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

2021 ◽  
Vol 18 (24) ◽  
pp. 13292
Author(s):  
Kauma Kurian ◽  
Theophilus Lakiang ◽  
Rajesh Kumar Sinha ◽  
Nishtha Kathuria ◽  
Priya Krishnan ◽  
...  
Keyword(s):  
Nutrition Education ◽  
Scoping Review ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Protein Energy Malnutrition ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Micronutrient Deficiencies ◽  
Nutrition Interventions ◽  
Maternal Undernutrition

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.

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

2012 ◽  
Vol 33 (2_suppl1) ◽  
pp. S27-S50 ◽  
Author(s):  
Lisa S. Saldanha ◽  
Laura Buback ◽  
Jessica M. White ◽  
Afework Mulugeta ◽  
Solomon G. Mariam ◽  
...  
Keyword(s):  
Program Implementation ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Background Information ◽  
Nutrition Interventions ◽  
District Health ◽  
Community Based ◽  
Maternal Undernutrition ◽  
Health And Nutrition ◽  
Nutrition Service

Background Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited. Objective This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in Ethiopia Methods Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region. Results Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels. Conclusions Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.

scholarly journals From Fome Zero to Bolsa Família: Social Policies and Poverty Alleviation under Lula

2006 ◽  
Vol 38 (4) ◽  
pp. 689-709 ◽  
Author(s):  
ANTHONY HALL
Keyword(s):  
Latin America ◽  
Social Policy ◽  
Poverty Alleviation ◽  
Maternal Nutrition ◽  
School Attendance ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Systematic Evaluation ◽  
The Poor ◽  
Bolsa Familia

Under the administrations of Fernando Henrique Cardoso (1995–2002) and especially President Lula (2003–), conditional cash transfer (CCT) programmes have become adopted as mainstream social policy in Brazil. This follows a marked trend since the 1990s in Latin America towards the setting up of targeted safety nets to alleviate poverty. Lula consolidated and expanded CCTs, firstly under Fome Zero and later Bolsa Família, now the largest such scheme in the world. Its four sub-programmes (educational stipends to boost school attendance, maternal nutrition, food supplements and a domestic gas subsidy) benefit some 30 million of Brazil's poorest people, with a target of 44 million by 2006. Since 2003, spending on Bolsa Família has risen significantly to consume over one-third of the social assistance budget for the poorest sectors and it remained a flagship policy in the run-up to the presidential elections of October 2006. Although coverage of Bolsa Família is impressive, however, systematic evaluation of its social and economic impacts is still lacking. Evidence from other CCT programmes in Latin America suggests that positive results may be achieved in terms of meeting some immediate needs of the poor. However, there have been many implementation problems. These include poor beneficiary targeting, lack of inter-ministerial coordination, inadequate monitoring, clientelism, weak accountability and alleged political bias. Given the heightened profile of cash transfers in Brazil's social policy agenda, key questions need to be asked. These concern, firstly, the extent to which Bolsa Família does indeed contribute to poverty alleviation; and secondly, whether it creates greater dependence of the poor on government hand-outs and political patronage at the expense of long-term social investment for development.

Association between iron deficiency anaemia and complementary feeding in children under 2 years assisted by a Conditional Cash Transfer programme

2020 ◽  
pp. 1-11
Author(s):  
Marília Moura e Mendes ◽  
Giovana de Montemor Marçal ◽  
Manuela Di Guaraldi Mafra Fragoso ◽  
Telma Maria de Menezes Toledo Florêncio ◽  
Nassib Bezerra Bueno ◽  
...  
Keyword(s):  
Nutrition Education ◽  
Complementary Feeding ◽  
Public Health Problem ◽  
Conditional Cash Transfer ◽  
Bottle Feeding ◽  
Cash Transfer ◽  
Measurement Scale ◽  
Food Groups ◽  
Cross Sectional ◽  
Deficiency Anaemia

Abstract Objective: To evaluate the association between Fe deficiency anaemia (IDA) and complementary feeding in children under 2 years old assisted by the Conditional Cash Transfer programme, Bolsa Família (BFP). Design: Cross-sectional study. Data were obtained through a standardised form, questionnaire to assess the eating habits of children under 2 years of age, capillary Hb (HemoCue®) and the Brazilian Household Food Insecurity Measurement Scale. Associations were calculated using hierarchical Poisson regression, adjusted at the last level by socio-economic, demographic and environmental variables from previous hierarchical levels. Setting: Six municipalities from the State of Alagoas, Brazil. Participants: Children aged 6–24 months assisted by BFP. Results: A total of 1604 children were evaluated, among whom 58·1 % had anaemia. A higher number of food groups consumed (prevalence ratio (PR) = 0·97; 95 % CI 0·95, 0·99; P = 0·009), the consumption of dairy (PR = 0·86; 95 % CI 0·79, 0·84; P = 0·001) and meat (PR = 0·90; 95 % CI 0·83, 0·99; P = 0·030) in addition to bottle feeding (PR = 0·88; 95 % CI 0·82, 0·96; P = 0·004) were associated with a lower prevalence of IDA. Conclusions: IDA is still a serious public health problem in children under 2 years old assisted by BFP in Alagoas. We highlight the importance of promoting complementary feeding based on a diversified dietary intake, as well strengthening prophylactic supplementation programmes to increase children’s adherence in conjunction with the implementation of food and nutrition education to help reduce the prevalence of this condition.

scholarly journals Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review

2020 ◽  
Vol 23 (14) ◽  
pp. 2626-2636
Author(s):  
Paul Kyere ◽  
J Lennert Veerman ◽  
Patricia Lee ◽  
Donald E Stewart
Keyword(s):  
Nutrition Education ◽  
School Nutrition ◽  
Nutrition Knowledge ◽  
Sub Saharan Africa ◽  
Nutrition Status ◽  
Food Supplementation ◽  
Micronutrient Deficiencies ◽  
Nutrition Interventions ◽  
School Based ◽  
Sub Saharan

AbstractObjective:To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour.Design:A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school’s physical and social environments, to the school’s nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community.Setting:Schools in SSA.Participants:School-aged children and adolescents, aged 5–19 years.Results:Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities.Conclusions:There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.

scholarly journals Understanding How the Strategic Use of Data Can Improve the Implementation of Maternal Nutrition Interventions in Uttar Pradesh (UP), India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 945-945
Author(s):  
Ahad Bootwala ◽  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Rasmi Avula ◽  
Sebanti Ghosh ◽  
...  
Keyword(s):  
Maternal Nutrition ◽  
Data Use ◽  
Nutrition Interventions ◽  
District Health ◽  
Monthly Review ◽  
Maternal Undernutrition ◽  
Use Of Data ◽  
District Government ◽  
The Government ◽  
The Impact

Abstract Objectives Maternal undernutrition remains high in India and is associated with maternal mortality and adverse birth outcomes. To address this challenge, Alive & Thrive (A&T) aimed to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in UP. The nutrition-intensified ANC (I-ANC) intervention facilitated regular use of data to enable corrective actions. We aimed to understand how maternal health data was used for improving the delivery of maternal nutrition services and to identify factors associated with data use. Methods In-depth interviews (N = 35) were conducted among sub-district government staff, frontline worker (FLW) supervisors and A&T staff in two districts in UP. Systematic coding of verbatim transcripts and detailed summaries was undertaken to elucidate themes and patterns related to data use and facilitators and barriers. Results Sub-district government staff reported using government data (i.e., HMIS) to estimate demand for prenatal supplements. Sub-district government staff, FLW supervisors and A&T staff used government and intervention monitoring data to understand the impact and reach of services delivered to women. Key indicators on the attendance of pregnant women at community health events and number of women receiving adequate supplements was discussed with FLWs in monthly review meetings. Data review guided identification of areas of low FLW performance (i.e., monitoring weight gain) and prompted refresher trainings. Facilitators of data use included collaboration between sub-district health department officials on data analysis and monthly review meetings to provide feedback on improving performance (including counseling topics and stock of supplements). Barriers to data use included staff vacancies, education level of FLWs and conflicts between FLWs and supervisors. Conclusions Use of data for decision making is critical for supporting intervention planning and providing targeted supervision and support for FLWs. Collaboration facilitated the use of data, but structural barriers such as staff vacancies need to be addressed to improve the implementation of maternal nutrition interventions. Funding Sources Bill & Melinda Gates Foundation (through Alive & Thrive, managed by FHI 360) and Emory University.

scholarly journals Bridging the Knowledge Gap in Bangladesh for Effective Locally Driven Conditional Cash Transfer in Multisectoral Nutrition Programming

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 130-130
Author(s):  
Enam Hasib ◽  
Taufique Joarder ◽  
Kharisma Nugroho ◽  
Kelly Perry ◽  
Jennifer Crum ◽  
...  
Keyword(s):  
International Development ◽  
Nutrition Education ◽  
Local Knowledge ◽  
Social Protection ◽  
Research Utilization ◽  
Conditional Cash Transfer ◽  
Decision Makers ◽  
Cash Transfer ◽  
Household Decision ◽  
Household Resources

Abstract Objectives The USAID's Strengthening Multisectoral Nutrition Programming through Implementation Science Activity (MSNP) in Bangladesh gathered local knowledge to augment national data to ensure nutrition programming delivery was appropriately targeted. Such knowledge allowed MSNP's social protection conditional cash transfer (CCT) activity to reach most at-risk individuals. Methods Using structured field observation forms, six trained staff documented nutrition programming decision-making processes and MSNP project activities regarding appropriate beneficiary targeting in six districts. Numerous project documents were reviewed and site visits conducted to evaluate CCT implementation in action. Data were coded into three aspects of learning (challenges and methods to alleviate them, successes, and recommendations for future programming) and analyzed according to themes identified in research utilization literature. Results CCT, an incentive-based delivery mechanism targeting women based on locally collected data, positively influenced household decision-makers, including women, to provide effective health and nutrition care for themselves and their children. CCT, received upon completion of antenatal care visits and participation in nutrition education sessions, effectively supported the uptake of MSNP community workers’ nutrition advice led to improve water, sanitation, and hygiene practices in remote areas. Requiring CCT beneficiaries to open bKash accounts to ensure financial transparency and that funds reached the intended participants helped establish women as nutrition decision makers, improving financial inclusion for extreme-poor women. Conclusions CCT stimulates use of nutrition and health services, increasing household resources for nutrition-related behaviors and allowing women to exercise financial freedom. To improve evidence utilization in nutrition programming, national indicators must be complemented with local knowledge gathering processes, with local stakeholders and beneficiaries involved to ensure appropriate targeting and to transform knowledge into practice. Funding Sources United States Agency for International Development (USAID).

scholarly journals ‘If he sees it with his own eyes, he will understand’: how gender informed the content and delivery of a maternal nutrition intervention in Burkina Faso

2020 ◽  
Vol 35 (5) ◽  
pp. 536-545 ◽  
Author(s):  
Jasmin Isler ◽  
N Hélène Sawadogo ◽  
Guy Harling ◽  
Till Bärnighausen ◽  
Maya Adam ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Nutrition Intervention ◽  
Nutrition Interventions ◽  
Group Discussions ◽  
Intervention Delivery ◽  
Meal Preparation ◽  
And Gender ◽  
Two Stages

Abstract A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world’s most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.’s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one’s own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men’s perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso.

Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues

2012 ◽  
Vol 33 (2_suppl1) ◽  
pp. S6-S26 ◽  
Author(s):  
Cesar G. Victora ◽  
Fernando C. Barros ◽  
Maria Cecilia Assunção ◽  
Maria Clara Restrepo-Méndez ◽  
Alicia Matijasevich ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Maternal Nutrition ◽  
Scaling Up ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Food Supplementation ◽  
Food Fortification ◽  
Micronutrient Supplementation ◽  
Transfer Program ◽  
Nutrition Programs

Background Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition. Objective Analyses of scaling-up of five program implemented in several countries. These include micronutrient supplementation, food fortification, food supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and sustained coverage, and reasons for success or failure Methods Systematic review of articles on large-scale programs in several databases. Two separate reviewers carried out independent searches. A separate review of the gray literature was carried out including websites of the most important organizations leading with these programs. With Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was conducted. Results Food fortification programs: iron and folic acid fortification were less successful than salt iodization initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal achieved good coverage. Key elements of success are antenatal care coverage, ensuring availability of tablets, and improving compliance. Integrated nutrition programs in India, Bangladesh, and Madagascar with food supplementation and/or behavioral change interventions report improved coverage and behaviors, but achievements are below targets. The Mexican conditional cash transfer program provides a good example of use of this platform to deliver maternal nutritional interventions. Conclusions Programs differ in complexity, and key elements for success vary with the type of program and the context in which they operate. Special attention must be given to equity, as even with improved overall coverage and impact inequalities may even be increased. Finally, much greater investments are needed in independent monitoring and evaluation.

Substantial Educational and Health Improvement of Indigenous Learner Beneficiaries of Conditional Cash Transfer Program

2013 ◽  
Vol 7 (1) ◽  
Author(s):  
HESED A. SORIANO LIM ◽  
HELEN Q. OMBLERO
Keyword(s):  
Health Education ◽  
Indigenous People ◽  
Health Workers ◽  
Conditional Cash Transfer ◽  
Point Of View ◽  
Cash Transfer ◽  
Health Improvement ◽  
Transfer Program ◽  
Hermeneutic Approach ◽  
The Government

The Indigenous People experienced substantial life improvement upon joining the Poverty Alleviation Program of the Government (Conditional Cash Transfer). The objective of the study was to determine the economic, health, education and life experiences of beneficiaries before and after implementation of the 4P’s. Twelve (12) housewives responded in the In-depth Interview conducted. The study employed the thematic process of interviewing, listening, and taking down notes on the narrated stories. Data categorization and classification were employed for deeper understanding. Hermeneutic approach was used to understand culture. The use of phenomenological method obtained meanings from participants’ point of view, experiences, and perceptions. Findings revealed that beneficiaries obtained substantial life after joining the Pantawid Pamilya Program. The beneficiaries gratefully expressed that their kids were able to attend school regularly and health education was reinforced as to constant monitoring health monitoring is conducted by the health workers assigned in the area. This program ends in 2015; however, we highly recommend the continuance of the program for the betterment and improved quality of life of the indigenous people beneficiaries.Keywords: Social Science, Poverty, Indigenous, Phenomenology, Conditional Cash Transfer, Hermeneutic Approach, Philippines

scholarly journals Maternal Nutrition and Neurodevelopment: A Scoping Review

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3530
Author(s):  
María Camila Cortés-Albornoz ◽  
Danna Paola García-Guáqueta ◽  
Alberto Velez-van-Meerbeke ◽  
Claudia Talero-Gutiérrez
Keyword(s):  
Scoping Review ◽  
Maternal Nutrition ◽  
Abnormal Behavior ◽  
Motor Deficits ◽  
Qualitative Synthesis ◽  
Maternal Undernutrition ◽  
Ketogenic Diets ◽  
Increased Risk ◽  
Fat Diets ◽  
Anxiety Depression

In this scoping review, we examined the association between maternal nutrition during pregnancy and neurodevelopment in offspring. We searched the Pubmed and ScienceDirect databases for articles published from 2000 to 2020 on inadequate intake of vitamins (B12, folate, vitamin D, vitamin A, vitamin E, vitamin K), micronutrients (cooper, iron, creatine, choline, zinc, iodine), macronutrients (fatty acids, proteins), high fat diets, ketogenic diets, hypercaloric diets, and maternal undernutrition. Some older relevant articles were included. The search produced a total of 3590 articles, and 84 studies were included in the qualitative synthesis. Data were extracted and analyzed using charts and the frequency of terms used. We concluded that inadequate nutrient intake during pregnancy was associated with brain defects (diminished cerebral volume, spina bifida, alteration of hypothalamic and hippocampal pathways), an increased risk of abnormal behavior, neuropsychiatric disorders (ASD, ADHD, schizophrenia, anxiety, depression), altered cognition, visual impairment, and motor deficits. Future studies should establish and quantify the benefits of maternal nutrition during pregnancy on neurodevelopment and recommend adequate supplementation.

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