Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial

Abstract Background In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. Methods We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. Results Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. Conclusions Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. Trial registration Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

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Dietary intake and processes of behaviour change in a nutrition education intervention for pregnant women in rural Malawi: a cluster-randomised controlled trial

Public Health Nutrition ◽

10.1017/s1368980020000294 ◽

2020 ◽

Vol 23 (13) ◽

pp. 2345-2354

Author(s):

Lillian Ziyenda Katenga-Kaunda ◽

Per Ole Iversen ◽

Gerd Holmboe-Ottesen ◽

Heidi Fjeld ◽

Ibrahimu Mdala ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Dietary Intake ◽

Pregnant Women ◽

Nutrition Education ◽

Dietary Diversity ◽

Controlled Trial ◽

Intervention Group ◽

Dietary Behaviour ◽

Dietary Intakes ◽

Randomised Controlled

AbstractObjective:To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour.Design:We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables.Setting:The study was conducted in twenty villages in rural Malawi.Participants:Data from 257 pregnant women who were enrolled during late first trimester and followed until birth.Results:The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS.Conclusions:Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.

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Nutrition Knowledge and Dietary Intake in Pregnancy in Rural Malawi: Comparing Supplementary Nutrition Education and -Counseling With Routine Antenatal Care

Current Developments in Nutrition ◽

10.1093/cdn/nzab035_053 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 145-145

Author(s):

Lillian Katenga-Kaunda ◽

Penjani Rhoda Kamudoni ◽

Gerd Holmboe-Ottesen ◽

Heidi Fjeld ◽

Ibrahimu Mdala ◽

...

Keyword(s):

Nutrition Education ◽

Low Income ◽

Dietary Habits ◽

Dietary Diversity ◽

Intervention Group ◽

Study Groups ◽

Nutrition Knowledge ◽

Randomised Control Trial ◽

Control Group ◽

End Point

Abstract Objectives To describe and compare changes in nutrition knowledge, perception and dietary habits between the intervention and control group and to evaluate the effects of nutrition knowledge on dietary diversification among the two study groups. Methods This study was a two armed randomised control trial. We recruited 257 women (gestational week 9–12) of which 195 (76%) were available for analyses: intervention 92; Control 103) the women were assessed at inclusion (baseine) and two weeks before the expected date of delivery (study end-point) for differences in nutrition knowledge, perception (using a structured questionnaire) and dietary habits (assessing dietary diversity score). We performed descriptive analyses to assess these differences between the two study groups. Three-level linear multilevel regression models with random intercept and random effect of time on participant at level 1 and village level 2 were used to expore the association between nutrition knowledge and dietary habits Results Our results show that both nutrition knowledge and dietary diversity improved in both study groups, but the improvement were significantly higher in the intervention group at study-end point. Increase in nutrition knowledge was associated with improved dietary diversity only among women in the intervention group. Moreover, women in the intervention group improved their nutrition perception and behaviour. Conclusions Our results provide evidence that poor nutrition knowledge is a barrier to consumption of healthy diet during pregnancy, thus supporting the relevance for augmenting nutrition education offered at ANC with supplementary and community-based nutrition interventions. We thus suggest that efforts should be made to strengthen the education component of ANC services as these are decentralized and locally accessible in Malawi and other low-income countries Funding Sources This project was funded by the University of Oslo, The Global Health and Vaccination Program (GLOBVAC) of the research council of Norway and by the Throne Holst foundation.

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Effects of guided counseling during pregnancy on birth weight of newborns in West Gojjam Zone, Ethiopia: a cluster-randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-020-02363-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yeshalem Mulugeta Demilew ◽

Getu Degu Alene ◽

Tefera Belachew

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Nutrition Education ◽

Controlled Trial ◽

Intervention Group ◽

Average Birth Weight ◽

Randomized Controlled ◽

West Gojjam ◽

Cluster Randomized ◽

West Gojjam Zone

Abstract Background The high proportion of birth weight in Ethiopia is hypothesized to be due to inadequate maternal diet which is associated with poor nutrition education during pregnancy. There was no study that evaluated the effect of nutrition education on birth weight in the study area. This study aimed to assess the effects (overall, direct and indirect effects) of guided counseling on the birth weight of neonates. Methods A two-arm parallel cluster randomized controlled community trial was conducted from May 1, 2018, to April 30, 2019, in West Gojjam Zone, Northwest Ethiopia. At the baseline, 346 pregnant women in the 11 intervention clusters and 348 pregnant women in the 11 control clusters were recruited. However, birth weight was measured from 258 and 272 newborns in the intervention and control groups, respectively. In the intervention group, counseling was given monthly for four consecutive months in the participant’s homes. Besides, leaflets with key counseling messages were distributed to each woman in the intervention arm. Pregnant women who attended routine nutrition education given by the health system were recruited as control. Dietary practice, nutritional status, and birth weight were the primary, secondary and tertiary outcomes of this intervention. Data were collected using a structured data collection tool. Birth weight was measured within 48 h after birth. Independent sample t-test, linear mixed-effects model, and path analysis were fitted to assess effects of the intervention. Results The intra-cluster correlation coefficient was 0.095. The average birth weight of newborns in the intervention group was 0.257 kg higher compared with their counterparts in the control arm (β = 0.257, P < 0.001). The direct effect of this intervention on birth weight was 0.17 (β = 0.17, P<0.001 ) whereas the indirect effect of this intervention was 0.08 (β = 0.08, P<0.001 ). Conclusion Counseling using the health belief model and the theory of planned behavior has a positive effect on improving birth weight. The findings suggest the need for enhancing nutrition education of pregnant women through the application of theories to improve birth weight. Trial registration Clinical Trials.gov NCT03627156, “Retrospectively registered Jun, 13, 2018”.

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Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): A Pragmatic Randomized Controlled Trial

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_006 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1289-1289

Author(s):

Hayford Avedzi ◽

Allison Soprovich ◽

Stephanie Ramage ◽

Abdulrhman Alghamdi ◽

Kate Storey ◽

...

Keyword(s):

Nutrition Education ◽

Glycemic Index ◽

Self Efficacy ◽

Text Messaging ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Dietary Intakes ◽

Web Based ◽

Phone Calls

Abstract Objectives Rigorous evidence is needed to support uptake of recommendations to include low glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for people with type 2 diabetes (T2D). We evaluated the effectiveness of a 12-week web-based GI-targeted nutrition education intervention on dietary intakes and GI-related knowledge among adults with T2D. Methods Participants were randomized to a control group (n = 34) that received standard printed copies of Canada's Food Guide and Diabetes Canada's GI resources or an intervention group (n = 33) that received those same materials, plus an online platform with six self-directed learning modules and supplementary print material. Each module consisted of a customized video, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and advice for low-GI shopping, recipes, and cooking tips by a Registered Dietitian. Preferred supports through email, text messaging, phone calls, or postal mail to reinforce participants’ learning were also provided. The primary outcome, average daily dietary GI intake, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin A1c, lipids, systolic blood pressure, body mass index, waist circumference, and computer proficiency, were assessed at baseline and at three months post-intervention. Results Participants (N = 67) were 64% men; mean (standard deviation [SD]) age 69.5 (9.3) years, with mean diabetes duration of 19.0 (13.7) years, BMI 30.1 (5.7) kg/m2 and A1c 7.1 (1.2)% at baseline. Mean daily GI intake decreased in the intervention group by 2.79 (7.77) compared to a 0.76 (6.48) increase in the control group (adjusted mean difference [95% CI]; −3.77 [−6.95, −0.58]). Mean GI knowledge 2.14 [0.59, 3.69], understanding of GI concept 1.65 [0.85, 2.44] and self-efficacy for consuming low-GI foods 1.29 [0.51, 2.07] increased among the intervention group (P < 0.01) compared with the control group. Conclusions Web-based GI-targeted education program improved the quality of carbohydrate consumption among adults with T2D and may have been mediated through increases in knowledge and self-efficacy. Web-based nutrition education may be an effective alternative in this population. Funding Sources Canadian Foundation for Dietetic Research.

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Nutrition information system (SISFORNUTRIMIL) application With Online Food Record for Indonesia Pregnant Women: Protocol for Randomized Controlled Trial

10.21203/rs.3.rs-634069/v1 ◽

2021 ◽

Author(s):

Mira Trisyani Koeryaman ◽

Saseendran Pallikadavath ◽

Isobel Ryder ◽

Ngianga Kandala

Keyword(s):

Randomized Controlled Trial ◽

Pregnant Women ◽

Dietary Diversity ◽

Controlled Trial ◽

Intervention Group ◽

Eating Behaviour ◽

Control Group ◽

Food Record ◽

Randomized Controlled ◽

The Impact

Abstract Background: The pregnant women and family may not have the necessary knowledge and skills to estimate nutrient value in food in line with dietary targets and the guidelines, i.e. they do not know whether or not they are consuming the right amount of nutrition needed during pregnancy. The aims of this randomized controlled trial (RCT) is to examine the impact of SISFORNUTRIMIL application on maternal eating behaviour and associated maternal factors such as weight gain, blood pressure, biochemical measurement, and pregnancy outcome.Methods: The study recruits 112 participants with eligible criteria during December 2019 to January 2020. The allocation of participants is 1:1 to the SISFORNUTRIMIL application user and non-user application, with criteria: singleton pregnancy (22-26 weeks), mother age between 20-35 years), have monthly income and literate. Both groups will receive 12-week standard health services from health professionals and received information about dietary diversity and food record. Particularly, intervention group could be access the SISFORNUTRIMIL on their devices, which provide necessary information about nutrition in pregnancy, food record and food choice includes total serving size calculation. In contrast, the control group only receive food information and food intake record by paper-based, and they should record and calculate the nutrition intake by traditionally. Discussion: This is the first randomized controlled trial to examine the SISFORNUTIMIL application. This mandate reflects keen interest and motivation for the proposed research study. This is in addition to the researcher’s personal efforts to reduce morbidity and mortality rate as well as a general focus on pregnancy complication prevention than nutrition treatment. Thus, an investigation of eating behaviour and associated maternal needed to address this issue. Firstly, the results could extend the scope of knowledge about nutrition intervention to include the Indonesia pregnant women context as well as the Indonesia health ministry context. Secondly, this research could help to change individual health behaviour and activity undertaken by an individual who believes her-self to be healthy.Trial registration: ISRCTN Registry: ISRCTN42690828. Date of registration: 22 October 2019.

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Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial

Public Health Nutrition ◽

10.1017/s1368980015000920 ◽

2015 ◽

Vol 18 (18) ◽

pp. 3406-3419 ◽

Cited By ~ 24

Author(s):

Lydiah M Waswa ◽

Irmgard Jordan ◽

Johannes Herrmann ◽

Michael B Krawinkel ◽

Gudrun B Keding

Keyword(s):

Nutrition Education ◽

Educational Intervention ◽

Treatment Effect ◽

Rural Areas ◽

Dietary Diversity ◽

Intervention Group ◽

Nutrition Knowledge ◽

Control Group ◽

Education Intervention ◽

Western Kenya

AbstractObjectiveLack of diversity is a major factor contributing to inadequate nutrient intakes among children during the complementary feeding period in many rural areas in developing countries. This has been attributed to inadequate feeding practices and nutrition knowledge among their caregivers. The aim of the present study was to assess the effect of an educational intervention on children’s dietary diversity and nutrition knowledge of caregivers.DesignCluster randomization was applied and twenty matched village pairs were randomly assigned to the intervention or control group. The nutrition education intervention consisted of four sessions comprising of group trainings and cooking demonstrations that were conducted over a period of 5 months.SettingHouseholds in rural communities in Bondo and Teso South sub-counties, western Kenya.SubjectsCaregivers with children aged 6–17 months receiving nutrition education.ResultsThe children’s dietary diversity scores (CDDS) and nutrition knowledge scores of the caregivers improved significantly in the intervention group at endline. The treatment effect on CDDS was positive and significant (P=0·001). The CDDS rate of the children in the intervention group was 27 % larger than it would have been without the treatment effect. The intervention also had a significant effect on the caregivers’ nutrition knowledge scores (incidence rate ratio=2·05; P<0·001). However, the nutrition knowledge of the caregivers did not have a significant effect on CDDS (P=0·731).ConclusionsThe nutrition education intervention led to improvements in children’s dietary diversity and nutrition knowledge of the caregivers.

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Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana

Global Health Promotion ◽

10.1177/1757975920945241 ◽

2020 ◽

Vol 27 (4) ◽

pp. 114-122

Author(s):

Janet Antwi ◽

Agartha Ohemeng ◽

Laurene Boateng ◽

Esi Quaidoo ◽

Boateng Bannerman

Keyword(s):

Nutrition Education ◽

Dietary Diversity ◽

Intervention Group ◽

Nutrition Knowledge ◽

Nutrition Status ◽

School Age Children ◽

Control Group ◽

Education Intervention ◽

School Age ◽

Significant Difference

This study was performed to evaluate the effect of a six-week nutrition education intervention on the nutrition knowledge, attitude, practices, and nutrition status of school-age children (aged 6–12 years) in basic schools in Ghana. Short-term effects of nutrition education training sessions on teachers and caregivers were also assessed. Pre-post controlled design was used to evaluate the program. Intervention groups had significantly higher nutrition knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in the lower primary level. A higher proportion of children in the intervention group strongly agreed they enjoyed learning about food and nutrition issues compared to the control group (88% vs. 77%, P = 0.031). There was no significant difference in dietary diversity scores (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184) or in measured anthropometric indices (3.6% vs. 8.2%, P = 0.08). A marginally lower proportion of stunted schoolchildren was observed among the intervention group compared to the control group (3.6% vs. 8.2%, P = 0.080). Nutrition knowledge of teachers and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.86 ± 0.73 to 6.24 ± 1.02, P = 0.009), respectively. Nutrition education intervention could have positive impacts on knowledge and attitudes of school children, and may be crucial in the development of healthy behaviors for improved nutrition status.

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The Effect of Education Based on Theory of Planned Behavior in Promoting Nutrition-related Behaviors to Prevent Anemia in Pregnant Women

Journal of Arak University of Medical Sciences ◽

10.32598/jams.23.6.135.37 ◽

2021 ◽

Vol 23 (6) ◽

pp. 872-887

Author(s):

Zahra Jahangiri ◽

◽

Mohsen Shamsi ◽

Mahboobeh Khorsandi ◽

Rahmatollah Moradzade ◽

...

Keyword(s):

Theory Of Planned Behavior ◽

Pregnant Women ◽

Planned Behavior ◽

Educational Intervention ◽

Test Performance ◽

Controlled Trial ◽

Intervention Group ◽

Test Group ◽

Study Groups ◽

Clinical Trial Registration

Background and Aim: Iron deficiency is among the most prevalent nutritional problems during pregnancy. Besides, it can significantly affect pregnant women’s health. Therefore, this study aimed to determine the effect of education based on the Theory of Planned Behavior (TPB) on promoting anesthetic prevention nutritional behaviors in the pregnant woman. Methods & Materials: This was an educational randomized controlled trial study. In total, 80 pregnant women were randomly divided into two groups of test and control (n=40/group). Data collection with reliable and validity questionnaire consist of demographic factors, knowledge, the construct of TPB (attitude, subjective norms, perceived behavior control, intention), and performance. Before performing the intervention, pre-test data were collected from the study groups. Then, the educational intervention was performed based on the results of the needs assessment for the test group, within a month and in the form of four 60-minute training sessions based on the TPB. The results were collected 3 months after the intervention and analyzed using the Mann-Whitney U test, Chi-squared test, and correlation coefficient. Ethical Considerations: The present study was registered with the code IRCT2017052334106N1 in the Clinical Trial Registration Center of Iran and was approved by the Research Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1395.445). Results: The present research results indicated that before the intervention, all variables were the same in the study groups. However, after the intervention, the research groups significantly differed concerning all the studied structures (P<0.05). Moreover, the Mean±SD pre-test performance score of the intervention group was equal to 2.88±0.415 (out of 5); accordingly, it was significantly improved after training to 3.64±0.216 (P<0.001). Conclusion: Educational intervention based on the TPB improved anesthetic anxiety behaviors in the studied pregnant women; such a modification can be attributed to the provided educational program in the intervention group.

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Nutrition Education Impact on Nutrition Knowledge, Attitude and Practice of Schoolchildren: A Pilot Study in Ghana

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_004 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1287-1287

Author(s):

Janet Antwi

Keyword(s):

Nutrition Education ◽

Dietary Diversity ◽

Intervention Group ◽

Nutrition Knowledge ◽

Sub Saharan Africa ◽

Health Concern ◽

Nutrition Status ◽

Control Group ◽

Positive Effects ◽

The Impact

Abstract Objectives Malnutrition among children, and adolescents remains a crucial public health concern in sub-Saharan Africa. Nutrition education contributes to acquisition of nutrition knowledge, attitude, and practices (KAP) which may lead to improved nutrition status and health, and brings greatest benefits to the poor and the most vulnerable particularly school-age children (SAC). We evaluated the impact of a 6-week nutrition education intervention on nutrition KAP, and nutrition status of SAC. The effect of nutrition education training on the knowledge of teachers and caregivers was also evaluated. Methods Pretest-posttest controlled design was used in elementary schools in Ghana. A total of 325 SAC 6–12 years old, 6 teachers and 99 caregivers completed the study. Nutrition KAP were estimated using a standardized questionnaire. Nutrition status was calculated using height and weight measurements. Results Schoolchildren in the intervention group had significantly higher knowledge scores (8.8 ± 2.0 vs. 5.9 ± 2.1, P < 0.0001) compared to controls in lower elementary level. The attitude of children in learning about food and nutrition issues was a higher proportion in the intervention group as compared to control group (88% vs. 77%, P = 0.031). Dietary diversity score did not differ significantly between intervention and control groups (4.8 ± 2.0 vs. 5.1 ± 1.4, P = 0.184). Intervention group had a marginally lower proportion of stunted SAC at the end of the study period as compared to control group (3.6% vs. 8.2%, P = 0.080). The nutrition knowledge of teachers, and caregivers significantly improved (12.5 ± 1.87 vs. 9.2 ± 2.1; P = 0.031) and (5.85 ± 0.73 to 6.29 ± 1.02, P = 0.009), respectively. Conclusions Nutrition education could have positive effects for passing on nutrition knowledge, and attitudes to elementary school children which are essential to developing healthy behaviors, and managing nutrition status. Funding Sources This study was funded by the Institute of International Education with award of the Carnegie African Diaspora Fellowship Program.

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Breastfeeding Training through Role-Play and Effects on Mother-infant Attachment Behaviours: A Randomised Controlled Trial

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/6232 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Farokh Saljughi ◽

Mitra Savabi-Esfahani ◽

Shahnaz Kohan ◽

Soheila Ehsanpour

Keyword(s):

Pregnant Women ◽

Maternal Employment ◽

Controlled Trial ◽

Role Play ◽

Intervention Group ◽

Control Group ◽

Maternal Behaviour ◽

Infant Attachment ◽

Significant Difference ◽

History Of

Mother-infant attachment is an intimate, lasting and satisfying relationship that leads to better cognitive, emotional and social growth of the infant. The aim of this study was to determine the effects of breastfeeding training by role-play on mother-infant attachment behaviours. This research was a randomised clinical trial (parallel design). Inclusion criteria were: no history of mental disorders; ability to read and write the Persian language to complete the questionnaire; no history of drug and tobacco intake in primigravida women. The sample comprised 100 pregnant women (in 2 groups), selected through simple random sampling at healthcare centres. The researcher reviewed prenatal care registries of selected healthcare centres and extracted the names of pregnant women in their early third trimester. The data were imported into randomisation software. The control group received routine breastfeeding training, while the intervention group received routine training together with training through role-play. The data collection tool was the Maternal Behaviour Inventory Questionnaire. Consequently 75 samples were analysed in SPSS16. Independent t-tests and chi-square tests were used to examine the difference between the two groups. Results showed that the mean score of mother-infant attachment one week after delivery was significantly higher in the intervention group in comparison to that in the control group (p<0.001). No significant difference was observed between the two groups in maternal age, age of marriage, neonatal gender, maternal employment and education, number of parity, and number of abortions (P>0.05). Since breastfeeding training through role-play could affect mother-infant attachment, it is suggested that this type of training should be provided for pregnant women to promote mother-infant attachment and exclusive breastfeeding.

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