학술논문
Intensified Nutrition Interventions in Antenatal Care Services Increased Consumption of Iron and Folic Acid Supplements and Early Breastfeeding Practices in Burkina Faso: Results of a Cluster-Randomized Program Evaluation.
Document Type
Academic Journal
Author
Kim SS; Nutrition, Diets, and Health Unit, Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States. Electronic address: sunny.kim@cgiar.org.; Zagré RR; Nutrition, Diets, and Health Unit, IFPRI, Dakar, Senegal.; Ouédraogo CT; Independent Consultant, Ouagadougou, Burkina Faso.; Sununtnasuk C; Nutrition, Diets, and Health Unit, Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States.; Ganaba R; AFRICSanté, Bobo-Dioulasso, Burkina Faso.; Zafimanjaka MG; FHI Solutions, Ouagadougou, Burkina Faso.; Tharaney M; FHI Solutions, Washington, DC, United States.; Sanghvi T; FHI Solutions, Washington, DC, United States.; Menon P; Food and Nutrition Policy, IFPRI, New Delhi, India.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 0404243 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1541-6100 (Electronic) Linking ISSN: 00223166 NLM ISO Abbreviation: J Nutr Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Alive & Thrive supported the Government of Burkina Faso to strengthen the provision of iron and folic acid (IFA) supplementation and interpersonal counseling on maternal nutrition and breastfeeding through antenatal care (ANC) services and community-based contacts in 2 regions.
Objectives: We assessed the impacts of intensified nutrition interventions during ANC compared with standard ANC services on intervention coverage and maternal nutrition practices.
Methods: A cluster-randomized evaluation compared 40 health center catchment areas in intervention areas with 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0-5 mo of age per survey round) provided data on impact indicators, intervention exposure, and other factors. We derived difference-in-difference (DID) effect estimates, adjusted for geographic clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices.
Results: More women in intervention areas had 4+ ANC visits (DID: 8.3 percentage points [pps]) and started ANC during the first trimester (DID: 10.5 pp), compared with control areas. Improvements were achieved in exposure to nutrition counseling on dietary diversity (DID: 44.4 pp), food quantity (DID: 42.9 pp), adequate weight gain (DID: 35.1 pp), and breastfeeding (DID: 25.9 pp). Women in intervention areas consumed more IFA supplements during pregnancy (DID: 21 tablets). Early initiation of and exclusive breastfeeding also improved (DID: 17.0 and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrient intake (14%) among pregnant women remained low in both areas.
Conclusions: Strengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices. Continued efforts to strengthen the delivery and use of maternal nutrition services may be required for greater behavior changes, and to address family support, social norms, and other factors to improve women's diets during pregnancy.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Objectives: We assessed the impacts of intensified nutrition interventions during ANC compared with standard ANC services on intervention coverage and maternal nutrition practices.
Methods: A cluster-randomized evaluation compared 40 health center catchment areas in intervention areas with 40 in control areas. Repeated cross-sectional surveys in 2019 and 2021 (960 pregnant women and 1920 women with children 0-5 mo of age per survey round) provided data on impact indicators, intervention exposure, and other factors. We derived difference-in-difference (DID) effect estimates, adjusted for geographic clustering, for maternal dietary diversity, IFA consumption, and early breastfeeding practices.
Results: More women in intervention areas had 4+ ANC visits (DID: 8.3 percentage points [pps]) and started ANC during the first trimester (DID: 10.5 pp), compared with control areas. Improvements were achieved in exposure to nutrition counseling on dietary diversity (DID: 44.4 pp), food quantity (DID: 42.9 pp), adequate weight gain (DID: 35.1 pp), and breastfeeding (DID: 25.9 pp). Women in intervention areas consumed more IFA supplements during pregnancy (DID: 21 tablets). Early initiation of and exclusive breastfeeding also improved (DID: 17.0 and 8.3 pp, respectively). However, dietary diversity (4 out of 10 food groups) and mean probability of adequacy of micronutrient intake (14%) among pregnant women remained low in both areas.
Conclusions: Strengthening maternal nutrition interventions delivered through government ANC services was feasible and effective in improving maternal nutrition practices. Continued efforts to strengthen the delivery and use of maternal nutrition services may be required for greater behavior changes, and to address family support, social norms, and other factors to improve women's diets during pregnancy.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)