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Randomized Controlled Trial
. 2017 Dec;147(12):2326-2337.
doi: 10.3945/jn.117.257303. Epub 2017 Oct 11.

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

Phuong Hong Nguyen  1 , Sunny S Kim  2 , Tina Sanghvi  3 , Zeba Mahmud  3 , Lan Mai Tran  3 , Sadia Shabnam  4 , Bachera Aktar  4 , Raisul Haque  4 , Kaosar Afsana  4 , Edward A Frongillo  5 , Marie T Ruel  2 , Purnima Menon  2
Affiliations
Randomized Controlled Trial

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

Phuong Hong Nguyen et al. J Nutr. 2017 Dec.

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.

Keywords: Bangladesh; breastfeeding; cluster-randomized trial; community mobilization; dietary diversity; interpersonal counseling; maternal undernutrition; micronutrient intake.

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Conflict of interest statement

Author disclosures: PHN, SSK, TS, ZM, LMT, SS, BA, RH, KA, EAF, MTR, and PM, no conflicts of interest. TS, ZM, SS, BA, and KA were members of the program implementation team that designed and implemented the interventions studied and reported on in this article. They reviewed the manuscript and provided contextual interpretation of the results, but final decisions on the manuscript content lay with the primary authors from the evaluation team (PHN, SSK, EAF, MTR, and PM). Alive & Thrive provided specific inputs to the manuscript regarding intervention design and provided feedback on the interpretation of results. Freedom to publish the study findings was protected contractually in the agreement between the respective funding sources and the International Food Policy Research Institute. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).

Figures

FIGURE 1
FIGURE 1
Trial profile. MNCH, Maternal, Neonatal, and Child Health.
FIGURE 2
FIGURE 2
Consumption of IFA and calcium supplements in recently delivered women, by program group and survey round, for percentages of women who ever used IFA (A) or calcium (B) supplements and numbers of women who used IFA (C) or calcium (D) supplements. The recommended dosage for pregnancy was 180 tablets of IFA and calcium. Difference-in-difference effect estimates between baseline and endline adjusted for clustering effect at the district and subdistrict levels. ∗∗∗P < 0.001. IFA, iron and folic acid; MNCH, Maternal, Neonatal, and Child Health.
FIGURE 3
FIGURE 3
Breastfeeding practices, by program group and survey round, for early initiation of breastfeeding (A) and exclusive breastfeeding (B). Difference-in-difference effect estimates between baseline and endline adjusted for clustering effect at the district and subdistrict levels. **P < 0.01; ***P < 0.001. MNCH, Maternal, Neonatal, and Child Health.
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