Namukose Samalie, Maina Gakenia Wamuyu, Kiwanuka Suzanne N, Makumbi Fredrick Edward
Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
J Health Popul Nutr. 2024 Jun 12;43(1):84. doi: 10.1186/s41043-024-00559-7.
Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda.
A comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1.
A total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers' age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd - 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher.
The comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.
营养不良仍然是15至49岁女性及其婴儿面临的一项健康挑战。虽然营养评估咨询与支持（NACS）被认为是一项有前景的策略，但其有效性的证据仍然不足。本研究评估了全面NACS方案对乌干达东部两个地区母婴行为、健康和营养状况的影响。
采用比较非等效准实验设计，分为两组；全面NACS组（托罗罗）和常规NACS组（布塔莱贾）。纳入处于不同孕期的孕妇，并在整个孕期和产后进行跟踪，以监测她们的健康和营养状况。对婴儿在出生时、出生后第6周、第10周、第14周以及第6个月、第9个月和第12个月的喂养行为、健康和营养状况进行跟踪。倾向得分匹配确保了研究组的可比性。通过最近邻匹配和逻辑回归方法估计NACS的效果。统计分析使用STATA 15版和R 4.1.1版。
共分析了666/784（85%）有完整数据的样本（常规组：412例，全面组：254例）。两组在母亲年龄、上臂中部周长、产前检查次数、进餐频率、微量营养素补充以及母亲头痛、抑郁和腹泻情况方面具有可比性。然而，在孕周、收入、家庭规模、教育程度和其他生活条件方面存在差异。全面NACS组的婴儿出生体重更高，在第3至6次访视时年龄别体重Z评分更高（p < 0.001），在第4至7次访视时年龄别身长Z评分更高（p < 0.001），在第3至5次访视时身长别体重Z评分更高（p <= 0.001）。腹泻和发热发作次数较少，但上呼吸道感染较多。
全面NACS方案显示母婴营养和其他健康状况有所改善，这表明需要提供综合全面的护理，以改善孕产妇、婴儿和儿童的健康。
