Dietary intake and processes of behaviour change in a nutrition education intervention for pregnant women in rural Malawi: a cluster-randomised controlled trial
Abstract:Objective:
To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour.
Design:
We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the inte… Show more
“…Pregnant women who received theory-based nutrition education had higher dietary diversity scores compared with the control group. Similar findings were reported from a study in Malawi and Ethiopia in which the intervention groups had higher DDS (Demilew et al, 2020a;Ziyenda Katenga-Kaunda et al, 2020). This implies that theory-based nutrition education promotes healthy dietary behaviours.…”
Maternal undernutrition is a major public health problem that disproportionately affects women in low‐income countries. Despite attempts to address maternal nutritional needs, Ethiopia still has a high rate of undernutrition. Hence, this study aimed to evaluate the effect of theory‐based nutrition education through male engagement on dietary practice and the nutritional status of pregnant women. A pretest−posttest quasi‐experimental study was conducted among 403 pregnant women selected from 22 kebeles of Illu Aba Bor zone, Southwest Ethiopia from July to December 2019. A pre‐tested, structured interviewer‐administered questionnaire was used for data collection. A qualitative 24‐h dietary recall was used to assess dietary diversity, and the Mid‐Upper Arm Circumference was used to assess nutritional status. The intervention effect was evaluated using difference‐in‐difference, generalized estimating equation, and linear mixed‐effects models. The mean dietary diversity score differed significantly between the couple group, women‐alone and the control group (p < 0.001). According to the multivariable generalized estimating equations model, couples were 3.9 times; adjusted odds ratio (AOR) = 3.91, 95% CI: (2.57, 6.88) and women alone were 2.8 times; AOR = 2.86, 95% CI: (2.17, 3.88) more likely to consume a diverse diet than the control group. The nutritional status of the women in the couple group improved significantly by the end of the intervention (p < 0.001). This study showed that involving males in nutrition education intervention was effective in improving the dietary diversity practice and nutritional status of pregnant women. The findings imply the need for targeting couples in designing nutrition education interventions.
“…Pregnant women who received theory-based nutrition education had higher dietary diversity scores compared with the control group. Similar findings were reported from a study in Malawi and Ethiopia in which the intervention groups had higher DDS (Demilew et al, 2020a;Ziyenda Katenga-Kaunda et al, 2020). This implies that theory-based nutrition education promotes healthy dietary behaviours.…”
Maternal undernutrition is a major public health problem that disproportionately affects women in low‐income countries. Despite attempts to address maternal nutritional needs, Ethiopia still has a high rate of undernutrition. Hence, this study aimed to evaluate the effect of theory‐based nutrition education through male engagement on dietary practice and the nutritional status of pregnant women. A pretest−posttest quasi‐experimental study was conducted among 403 pregnant women selected from 22 kebeles of Illu Aba Bor zone, Southwest Ethiopia from July to December 2019. A pre‐tested, structured interviewer‐administered questionnaire was used for data collection. A qualitative 24‐h dietary recall was used to assess dietary diversity, and the Mid‐Upper Arm Circumference was used to assess nutritional status. The intervention effect was evaluated using difference‐in‐difference, generalized estimating equation, and linear mixed‐effects models. The mean dietary diversity score differed significantly between the couple group, women‐alone and the control group (p < 0.001). According to the multivariable generalized estimating equations model, couples were 3.9 times; adjusted odds ratio (AOR) = 3.91, 95% CI: (2.57, 6.88) and women alone were 2.8 times; AOR = 2.86, 95% CI: (2.17, 3.88) more likely to consume a diverse diet than the control group. The nutritional status of the women in the couple group improved significantly by the end of the intervention (p < 0.001). This study showed that involving males in nutrition education intervention was effective in improving the dietary diversity practice and nutritional status of pregnant women. The findings imply the need for targeting couples in designing nutrition education interventions.
“…The nutrition education offered is based on the National Nutrition Guidelines [ 33 ], which note that during pregnancy, women should eat meals containing ingredients from each of the SFG and eat two extra meals per day. The SFG dietary guideline is easy to apply in a low-resource settings and its rating corresponds to the MDD-W rating in terms of dietary adequacy [ 20 ].…”
Section: Discussionmentioning
confidence: 99%
“…We included pregnant women attending ANC from Monkebay, Namkhumba, Malembo and Nkope health centres. The population of the area is about 150,000 and the inhabitants' livelihood is mainly fishing or farming (depending on geographical location) [ 20 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Each counsellor was expected to support up to twenty women within walking distance from the counsellor’s home. More information regarding delivery of the intervention has been previously described [ 20 ]. No intervention-related harm was detected.…”
Background
In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women.
Methods
We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables.
Results
Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group.
Conclusions
Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting.
Trial registration
Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).
“…Women carrying multiple fetuses and those with severe illnesses were excluded from the study. A more detailed description of the design of the RCT and participant recruitment has recently been published (32) .…”
Objective:
We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change.
Design:
We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence.
Setting:
Mangochi district in rural Malawi.
Participants:
We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors.
Results:
The participants’ experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods.
Conclusions:
Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393.
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