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

PLoS ONE

Jul 2017

DOI: 10.1371/journal.pone.0179873

Citations:114

Influential Citations:12

Observational Studies (Human)

Enhanced Details

Methods

Baseline cross-sectional household survey (2015) in BRAC MNCH program areas; participants included 600 pregnant women and 2,000 recently delivered women (ages 13–44; mean age ≈24); all female; structured interviews; multivariate linear and logistic regression used to examine determinants of total IFA tablets consumed, total calcium tablets consumed, and dietary diversity.

Intervention

IFA tablets: 60 mg iron + 400 micrograms folic acid per tablet; ~180 tablets (6 months) during pregnancy; daily intake; provided through MNCH program (free IFA via government clinics). Calcium tablets: 500 mg per tablet; ~180 tablets (6 months) during pregnancy; daily intake; lower dosage in MNCH program; provided through MNCH program (some free).

Results

Knowledge of IFA/calcium, self-efficacy, and perceived social norms were strongly associated with higher consumption of both supplements and with dietary diversity. Husband’s support and support from other family members also linked to higher intake and diversity. Early enrollment in prenatal care and higher total prenatal visits were associated with higher supplement consumption. Receiving free supplements related to higher intake. Under combined exposure to modifiable factors, women would consume an additional 46 IFA tablets and 53 calcium tablets, on top of the current mean of 94 IFA and 82 calcium tablets (total ~140 IFA and ~137 calcium). About 17% more pregnant women would achieve dietary diversity. Conclusion: Strengthening knowledge, self-efficacy, and social norms among pregnant women; increasing husbands’ and families’ support; ensuring early prenatal care enrollment; and providing free supplements could largely improve maternal nutrition practices within MNCH programs.

Limitations

Cross-sectional design; reliance on self-reported intake with potential recall and social desirability bias; results may not generalize beyond BRAC MNCH program areas; causality cannot be inferred.

Abstract

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. show less