Improving household food security in eastern Democratic Republic of the Congo: a comparative analysis of four interventions

Food insecurity contributes to poor nutritional status of many populations, but long-term approaches to improving household food insecurity have not been widely evaluated. This study evaluates the effectiveness of four interventions, Women's Empowerment Groups (WEG), Prevention of Malnutrition in Children under 2 Approach (PM2A), Farmer Field Schools (FFS), and the Farmer to Farmer approach (F2F), implemented in the context of a five-year Development Food Assistance Program in South Kivu, Democratic Republic of the Congo. A community-matched quasi-experimental design was used. Primary outcome measures included Household Dietary Diversity Score (HDDS) and the Household Food Insecurity Access Scale (HFIAS). Mean HDDS was significantly greater than the control group for three interventions (FFS, WEG, PM2A; beta: 0.69-0.88, p < 0.001 for all) as was the difference in proportion of households achieving target HDDS compared to the control group (12.3-21.7%, p < 0.001 for all). HFIAS score was significantly lower for all interventions compared to the control group, but smaller gains were seen in F2F (beta: -2.06 - -4.59, p < 0.001 for all). The adjusted difference in proportion of households improving in HFIAS category compared to controls was significant for all groups, but smallest among F2F (15.0-26.7%, p < 0.05 for all). WEG, PM2A, and FFS interventions had significant effects on improving household dietary diversity and food security; the F2F approach was less effective. Food insecurity remained prevalent despite the interventions, suggesting more research is needed to understand the pathways through which they were effective and how interventions could be strengthened to improve food insecurity in post-conflict settings.