School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal.
Matern Child Nutr. 2018 Nov;14 Suppl 4(Suppl 4):e12699. doi: 10.1111/mcn.12699.
The nutritional status of women before pregnancy, during pregnancy, and after delivery has far reaching consequences for maternal health and child survival, growth, and development. In South Asia, the high prevalence of short stature, thinness, and anaemia among women of reproductive age underlie the high prevalence of child undernutrition in the region, whereas overweight and obesity are rising concerns. A systematic review of evidence (2000-2017) was conducted to identify barriers and programme approaches to improving the coverage of maternal nutrition interventions in the region. The search strategy used 13 electronic bibliographic databases and 14 websites of development and technical agencies and identified 2,247 citations. Nine studies conducted in Bangladesh (n = 2), India (n = 5), Nepal (n = 1), and Pakistan (n = 1) were selected for the review, and outcomes included the receipt and consumption of iron and folic acid and calcium supplements and the receipt of information on dietary intake during pregnancy. The studies indicate that a range of barriers acting at the individual (maternal), household, and health service delivery levels affects intervention coverage during pregnancy. Programme approaches that were effective in improving intervention coverage addressed barriers at multiple levels and had several common features: use of formative research and client assessments to inform the design of programme approaches and actions; community-based delivery platforms to increase access to services; engagement of family members, as well as pregnant women, in influencing behavioural change; actions to improve the capacity, supervision, monitoring, and motivation of front-line service providers to provide information and counselling; and access to free supplements.
妇女在怀孕前、怀孕期间和分娩后的营养状况对母婴健康以及儿童的生存、生长和发育有着深远的影响。在南亚，育龄妇女中普遍存在身材矮小、消瘦和贫血，这是该地区儿童营养不足高发的原因，而超重和肥胖则是日益令人关注的问题。对证据（2000-2017 年）进行了系统审查，以确定改善该区域孕产妇营养干预措施覆盖率的障碍和方案方法。该搜索策略使用了 13 个电子书目数据库和 14 个发展和技术机构的网站，共确定了 2247 条引文。选择了在孟加拉国（n=2）、印度（n=5）、尼泊尔（n=1）和巴基斯坦（n=1）进行的九项研究进行综述，结果包括接受和使用铁和叶酸及钙补充剂以及在怀孕期间获得关于饮食摄入的信息。这些研究表明，一系列在个人（产妇）、家庭和卫生服务提供层面上起作用的障碍，影响了怀孕期间的干预措施的覆盖范围。在提高干预措施覆盖范围方面有效的方案方法解决了多个层面的障碍，并且具有几个共同特征：使用形成性研究和客户评估为方案方法和行动的设计提供信息；利用社区提供服务的平台增加获得服务的机会；让家庭成员以及孕妇参与影响行为改变的活动；采取行动提高一线服务提供者提供信息和咨询的能力、监督、监测和激励；并提供免费补充剂。
