BackgroundUndernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0–16 months of community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers to pregnant women.MethodsWe randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10–49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya ‘Super Cereal’, n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0–16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed.ResultsIn PLA plus food/cash arms, 94–97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0–16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms.InterpretationFood supplements in pregnancy with PLA women’s groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition int...

We examined the influence of social and cultural contexts on participation in recommended levels of physical activity (PA) among African American women using a grounded theory approach. Data were collected through in-depth interviews and focus groups with 15 physically active African American women. Participants described social and cultural factors that served as challenges for participation in PA. Of particular importance, participants discussed their strategies for overcoming these challenges to initiate and maintain an active lifestyle. Strategies emerged to address three main areas: lack of PA exposure, PA norms and beliefs, and hair maintenance. Understanding contextually appropriate strategies to assist African American women in long-term PA maintenance will help inform effective health promotion efforts to reduce the burden of sedentary lifestyle and chronic disease in this community of women.

Background/ObjectivesUnderstanding of the patterns and predictors of intra-household food allocation could enable nutrition programs to better target nutritionally vulnerable individuals. This study aims to characterise the status and determinants of intra-household food and nutrient allocation in Nepal.Subjects/MethodsPregnant women, their mothers-in-law, and male households heads from Dhanusha and Mahottari districts in Nepal responded to 24-hour dietary recalls, thrice-repeated on non-consecutive days (n=150 households; 1278 individual recalls). Intra-household inequity was measured using ratios between household members in: food intakes (‘food shares’); food-energy intake proportions (‘food shares-to-energy shares’, FS:ES); calorie-requirement proportions (‘Relative Dietary Energy Adequacy Ratios’, RDEARs); and Mean Probability of Adequacy for 11 micronutrients (MPA ratios). Hypothesised determinants were collected during the recalls, and their associations with the outcomes were tested using multivariable mixed-effects linear regression models.ResultsWomen’s diets (pregnant women and mothers-in-law) consisted of larger FS:ES of starchy foods, pulses, fruits, and vegetables than male household heads, whereas men had larger FS:ES of animal-source foods. Pregnant women had the lowest MPA (37%) followed by their mothers-in-law (52%), and male household heads (57%). RDEARs between pregnant women and household heads were 31% higher (log-RDEAR coeff=0.27 (95% CI 0.12,0.42), P<0.001) when pregnant women earned more or the same as their spouse, and log-MPA ratios between pregnant women and mothers-in-law were positively associated with household-level calorie intakes (coeff=0.43 (0.23,0.63), P<0.001, per 1000 kcal).ConclusionsPregnant women receive inequitably lower shares of food and nutrients, but this could be improved by increasing pregnant women’s cash earnings and household food security.