Browsing by Author "Menon, Purnima"

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Engagement of husbands in a maternal nutrition program substantially contributed to greater intake of micronutrient supplements and dietary diversity during pregnancy: Results of a cluster-randomized program evaluation in Bangladesh
(Oxford Academic, 8/1/2018) Nguyen, Phuong Hong; Frongillo, Edward A; Sanghvi, Tina; Wable, Gargi; Mahmud, Zeba; Tran, Lan Mai; Aktar, Bachera; Afsana, Kaosar; Alayon, Silvia; Ruel, Marie T; Menon, Purnima
Background: Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands' engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh. Objectives: We evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands' behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women's supplement intake and dietary diversity was explained by husbands' behavioral determinants and support. Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n = ∼1000 women and ∼700 husbands/survey). We used mixed linear regression accounting for clustering to estimate difference-in-differences (DIDs) for impact on husbands' behavioral determinants and path analysis to examine how much these determinants explained the impact on women's nutrition behaviors. Results: Of husbands in the nutrition-focused MNCH group, 62% were counseled by health workers, 66% attended a husbands' forum, and 34% saw video shows. The nutrition-focused MNCH, compared with the standard MNCH group, resulted in greater husbands' awareness (DID: 2.74 of 10 points), knowledge (DID: 1.31), self-efficacy and social norms with regard to optimal nutrition practices (difference: 1.08), and support to their wives (DID: 1.86). Husbands' behavioral determinants and support explained nearly half of the program impact for maternal supplement intake and one-quarter for dietary diversity. Conclusions: A nutrition-focused MNCH program that promoted and facilitated husbands' engagement during their wives' pregnancies significantly improved husbands' awareness, knowledge, self-efficacy, and support. These improvements substantially explained the program's impact on women's intake of micronutrient supplements and dietary diversity. Targeting wives and husbands and designing activities to engage men in maternal nutrition programs are important to maximize impact. This trial was registered at www.clinicaltrials.gov as NCT02745249.
How has early marriage, a critical social determinant of child stunting and wasting, changed over a decade in South Asia? trends, inequities and drivers, 2005 to 2018
(Oxford Academic, 5/29/2020) Scott, Samuel; Nguyen, Phuong; Neupane, Sumanta; Pramanik, Priyanjana; Nanda, Priya; Menon, Purnima; Bhutta, Zulfiqar; Afsana, Kaosar
Objectives: In South Asia, many women are married before their 18th birthday and give birth soon after. Delaying marriage is an attractive nutrition policy target as previous research shows that early marriage (EM) is associated with poor child growth outcomes, operating through many pathways. We sought to describe the prevalence, trends, inequities and predictors of EM in South Asia. Methods We used Demographic and Health Survey data available in the last 15 years for 7 South Asian countries: Afghanistan (AF; 2015), Bangladesh (BG; 2007, 2014), India (IN; 2006, 2016), Maldives (MV; 2009, 2017), Nepal (NP; 2005, 2016), and Pakistan (PK; 2007, 2018). EM was defined as the percentage of women aged 20–24 years who were married before 18 years of age. Our analyses included 133,680 women. The prevalence and absolute burden in terms of number of individuals affected were estimated for each survey round. Relative trends were examined using average annual rate of reduction (AARR). Inequities were examined by geography, wealth, place of residence, and education. Regression decomposition was used to examine the contribution of improvements in wealth and education to EM reductions. Results The most recent rounds of data show that EM is common in BG (69%), AF (52%), NP (52%), IN (41%), and PK (37%) but not MV (4%). IN accounts for 68% of the regional burden, with 21.9 million women married early in 2016. The fastest reductions in EM have occurred in IN (59% to 41% over 10 years, an AARR of −3.8% per year), PK (−2.8% per year), and BG (−1.5% per year). EM prevalence varies subnationally, e.g., from 5% to 52% for states within IN in 2016. Equity analysis shows that EM disproportionately burdens women who are poor, uneducated, and live in rural areas. Progress in narrowing these inequalities has been slow in the past decade. When examining predictors of EM, completion of secondary school was associated with a 20% (PK) to 36% (NP) lower EM prevalence. Decomposition analysis shows that improvements in wealth and education alone predicted between 46% (PK) and 96% (NP) of the actual EM reduction. Conclusions EM remains highly prevalent in South Asia and trends indicate an enduring problem. The nutrition community should invest in building linkages with researchers and practitioners to further understand and address this important social determinant of poor child growth.
Importance of coverage and quality for impact of nutrition interventions delivered through an existing health programme in Bangladesh
(Wiley Online Library, 2018-10) Nguyen, Phuong Hong; Frongillo, Edward A.; Sanghvi, Tina; Kim, Sunny S.; Alayon, Silvia; Tran, Lan Mai; Mahmud, Zeba; Aktar, Bachera; Menon, Purnima
Understanding implementation of interventions is critical to illuminate if, how, and why the interventions achieve impact. Alive & Thrive integrated a nutrition intervention into an existing maternal, neonatal, and child health (MNCH) programme in Bangladesh, documenting improvements in women's micronutrient supplement intake and dietary diversity. Here, we examined how well the nutrition intervention was implemented and which elements of implementation explained intervention impact. Survey data were collected in 2015 and 2016 from frontline health workers (FLW) and households in areas randomized to nutrition‐focused MNCH (intensified interpersonal counselling, community mobilization, distribution of free micronutrient supplements, and weight‐gain monitoring) or standard MNCH (antenatal care with standard nutrition counselling). Seven intervention elements were measured: time commitment, training quality, knowledge, coverage, counselling quality, supervision, and incentives. Multiple regression was used to derive difference‐in‐differences (DID) estimates. Using village‐level endline data, path analysis was used to determine which elements most explained intervention impacts. FLWs in both areas were highly committed and well supervised. Coverage was high (>90%) for counselling, supplement provision, and weight‐gain monitoring. Improvements were significantly greater for nutrition‐focused MNCH, versus standard MNCH, for training quality (DID: 2.42 points of 10), knowledge (DID: 1.20 points), delivery coverage (DID: 4.16 points), and counselling quality (DID: 1.60 points). Impact was substantially explained by coverage and delivery quality. In conclusion, integration nutrition intervention into the MNCH programme was feasible and well‐implemented. Although differences in coverage and counselling quality most explained impacts, all intervention elements—particularly FLW training and performance—were likely important to achieving impact.
Nutrition interventions integrated into an existing maternal, neonatal, and child health program reduce food insecurity among recently delivered and pregnant women in Bangladesh.
(Oxford Academic, 1/13/2019) Frongillo, Edward A; Nguyen, Phuong H; Sanghvi, Tina; Mahmud, Zeba; Aktar, Bachera; Alayon, Silvia; Menon, Purnima
Background: Antenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods. Objective: With the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity. Methods: Alive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline. Results: At baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline. Conclusions: Participation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249. J Nutr 2019;149:159–166.
Why are adolescent mothers more likely to have stunted and underweight children than adult mothers? A path analysis using data from 30,000 Bangladeshi mothers, 1996–2014
(Oxford Academic, 5/29/2020) Nguyen, Phuong; Scott, Samuel; Khuong, Long; Pramanik, Priyanjana; Ahmed, Akhter; Afsana, Kaosar; Menon, Purnima
Objectives: Adolescent pregnancy is a major global concern due to its adverse effects on maternal and child health and wellbeing. Bangladesh has one of the highest rates of adolescent pregnancy globally. We sought to examine trends in adolescent pregnancy and associated factors in Bangladesh in the last two decades, and to understand why children of adolescent mothers are at high risk of poor growth. Methods Data were from 6 rounds of Bangladesh Demographic and Health Survey (1996–2014). Women aged 15–49 years who gave birth in the 5 years preceding each survey (n = 30,331) were classified based on age at first birth: ≤19 years (adolescence), 20–24 years (young adulthood), and ≥25 years (adulthood). Trend analysis was used to assess the progress over time. Multivariable regression and structural equation models were used to understand how adolescent pregnancy is linked to child undernutrition through maternal nutritional status, education and bargaining power, health service use, child feeding and living conditions. Results Adolescent pregnancy has declined slowly, from 84% in 1996 to 73% in 2014. Children born to adolescent mothers had lower z-scores for height-for-age (mean difference: −0·64 SD), weight-for-age (−0·45 SD), and higher prevalence of stunting (18 percentage points [pp]) and underweight (12pp) than children born to adult mothers. Compared to adult mothers, adolescent mothers were shorter (−0·8 cm), lighter (−6.9 kg), more likely to be underweight (+14pp), had lower education (−4·3 years), less decision-making power (−9pp), and lived in poorer households (−0·79 SD) with poorer sanitation (−23pp) (all P < 0.05). Adolescent mothers were less likely to access ANC (−20pp), institutional delivery (−42pp), postnatal care services (−24pp) and had poorer complementary feeding practices (−15pp). In path analyses, these intermediate factors explained 66% of the association between adolescent pregnancy and child anthropometry, with the strongest links being through women's weight, education, socioeconomic status and complementary feeding practices. Conclusions Adolescent pregnancy is still the norm in Bangladesh. Policies and programs to address poverty and improve women's education can help to improve women's health, reduce early childbearing and break the intergenerational cycle of poverty and undernutrition.