Delivering an Integrated Package of Maternal Nutrition Services in Andhra Pradesh and Telangana (India)

Abstract

Background: Maternal spot feeding programs operational in southern Indian States are providing a package of nutrition services (food, micronutrient supplementation, deworming, gestation weight gain monitoring, and fortnightly nutrition health education) to pregnant women. These remain to be evaluated. Objective: We evaluated the maternal spot feeding programs in 2 Southern Indian states. Methods: Study design was cross-sectional entailing primary data collection (July to November 2016) on 360 pregnant and lactating women (of infants aged 0-6 months) per state and a review of the scheme’s management information system (MIS) beneficiaries’ records for the time period April 2014 to August 2017. To gain program functioning insights, open-ended interviews (n = 252) with state, district, and block program managers a state-level open space technology workshop was conducted. Results: Average days of meal consumption ranged from 19 to 21 days per month; spot meal enhanced high dietary diversity (≥6 food groups; 57%-59%) and consumption of eggs and milk (74%-96%) among pregnant and lactating women. On-the-spot consumption of iron, folic acid, calcium, and deworming was 18%, 87%, and 56%, respectively; 94% attended at least 1 of the 2 nutrition monthly counseling sessions. Majority (68%) of the beneficiaries were motivated to enroll by self-help groups or family members, suggesting the crucial persuasive role of peers and family members. Conclusion: Maternal spot feeding schemes can potentially deliver nutrition interventions outlined in the World Health Organization antenatal care guidelines 2016 for a positive pregnancy outcome. Research on schemes’ impact on birth outcomes, maternal depression, social norms, and its cost-effectiveness is needed.

Maternal Diets in India: Gaps, Barriers, and Opportunities

“…The review identified three studies on hot cooked meals, which found some improvements in the proportion of women consuming diverse diets post-intervention (~60%), consumption of specific food groups (eggs and milk—74% to 96%), and energy and protein intake among pregnant women [ 45 , 46 , 47 ]. However, several implementation issues were noted, including lower distribution of foods and fewer feeding days compared with the program protocol.…”

Screening and management options for severe thinness during pregnancy in India

“…WHO recommended the development of country‐specific cutoffs for MUAC 45 . A review of Indian studies on pregnant and nonpregnant women suggests MUAC <23 and <21 cm or <19 cm correlates with thinness (any form) and moderate to severe thinness, respectively 50,51 . This corresponds with guidance from the Government of India (GoI) by including guidelines on the management of undernutrition in pregnant women affected by tuberculosis 23,52 .…”

Can Anganwadi services strengthening improve the association between maternal and child dietary diversity? Evidence from Project Spotlight implemented in tribal dominated Gadchiroli and Chandrapur districts of Maharashtra, India

“…For instance, some states in India such as Andhra Pradesh, Karnataka, Telangana, Gujarat and Maharashtra have launched hot cooked meal schemes (One Full Meal) to promote maternal dietary diversity and nutritional intake [ 33 ]. These schemes are found to have considerable impact on the maternal nutrition [ 34 ]. The low-income communities can benefit from such initiatives as they are more regular in utilization of ICDS services during the first 1000 days and beyond [ 23 ].…”