Kliniken &… Institute Heidelberger Institut… Groups & Projects Working Groups Research Maternal and child… FAARM

Food and Agricultural Approaches to Reducing Malnutrition (FAARM)

Full title: Reducing young child undernutrition through an integrated agricultural project with women’s groups: A cluster-randomised trial in rural Bangladesh

Project team: Sabine Gabrysch, Amanda Wendt, Anna Müller, Andreas Deckert, Anja Schoeps, Thalia Sparling, Andrea Seiermann, Gabriele Stieglbauer

External collaborators: Jillian Waid (HKI Bangladesh), Tarique Huda (icddr,b), Malabika Sarker (BRAC University), Irmgard Jordan (Gießen University), Katja Kehlenbeck (Rhine-Waal University)

Funding: Federal Ministry of Education and Research (BMBF) Junior Scientist Group, Nutrition Embedding Evaluation Program (NEEP) from the UK’s Department for International Development

An estimated 165 million children worldwide suffer from chronic undernutrition which leads to compromised physical and cognitive development and prevents them from reaching their full potential. Nutrition-sensitive agricultural interventions that aim to increase dietary diversity, empower women and include an educational behaviour change component focused on nutrition and hygiene are a promising and sustainable approach to addressing undernutrition. However, evidence on the impact of such complex interventions is still scarce due to a lack of rigorous long-term evaluations (e.g. Masset et al ).

This study will test the hypothesis that integrated agriculture, nutrition and hygiene interventions can reduce undernutrition when children benefit in their crucial first 1000 days. We will conduct an impact evaluation of Helen Keller International’s Homestead Food Production program in Bangladesh that trains women’s groups in vegetable and fruit gardening, poultry rearing, hygiene, child care and nutrition. Furthermore, we will assess the program impact pathways to discern how any impact is achieved. 

The study design is a cluster-randomized controlled field trial in two sub-districts of Habiganj District, Sylhet Division, Bangladesh, including 2600 young women in 96 settlements. After the baseline survey in 2015, settlements were randomized into 48 intervention and 48 control settlements. Women in the intervention settlements receive training and support in Homestead Food Production over three years. A surveillance system collects data on pregnancies, births, child development, nutrition and infections as well as pathway indicators. In 2019, we will conduct the endline survey to assess the nutritional status of the 2600 women and their then approximately 1500 children below 3 years of age and compare between intervention and control.

The main outcomes of interest are stunting (primary outcome: length-for-age), wasting, anaemia, micronutrient deficiencies, early child development, infection prevalence and dietary intake in children under age 3, intra-uterine growth retardation, as well as underweight and micronutrient deficiencies in the women. To better understand how well and through which pathways the program is working, we collect data on the implementation of the various project components and on pathway indicators including food production, income, food security, health service use, women’s empowerment, feeding and hygiene practices.

FAARM was featured in the June 2015 issue "Gesund & Krank" (Healthy & Sick) of Heidelberg University's research magazine Ruperto Carola: "Der stille Hunger. Nachhaltig gegen Mangelernährung" (Hidden hunger. Sustainable action against malnutrition). The article is in German, with a one-page English translation.

HKI's Press Room featured an article on FAARM in June 2016: "Gardening: A Sustainable Solution for Malnutrition?".

Presentation on FAARM on 6 June 2018 by Sabine Gabrysch at LSHTM's Centre for Evaluation (30 min.): watch here.

Faarm featured in BMBF Newsletter in June 2019: 


“Preis für mutige Wissenschaft” (Award for bold research) of the State of Baden-Württemberg awarded for FAARM in 2018:  Press release (in German, with details about FAARM in the linked PDF at the bottom of the page).


Wendt AS, Sparling TM, Waid JL, Mueller AA, Gabrysch S. (2019): Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh. BMJ Open, 9(7):e031037. doi: 10.1136/bmjopen-2019-031037. 

Gabrysch S, Waid, JL, Wendt AS, Müller AA, Kader A, Gosh U. (2018): Nutritional effects of flooding due to unseasonably early monsoon rainfall in Bangladesh: a cross-sectional study in an ongoing cluster-randomised trial. The Lancet Planetary Health, Vol. 2 Suppl. 1, p. S3, doi: 10.1016/S2542-5196(18)30088-3

Wendt A., Waid J., Gabrysch S. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh. UNSCN News. 2017; 42: 149-50.

Lorenz, E, Gabrysch, S. Covariate-constrained randomization routine for achieving baseline balance in cluster-randomized trials, The Stata Journal 2017; 17(2):503-510

Wendt A., Waid J., Gabrysch S.  Iron Content in Groundwater Associated with Anemia among Children 6–37 Months in Rural Bangladesh. FASEB J April 2017, 31(1):786.7

Sinharoy S., Waid JL., Haardörfer R., Wendt A., Gabrysch S.*, Yount KM*. Women’s dietary diversity in rural Bangladesh: Pathways through women’s empowerment. Maternal & Child Nutrition 2017, doi:10.1111/mcn.12489. (* equal contribution)

Wendt A., Waid J., Gabrysch S. Perceived iron content in drinking water associated with anemia among women with iron-poor diets in Bangladesh. FASEB J April 2016 30(1):892.1