Integrating Nutrition‐focused Behavior Change Communication and Community Mobilization into Existing Maternal, Neonatal and Child Health Platform Improved Consumption of Diversified Foods and Micronutrients and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster‐randomized Program Evaluation
Authors: Nguyen Phuong , Sanghvi Tina , Mahmud Zeba , Tran Lan , Shabnam Sadia , Aktar Bachera , Afsana Kaosar , Frongillo Edward , Ruel Marie , Menon Purnima 
Published: November 2023

Background

Maternal undernutrition is a significant public health concern globally, contributing to poor fetal and early childhood growth and increased infant morbidity and mortality, with long‐term adverse consequences for child development and lifelong health. Limited evidence exists, however, on delivering multiple interventions for maternal nutrition. Alive & Thrive aimed to address this gap through integrating nutrition‐focused behavior change communication addressing dietary practices, micronutrient supplementation, weight gain, and rest during pregnancy. Intervention components included interpersonal counseling (IPC), community mobilization (CM), and provision of free micronutrient supplements through an existing Maternal, Neonatal and Child Health (MNCH) platform implemented by BRAC, a large non‐governmental organization in Bangladesh.

Methods

We evaluated the impact of providing intensified IPC + CM (intensive) compared to standard nutrition counseling (non‐intensive) on consumption of diversified foods and micronutrient supplements (iron folic acid – IFA and calcium) and early breastfeeding (BF) practices using a cluster‐randomized design. We used cross‐sectional surveys at baseline (2015) and at endline (2016) [n~300 and 1,000 pregnant or recently delivered women per group, respectively]. We derived difference‐in‐difference impact estimates (DDE), adjusted for geographic clustering, infant age, and gender (for BF outcomes).

Results

Groups were similar at baseline. Improvements were significantly greater in the intensive, compared to non‐intensive group, for maternal dietary diversity (DDE were 1.6 for number of food consumed and 30.0 percentage points (pp) for achieving recommended 5 food groups). Significant impacts were also observed for proportion of ever consumed IFA (DDE: 9.8pp) and calcium supplements (DDE 12.8pp) and for number IFA (DDE: 46 tablets) and calcium (DDE: 50 tablets) consumed. Greater improvements in the intensive, compared to non‐intensive group, were seen for exclusive BF (DDE 34.8 pp), but no change was observed for early initiation of BF. The coverage of IPC was high; >90% of mothers in intensive group were visited at home by frontline health workers with high frequency and exposed to maternal nutrition and BF counseling. The coverage of CM was ~50%.

Conclusions

An intensified IPC and CM intervention addressing multiple dimensions of nutrition during pregnancy and delivered through an existing MNCH platform significantly improved multiple outcomes such as maternal dietary diversity, micronutrient supplement consumption, and exclusive BF practices, but not early initiation of BF.

Support or Funding Information

Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360; CGIAR Research Program on Agriculture for Nutrition and Health, led by IFPRI.