Integrating Nutrition Interventions Into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation
Edward Frongillo: https://orcid.org/0000-0002-8265-9815
Adult; Bangladesh; Breast Feeding; Child Health Services; Child Nutritional Physiological Phenomena; Child, Preschool; Diet (classification); Female; Humans; Infant; Infant, Newborn; Malnutrition (prevention & control); Maternal Health Services; Maternal Nutritional Physiological Phenomena; Micronutrients (administration & dosage); Nutritional Status; Pregnancy
Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices. We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) ( ∼ 300 and 1000 pregnant or recently delivered women, respectively, per survey round). We derived difference-in-difference effect estimates, adjusted for geographic clustering and infant age and sex. Coverage of interpersonal counseling was high; >90% of women in the nutrition-focused MNCH group were visited at home by health workers for maternal nutrition and breastfeeding counseling. The coverage of community mobilization activities was ∼50%. Improvements were significantly greater in the nutrition-focused MNCH group than in the standard MNCH group for consumption of iron and folic acid [effect: 9.8 percentage points (pp); 46 tablets] and calcium supplements (effect: 12.8 pp; 50 tablets). Significant impacts were observed for the number of food groups consumed (effect: 1.6 food groups), percentage of women who consumed ≥5 food groups/d (effect: 30.0 pp), and daily intakes of several micronutrients. A significant impact was also observed for exclusive breastfeeding (EBF; effect: 31 pp) but not for early initiation of breastfeeding. Addressing nutrition during pregnancy by delivering interpersonal counseling and community mobilization, providing free supplements, and ensuring weight-gain monitoring through an existing MNCH program improved maternal dietary diversity, micronutrient supplement consumption, and EBF practices. This trial was registered at clinicaltrials.gov as NCT02745249.
Digital Object Identifier (DOI)
Published in The Journal of Nutrition, Volume 147, Issue 12, 2017, pages 2326-2337.
© 2022 American Society for Nutrition
This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).
Nguyen, P., Kim, S., Sanghvi, T., Mahmud, Z., Tran, L., & Shabnam, S. et al. (2017). Integrating Nutrition Interventions into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation. The Journal Of Nutrition, 147(12), 2326-2337. https://doi.org/10.3945/jn.117.257303