Maternal and infant nutrition

Maternal nutrition represents the greatest influence among environmental factors on birth size in low income countries. Mapping dietary intake deficiencies and patterns can offer a basis for developing effective but still feasible and culturally sensitive food based recommendations.

A community volunteer offering nutrition counselling during a home visit in Malawi

A community volunteer offering nutrition counselling during a home visit. Photo. Penjani Rhoda Kamudoni

About the project

A research project is currently underway where a food based intervention for pregnant women has been developed and is further being investigated in a cluster randomized controlled trial to assess its effectiveness in improving infant birth size.

The trial was preceded by cross-sectional surveys which examined dietary intakes during pregnancy. Through optimization modeling frequently eaten foods which could be increased and meet the gaps in nutrient intakes were identified. Recipe and food intake recommendations which maximize the intake of these foods were developed. And these are being promoted to pregnant women as an educational intervention. The intervention is being offered by female community volunteers through both cooking demonstrations as well as individual counselling sessions by means of home visits.

Objectives

  1. To examine the adequacy of dietary intakes during pregnancy in Mangochi, Malawi
  2. To measure the association between pregnancy dietary intake and infant birthsize
  3. To investigate food beliefs and taboos among pregnant women in Mangochi, Malawi
  4. To measure the effect of dietary counselling offered during pregnancy on pregnancy weight gain, dietary intake , nutritional knowledge and infant birthsize
  5. To evaluate the process of delivering nutrition education through community volunteers

Outcomes

Studies on measuring pregnancy dietary intakes and assessing its adequacy; and investigating food beliefs have been undertaken. Results show that intakes of all nutrients were below the required intakes during both the harvesting season when food is abundant as well as the planting season when food is somewhat harder to find. However, increasing intakes of a few locally foods: whole maize, beans, small bony fishes and green leafy vegetables, papaya and mangoes, in addition to taking pregnancy Iron supplements, would fully meet the requirement for most nutrients and still increase their intakes for a few others like calcium, riboflavin, folate, niacin though not fully meeting the required amount for these. But if additionally, the pregnant women also ate a more diverse diet of the locally available foods they could fully meet their nutrients’ requirement. Additionally intakes of milk, Vitamin C, fat were shown to be independently associated with a bigger birth weight.

Eating eggs, fish without scales and sugarcane when a woman is pregnant was believed to harm the unborn baby. Food choices in the homes were reported to be made without consideration of nutritive value of the food. On day-to-day basis women reported making decisions on food choices for meals. This is mostly limited to farm fended foods like greens. However, with regards to market purchased foods like meats, men were reported to have the decision making power through cash control on when these can be eaten in the home.

Background

The project has been constituted by different sub-studies, which have utilized the following methods :

Cross-sectional study – Utilizing an interactive 24-hr recall, individual food intakes of third trimester pregnant women were assessed quantitatively on 3 days; and on 4 days without quantities. Additionally data on infant birth sizes were collected.

Qualitative explorative study - Focus group discussions and key informant interviews were conducted with both women and men to map food beliefs and social influences on eating patterns

Cluster-randomized controlled trial - Twenty-villages have been randomized into control and intervention villages. The intervention group is receiving the nutrition education developed from the cross-sectional and qualitative findings. The control group receives birth preparedness lessons.

Qualitative process-evaluation – using focus group discussions, in-depth interviews the feasibility of delivering a nutrition education intervention through village volunteers is being assessed

Sub-projects

  1. Cross-sectional surveys measuring pregnancy dietary intake and birth size
  2. Qualitative explorative study investigating food beliefs and socio-cultural context of food
  3. Cluster-randomized controlled trial on effectiveness of a food-based intervention in improving birth size
  4. Qualitative process-evaluation of the delivery of a nutrition education intervention

Financing

  • Global Health and Vaccination Research, Norwegian Research Council

Cooperation

  • University of Malawi

Start - finish

2012-2017

 

Published Jan. 2, 2017 11:43 AM - Last modified Jan. 3, 2017 2:40 PM

Participants

Detailed list of participants