A Grandmother‐Inclusive Approach to Community Nutrition Positively Impacted Maternal Nutrition and Health Seeking Practices in Southern Sierra Leone

Abstract

Poor nutrition and health seeking practices of pregnant and lactating women contribute to maternal morbidity, poor birth outcomes and undernutrition of children in Sierra Leone. We examined how a grandmother (GM) inclusive approach to nutrition‐related social and behavior change affected maternal diet and health seeking practices in southern Sierra Leone. The GM‐inclusive approach is grounded in formative ethnographic research and builds on GMs' culturally‐designated role as advisors and caregivers and aims to strengthen their knowledge and confidence to promote positive change for maternal and child health. Following mixed methods formative research, World Vision implemented a quasi‐experimental proof of concept study in two sections in the Bum Chiefdom, Bonthe Sierra Leone. The villages of one section received the grandmother‐inclusive approach consisting of monthly participatory nutrition education sessions with GMs, quarterly community praise sessions focused on the attributes of and supportive roles of GMs, the identification and support of GM leaders as change agents for maternal and child health and intergenerational forums. Villages in the control section received the standard of care for nutrition education provided by the Ministry of Health. The endline survey utilized a census based sampling strategy and surveyed all women in the study communities who were pregnant (PW, N=101) or had a child less than 2 years of age (MU2, N=291). Data were collected on household sociodemographics, maternal diet and IYCF knowledge, attitudes, and intentions/practices. Preliminary analyses examined differences in proportions between intervention and comparison participants with chi‐square. The proportions of MU2 (94.6% vs. 67.3%, P<0.001) and PW (96.3% vs 61.7%, P<0.001) achieving minimum dietary diversity in the previous 24 hours were significantly higher in the intervention compared to the comparison group. As well, a significantly greater proportion of PW in the intervention group intended to consume more food (88.9% vs 48.9%, P<0.0001) and work less (94.4% and 88.1%, P=0.002) during their current pregnancy. Similarly, a significantly greater proportion of MU2 in the intervention group reported increased meal frequency (94.6% vs 63.6%, P<0.001) and decreased work (91.3% vs 75.7%, P<0.001) during their most recent pregnancy. A greater proportion of MU2 in the intervention communities also reported attending ANC at least 4 times (97.1% vs. 80.8%, P<0.001) and delivering in a health facility (96.7% vs 90.7%, P=0.03). Few studies have shown improved nutrition practices during pregnancy, and particularly during crisis (e.g., Ebola). Preliminary analyses suggest that a grandmother‐inclusive approach that recognizes GMs' role in nutrition and health and strengthens their knowledge can contribute to improved nutrition and health practices during pregnancy improved nutrition and health practices in pregnancy.Support or Funding InformationFunding provided by World Vision Canada, World Vision Germany, World Vision Sierra Leone and the Emory University Global Field Experiences Program