A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study

Abstract

BackgroundPrenatal balanced protein energy supplementation consumed by undernourished women improves mid-upper arm circumference in early infancy. This study aimed to identify whether locally produced maternal food-based supplementation improved anthropometric measures at birth and early infancy.MethodsA village-matched evaluation, applying principles of a cluster randomised controlled trial, of a locally produced supplemental food to 87 undernourished pregnant women. 12 villages (intervention: n = 8; control: n = 4) in Pirganj sub-district, Rangpur District, northern Bangladesh. Daily supplements were provided.ResultsAnthropometric data at birth were available for 77 mother-infant dyads and longer-term infant growth data for 75 infants. Mid-upper arm circumference (MUAC) was significantly larger in infants of mothers in the intervention group compared with the control group at 6 months (p < 0.05). The mean birth weight in babies of supplemented mothers (mean: 2·91 kg; SD: 0·19) was higher than in babies of mothers in the control group (mean: 2·72 kg; SD: 0·13), and these changes persisted until 6 months. Also, the proportion of low birth weight babies in the intervention group was much lower (event rate = 0.04) than in the control group (event rate = 0.16). However, none of these differences were statistically significant (p > 0·05; most likely due to small sample size). The intervention reduced the risk of wasting at 6 months by 63.38% (RRR = 0.6338), and of low birth weight by 88·58% (RRR = 0.8858), with NNT of 2.22 and 6.32, respectively. Only three pregnant women require this intervention in order to prevent wasting at 6 months in one child, and seven need the intervention to prevent low birth weight of one child.ConclusionsLocally produced food-based balanced protein energy supplementation in undernourished pregnant women in northern Bangladesh resulted in larger MUAC in infants at 6 months. Further research, with larger sample sizes, is required to confirm the role of locally produced supplementation for undernourished pregnant women on weight and linear growth in newborns and infants.Trial registrationThis research was registered with the ISRCTN registry (ISRCTN97447076). This project had human research ethical approval from the James Cook University (Australia) Ethics committee (H4498) and the Bangladesh Medical Research Council (BMRC/NREC/2010–2013/58).Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1915-x) contains supplementary material, which is available to authorized users.

Screening and management options for severe thinness during pregnancy in India

“…No significant difference was observed in other maternal and infant outcomes. 26 The study from Bangalore did not observe any significant difference in GWG, birthweight, birth length, or gestational age in 12 underweight pregnant women (BMI <18.5) who were provided a daily food supplement. 27…”

Scoping Review of Intervention Strategies for Improving Coverage and Uptake of Maternal Nutrition Services in Southeast Asia

“…Of all the 31 studies included in the review, only 22 have at least one outcome associated with delivery mechanisms; the study characteristics of all the 31 papers are summarized in Table 1 and Table 2 [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. A total of 22 studies were ultimately included in this review for narrative synthesis [ 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 32 , 33 , 34 , 36 , 37 , 39 , 40 , 42 , 43 ...…”

“…In Nepal, the provision of 10 kg per month of a fortified BEP supplement of wheat-soya blended flour with 10% added sugar, called super cereal, delivered by community health workers, along with the participatory learning and action approach, significantly improved the birth weight of newborns and equity in energy allocation among pregnant women [ 37 , 40 ]. Similarly, in Bangladesh, a locally produced food-based BEP supplementation for undernourished pregnant women delivered along with nutrition education and counselling and regularly monitored by community nutrition volunteers either at the designated center in the community or through home visits showed a 98% compliance rate, with almost all women consuming the full supplement daily [ 43 ]. However, evaluation of supplementary food programs delivered in India through the Integrated Child Development Service Scheme by Anganwadi workers reported that only 20.5% of women received supplementary food during their pregnancies due to a weak procurement system and poor quality of food products [ 20 ].…”

“…Many studies lack data on the direct effect of health workers on the uptake of services/compliance (as revealed through association/regression/attribution) [ 12 , 18 , 19 , 23 , 24 , 26 , 29 , 32 , 33 , 34 , 35 , 37 , 38 , 42 , 43 ]. These studies compared the effect of the intervention (as a whole) on the outcomes without delineating the isolated effects of health workers/delivery mechanisms.…”

A life history approach to prenatal supplementation: Building a bridge from biological anthropology to public health and nutrition

“…In some cases, additional energy and nutrients lead to gains in perinatal outcomes across the study sample (eg, Huynh, Tran, Nguyen, Berde, & Low, ). In others, they do not (eg, Mantaring et al, ; Stevens et al, ). Most recent studies in diverse populations, however, point to the importance of maternal and ecological characteristics in mediating the impact of supplementation.…”