Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India
Background: To address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive (I...
| Main Authors: | , , , , , |
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| Format: | Journal Article |
| Language: | Inglés |
| Published: |
Elsevier
2022
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/141117 |
| _version_ | 1855537218908585984 |
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| author | Kachwaha, Shivani Nguyen, Phuong Hong Tran, Lan Mai Avula, Rasmi Young, Melissa F. Menon, Purnima |
| author_browse | Avula, Rasmi Kachwaha, Shivani Menon, Purnima Nguyen, Phuong Hong Tran, Lan Mai Young, Melissa F. |
| author_facet | Kachwaha, Shivani Nguyen, Phuong Hong Tran, Lan Mai Avula, Rasmi Young, Melissa F. Menon, Purnima |
| author_sort | Kachwaha, Shivani |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background: To address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive (I-ANC) to standard (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight gain monitoring. Objectives: This study examined intervention-specific program impact pathways (PIP) and identified reasons for limited impacts of the A&T maternal nutrition intervention package. Methods: We used mixed methods: frontline workers surveys (FLWs, n∼500); counseling observations (n = 407); and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed seven PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling. Results: Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC versus S-ANC (90 vs.70%), but gaps remained for training content and refresher trainings. FLW's knowledge improvement was higher in I-ANC than S-ANC (22–36 percentage points), but knowledge on micronutrient supplement benefits and recommended foods was insufficient (<50%). Most FLWs received supervision (>90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30–50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52 vs. 36%), but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight gain monitoring were low (30–40%). Conclusions: Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact. |
| format | Journal Article |
| id | CGSpace141117 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Elsevier |
| publisherStr | Elsevier |
| record_format | dspace |
| spelling | CGSpace1411172025-10-28T10:12:08Z Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India Kachwaha, Shivani Nguyen, Phuong Hong Tran, Lan Mai Avula, Rasmi Young, Melissa F. Menon, Purnima models food supplements weight gain nutrition trace elements supplementary feeding diet maternal nutrition dietary diversity Background: To address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive (I-ANC) to standard (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight gain monitoring. Objectives: This study examined intervention-specific program impact pathways (PIP) and identified reasons for limited impacts of the A&T maternal nutrition intervention package. Methods: We used mixed methods: frontline workers surveys (FLWs, n∼500); counseling observations (n = 407); and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed seven PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling. Results: Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC versus S-ANC (90 vs.70%), but gaps remained for training content and refresher trainings. FLW's knowledge improvement was higher in I-ANC than S-ANC (22–36 percentage points), but knowledge on micronutrient supplement benefits and recommended foods was insufficient (<50%). Most FLWs received supervision (>90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30–50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52 vs. 36%), but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight gain monitoring were low (30–40%). Conclusions: Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact. 2022-02 2024-04-12T13:37:19Z 2024-04-12T13:37:19Z Journal Article https://hdl.handle.net/10568/141117 en https://doi.org/10.1093/jn/nxab131 Open Access Elsevier Kachwaha, Shivani; Nguyen, Phuong Hong; Mai Tran, Lan; Avula, Rasmi; Young, Melissa; Menon, Purnima; et al. 2022. Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India. Journal of Nutrition 152(2): 612-629. https://doi.org/10.1093/jn/nxab390 |
| spellingShingle | models food supplements weight gain nutrition trace elements supplementary feeding diet maternal nutrition dietary diversity Kachwaha, Shivani Nguyen, Phuong Hong Tran, Lan Mai Avula, Rasmi Young, Melissa F. Menon, Purnima Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title | Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title_full | Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title_fullStr | Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title_full_unstemmed | Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title_short | Specificity matters: Unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in India |
| title_sort | specificity matters unpacking impact pathways of individual interventions within bundled packages helps interpret the limited impacts of a maternal nutrition intervention in india |
| topic | models food supplements weight gain nutrition trace elements supplementary feeding diet maternal nutrition dietary diversity |
| url | https://hdl.handle.net/10568/141117 |
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