Assessing the Feasibility of Integrating Maternal Nutrition Interventions Into an Existing MNCH Platform in Bangladesh
Condition: Poor Fetal Growth; Small-for-gestational Age; Premature Birth
MeSH terms: Premature Birth; Fetal Growth Retardation
Study type: Interventional

Summary: 
      Inadequate maternal nutrition is likely to undermine the potential impact of infant and young
      child feeding (IYCF) improvements made in the Alive & Thrive (A&T) first phase because it is
      linked to poor fetal growth leading to small-for-gestational age and pre-term newborns. These
      babies do not respond to growth promoting feeding practices as well as normal newborns do. In
      Phase 2, Alive & Thrive decided to focus on integrating a package of maternal nutrition
      interventions in a large-scale maternal, newborn and child health program (MNCH). This
      proposed evaluation aims to assess the feasibility of integrating maternal nutrition
      interventions into an existing MNCH platform in Bangladesh, using a cluster-randomized
      evaluation design.
    

Detailed description: 
      Inadequate maternal nutrition is likely to undermine the potential impact of IYCF
      improvements made in the Alive & Thrive (A&T) first phase because it is linked to poor fetal
      growth leading to small-for-gestational age and pre-term newborns. These babies do not
      respond to growth promoting feeding practices as well as normal newborns do (WHO Healthy
      Growth project). In a study of 16,290 singleton infants born in rural Bangladesh from 2004 to
      2007, more than 50% were born with low birth-weight. Low birth-weight is a risk factor for
      neonatal deaths, estimated to be 37 per 1,000 live births in Bangladesh. Factors associated
      with low birth-weight include young maternal age, poor pre-pregnant nutritional status, short
      birth intervals, poor maternal dietary intake (quality, quantity, and diversity), and
      inadequate pregnancy weight gain. Better maternal nutrition will improve maternal and newborn
      outcomes and facilitate achievement of a continuum of good nutrition.

      In setting its country program goal for Bangladesh in phase 2, Alive & Thrive decided to
      focus on demonstrating the feasibility of integrating a package of maternal nutrition
      interventions in a large-scale MNCH program. Maternal nutrition should receive equal priority
      as child nutrition and the A&T program of BRAC already has developed an effective strategy
      though improving IYCF practices. MNCH programs offer the best opportunity for achieving large
      scale and sustainability. The GOB also promotes mainstreaming of nutrition intervention in
      health services. Considering the behavior change focus of the Alive & Thrive strategy,
      efforts will concentrate on improving dietary practices, specifically, improved diversity of
      foods and energy intakes of pregnant women, and improve the intake of calcium and iron/folic
      acid supplements. BRAC's supply system will be used to ensure access to calcium and
      iron/folic acid supplements. The current Government of Bangladesh guidelines of supplementing
      pregnant women with iron and folic acid and calcium, taken with food (to minimize adverse
      effects) would be a focus of behavior change interventions.

      The primary objectives of the proposed evaluation are to answer the following questions using
      a cluster-randomized evaluation design:

        -  Can the coverage and utilization of key maternal nutrition interventions be improved
           equitably by integrating nutrition-focused BCC and community mobilization into BRAC's
           rural MNCH program?

        -  What factors affect high quality integration of nutrition interventions into a
           well-established MNCH program platform?

      Secondary objectives are to examine the following question:

      • Can an intensive, formative-research based BCC intervention for maternal nutrition improve
      the quality of diets of pregnant women in rural Bangladesh and facilitate better early
      breastfeeding practices than via routine MNCH services?
    

Intervention name(s): Maternal Nutrition Behavior change
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention