Effects of a participatory agriculture and nutrition education project on child growth in northern Malawi

Objective: To investigate whether children in households involved in a participatory agriculture and nutrition intervention had improved growth compared to children in matched comparable households and whether the level of involvement and length of time in the project had an effect on child growth. Design: A prospective quasi-experimental study comparing baseline and follow-up data in 'intervention' villages with matched subjects in 'comparison' villages. Mixed model analyses were conducted on standardized child growth scores (weight-and height-for-age Z-scores), controlling for child age and testing for effects of length of time and intensity of village involvement in the intervention. Setting: A participatory agriculture and nutrition project (the Soils, Food and Healthy Communities (SFHC) project) was initiated by Ekwendeni Hospital aimed at improving child nutritional status with smallholder farmers in a rural area in northern Malawi. Agricultural interventions involved intercropping legumes and visits from farmer researchers, while nutrition education involved home visits and group meetings. Subjects: Participants in intervention villages were self-selected, and control participants were matched by age and household food security status of the child. Over a 6-year period, nine surveys were conducted, taking 3838 height and weight measures of children under the age of 3 years. Results: There was an improvement over initial conditions of up to 0.6 in weight-for-age Z-score (WAZ; from -0.4 (SD 0.5) to 0.3 (SD 0.4)) for children in the longest involved villages, and an improvement over initial conditions of 0.8 in WAZ for children in the most intensely involved villages (from -0.6 (SD 0.4) to 0.2 (SD 0.4)). Conclusions: Long-term efforts to improve child nutrition through participatory agricultural interventions had a significant effect on child growth.