Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program

Abstract

The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII’s 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2–5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6–24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2–5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2–5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets.

Exploring the Influence of Social Norms on Complementary Feeding: A Scoping Review of Observational, Intervention, and Effectiveness Studies

“…Ten interventions used community events to sensitize the public and mobilize collective encouragement for CF behaviors through interaction and information sharing and to organize diffusion of positive norms ( 44 , 59 , 67 , 68 , 70 , 71 , 77 – 79 , 87 , 90 ). Activities included community dramas, movie screenings, demonstrations, messages during religious gatherings, and school activities.…”

“…Another approach was to create positive new norms by publicly recognizing people who practiced recommended behaviors and encouraged others to challenge norms or change their behavior ( 44 , 59 , 71 , 84 , 87 – 89 ). These interventions relied on “champions” or credible community members to set the example and encourage shifts in social norms.…”

“…These interventions relied on “champions” or credible community members to set the example and encourage shifts in social norms. To influence social norms and empower women, Suaahara organized community events celebrating key life events and recognizing “ideal families” practicing target behaviors ( 87 – 89 ).…”

“…To include a comprehensive range of programs, we chose not to exclude evaluations based on research design, and variation in quality must be considered in interpreting results. While 12 program evaluations used cluster-randomized or quasi-experimental evaluation designs with comparison groups and measured preintervention to postintervention change, 3 evaluations had pre-post designs with no comparison groups ( 67 , 75 , 86 ) and 2 only compared intervention with nonintervention communities at endline ( 60 , 87 ). Not all quantitative studies reported rigorous statistical analysis.…”

Associations between parents' exposure to a multisectoral programme and infant and young child feeding practices in Nepal

“…The mass media edutainment radio programme, titled Bhanchhin Aama ( Mother Knows Best ), covers the wide range of practices that Suaahara II seeks to influence. These interventions target mothers and family members in 1000‐day households to reinforce key messages and promote optimal nutrition‐related practices (Pun et al, 2019 ; Suresh et al, 2019 ).…”