Abstract
Background: 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.Objectives: 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.Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n ∼ 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.Results: 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.Conclusions: 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.
Highlights
Maternal undernutrition is a major public health concern globally, contributing to poor fetal and early childhood growth and increased infant morbidity and mortality, with long-term adverse consequences for child development and life-long health [1].There is growing recognition of the importance of maternal nutrition interventions as part of antenatal care (ANC) to improve maternal and infant health outcomes [2]
No evaluation clusters were lost to follow-up, and none crossed from standard MNCH to nutritionfocused MNCH groups during implementation (Figure 1)
Given the short 1-y period of intervention, the effects were substantial, showing an increase in women who consumed iron and folic acid (IFA) and calcium tablets by 46 and 50 pp, respectively; a 30-pp increase in the women who consumed $5 food groups/d; an increase in individual food groups consumed ranging from 16 to 36 pp; a significant increase in intakes of most micronutrients studied; and a 31-pp increase in the women exclusively breastfeeding their infant 0–6 mo of age in the nutrition-focused MNCH compared with the standard MNCH group
Summary
Maternal undernutrition is a major public health concern globally, contributing to poor fetal and early childhood growth and increased infant morbidity and mortality, with long-term adverse consequences for child development and life-long health [1].There is growing recognition of the importance of maternal nutrition interventions as part of antenatal care (ANC) to improve maternal and infant health outcomes [2]. 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. Objectives: 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. Conclusions: 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.
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