Scoping Review of Intervention Strategies for Improving Coverage and Uptake of Maternal Nutrition Services in Southeast Asia.

Kauma Kurian,Devika Mehra,Theophilus Lakiang,Rajesh Kumar Sinha,Priya Krishnan,Shantanu Sharma,Sunil Mehra,Nishtha Kathuria

doi:10.3390/ijerph182413292

Abstract

Maternal undernutrition can lead to protein-energy malnutrition, micronutrient deficiencies, or anemia during pregnancy or after birth. It remains a major problem, despite evidence-based maternal-nutrition interventions happening on ground. We conducted a scoping review to understand different strategies and delivery mechanisms to improve maternal nutrition, as well as how interventions have improved coverage and uptake of services. An electronic search was conducted in PubMed and Google Scholar for published studies reporting on the effectiveness of maternal-nutrition interventions in terms of access or coverage, health outcomes, compliance, and barriers to intervention utilization. The search was limited to studies published within ten years before the initial search date, 8 November 2019; later, it was updated to 17 February 2021. Of 31 studies identified following screening and data extraction, 22 studies were included for narrative synthesis. Twelve studies were reported from India and eleven from Bangladesh, three from Nepal, two from both Pakistan and Thailand (Myanmar), and one from Indonesia. Nutrition education and counselling, home visits, directly observed supplement intake, community mobilization, food, and conditional cash transfer by community health workers were found to be effective. There is a need to incorporate diverse strategies, including various health education approaches, supplementation, as well as strengthening of community participation and the response of the health system in order to achieve impactful maternal nutrition programs.

Highlights

Review of implementation of various evidence-based interventions to improve maternal nutrition and birth outcomes indicates that community health workers, home visits, directly observed nutrition supplementation, community mobilization, and social marketing approaches for delivery of interventions like iron and folic acid (IFA) supplementation, deworming, balanced energy and protein supplements (BEP) supplementation, and nutrition education and counselling provide better results in terms of coverage, compliance with services and uptake of these interventions
The review found that auxiliary nurse midwives, female health workers, community health workers, Anganwadi workers, accredited social health activists, and community volunteers all play a crucial role in delivering public health interventions either at a designated facility or community centers, on a designated day or through house visits
The findings show that home visits by community health workers improved care-seeking behavior and knowledge among pregnant women

Summary

Introduction

A shortfall in nutrition during these periods can lead to protein-energy malnutrition, micronutrient deficiencies, poor weight gain, or anemia [1]. In low- and middle-income countries, 450 million women are estimated to have short stature, 240 million are underweight (Body Mass Index-BMI < 18.5 kg/m2 ), and 468 million are anemic [2]. This could be attributed, in part, to the poor performance of maternal nutrition programs in low- and middle-income countries. Only 31% of pregnant women in low- and middle-income countries consumed iron-folic acid tablets for 90+ days during pregnancy. 19% of the population in Asia and 56% in Africa are food-insecure

Objectives

Methods

Results

Discussion

Conclusion