Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation
Background: Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. Objectives: We compared nutr...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | Inglés |
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Oxford University Press
2021
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/142742 |
| _version_ | 1855519678452989952 |
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| author | Nguyen, Phuong Hong Kachwaha, Shivani Tran, Lan Mai Avula, Rasmi Young, Melissa F. Ghosh, Sebanti Sharma, Praveen Kumar Escobar-Alegria, Jessica Forissier, Thomas Patil, Sumeet Frongillo, Edward A. Menon, Purnima |
| author_browse | Avula, Rasmi Escobar-Alegria, Jessica Forissier, Thomas Frongillo, Edward A. Ghosh, Sebanti Kachwaha, Shivani Menon, Purnima Nguyen, Phuong Hong Patil, Sumeet Sharma, Praveen Kumar Tran, Lan Mai Young, Melissa F. |
| author_facet | Nguyen, Phuong Hong Kachwaha, Shivani Tran, Lan Mai Avula, Rasmi Young, Melissa F. Ghosh, Sebanti Sharma, Praveen Kumar Escobar-Alegria, Jessica Forissier, Thomas Patil, Sumeet Frongillo, Edward A. Menon, Purnima |
| author_sort | Nguyen, Phuong Hong |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background: Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. Objectives: We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices. Methods: We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices. Results: Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg). Conclusions: Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141. |
| format | Journal Article |
| id | CGSpace142742 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Oxford University Press |
| publisherStr | Oxford University Press |
| record_format | dspace |
| spelling | CGSpace1427422025-04-03T21:29:33Z Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation Nguyen, Phuong Hong Kachwaha, Shivani Tran, Lan Mai Avula, Rasmi Young, Melissa F. Ghosh, Sebanti Sharma, Praveen Kumar Escobar-Alegria, Jessica Forissier, Thomas Patil, Sumeet Frongillo, Edward A. Menon, Purnima maternal and child health child nutrition weight gain malnutrition nutrition trace elements psychology diet breastfeeding maternal nutrition food intake Background: Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. Objectives: We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices. Methods: We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices. Results: Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg). Conclusions: Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141. 2021-08-18 2024-05-22T12:10:58Z 2024-05-22T12:10:58Z Journal Article https://hdl.handle.net/10568/142742 en https://doi.org/10.1093/cdn/nzaa054_122 https://doi.org/10.1093/cdn/nzab081 https://doi.org/10.1093/jn/nxab390 https://doi.org/10.1016/j.foodpol.2021.102173 Open Access Oxford University Press Nguyen, Phuong Hong; Kachwaha, Shivani; Tran, Lan Mai; Avula, Rasmi; Young, Melissa; Ghosh, Sebanti; Sharma, Praveen K.; Escobar-Alegria, Jessica; Forissier, Thomas; Patil, Sumeet; Frongillo, Edward A.; and Menon, Purnima. 2021. Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation. Journal of Nutrition 151(8): 2282–2295. https://doi.org/10.1093/jn/nxab131 |
| spellingShingle | maternal and child health child nutrition weight gain malnutrition nutrition trace elements psychology diet breastfeeding maternal nutrition food intake Nguyen, Phuong Hong Kachwaha, Shivani Tran, Lan Mai Avula, Rasmi Young, Melissa F. Ghosh, Sebanti Sharma, Praveen Kumar Escobar-Alegria, Jessica Forissier, Thomas Patil, Sumeet Frongillo, Edward A. Menon, Purnima Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title | Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title_full | Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title_fullStr | Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title_full_unstemmed | Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title_short | Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation |
| title_sort | strengthening nutrition interventions in antenatal care services affects dietary intake micronutrient intake gestational weight gain and breastfeeding in uttar pradesh india results of a cluster randomized program evaluation |
| topic | maternal and child health child nutrition weight gain malnutrition nutrition trace elements psychology diet breastfeeding maternal nutrition food intake |
| url | https://hdl.handle.net/10568/142742 |
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