Rasul Md Golam, Hasan Mahamudul, Hossain Daluwar, Haseen Fariha, Das Subhasish, Ahmed Tahmeed
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
BMJ Nutr Prev Health. 2023 Feb 15;6(1):65-75. doi: 10.1136/bmjnph-2021-000395. eCollection 2023.
Maternal undernutrition is highly prevalent in most of the developing countries. Prevalence of both extremes of maternal malnutrition (undernutrition and overweight/obesity) are common in those countries. For Bangladesh, the scenario is not different. The Government of Bangladesh recognises maternal nutrition as a public health priority and addresses the issue in its policies and programmes. We identified and analysed the existing maternal nutrition programmes and determined the bottlenecks in implementing the programmes in Bangladesh using qualitative approach.
We followed a qualitative research approach and conducted 25 key informant interviews with the programme managers and policymakers, 10 in-depth interviews with the service providers and six focus group discussions with the pregnant women to identify the constraints of programme implementation. We analysed data using thematic and inductive approaches of qualitative research methods.
We have found that successful implementation of maternal nutrition intervention was being hampered by both the demand and supply side issues. On the demand side, major constraints were financial inability of the families to avail maternal nutrition-related services, ignorance of the family members and cultural barriers of using maternal nutrition-related services. Lack of priority and heavy workload of the service providers, lack of human resources, poor monitoring system, lack of medicine to supply and incoordination have been identified as major supply-side constraints in providing maternal nutrition-related interventions in Bangladesh.
Both supply side and demand side issues are responsible for the existing bottlenecks in implementing maternal nutrition-related programmes in Bangladesh. Findings of this study will help the policymakers to learn about the programmatic constraints regarding maternal nutrition services in Bangladesh.
在大多数发展中国家，孕产妇营养不良的情况极为普遍。在这些国家，孕产妇营养不良的两个极端情况（营养不足和超重/肥胖）都很常见。孟加拉国的情况也不例外。孟加拉国政府将孕产妇营养视为公共卫生的优先事项，并在其政策和计划中解决这一问题。我们通过定性方法识别并分析了现有的孕产妇营养计划，并确定了在孟加拉国实施这些计划的瓶颈。
我们采用定性研究方法，对项目管理人员和政策制定者进行了25次关键信息访谈，对服务提供者进行了10次深入访谈，并与孕妇进行了6次焦点小组讨论，以确定计划实施的制约因素。我们使用定性研究方法的主题和归纳方法对数据进行了分析。
我们发现，孕产妇营养干预措施的成功实施受到需求和供应两方面问题的阻碍。在需求方面，主要制约因素包括家庭在获取孕产妇营养相关服务方面的经济能力不足、家庭成员的无知以及使用孕产妇营养相关服务的文化障碍。在孟加拉国提供孕产妇营养相关干预措施时，服务提供者缺乏优先级和工作量大、人力资源短缺、监测系统不完善、药品供应不足以及协调不力被确定为主要的供应方制约因素。
供应方和需求方的问题都是孟加拉国实施孕产妇营养相关计划时现有瓶颈的原因。本研究的结果将有助于政策制定者了解孟加拉国孕产妇营养服务的计划制约因素。
