College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
Catholic Relief Services, Kigali, Rwanda.
Matern Child Nutr. 2022 Jul;18(3):e13367. doi: 10.1111/mcn.13367. Epub 2022 May 10.
Maternal undernutrition remains a major public health concern in Rwanda despite significant gains and progress. An integration of nutrition-specific and nutrition-sensitive interventions was implemented in five districts of Rwanda to improve maternal and child nutrition. The package included nutrition education and counselling, promotion of agricultural productivity, promotion of financial literacy/economic resilience and provision of Water, Hygiene and Sanitation services. However, there is limited evidence about the effect of such interventions in reducing maternal undernutrition. A postintervention quasi-experimental study was conducted among pregnant women to determine the effect of the integrated intervention on their nutritional status. It was carried out in two intervention districts, namely Kicukiro and Kayonza, and two control districts, namely Gasabo and Gisagara between November 2020 and June 2021. Five hundred and fifty-two women were recruited for the intervention arm, while 545 were recruited for the control arm. Maternal undernutrition was defined as either having low mid-upper arm circumference (<23 cm) during delivery or low body mass index (<18.5 kg/m ) in the first trimester or both. A multivariable logistic regression model was used to assess the effect of the integrated interventions. The prevalence of maternal undernutrition was significantly lower in the intervention group compared with the control group (4.7% vs. 18.2%; p < 0.001). After controlling the potential confounders, the risk of maternal undernutrition was 77.0% lower in the intervention group than in the control group [adjusted odds ratio= 0.23; 95% confidence interval = 0.15-0.36; p < 0.001]. Further studies are therefore recommended to establish causation and inform the potential scale-up of these interventions nationally in Rwanda.
尽管卢旺达在这方面取得了显著的进步，但孕产妇营养不良仍然是一个主要的公共卫生问题。卢旺达五个地区实施了营养具体和营养敏感干预措施的整合，以改善孕产妇和儿童的营养状况。该方案包括营养教育和咨询、促进农业生产力、促进金融知识/经济复原力以及提供水、卫生和环境卫生服务。然而，关于这些干预措施在减少孕产妇营养不良方面的效果的证据有限。在 2020 年 11 月至 2021 年 6 月期间，在孕妇中进行了一项干预后准实验研究，以确定综合干预对其营养状况的影响。该研究在两个干预区，即基库伊罗和卡永扎，以及两个对照区，即加萨博和吉萨加进行。552 名妇女被招募到干预组，545 名妇女被招募到对照组。孕产妇营养不良的定义是分娩时中上臂围（<23cm）或孕早期体重指数（<18.5kg/m ）低，或两者兼有。采用多变量逻辑回归模型评估综合干预的效果。与对照组相比，干预组的孕产妇营养不良发生率显著降低（4.7%对 18.2%；p<0.001）。在控制潜在混杂因素后，干预组发生孕产妇营养不良的风险比对照组低 77.0%（调整优势比=0.23；95%置信区间=0.15-0.36；p<0.001）。因此，建议进一步研究以确定因果关系，并为在卢旺达全国范围内扩大这些干预措施提供信息。
