Assessing the Feasibility of Integrating Maternal Nutrition Interventions Into an Existing MNCH Platform in Bangladesh

Not Applicable

Completed

• Conditions: Premature Birth; Poor Fetal Growth; Small-for-gestational Age
• Interventions: Behavioral: Maternal Nutrition Behavior change

• Registration Number: NCT02745249
• Lead Sponsor: International Food Policy Research Institute

Brief Summary

Inadequate maternal nutrition is likely to undermine the potential impact of infant and young child feeding (IYCF) improvements made in the Alive \& Thrive (A\&T) first phase because it is linked to poor fetal growth leading to small-for-gestational age and pre-term newborns. These babies do not respond to growth promoting feeding practices as well as normal newborns do. In Phase 2, Alive \& Thrive decided to focus on integrating a package of maternal nutrition interventions in a large-scale maternal, newborn and child health program (MNCH). This proposed evaluation aims to assess the feasibility of integrating maternal nutrition interventions into an existing MNCH platform in Bangladesh, using a cluster-randomized evaluation design.

Detailed Description

Inadequate maternal nutrition is likely to undermine the potential impact of IYCF improvements made in the Alive \& Thrive (A\&T) first phase because it is linked to poor fetal growth leading to small-for-gestational age and pre-term newborns. These babies do not respond to growth promoting feeding practices as well as normal newborns do (WHO Healthy Growth project). In a study of 16,290 singleton infants born in rural Bangladesh from 2004 to 2007, more than 50% were born with low birth-weight. Low birth-weight is a risk factor for neonatal deaths, estimated to be 37 per 1,000 live births in Bangladesh. Factors associated with low birth-weight include young maternal age, poor pre-pregnant nutritional status, short birth intervals, poor maternal dietary intake (quality, quantity, and diversity), and inadequate pregnancy weight gain. Better maternal nutrition will improve maternal and newborn outcomes and facilitate achievement of a continuum of good nutrition.

In setting its country program goal for Bangladesh in phase 2, Alive \& Thrive decided to focus on demonstrating the feasibility of integrating a package of maternal nutrition interventions in a large-scale MNCH program. Maternal nutrition should receive equal priority as child nutrition and the A\&T program of BRAC already has developed an effective strategy though improving IYCF practices. MNCH programs offer the best opportunity for achieving large scale and sustainability. The GOB also promotes mainstreaming of nutrition intervention in health services. Considering the behavior change focus of the Alive \& Thrive strategy, efforts will concentrate on improving dietary practices, specifically, improved diversity of foods and energy intakes of pregnant women, and improve the intake of calcium and iron/folic acid supplements. BRAC's supply system will be used to ensure access to calcium and iron/folic acid supplements. The current Government of Bangladesh guidelines of supplementing pregnant women with iron and folic acid and calcium, taken with food (to minimize adverse effects) would be a focus of behavior change interventions.

The primary objectives of the proposed evaluation are to answer the following questions using a cluster-randomized evaluation design:

* Can the coverage and utilization of key maternal nutrition interventions be improved equitably by integrating nutrition-focused BCC and community mobilization into BRAC's rural MNCH program?

* What factors affect high quality integration of nutrition interventions into a well-established MNCH program platform?

Secondary objectives are to examine the following question:

• Can an intensive, formative-research based BCC intervention for maternal nutrition improve the quality of diets of pregnant women in rural Bangladesh and facilitate better early breastfeeding practices than via routine MNCH services?

Study Timeline

• Study Start: 2015-07
• Study First Submitted: 2016-04-01
• Study First Submitted QC: 2016-04-15
• Study First Posted: 2016-04-20
• Primary Completion: 2016-10
• Study Completion: 2016-10
• Status Verified: 2017-09
• Last Update Submitted: 2017-09-26
• Last Update Posted: 2017-09-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 3500

Inclusion Criteria

• Recently delivered women with children <6 months of age
• Pregnant women in second and third trimester and her husbands
• Frontline health workers in the areas

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Exclusion Criteria

• Age <18
• Mental disorders that cannot understand and answer the questions

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
A&T- intensive	Maternal Nutrition Behavior change	A\&T-intensive arm receive standard MNCH services and intensified maternal nutrition behavior change intervention which focus on improving dietary practices, specifically improved diversity of foods and energy intakes of pregnant women, and improved intake of calcium and iron/folic acid (IFA) supplements.

Primary Outcome Measures

Name	Time	Method
Use of iron-folic acid supplements	IFA tablets used during 9 months of last pregnancy among recently delivered women with children <6 months of age by June 2016	Recall the total number of IFA tablets consumed throughout the last pregnancy
Use of calcium supplements	Calcium tablets used during 9 months of last pregnancy among recently delivered women with children <6 months of age by June 2016	Recall the total number of calcium tablets consumed throughout the last pregnancy
Dietary micronutrient intakes	Pregnant women in second and third trimester of pregnancy (4-9 months) by June- August 2016	Quantity of micronutrient intakes using 24-hour recall complemented by food weighing.
Dietary diversity during pregnancy	Pregnant women in second and third trimester of pregnancy (4-9 months) by June- August 2016	Number of food groups women consumed
Coverage of maternal nutrition intervention	1 year	The proportion of pregnant and recently delivery women expose to and use of MNCH platform during the last 1 year

Secondary Outcome Measures

Name	Time	Method
Early initiation of breastfeeding	Infants up to 6 months in a cross-sectional endline survey scheduled for June- August 2016	The proportion of newborns aged less than 6 months who were breastfed within 1 hour of birth
Exclusive breastfeeding	Infants up to 6 months in a cross-sectional endline survey scheduled for June- August 2016	The proportion of infants aged less than 6 months who were exclusively breastfed on the day preceding the interview.

Trial Locations

Locations (1)

International Food Policy Research Institute; 🇺🇸 Washington, D.C., District of Columbia, United States