Abstract
BackgroundIn many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women.MethodsWe used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables.ResultsAmong 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group.ConclusionsNutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting.Trial registrationClinical trials.gov ID: NCT03136393 (registered on 02/05/2017).
Highlights
In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy
World Health Organisation (WHO)-revised guidelines for undernourished populations emphasise the relevance of nutrition education and counselling services for ANC, aiming to increase daily energy and protein intake to reduce the risk of low birth weight (LBW, birth weight < 2,500 g) infants [3]
The results showed that the median nutrition knowledge scores using Six Food Group (SFG) rating among the women in the intervention and control group was 6 versus 3 at study endpoint
Summary
In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. World Health Organisation (WHO)-revised guidelines for undernourished populations emphasise the relevance of nutrition education and counselling services for ANC, aiming to increase daily energy and protein intake to reduce the risk of low birth weight (LBW, birth weight < 2,500 g) infants [3]. This is relevant for Malawi, where maternal malnutrition accounts for more than half of the LBW babies [4]. Knowing the beneficial effects of good nutrition and having skills to prepare the food can motivate the pregnant women to develop intentions to improve their dietary habits [5]
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