Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Adventist Development and Relief Organization, Silver Spring, MD, USA.
Glob Health Sci Pract. 2017 Dec 28;5(4):630-643. doi: 10.9745/GHSP-D-17-00203.
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.
To characterize the changes in agricultural production techniques, household food security, and child nutritional status associated with participation in FFS programs.
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 tests and analysis of covariance; regression models using a bootstrap were applied to generate values and confidence intervals while accounting for differences between groups.
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 (<.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; <.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 (>.05).
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.
在刚果民主共和国东部，食物和营养安全受到政治不稳定和长期贫困的威胁。Jenga Jamaa II 项目于 2011 年至 2016 年在南基伍省实施，旨在通过各种干预策略（包括农民田间学校[FFS]项目）提高家庭粮食安全和儿童营养状况。
描述参与 FFS 项目后农业生产技术、家庭粮食安全和儿童营养状况的变化。
我们使用社区匹配设计，从项目实施的 3 个卫生区中选择 FFS 干预和对照家庭。在两组中，每半年收集一次半年度的粮食安全（家庭饮食多样性评分[HDDS]和家庭粮食不安全获取量表[HFIAS]）和儿童人体测量数据。仅在 FFS 组每年收集关于农业实践的额外数据。在项目的最后一年，对 FFS 工作人员和受益人的焦点小组进行了访谈。统计分析包括基本描述性统计，如配对 t 检验和协方差分析；使用自举法的回归模型生成 值和置信区间，同时考虑到组间差异。
该研究共纳入 388 名 FFS 受益人和他们所在的干预组家庭以及 324 名非 FFS 家庭作为对照组。FFS 参与者报告称，在项目期间，他们使用的农业技术种类平均增加了 2.7 种，从 2013 年的 5.1 种增加到 2016 年的 7.9 种（<.001）。FFS 组的 HDDS 和 HFIAS 均值均优于对照组（HDDS 的干预与对照组的平均差异为 0.9 分，HFIAS 的差异为-4.6 分；<.001）。然而，两组在项目结束时的儿童发育迟缓（60.2%干预组 vs. 58.8%对照组）和消瘦（22.3%干预组 vs. 29.8%对照组）患病率相似（>.05）。
尽管 FFS 参与者多样化了他们的农业生产策略，并经历了家庭粮食安全的改善，但对儿童营养状况没有积极影响。在这种粮食不安全的情况下，仅改善农业生产不太可能显著改变儿童营养状况——这是一个具有复杂、多层次因果关系的健康结果。
