Huda Tanvir M, Alam Ashraful, Tahsina Tazeen, Hasan Mohammad Mehedi, Khan Jasmin, Rahman Mohammad Masudur, Siddique Abu Bakkar, Arifeen Shams El, Dibley Michael J
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
JMIR Mhealth Uhealth. 2018 Jul 18;6(7):e156. doi: 10.2196/mhealth.8832.
Inappropriate feeding practices, inadequate nutrition knowledge, and insufficient access to food are major risk factors for maternal and child undernutrition. There is evidence to suggest that the combination of cash transfer and nutrition education improves child growth. However, a cost-effective delivery platform is needed to achieve complete, population-wide coverage of these interventions.
This study aimed to assess the feasibility, acceptability, and perceived appropriateness of an intervention package consisting of voice messaging, direct counseling, and unconditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of a child's life in a poor rural community in Bangladesh.
We conducted a mixed-methods pilot study. We recruited 340 pregnant or recently delivered, lactating women from rural Bangladesh. The intervention consisted of an unconditional cash transfer combined with nutrition counseling, both delivered on a mobile platform. The participants received a mobile phone and BDT 787 per month (US $10). We used a voice messaging service to deliver nutrition-related messages. We provided additional nutrition counseling through a nutrition counselor from a call center. We carried out cross-sectional surveys at baseline and at the end of the study, focus group discussions, and in-depth interviews with participants and their family members.
Approximately 89% (245/275) of participants reported that they were able to operate the mobile phones without much trouble. Charging of the mobile handsets posed some challenges since only approximately 45% (124/275) households in our study had electricity at home. Approximately 26% (72/275) women reported they had charged their mobile phones at their neighbor's house, while 34% (94/275) reported that they charged it at a marketplace. Less than 10% (22/275) of women reported difficulties understanding the voice messages or direct counseling through mobile phones, while only 3% (8/275) of women reported they had some problems withdrawing cash from the mobile bank agent. Approximately 87% (236/275) women reported spending the cash to purchase food for themselves and their children.
The nature of our study precludes any conclusion about the effectiveness of the intervention package. However, the high coverage of our intervention and the positive feedback from the mothers were encouraging and support the feasibility, acceptability, and appropriateness of this program. Further research is needed to determine the efficacy and cost-effectiveness of mobile-based nutrition counseling and unconditional cash transfers in improving maternal and child nutrition in Bangladesh.
不当的喂养方式、营养知识不足以及食物获取受限是母婴营养不良的主要风险因素。有证据表明，现金转移与营养教育相结合可促进儿童生长。然而，需要一个具有成本效益的交付平台来实现这些干预措施在全人群中的全面覆盖。
本研究旨在评估一套干预方案的可行性、可接受性及感知适宜性，该方案包括语音信息、直接咨询以及在移动平台上进行的无条件现金转移，旨在改变孟加拉国一个贫困农村社区对孕期及儿童出生后第一年营养问题的认知。
我们开展了一项混合方法的试点研究。我们从孟加拉国农村招募了340名孕妇或刚分娩的哺乳期妇女。干预措施包括无条件现金转移与营养咨询，二者均通过移动平台提供。参与者获得一部手机以及每月787孟加拉塔卡（10美元）。我们使用语音信息服务发送与营养相关的信息。我们通过呼叫中心的营养顾问提供额外的营养咨询。我们在基线和研究结束时进行了横断面调查、焦点小组讨论，并对参与者及其家庭成员进行了深入访谈。
约89%（245/275）的参与者表示他们能够轻松操作手机。手机充电存在一些挑战，因为我们研究中只有约45%（124/275）的家庭家中有电。约26%（72/275）的女性表示她们在邻居家给手机充电，而34%（94/275）的女性表示她们在市场充电。不到10%（22/275）的女性表示理解语音信息或通过手机进行直接咨询有困难，而只有3%（8/275）的女性表示她们从移动银行代理处取款存在一些问题。约87%（236/275）的女性表示将现金用于为自己和孩子购买食物。
我们研究的性质使我们无法就干预方案的有效性得出任何结论。然而，我们干预措施的高覆盖率以及母亲们的积极反馈令人鼓舞，并支持了该项目的可行性、可接受性及适宜性。需要进一步研究以确定基于移动设备的营养咨询和无条件现金转移在改善孟加拉国母婴营养方面的效果和成本效益。
