Mainstreaming and Scaling Up Nutrition Best Practices in a Nation-Wide Primary Healthcare Model of Bangladesh: Implementation Lessons Learned

Abstract

Objectives The objective of the implementation research was to evaluate the effectiveness of a maternal and child nutrition-focused multi-component intervention, and assess the feasibility of incorporating it into an existing PHC program. Methods A cluster randomized impact evaluation compared the impact in terms of coverage of intervention, consumption of diversified foods and macro- and micronutrients during pregnancy, and early breastfeeding practices. A similar study was conducted among pregnant (n = 600) and recently delivered women (n = 2000) which examined factors influencing maternal nutrition practices. Cross-sectional surveys (2015 & 2016) were (n = 1000 women & 700 husbands) conducted to document the impact of husbands’ support on women’s supplement intake and dietary diversity. Three subsequent cross-sectional studies (2013, 2014 & 2015) were conducted to evaluate the impact of a large scale SBCC program aimed at maternal dietary behavior and IYCF practices. A cRCT among 900 pregnant women assessed the relationship between maternal nutrition education and infant birthweight. Results Results showed that 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 (β 31.9, 95% CI: 20.9, 43.0) and diverse diet (OR = 1.8, 95% CI: 1.0 ± 3.1). The mean dietary diversity score of pregnant women increased from 4.28 + 1.08 to 4.76 + 1.16. About 83% of the respondents-initiated breastfeeding within an hour of childbirth, which was 62% at baseline. Less than a fifth (18%) of the children were eating a minimally acceptable diet at baseline, which reached to 52% by endline. Study showed that husbands support played a critical role for the women to increase supplement intake and dietary diversity. Nutrition counselling during pregnancy increased mean birthweight by 127.5 g (95% CI: 11.1 to 243.9; P = 0.032) and the risk of LBW was reduced by 54% (relative risk (RR): 0.43; 95% CI: 0.25 to 0.75; P = 0.003). Conclusions Integration of nutrition intervention into the existing health programme was feasible and well-implemented. Although differences in coverage and counselling quality most explained most impacts, all intervention elements particularly CHW training and performance were likely important to achieving impact. Funding Sources BRAC.