Nguyen Phuong H, Sununtnasuk Celeste, Christopher Anita, Ash Deborah, Ireen Santhia, Kabir Rowshan, Mahmud Zeba, Ali Mohsin, Forissier Thomas, Escobar-DeMarco Jessica, Frongillo Edward A, Menon Purnima
Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States.
Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States.
J Nutr. 2023 Oct;153(10):3068-3082. doi: 10.1016/j.tjnut.2023.06.023. Epub 2023 Jun 23.
Bangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services.
We assessed the effect of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron and folic acid (IFA) and calcium consumption, and child feeding practices.
We used a quasi-experimental design with a nonrandom assignment of 20 health care facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n = 2455 observations and surveys with 1678 pregnant women [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering.
Exposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC checkups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counseling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25 pp) and calcium supplementation (19 pp), showed adequate weight gain (44 pp), and recorded appropriate child feeding (27 pp). Improvements were greater in the intensive than the standard arm for the number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23 pp); no effect was observed for IFA and calcium consumption during pregnancy. However, effects were observed for early initiation of (20 pp) and exclusive breastfeeding (45 pp), introduction of solid or semisolid foods (28 pp), and egg and/or flesh food consumption (33 pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms.
Intensifying nutrition in government-aligned health care services delivered by experienced nongovernmental organization-run facilities is a feasible model to address the urban health gap, nutrition services coverage, and improve practices. The trial was registered at clinicaltrials.gov as NCT03882268.
孟加拉国正在迅速城市化，面临着营养不良、城市营养服务覆盖率低和质量差等挑战。
我们评估了在城市母婴和儿童健康设施中实施的孕产妇、婴幼儿营养干预措施对孕产妇饮食多样性、铁和叶酸（IFA）及钙的摄入量以及儿童喂养方式的影响。
我们采用了准实验设计，将达卡的20家医疗机构非随机分配到强化服务组和标准服务组。在基线期（2020年）和终末期（2022年）进行了基于机构的观察和社区调查（终末期有2455次观察和调查，涉及1678名孕妇[PW]或近期分娩的妇女[RDW]）。我们得出了差异中的差异（DID）估计值，对基线期或终末期不同的特征进行了调整，并考虑了聚类情况。
两组接受产前护理（ANC）的情况相似：三分之二的RDW在孕早期接受了ANC，四分之三的人接受了≥4次ANC检查。与标准组相比，强化组中更高比例的PW接受了饮食多样性咨询（DID：45个百分点[pp]），更高比例的RDW接受了IFA（25 pp）和钙补充剂（19 pp），体重增加充足（44 pp），并记录了适当的儿童喂养方式（27 pp）。强化组在食物种类摄入量（DID：1.1种食物类别）和最低饮食多样性（23 pp）方面的改善大于标准组；孕期IFA和钙的摄入量未观察到影响。然而，在儿童中观察到了早期开始母乳喂养（20 pp）和纯母乳喂养（45 pp）、引入固体或半固体食物（28 pp）以及鸡蛋和/或肉类食物摄入（33 pp）方面的影响。两组的最低饮食多样性和可接受饮食仍然较低。
由经验丰富的非政府组织运营的设施在与政府合作的医疗服务中加强营养是解决城市健康差距、营养服务覆盖率并改善相关做法的可行模式。该试验已在clinicaltrials.gov上注册，注册号为NCT03882268。
