Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues

Victora, César G.; Barros, Fernando C.; Assunção, Maria Cecília Formoso; Restrepo‐Méndez, María Clara; Matijasevich, Alícia; Martorell, Reynaldo

doi:10.1177/15648265120332s102

Cited by 63 publications

(132 citation statements)

References 62 publications

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“…Cash transfers and safety nets were included because they are potential platforms for the above interventions and because of their potential to directly improve maternal nutrition [1]. Selected health measures that affect nutritional status, such as deworming and malaria prevention and control, were also included.…”

Section: S29mentioning

confidence: 99%

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

Saldanha¹,

Buback²,

White³

et al. 2012

Food Nutr Bull

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Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.

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Section: S29mentioning

confidence: 99%

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

Saldanha¹,

Buback²,

White³

et al. 2012

Food Nutr Bull

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“…A systematic review of large-scale maternal nutrition programs in several countries showed mixed findings in terms of implementation issues [9]. Food fortification with IFA was less successfully scaled up than salt iodization initiatives.…”

Section: Introductionmentioning

confidence: 99%

“…In Nepal and Nicaragua, micronutrient supplementation programs achieved good coverage under conditions of high antenatal care coverage, availability of tablets, and compliance. However, programs that integrated food supplementation and behavioral change interventions in India, Bangladesh, and Madagascar achieved only moderate coverage [9]. A recent study of barriers to providing IFA supplementation through antenatal care in 22 countries [8] identified four ‘falter points’ to delivering at scale: 1) low antenatal care coverage, 2) irregular supplies of IFA tablets, 3) low acceptance of IFA, and 4) low adherence to 180 days of supplementation.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing maternal nutrition practices in a large scale maternal, newborn and child health program in Bangladesh

et al. 2017

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Improving maternal nutrition practices during pregnancy is essential to save lives and improve health outcomes for both mothers and babies. This paper examines the maternal, household, and health service factors influencing maternal nutrition practices in the context of a large scale maternal, newborn, and child health (MNCH) program in Bangladesh. Data were from a household survey of pregnant (n = 600) and recently delivered women (n = 2,000). Multivariate linear and logistic regression analyses were used to examine the determinants of three outcomes: consumption of iron and folic acid (IFA) tablets, calcium tablets, and diverse diets. Women consumed 94 ± 68 IFA and 82 ± 66 calcium tablets (out of 180 as recommended) during pregnancy, and only half of them consumed an adequately diverse diet. Good nutrition knowledge was the key maternal factor associated with higher consumption of IFA (β = 32.5, 95% CI: 19.5, 45.6) and calcium tablets (β ~31.9, 95% CI: 20.9, 43.0) and diverse diet (OR = 1.8, 95% CI: 1.0–3.1), compared to poor knowledge. Women’s self-efficacy in achieving the recommended practices and perception of enabling social norms were significantly associated with dietary diversity. At the household level, women who reported a high level of husband’s support were more likely to consume IFA (β = 25.0, 95% CI: 18.0, 32.1) and calcium (β = 26.6, 95% CI: 19.4, 33.7) tablets and diverse diet (OR = 1.9, 95% CI: 1.2, 3.3), compared to those who received low support. Health service factors associated with higher intakes of IFA and calcium tablets were early and more prenatal care visits and receipt of free supplements. Combined exposure to several of these factors was attributed to the consumption of an additional 46 IFA and 53 calcium tablets and 17% higher proportions of women consuming diverse diets. Our study shows that improving knowledge, self-efficacy and perceptions of social norms among pregnant women, and increasing husbands’ support, early registration in prenatal care, and provision of free supplements will largely improve maternal nutrition practices.

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“…Adherence to IFA is an important issue and has been difficult to achieve outside of clinical trials [13–22], not least because of the many operational problems that affect programmatic delivery. Women may also not like taking iron tablets because of gastro-intestinal side effects caused by daily iron [19].…”

Section: Introductionmentioning

confidence: 99%

“…Such lack of concern could also reflect a limited understanding of anemia and the important role of iron. Recent recommendations therefore encourage health providers to improve nutritional counselling [22]. …”

Section: Introductionmentioning

confidence: 99%

“There is Iron and Iron…” Burkinabè Women’s Perceptions of Iron Supplementation: A Qualitative Study

Compaoré

Gies

Brabin

et al. 2014

Matern Child Health J

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Objectives Most pregnant women in Burkina Faso are iron deficient and many are anemic. This study assessed women’s understanding of anemia and the role of iron in preventing and treating this condition. Methods A qualitative study was conducted within a randomized controlled trial of weekly iron supplementation in a rural malaria endemic area. Focus groups with women of similar age, parity, and marital status took place in 12 of 24 study villages. Two additional focus groups were conducted with female field workers. Tape-recorded transcripts were translated into French and analyzed using Framework analysis. Results Anemia, for which no Mooré term or traditional treatment for anemia was evident, was described in terms of blood volume. Moderate blood loss (diminished blood) could be easily replaced by eating well and was not considered serious. Massive blood loss (finished blood) was a rare, life-threatening illness. Iron tablets could increase blood volume and help women withstand massive blood loss at delivery, but for the latter, transfusion was indicated. Women had no knowledge of iron’s role and did not readily concede that iron supplements contained elemental iron. Neither adolescents nor field workers were convinced of the benefits of supplementing non-pregnant adolescents, who were incorrectly considered to be at low risk of anemia. Conclusions Young women’s knowledge of anemia did not provide an adequate explanatory framework to motivate anemia prevention. Improving information on the role of iron is especially important for adolescent girls who may be incorrectly considered at low risk of anemia as they have not yet experienced pregnancy.

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Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues

Abstract: Background. Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition.Objective.

Cited by 63 publications

References 62 publications

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

Factors influencing maternal nutrition practices in a large scale maternal, newborn and child health program in Bangladesh

“There is Iron and Iron…” Burkinabè Women’s Perceptions of Iron Supplementation: A Qualitative Study

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