The Impact of Antenatal Balanced Plate Nutrition Education for Pregnant Women on Birth Weight: A Cluster Randomised Controlled Trial in Rural Bangladesh

Effect of nutrition education integrating the health belief model and theory of planned behavior during pregnancy on gestational weight gain and birth weight in Southeast Ethiopia using complex analyses

BACKGROUND

The incidence of inadequate or excessive gestational weight gain (GWG) is an indicator of reproductive health problems. However, scientific evidence for the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Ethiopia is sparse. This study aimed to assess the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control) from February to December 2021. Study participants were selected by multistage cluster sampling followed by systematic sampling. Women receiving the intervention received six nutrition education sessions, while women in the control group received standard care. GWG was the difference between the last recorded weight before delivery and the weight recorded during the first trimester. BW was measured within the first hour of delivery. The generalized structural equations model (GSEM) and structural equations model (SEM) were used to examine the direct, indirect, and total effects of nutrition education on GWG and BW via the dietary diversity score (DDS), food security (FS), and knowledge.

RESULTS

The GSEM revealed that receiving intervention during pregnancy had a total effect on GWG [(AOR = 2.056, 95% CI: 1.705, 2.695)]. Having dietary diversity had direct and total effects on GWG [(AOR = 1.105, 95% CI: 1.022, 1.196)]. Having food security had a total effect on GWG [(AOR = 1.928, 95% CI: 1.817, 2.052)]. Having fruit and vegetable knowledge had a total effect on GWG [(AOR = 1.971, 95% CI: 1.856, 2.105)]. The SEM revealed that receiving intervention during pregnancy had a direct effect on BW (unstandardized β = 0.144, 95% CI: 0.034, 0.252). Similarly, it revealed that receiving intervention during pregnancy had a direct effect on DDS (β = 0.580, 95% CI: 0.024, 1.038). Likewise, it indicated that receiving intervention during pregnancy had a total effect on increasing BW (β = 0.137, 95% CI: 0.029, 0.243). Nevertheless, there was no statistically observed indirect effect of nutrition education during pregnancy on GWG and BW via mediators.

CONCLUSION

The SEM revealed that receiving nutrition education interventions during pregnancy had a total effect on GWG and direct and total effects on BW. The generalized structural equation modelling (GSEM) and structural equation modelling (SEM) findings show that integrating theory-based nutrition education during pregnancy will improve gestational weight gain (GWG) and birth weight (BW) in Ethiopia.

TRIAL REGISTRATION

The trial was registered on Pan African Clinical Trials Registry (PACTR202201731802989, retrospectively registered on 24/01/ 2022).

Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh

Background

Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity.

Methods

We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity.

Results

A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods.

Conclusions

Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh.

Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Space-time distribution of intestinal infectious diseases and their association with socioeconomic variables in Ecuador

Background

Intestinal infectious diseases are a global concern in terms of morbidity, and they are closely linked to socioeconomic variables such as quality of life, weather and access to healthcare services. Despite progress in spatial analysis tools and geographic information systems in epidemiology, studies in Ecuador that evaluate temporal trends, specific geographic groups, and their correlation with socioeconomic variables are lacking. The absence of such information makes it challenging to formulate public health policies. This study sought to identify the spatial and temporal patterns of these diseases in Ecuador, along with their correlation with socioeconomic variables.

Methods

In Ecuador, the study was carried out in a continental territory, focusing on data related to intestinal infectious diseases collected from the National Institute of Statistics and Census (Instituto Nacional de Estadística y Censos) during the period from 2014 to 2019. This study involved spatial and temporal analyses using tools such as the global Moran's index and Local Indicators of Spatial Association to identify spatial clustering patterns and autocorrelation. Additionally, correlations between morbidity rates and socioeconomic variables were examined.

Results

During the investigated period, Ecuador registered 209,668 cases of these diseases. Notable variations in case numbers were identified, with a 9.2% increase in 2019 compared to the previous year. The most impacted group was children under 5 years old, and the highest rates were centered in the southern and southwestern regions of the country, with Limón Indanza and Chunchi being the cantons with the highest rates, notably showing a significant increase in Limón Indanza. Additionally, there were significant correlations between morbidity rates and socioeconomic variables, school dropout rates, low birth weight, and access to water services.

Conclusion

This study emphasizes the importance of considering socioeconomic variables when addressing these diseases in Ecuador. Understanding these correlations and geospatial trends can guide the development of health policies and specific intervention programs to reduce the incidence in identified high-risk areas. More specific research is needed to understand the underlying causes of variability in morbidity and develop effective prevention strategies.

Effect of the enhancing nutrition and antenatal infection treatment (ENAT) intervention on birth weight in Ethiopia: a cluster randomized controlled trial

BACKGROUND

The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight (BW) by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight.

METHODS

We conducted a cluster randomized controlled trial of 22 clusters (health centers), randomized equally between 11 intervention and 11 control clusters. This study enrolled and followed pregnant women from ANC booking to the end of pregnancy or loss to follow-up. The primary outcome was mean BW, and the incidence of low birth weight (LBW) was the secondary outcome. We presented univariate comparisons of outcomes between the intervention and control arms for mean BW and LBW. Multilevel analyses using random effects models were performed to adjust for clustering and individual-level covariates.

RESULTS

We enrolled and followed up 4,868 and 4,821 pregnant women in the intervention and control arms, respectively, from March 2021-July 2022. During follow-up, 3445 pregnant women in the intervention and 3192 in the control delivered in the health centers, and BW measurements of their babies were recorded within 48 h. The mean BW was 3,152 g (standard deviation (SD) = 339.8 g) in the intervention and 3,044 g (SD = 353.8 g) in the control arms (mean difference, 108 g; 95% confidence interval (CI): 91.3-124.6; P = 0.000). Adjusting for clustering and several covariates, the mean BW remained significantly higher in the intervention arm than in the control arm (adjusted ß coef., 114.3; p = 0.011). The incidence of LBW was 4.7% and 7.3% in the intervention and control arms, respectively. The adjusted risk of LBW was significantly lower by 36% in the intervention arm than in the control arm (adjusted relative risk, 0.645; p = 0.027).

CONCLUSION

This study provided sufficient evidence of the effectiveness of the ENAT intervention in improving birth weight in the study population. The intervention demonstrated that an increase in birth weight can be attained by availing point-of-care testing, strengthening infection prevention, and maternal nutrition within the ANC platform of public health facilities in a low-income setting.

TRIAL REGISTRATION

Registered at Pan African Clinical Trial Registry (PACTR) database dated 09/05/2023, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25493 . The unique identification number for the registry is PACTR202305694761480.