Effect of integrated nutrition‐sensitive and nutrition‐specific intervention package on maternal malnutrition among pregnant women in Rwanda

Abstract

Maternal undernutrition remains a major public health concern in Rwanda despite significant gains and progress. An integration of nutrition‐specific and nutrition‐sensitive interventions was implemented in five districts of Rwanda to improve maternal and child nutrition. The package included nutrition education and counselling, promotion of agricultural productivity, promotion of financial literacy/economic resilience and provision of Water, Hygiene and Sanitation services. However, there is limited evidence about the effect of such interventions in reducing maternal undernutrition. A postintervention quasi‐experimental study was conducted among pregnant women to determine the effect of the integrated intervention on their nutritional status. It was carried out in two intervention districts, namely Kicukiro and Kayonza, and two control districts, namely Gasabo and Gisagara between November 2020 and June 2021. Five hundred and fifty‐two women were recruited for the intervention arm, while 545 were recruited for the control arm. Maternal undernutrition was defined as either having low mid‐upper arm circumference (<23 cm) during delivery or low body mass index (<18.5 kg/m2) in the first trimester or both. A multivariable logistic regression model was used to assess the effect of the integrated interventions. The prevalence of maternal undernutrition was significantly lower in the intervention group compared with the control group (4.7% vs. 18.2%; p < 0.001). After controlling the potential confounders, the risk of maternal undernutrition was 77.0% lower in the intervention group than in the control group [adjusted odds ratio= 0.23; 95% confidence interval = 0.15–0.36; p < 0.001]. Further studies are therefore recommended to establish causation and inform the potential scale‐up of these interventions nationally in Rwanda.

Effect of nutrition assessment, counselling and support integration on mother- infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non equivalent quasi experimental study

“…Studies by Michael Habtu et al [32], Sunita Taneja et al [7], Melesse Kuma et al [33] revealed elevated haemoglobin levels among women in the intervention group, findings that our study was unable to replicate due to the constraints related to equipment and supplies.…”

“…However, it is worth noting that the effect of iron/folic acid supplementation on haemoglobin levels in both settings could not be assessed in both settings due to lack of equipment and supplies. Studies by Michael Habtu et al [32], Sunita Taneja et al [7], Melesse Kuma et al [33] revealed elevated haemoglobin levels among women in the intervention group, findings that our study was unable to replicate due to the constraints related to equipment and supplies.…”

Effect and Challenges of an Integrated Nutrition-Intervention Package Utilization among Pregnant Women and Lactating Mothers in Rwanda: An Exploratory Qualitative Study

“…All these improved knowledge and skills; in addition, a changed positive mindset regarding nutrition and women empowerment could have affected on the perceived improved nutritional status by addressing both immediate and underlying causes of malnutrition as highly expressed by many of the key informants and FGDs participants in the study. This is supported by quasi-experimental studies conducted by the same authors, which found that the Gikuriro intervention was associated with a significant reduction of low birth weight and maternal undernutrition [ 12 , 13 ].…”

“…Recent quantitative studies have been performed to evaluate the effect of the Gikuriro program on maternal nutritional status and birth weight. Both postprogram quasi-experiments revealed that the intervention led to significant reduction of low birth weight and maternal undernutrition [ 12 , 13 ]. The main success factor having been attributed to the integration of nutrition-specific and nutrition-sensitive intervention package.…”

Effect of Social and Behavioral Change interventions on improving minimum dietary diversity among pregnant women and associated socio-economic inequality to improve nutrition outcomes in Rajasthan, India.

“…These follow a pathway to enhance calorie consumption and micronutrient intakes that, in turn, affect maternal health outcomes (18). Together, nutrition-speci c interventions such as counselling -behavioural change interventions and education/ awareness and nutrition-sensitive interventions -cash incentives have compounding effect on the maternal dietary diversity compared to a speci c intervention (19). However, pathways determining the change across population groups have been a contesting topic.…”