含微量营养素的食物，以及母亲和儿童对其中一些食物的摄入量（或摄入频率）。评价设计的弱点（例如，在基线时各群体之间缺乏可比性，未能控制家庭自我选择参与干预措施，以及在不同季节收集基线和底线数据），这些都妨碍了对方案影响得出明确的结论。对影响途径的分析还表明，该方案在家庭一级的惠益并没有转化为孕产妇和儿童健康和营养的显著改善。使用方案理论框架对方案进行仔细的重新设计和严格的评估，将有助于释放其改善孕产妇和儿童健康和营养成果的真正潜力。
Background. Homestead food production programs have the potential to improve maternal and child health and nutrition through multiple pathways.Objective. To evaluate the impact of a homestead food production program in Cambodia on household production and consumption of micronutrient-rich foods and on maternal and child health and nutrition (intake of micronutrient-rich foods, anthropometry, hemoglobin, and anemia prevalence); and to assess pathways of impact on maternal and child health and nutrition.Methods. Two cross-sectional surveys (baseline and endline) were used to assess differences between intervention (n = 300) and control (n = 200) households using t-tests and chi-square tests. Using endline data and multivariate analyses, we examined the pathways of impact of the program on maternal and child health and nutrition.Results. Intervention and control households were similar at baseline in sociodemographic characteristics, but more intervention households owned animals, earned income from homestead food production, and produced and consumed micronutrient-rich foods. At endline, some of these differences had widened, more intervention households produced and consumed more vegetables, had higher dietary diversity, and had a lower prevalence of fever among children under 5 years of age. In the intervention group, more children consumed more eggs and more mothers consumed micronutrient-rich food more frequently than in the control group. There were no other differences between the groups in maternal and child health and nutrition. Greater household production of fruits and vegetables was associated with greater household dietary diversity, which was associated with dietary diversity among mothers and children. Dietary diversity was not associated with other maternal and child health and nutrition outcomes.Conclusions. Cambodian homestead food production program increased household production and consumption of micronutrient-rich foods and maternal and child intake (or frequency of intake) of some of these foods. Weaknesses in the evaluation design (e.g., lack of comparability between groups at baseline, failure to control for self-selection of households into the intervention, and collection of baseline and endline data during different seasons) prevent drawing firm conclusions about the program impacts. Analysis of impact pathways also shows that household-level benefits from the program did not translate into significant improvements in maternal and child health and nutrition. A careful redesign and rigorous assessment of the program using a program theory framework would help unleash its true potential to improve maternal and child health and nutrition outcomes.