Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal

Abstract Among the three delays that play a pivotal role in increasing maternal mortality, delay in transportation is a major challenge for the uptake of services for pregnant women in remote areas of Nepal. Due to difficult terrain and the lack of adequate public transportation, women face difficulties in reaching health facilities and end up giving birth on the way unsafely. Here, I describe the struggle of a pregnant woman who started her journey to deliver at health facility, but never reached it. She remained helpless in the middle of the highway, where our team intervened and conducted her delivery right over there.

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Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03141-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).

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Smartphone tool to collect repeated 24 h dietary recall data in Nepal

Public Health Nutrition ◽

10.1017/s136898001700204x ◽

2017 ◽

Vol 21 (2) ◽

pp. 260-272 ◽

Cited By ~ 8

Author(s):

Helen Harris-Fry ◽

B James Beard ◽

Tom Harrisson ◽

Puskar Paudel ◽

Niva Shrestha ◽

...

Keyword(s):

Pregnant Women ◽

Nutritional Composition ◽

Dietary Recall ◽

Recall Data ◽

Plausible Values ◽

Portion Sizes ◽

Paper Form ◽

Household Heads ◽

Rural Nepal ◽

Future Work

AbstractObjectiveTo outline the development of a smartphone-based tool to collect thrice-repeated 24 h dietary recall data in rural Nepal, and to describe energy intakes, common errors and researchers’ experiences using the tool.DesignWe designed a novel tool to collect multi-pass 24 h dietary recalls in rural Nepal by combining the use of a CommCare questionnaire on smartphones, a paper form, a QR (quick response)-coded list of foods and a photographic atlas of portion sizes. Twenty interviewers collected dietary data on three non-consecutive days per respondent, with three respondents per household. Intakes were converted into nutrients using databases on nutritional composition of foods, recipes and portion sizes.SettingDhanusha and Mahottari districts, Nepal.SubjectsPregnant women, their mothers-in-law and male household heads. Energy intakes assessed in 150 households; data corrections and our experiences reported from 805 households and 6765 individual recalls.ResultsDietary intake estimates gave plausible values, with male household heads appearing to have higher energy intakes (median (25th–75th centile): 12 079 (9293–14 108) kJ/d) than female members (8979 (7234–11 042) kJ/d for pregnant women). Manual editing of data was required when interviewers mistook portions for food codes and for coding items not on the food list. Smartphones enabled quick monitoring of data and interviewer performance, but we initially faced technical challenges with CommCare forms crashing.ConclusionsWith sufficient time dedicated to development and pre-testing, this novel smartphone-based tool provides a useful method to collect data. Future work is needed to further validate this tool and adapt it for other contexts.

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Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

10.21203/rs.2.15484/v3 ◽

2020 ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal.Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs is reported from Poisson regressions with robust variance.Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n=1793) throughout pregnancy and 60.6% (n=731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29).Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester.Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254)

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Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

10.21203/rs.2.15484/v2 ◽

2020 ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal.Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs is reported from Poisson regressions with robust variance.Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n=1793) throughout pregnancy and 60.6% (n=731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29).Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester.Trial registration ClinicalTrials.gov number (NCT01034254)

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Supplementation with Micronutrients in Addition to Iron and Folic Acid Does Not Further Improve the Hematologic Status of Pregnant Women in Rural Nepal

Journal of Nutrition ◽

10.1093/jn/133.11.3492 ◽

2003 ◽

Vol 133 (11) ◽

pp. 3492-3498 ◽

Cited By ~ 74

Author(s):

Parul Christian ◽

Jaibar Shrestha ◽

Steven C. LeClerq ◽

Subarna K. Khatry ◽

Tianan Jiang ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Iron And Folic Acid ◽

Rural Nepal

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Home consumption of two fortified balanced energy protein supplements by pregnant women in Burkina Faso

Maternal and Child Nutrition ◽

10.1111/mcn.13134 ◽

2021 ◽

Author(s):

Brenda Kok ◽

Katie Moore ◽

Leslie Jones ◽

Katrien Vanslambrouck ◽

Laeticia Celine Toe ◽

...

Keyword(s):

Burkina Faso ◽

Pregnant Women ◽

Protein Supplements ◽

Home Consumption

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Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

10.21203/rs.2.15484/v1 ◽

2019 ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Adverse Birth Outcomes ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite (NVP) during pregnancy on birth outcomes in rural Nepal. Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Symptoms of NVP were recorded monthly throughout pregnancy; exposure was defined as NVP at any point during pregnancy and by trimester. Adverse outcomes were low birth weight (LBW), preterm birth, and small for gestational age (SGA). Adjusted relative risk (RR) with 95% CIs is reported from Poisson regressions with robust variance. Results: Among 3,623 pregnant women, the prevalence of NVP was 49.5% (n=1793) any time during pregnancy and 60.6% (n=731) in the first trimester. Significantly higher RRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower RR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions: NVP during pregnancy is associated with birth outcomes in a setting with limited resources, especially beyond the first trimester. Trial registration: ClinicalTrials.gov number (NCT01034254) Keywords: Nausea and vomiting in pregnancy, adverse birth outcomes, pregnancy, birthweight, low birth weight, small for gestational age, preterm birth, Nepal

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