scholarly journals Strengthening Nutrition Interventions in Antenatal Care Services Had Modest Impacts on Diet Diversity, Micronutrient Intake, and Breastfeeding in Uttar Pradesh, India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1050-1050
Author(s):  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Lan Mai Tran ◽  
Rasmi Avula ◽  
Melissa Young ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Process Evaluation ◽  
Maternal Nutrition ◽  
Dietary Diversity ◽  
System Level ◽  
Food Groups ◽  
Diet Diversity ◽  
Calcium Supplements ◽  
The Impact

Abstract Objectives Interventions to improve maternal nutrition are poorly integrated into antenatal care (ANC) services in India. Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization implemented through government ANC services. We evaluated the impact of nutrition-intensified ANC (I-ANC) compared to standard ANC (S-ANC) on diet diversity, consumption of iron-folic acid (IFA) and calcium supplements, and early breastfeeding practices. Methods We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019) (n ∼660 pregnant women and 1800 recently delivered women per survey) and a process evaluation. We derived difference-in-difference effect estimates, adjusted for geographic clustering, gestational age, infant age, and sex. Results Coverage of interventions was high at endline; 70–90% women were contacted by frontline workers at home or nutrition centers. Women in the I-ANC arm were significantly more likely to have received counseling on core nutrition messages (10–18 percentage points [pp]) than those in the S-ANC arm. Dietary diversity improved modestly among pregnant women in the I-ANC arm compared to the S-ANC arm (effect: 8.3 pp). The number of food groups consumed increased slightly over time but remained low in both arms. The percentage of women who consumed 100 + IFA improved equally in both arms (from 8 to 25%). Small significant impacts were observed for any consumption of IFA and calcium supplements (effects 10.3 and 12.4 pp, respectively). Significant impacts were also observed for non-prelacteal feeding (effect: −6.3 pp) and exclusive breastfeeding (effect: 7.4 pp) but not for early initiation of breastfeeding. The process evaluation found that system-level and supply-chain challenges, household context, and local diet preferences affected implementation and uptake. Conclusions Intensifying nutrition in existing government ANC services resulted in modest improvements in maternal nutrition practices. Dietary diversity and consumption of supplements remained sub-optimal. Additional efforts are needed for further improvement of maternal nutrition services. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

scholarly journals Self-Identified Vegetarian Pregnant Women in India Have Better Diets Than Self-Identified Non-Vegetarian Women Because of the Intersections of Caste and Economic Status

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 508-508
Author(s):  
Alexandra Bellows ◽  
Shivani Kachwaha ◽  
Purnima Menon ◽  
Phuong Nguyen
Keyword(s):  
Dietary Intake ◽  
Pregnant Women ◽  
Maternal Nutrition ◽  
Dietary Diversity ◽  
Economic Status ◽  
Uttar Pradesh ◽  
Health Concern ◽  
Food Groups ◽  
Diet Diversity ◽  
Nutrient Adequacy

Abstract Objectives Poor dietary intake during pregnancy remains a significant public health concern affecting the health of the mother and fetus. This study examines the adequacy of energy, macronutrient and micronutrient intakes among vegetarian and non-vegetarian pregnant women. Methods We analyzed dietary data from 627 pregnant women enrolled at baseline from an Alive &Thrive maternal nutrition program in Uttar Pradesh, India. Dietary intake was assessed using a multiple-pass 24-hour diet recall. We compared differences between vegetarian and non-vegetarian women in dietary diversity (calculated using the minimum dietary diversity for women guidelines), probability of adequacy, and mean probability of adequacy (MPA) for 11 micronutrients. Results Women who identified themselves as vegetarians (∼47%) were more likely to have higher education and socioeconomic status, and belong to upper caste groups than non-vegetarians. Average dietary diversity score was 4 out of 10 food groups for both groups. Vegetarian women were more likely to meet the MDD-W cutoff of five or more food groups compared to non-vegetarian women (39.2% compared to 32.4% respectively) (P < 0.05). Average MPA for vegetarians was 20% (SD:15.3) compared to 17% (SD:13.7) for non-vegetarian group (P = 0.02). In both groups, median intake of 9 out of 11 micronutrients was below the Estimated Average Requirement (EAR). Only zinc and thiamin had a median intake slightly above EAR. Starchy staple foods accounted for 62.4% of total energy for vegetarians and 69.1% for non-vegetarians. Dairy foods were an important source of fat, calcium, and vitamin B12 for both groups. Among non-vegetarian women, consumption of animal source foods was low (<8%). Conclusions Vegetarian women were more likely to have probability of nutrient adequacy and diet diversity during pregnancy than non-vegetarian women, but these differences are likely confounded by socio-economic and caste status. Since diets are poor for both groups, a range of policies and interventions that address the food environment, nutrition counseling during pregnancy, behavior change, and supplementation are needed in order to achieve adequate nutrient intake for pregnant women in this population. Funding Sources Bill and Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

scholarly journals Maternal minimum dietary diversity and associated factors among pregnant women, Southwest Ethiopia, 2021

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Abel Girma Tilahun ◽  
Abebaw Molla Kebede
Keyword(s):  
Logistic Regression ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Nutrition Education ◽  
Associated Factors ◽  
Dietary Diversity ◽  
Systematic Sampling ◽  
Age Group ◽  
Food Groups ◽  
Minimum Dietary Diversity

Abstract Background Inadequate dietary diversity intake during pregnancy increases risks of intrauterine growth restriction, abortion, low birth weight, preterm birth, prenatal and infant mortality,and morbidity and has long-lasting health impacts. Dietary diversity during pregnancy promotes the health status of the mother and her fetus. This study aimed to assess the magnitude of minimum dietary diversity and associated factors among pregnant women attending antenatal care. Methods A facility-based cross-sectional study was conducted among 274 pregnant women who attended antenatal care at Wacha primary hospital from January to February 2021. A systematic sampling method was used to select the study participants. The data were collected through face-to-face interviews using a structured and semi-structured questionnaire. Bivariate logistic regression was done to identify factors associated with maternal dietary diversity. Finally, multivariate logistic regression was done, and variables that showed P values of < 0.05 were considered statistically significant. Result The magnitude of minimum dietary diversity was 51% (95% CI: 44.5, 56.7). The mean (±SD) minimum dietary diversity score was 4.5 (± 1.268) with a minimum of 1 anda maximum of 8 food groups consumed out of ten food groups. Age fewer than 25 years (AOR 4.649; 95% CI; 1.404, 15.396), and the age group between 25 to 34 years (AOR 3.624; 95% CI: 1.315, 10.269), husband age group of 26 to 34 years (AOR 2.238; 95% CI; 1.028,4.873), and 35 to 44 years (AOR 3.555; 95% CI; 1.228,10.292) and nutrition awareness of women (AOR 2.182; 95% CI; 1.243, 3.829) were significantly associated with minimum dietary diversity. Conclusion The consumption of minimum dietary diversity of the pregnant mothers was found to be low. Women aged less than 25 and age between 25 to 34 years, husband’s age between 26 to 34 and 35 to 44 years, and nutrition awareness were the factors significantly associated with minimum dietary diversity. Therefore, providing nutrition education and counseling service warranted to promote maternal dietary diversity.

scholarly journals Health Systems Strengthening Efforts Help to Improve the Delivery of Maternal Nutrition Interventions in Antenatal Care in Uttar Pradesh (UP), India but Gaps Remain

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1314-1314
Author(s):  
Shivani Kachwaha ◽  
Phuong Nguyen ◽  
Lan Mai Tran ◽  
Rasmi Avula ◽  
Melissa Young ◽  
...  
Keyword(s):  
Weight Gain ◽  
Service Delivery ◽  
Antenatal Care ◽  
Health Systems ◽  
Maternal Nutrition ◽  
Health Systems Strengthening ◽  
Nutrition Interventions ◽  
Diet Diversity ◽  
Calcium Supplements ◽  
Diet Supplements

Abstract Objectives Frontline workers (FLWs) deliver essential nutrition services to reduce maternal undernutrition in India, but coverage and quality remain sub-optimal. Alive & Thrive aimed to strengthen delivery of interpersonal counselling, community mobilization and micronutrient supplements through the government antenatal care (ANC) platform in UP. We studied pathways through which the nutrition-intensified ANC (I-ANC) was intended to impact FLWs capacity, knowledge, and service delivery, compared to standard ANC (S-ANC). Methods We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019), ∼500 FLWs per survey. Differences between I-ANC and S-ANC were compared along six impact pathway components (training, availability of materials, supportive supervision, knowledge, service delivery, and counselling content) using mixed-effects regression adjusted for clustering. Results Training exposure was higher in I-ANC than S-ANC (9 percentage points, pp). Nutrition training topics were low-moderate (30–60%) in both arms. Job aids were more available in I-ANC (70–80%) than S-ANC (30–40%). Supply of iron-folate and calcium supplements were low in both arms, with 10–50% having stock-outs. FLWs in I-ANC were more likely to receive supervision visits (7 pp), but gaps remained in both arms. Compared to S-ANC, FLWs in I-ANC had higher knowledge on diet diversity (6 pp), adequate intake (10 pp), iron-folate (10 pp) and calcium supplements (30 pp), pregnancy weight gain (20–30 pp), and early breastfeeding (5 pp), but similarly low knowledge of exclusive breastfeeding. ANC check-ups by FLWs were 20 pp higher in I-ANC. FLWs in I-ANC did more counselling on adequate diet, supplements, and weight gain (10–20 pp). Counselling on diet diversity and breastfeeding were low in both arms. Conclusions Health systems strengthening efforts helped improve the delivery of maternal nutrition interventions in antenatal care in this context, but gaps remain. Several health system elements along the program pathway – supply chain management, training, supervisory practices – require strengthening to further improve FLW knowledge and nutrition service delivery. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

scholarly journals Father Engagement in Improving Infant and Young Child Feeding (IYCF) Practices: Evidence from a Clustered Randomized Controlled Trial in Ethiopia (P11-112-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yae Eun Han ◽  
Seollee Park ◽  
Ji Eun Kim ◽  
Hyuncheol Kim ◽  
John Hoddinott
Keyword(s):  
Randomized Controlled Trial ◽  
Dietary Diversity ◽  
Controlled Trial ◽  
Knowledge Gain ◽  
Food Groups ◽  
Child Feeding ◽  
Diet Diversity ◽  
Young Child Feeding ◽  
Randomized Controlled ◽  
The Impact

Abstract Objectives We identified lack of knowledge and lack of paternal support as barriers to improved IYCF practices in Ethiopia, the focus of this study. Behavior change communication (BCC) strategies are often used to improve knowledge, but BCC programs commonly target only mothers. The objective of this study is to assess the impact of both paternal and maternal BCC program on complementary feeding practices compared to maternal BCC program alone. Methods This study is a community-based, clustered randomized controlled trial conducted in Ejere district, Ethiopia. We randomly selected three rural kebeles (ward) and three urban kebeles within the Ejere district. 63 garees (villages) were identified and randomly assigned within selected kebeles into treatment and control groups: T1, maternal BCC only; T2, both maternal BCC and paternal BCC; and C, control. The maternal BCC program and paternal BCC program consisted of weekly one-hour long group sessions for the duration of 16 and 12 weeks, respectively. Both BCC program included messages on improved IYCF practices. In addition, paternal BCC program included messages on gender roles. Results Father's IYCF knowledge increased by 0.31SD when BCC was provided to mothers and by 0.62SD when provided to both mothers and fathers. Although we see spillover of knowledge from BCC from BCC-attending mothers to their partners in maternal BCC group, we see paternal BCC additionally increase father's knowledge by 0.36SD. The provision of both maternal and paternal BCC group improves child dietary diversity score (CDDS) by 0.64 food groups and increases the likelihood they meet minimum diet diversity by 18 percentage points. However, the additional impact of paternal BCC on child diets is not statistically significant at the 5% level. We see no differential impact on child anthropometry. Conclusions Nutrition BCC program that targets both fathers and mothers have greater impact on father's knowledge, compared to nutrition BCC program that targets mothers only. However, additional knowledge gain has limited impact on IYCF practices. Funding Sources Africa Future Foundation. Supporting Tables, Images and/or Graphs

scholarly journals Mainstreaming and Scaling Up Nutrition Best Practices in a Nation-Wide Primary Healthcare Model of Bangladesh: Implementation Lessons Learned

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 170-170
Author(s):  
Morseda Chowdhury ◽  
Imran Chowdhury
Keyword(s):  
Pregnant Women ◽  
Nutrition Education ◽  
Large Scale ◽  
Maternal Nutrition ◽  
Dietary Diversity ◽  
Critical Role ◽  
Lessons Learned ◽  
Cross Sectional ◽  
The Impact ◽  
Supplement Intake

Abstract Objectives The objective of the implementation research was to evaluate the effectiveness of a maternal and child nutrition-focused multi-component intervention, and assess the feasibility of incorporating it into an existing PHC program. Methods A cluster randomized impact evaluation compared the impact in terms of coverage of intervention, consumption of diversified foods and macro- and micronutrients during pregnancy, and early breastfeeding practices. A similar study was conducted among pregnant (n = 600) and recently delivered women (n = 2000) which examined factors influencing maternal nutrition practices. Cross-sectional surveys (2015 & 2016) were (n = 1000 women & 700 husbands) conducted to document the impact of husbands’ support on women's supplement intake and dietary diversity. Three subsequent cross-sectional studies (2013, 2014 & 2015) were conducted to evaluate the impact of a large scale SBCC program aimed at maternal dietary behavior and IYCF practices. A cRCT among 900 pregnant women assessed the relationship between maternal nutrition education and infant birthweight. Results Results showed that good nutrition knowledge was the key maternal factor associated with higher consumption of IFA (β = 32.5, 95% CI: 19.5, 45.6) and calcium (β 31.9, 95% CI: 20.9, 43.0) and diverse diet (OR = 1.8, 95% CI: 1.0 ± 3.1). The mean dietary diversity score of pregnant women increased from 4.28 + 1.08 to 4.76 + 1.16. About 83% of the respondents-initiated breastfeeding within an hour of childbirth, which was 62% at baseline. Less than a fifth (18%) of the children were eating a minimally acceptable diet at baseline, which reached to 52% by endline. Study showed that husbands support played a critical role for the women to increase supplement intake and dietary diversity. Nutrition counselling during pregnancy increased mean birthweight by 127.5 g (95% CI: 11.1 to 243.9; P = 0.032) and the risk of LBW was reduced by 54% (relative risk (RR): 0.43; 95% CI: 0.25 to 0.75; P = 0.003). Conclusions Integration of nutrition intervention into the existing health programme was feasible and well-implemented. Although differences in coverage and counselling quality most explained most impacts, all intervention elements particularly CHW training and performance were likely important to achieving impact. Funding Sources BRAC.

scholarly journals Household Characteristics, Housing Profile and Diet Diversity of Pantawid Pamilyang Pilipino Program (4Ps) Beneficiaries and Non-beneficiaries in Lucena City, Quezon, Philippines

2018 ◽  
Vol 52 (5) ◽  
Author(s):  
Ma-Ann M. Zarsuelo ◽  
Madeline M. Suva ◽  
Clarissa B. Juanico ◽  
Wilma A. Hurtada
Keyword(s):  
Maternal Education ◽  
Dietary Diversity ◽  
Conditional Cash Transfer ◽  
The Philippines ◽  
Cash Transfer ◽  
Food Groups ◽  
Assistance Program ◽  
Diet Diversity ◽  
Positive Correlation ◽  
The Impact

Background. The Philippines adopted the Conditional Cash Transfer (CCT) program as the Pantawid Pamilyang Pilipino Program (4Ps) that serves as the government’s flagship social assistance program for the poor. This provides short-term income support to poor families while investing on health and education to overcome future poverty. Objective. This study aimed to characterize the beneficiary and non-beneficiary households and evaluate the impact of 4Ps program on housing facilities and diet diversity. Methods. Quasi-experimental design was used to evaluate survey outcomes between 91 randomly sampled beneficiaries and 91 completely enumerated non-beneficiaries (incoming grantees). FANTA Household Dietary Diversity Score (HDDS) was used as an indicator for dietary diversity while structured questionnaire on housing profile was based on BIDANI and CEM-UPLB tools. Results. The 4Ps beneficiaries had significantly higher maternal education, household size (ρ=0.038), and improved water source (ρ=0.004) than non-beneficiaries. Cash transfer among 4Ps households provided 11% increase in the average monthly income of P7,324 pre-transfer. Diet diversity using FANTA scoring (0-12) showed that nonbeneficiaries were significantly lower by 0.4 than 4Ps score of 7.9 (ρ=0.003). Maternal education was found to have significant positive correlation with diet diversity. Both groups had high cereals and fats intake (>90%) while low in complex carbohydrates and legumes (<31%). Conclusion. The 4Ps had positive correlation on housing profile and diet diversity among beneficiaries. Family Development Session should integrate practical methods on improving variety of foods, specifically, the low consumption food groups. Additionally, a review on the selection criteria based on the provincial poverty threshold vis a vis income of grantees must be implemented to accurately target intended beneficiaries.

scholarly journals Crop diversity is associated with higher child diet diversity in Ethiopia, particularly among low-income households, but not in Vietnam

2021 ◽  
pp. 1-12
Author(s):  
Erin E Esaryk ◽  
Sarah Anne Reynolds ◽  
Lia CH Fernald ◽  
Andrew D Jones
Keyword(s):  
Low Income ◽  
Dietary Diversity ◽  
Positive Association ◽  
Household Wealth ◽  
Crop Diversity ◽  
Food Groups ◽  
Crop Species ◽  
Diet Diversity ◽  
Household Level ◽  
Functional Richness

Abstract Objectives: To examine associations of household crop diversity with school-aged child dietary diversity in Vietnam and Ethiopia and mechanisms underlying these associations. Design: We created a child diet diversity score (DDS) using data on seven food groups consumed in the last 24 h. Generalised estimating equations were used to model associations of household-level crop diversity, measured as a count of crop species richness (CSR) and of plant crop nutritional functional richness (CNFR), with DDS. We examined effect modification by household wealth and subsistence orientation, and mediation by the farm’s market orientation. Setting: Two survey years of longitudinal data from the Young Lives cohort. Participants: Children (aged 5 years in 2006 and 8 years in 2009) from rural farming households in Ethiopia (n 1012) and Vietnam (n 1083). Results: There was a small, positive association between household CNFR and DDS in Ethiopia (CNFR–DDS, β = 0·13; (95 % CI 0·07, 0·19)), but not in Vietnam. Associations of crop diversity and child diet diversity were strongest among poor households in Ethiopia and among subsistence-oriented households in Vietnam. Agricultural earnings positively mediated the crop diversity–diet diversity association in Ethiopia. Discussion: Children from households that are poorer and those that rely more on their own agricultural production for food may benefit most from increased crop diversity.

scholarly journals Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Emmanuel Amoako Agyei ◽  
Stephen Kofi Afrifa ◽  
Adam Munkaila ◽  
Patience Kanyiri Gaa ◽  
Eugene Dogkotenge Kuugbee ◽  
...  
Keyword(s):  
Vitamin A ◽  
Pregnant Women ◽  
Low Birthweight ◽  
Dietary Diversity ◽  
Nutrition Knowledge ◽  
Rural District ◽  
Leafy Vegetables ◽  
Northern Ghana ◽  
Food Groups ◽  
Essential Nutrients

Essential nutrients are necessary for reducing the risk of maternal mortality, prenatal mortality, and low-birthweight infants. Dietary diversity can play an important role in supplying essential nutrients to both the mother and the foetus. We evaluated nutrition knowledge, attitudes, and dietary diversity of pregnant women. In addition, we investigated the sociodemographic determinants of dietary diversity among pregnant women from a rural district in Ghana. Participants were pregnant women receiving antenatal care from a rural district hospital in Ghana. Dietary diversity was measured using a 24-hour dietary recall questionnaire. Multiple linear regression was used to determine the sociodemographic characteristics of dietary diversity. About 85% of the pregnant women knew that they should eat more in comparison to nonpregnant women, and only 16.9% knew the importance of folic acid supplementation during pregnancy. Mean (SD) dietary diversity score of the participants was 5.27 (1.35), 85.4% did not consume any fruits, and 82.3% did not take milk and milk products. Almost all participants took at least one food item in the starchy staples and green leafy vegetables food groups. Moreover, 53% consumed vitamin A-rich fruits, vegetables, and tubers; 7.7% organ meats; and 30.8% eggs. Those who earned a monthly income of ≥GHC 500 or US$ 87 (B = 1.82; 0.90–2.73; p < 0.001 ) significantly had higher dietary diversity scores compared to those who earned less. Dietary diversity of the pregnant women was suboptimal. The consumption of vitamin A- and iron-rich foods was inadequate. Income was an important determinant of the dietary diversity of pregnant women from Northern rural Ghana.

scholarly journals Dietary diversity practice and associated factors among pregnant women attending ANC in Kolfe Keranyo sub city health center, Addis Ababa, Ethiopia.

2020 ◽  
Author(s):  
Tsegahun Worku Brhanie ◽  
Walelgn Tefera ◽  
Mamo Dereje
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Dietary Diversity ◽  
Addis Ababa ◽  
Health Centers ◽  
Nutrition Information ◽  
Monthly Income ◽  
Dietary Diversity Score ◽  
Care Visit ◽  
The Mean

Abstract Background: Adequate and healthy diet during pregnancy is essential for the health of both mother and newborn. Dietary diversity is a proxy indicator of maternal nutrient adequacy. However, little is documented on the prevalence of dietary diversity among pregnant women. This study was aimed to assess the dietary diversity practice and associated factors among pregnant women attending antenatal care in health centers of the coffee keranyo sub city, Addis Ababa, Ethiopia. Methods: Institution based cross-sectional study was conducted on 406 randomly selected pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa from March 2-April 2/ 2018. Data were collected by using interviewer and 24 H dietary recall method. Data had entered and analyzed using SPSS version 21. Multiple logistic regression was run to assess factors associated with the dependent variable at P<0.05. Results: The mean Dietary Diversity Score of pregnant women was 5. 45+-1. 83. About 60.9% of pregnant women had good dietary diversity practice. Pregnant women who learned collage and above had more dietary diversity practice than the illiterate one [AOR=2.26, 95% CI: (1.066, 4.808)]. Pregnant women with monthly income more than 5,000 ETB had more dietary diversity than income less than 2,000 ETB [AOR=2.33, 95% CI: (1.234, 4.416)]. Pregnant women at second antenatal care visit had more dietary diversity than at the first visit [AOR=2.42, 95% CI: (1.183, 4.952)]. Having nutrition information during pregnancy increases 2 times better dietary diversity practice than none informed ones [AOR=2.10, 95% CI: (1.294, 3.422)].Conclusions: The mean Dietary Diversity Score of pregnant mothers was 5.45. And 60.9% of pregnant women had a good dietary diversity score, whereas 39.1 % of them had a poor diet diversity score. Mothers’ education, monthly income, second and third antenatal care visit and nutrition information had a significantly associated with pregnant mothers’ dietary diversity.

scholarly journals Measuring the Impact of Nutrition Sensitive Interventions on Diet: A Systematic Review of Tools and Indicators (P10-133-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ines Gonzalez Casanova ◽  
Amy Webb Girard ◽  
Sakshi Mehta ◽  
Usha Ramakrishnan
Keyword(s):  
Dietary Diversity ◽  
Monitoring And Evaluation ◽  
Biological Indicators ◽  
Assessment Tools ◽  
Sub Saharan Africa ◽  
Food Groups ◽  
Causal Pathway ◽  
Women And Children ◽  
Nutrition Sensitive ◽  
The Impact

Abstract Objectives Nutrition sensitive interventions (NSI), which target underlying causes of undernutrition, have been identified as essential to reduce the burden of malnutrition, which disproportionately affects women and children living in low to middle income countries. However, evaluating the impacts of NSI using anthropometry and/or biomarkers remains challenging due to lack of sensitivity. For agriculture NSI in particular, researchers increasingly recommend using indicators that assess dietary changes that lie on the causal pathway to improved biological indicators. We aimed to identify tools and indicators that can be used to assess the impact of agriculture-focused NSI on the diets of women and children. Methods Using Pubmed, Web of Science, and Agricola, we conducted a systematic search of the literature for NSI that assessed the impact on the diet of women and children (under 18 years) and were published after 2010. Twenty-three studies representing unique NSI or programs met inclusion/exclusion criteria. We systematically abstracted data from these studies into a standardized form. Results Included NSI were conducted in Sub-Saharan Africa (n = 18), South Asia (n = 3), Southeast Asia (n = 3), and Latin America (n = 1), with one conducted in three regions. The most common tools were food frequency questionnaires, 24-hour recalls, and household inventories. Dietary diversity (DD) scores were the most common indicators. These varied on the number of items and the duration of the recall period and included household DD (n = 7), women's DD (n = 5) and children's DD (n = 11); twelve studies assessed more than one outcome. Other indicators of children's diet, such as meal frequency, number of foods or food groups consumed, or minimum acceptable diet were assessed in nine NSI. Two and four studies reported nutrient intakes in women and children, respectively. Conclusions Diet assessment tools and indicators have been used successfully to assess the impact of NSI. We recommend including these measurement tools as part of the monitoring and evaluation of NSI, in particular DD was a frequently used indicator that was sensitive to the interventions. It will also be important to improve the reporting of the method used to improve interpretability and comparison across studies. Funding Sources Supported by the Bill and Melinda Gates Foundation.

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