Omer Afrah Mohammedsanni, Haile Demewoz, Shikur Bilal, Macarayan Erlyn Rachelle, Hagos Seifu
Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
Harvard Global Health Institute, Cambridge, MA 02138, USA.
Health Policy Plan. 2020 Nov 1;35(Supplement_1):i65-i75. doi: 10.1093/heapol/czaa101.
The World Health Organization (WHO) recommends the need for a strong nutrition training package for practitioners, including antenatal care (ANC) providers. Without such a training package, ANC visits remain a missed opportunity to address nutritional problems among pregnant women. This study evaluated the effectiveness of an in-service nutrition education and counselling package on the providers' counselling skills during ANC visits. A cluster randomized controlled trial was conducted in Addis Ababa, Ethiopia. All health-care providers working in ANC units across 20 health centres participated in this study. Health centres were allocated to intervention and control arms using a matched-pair randomization technique. An in-service nutrition education and counselling package, including training for ANC providers, supportive supervision and provision of modules, pamphlets and job aids, was provided for health centres assigned to the intervention arm. Observation checklists were used to assess the counselling skills of health-care providers. We used mixed-effect linear regression to evaluate the impact of the intervention. Significantly more health-care providers in the intervention arm informed pregnant women about the need to have one additional meal (Difference in proportion [DP] 49.17% vs -0.84%; DID 50.0%), about minimum required dietary diversity (DP 72.5% vs -2.5%; DID 75.0%) and about gestational weight gain (DP 68.33% vs -8.33%; DID 76.6%). Furthermore, providers improved in identifying key difficulties that pregnant women face (DP 28.34% vs -2.5%; DID 30.8%), and in recommending simple achievable actions on nutrition during pregnancy (DP 20.8% vs -10.9%; DID 31.6%). The intervention did not have statistically significant effects on how providers informed women about early initiation of breastfeeding (DP 6.67% vs 9.17%; DID -2.5%). The comprehensive in-service nutrition education and counselling package improved how ANC providers engaged with pregnant women and delivered nutrition messages during ANC consultations. This trial was registered in the Pan African Clinical Trial (PACTR registry, PACTR20170900 2477373; Date issued 21 September 2017).
世界卫生组织（WHO）建议为从业者，包括产前保健（ANC）提供者，提供一套完善的营养培训方案。如果没有这样一套培训方案，产前保健访视仍然是解决孕妇营养问题的一个被错失的机会。本研究评估了一项在职营养教育与咨询方案对产前保健访视期间提供者咨询技能的有效性。在埃塞俄比亚亚的斯亚贝巴进行了一项整群随机对照试验。在20个健康中心的所有从事产前保健工作的医护人员参与了本研究。采用配对随机化技术将健康中心分配到干预组和对照组。为分配到干预组的健康中心提供了一套在职营养教育与咨询方案，包括对产前保健提供者的培训、支持性监督以及提供模块、宣传册和工作辅助工具。使用观察清单来评估医护人员的咨询技能。我们使用混合效应线性回归来评估干预的影响。干预组中显著更多的医护人员告知孕妇需要额外加餐（比例差异[DP]为49.17%对-0.84%；差值-in-differences[DID]为50.0%）、所需的最低饮食多样性（DP为7
