Abstract
The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII’s 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2–5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6–24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2–5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2–5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets.
Highlights
The prevalence of maternal and child undernutrition in Nepal has greatly reduced over the last two decades, the prevalence remains among the highest in the world [1]
We found that exposure to any Suaahara II (SII) platform was positively associated with child Dietary diversity (DD) scores (b = 0.11; 95% CI: 0.01, 0.21; p = 0.03) for the older children, but not with whether they met minimum dietary diversity (MDD)
Between exposure to mass media and MDD scores for younger children (b = 0.32; 95% CI: 0.01, 0.63; p = 0.04) and DD scores for older children (b = 0.15; 95% CI: 0.04, 0.26; p = 0.01), We did not find any association between either interpersonal communication (IPC) or participation in community mobilization (CM) events and child DD
Summary
The prevalence of maternal and child undernutrition in Nepal has greatly reduced over the last two decades, the prevalence remains among the highest in the world [1]. Dietary diversity (DD) among children 6–23 months remains poor with only 47% meeting the child minimum dietary diversity (MDD) requirement of consuming foods from at least 4 of 7 food groups [1, 2, 4, 5]. About half of mothers with a child under 2 years of age meet MDD requirements of consuming foods from at least five of ten key food groups [2, 6]. Maintaining adequate dietary practices in Nepal can be challenging due to widespread food insecurity, insufficient availability of and access to diverse foods, or staple-oriented diets, which compromise diverse dietary intake [10]. A lack of knowledge of appropriate practices, limited access to healthcare services and supplies, and poor availability of quality services often prevent women from adopting ideal health practices [11]
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