Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial

Abstract

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).

Dietary Diversity Among Pregnant Women in Gurage Zone, South Central Ethiopia: Assessment Based on Longitudinal Repeated Measurement

“…Women having nutrition-related education were less likely to have sub-optimal dietary diversity in comparison to those who did not get information. Similar findings had been reported from Malawi, 39 Ghana, 40 and from the Southwest and Northwest regions of Ethiopia. 41 , 42 Improvement in nutritional knowledge improves dietary practice, which favors dietary diversity.…”

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: a systematic review

“…The 71 articles were published between 2004-2022 and included cluster randomised control trials (RCT)(n=38) (20, 39–75) , study evaluations(n=13) (52, 56, 68, 76–86) , quantitative studies(n=11) (87–100) , mixed methods studies(n=5) (88, 89, 101–103) , qualitative studies(n=3) (104–106) , and national case studies(n=2) (107, 108) . Behaviour change interventions were identified from 18 sub-Saharan African countries: Ethiopia(n=18) (42, 58, 59, 62, 64, 67, 68, 70, 79–81, 92–95, 100) , South Africa(n=8) (40, 41, 45, 46, 66, 87–89) , Malawi(n=8) (43, 44, 71, 77, 78, 82, 85, 106) , Kenya(n=5) (39, 96, 101, 102, 104) , Burundi(n=5) (48–52) , Nigeria(n=5) (73, 90, 97, 99, 105) , Burkina Faso(n=5) (48, 54, 56, 74, 109) , Ghana(n=4) (84, 91, 108) , Madagascar(n=2) (20, 75) , Zambia(n=2) (83, 110) ,Tanzania(n=2) (47, 72) and one each from, Central African Republic (107) , Mali (63) , Mozambique (65) , Rwanda (69) , Senegal (103) , Togo (61) , and Uganda (53) . A total of 30 studies were graded as low risk of bias, 30 as medium, and 11 as high (Table 2) .…”

“…Two interventions, graded as medium-high quality and based on nutrition education, found no significant changes in the nutrient intake of children in Malawi and South Africa (44, 88, 89) . Yet one RCT rated as medium-quality found significant infant dietary diversity improvement with a combined nutrition education and counselling approach in Malawi (71) . Three low quality lipid supplementation studies with behaviour change communication found no impact on maternal haemoglobin concentration and anaemia in Malawi (77, 78, 82) .…”

“…Interventions aimed to address psychosocial outcomes including nutrition knowledge (n=17) (40–42, 44–46, 58, 61, 71, 73, 84, 90, 94, 96, 97, 103, 104) , practices (e.g. food/recipes preparation, healthy eating)(n=5) (42, 90, 94, 96, 98) , attitudes (n=6) (42, 45, 46, 62, 90, 94) , intentions (n=4) (45, 46, 62, 99) and confidence in eating healthy food (n=1) (104) .…”

“…(28) . Functions (Appendix C) included education(n=51) (20, 39–41, 44–47, 49, 51–54, 56, 58, 69–75, 79–81, 83–89, 91, 92, 95, 97–102, 105–109, 111) , enablement(n=50) (20, 39, 44–47, 49, 51–54, 56, 59–71, 74–83, 85, 87–90, 93, 94, 97–99, 103–105, 108–111) , persuasion(n=38) (39, 49, 51, 52, 54, 56, 60–64, 67–72, 74, 76–78, 82, 83, 86, 96–98, 100, 103, 108–111) , training(n=36) (20, 39–42, 45–47, 54, 56, 59, 61, 65, 66, 69, 70, 72, 74, 75, 77, 78, 82, 84, 87, 90–94, 99, 101–105,…”