Bangladesh shows way to ensure maternal nutrition in existing health system

A new programme shows that it is possible to simultaneously improve nutritional health of both mothers and infants within the existing health system.

The Alive & Thrive has implemented the programme with the help of the Bangladesh government, and non-governmental organisation BRAC. Canada funded that maternal nutrition programme.

It was based on the WHO’s new 2016 Guidelines on Antenatal Care (ANC) that includes nutrition interventions that are proven to support a healthy pregnancy and birth experience.

Until now, there has been little experience in how to mainstream the maternal nutrition on a larger scale. The results show that integrating maternal nutrition into the Maternal, Neonatal and Child Health or MNCH programmes is both “effective and attainable”.

The International Food Policy Research Institute (IFPRI) had conducted the independent review which was disseminated on Wednesday in Dhaka.

IFPRI Research Fellow Phuong Hong Nguyen said they found it was “feasible and significant” to address “multiple dimensions” of nutrition during pregnancy and deliveries through an "existing" maternal, neonatal and child health platform.

She termed the model “effective” and said this “could be adopted and expanded for integration into the health system in Bangladesh and in similar context in other countries”.

The programme was focused on the entire 1,000-day “window of opportunity” -- from a woman’s pregnancy through her child’s second birthday.

# Why should we focus on maternal nutrition?
 
>> The first thousand days of a child’s life are critical including 280 days in the mother’s womb
>> Many pregnant women in Bangladesh are underweight, anemic, consume a poor and uncertain diet and endure exhausting workload
>> To disrupt the chronic intergenerational cycle of maternal

Dietary diversity, iron, folic acid and calcium supplementation, and breastfeeding practices were some of the areas they ensured through the project implementation.

This is critical, because together they can help stop the intergenerational cycle of malnutrition, experts say.

An undernourished woman often gives birth to a low birth weight baby, who never develops to her full potential. An undernourished infant or young child, in turn, is more likely to become an undernourished mother who starts the cycle over again.

What was the intervention?

The programme was focused on tailoring communications to the audiences involved in supporting a pregnant woman’s nutrition—including community health workers, fathers, local opinion leaders, and the pregnant women themselves.

Community health workers were trained and supported to deliver engaging counselling sessions with pregnant women and their families, including practical demonstrations of how to prepare meals with adequate dietary diversity and quantity.

Fathers were engaged through husbands’ forums, in which they discussed their role and responsibility to support their pregnant wives.

# Why should we focus on early initiation of breast feeding and exclusive breast feeding for six months of the child’s age?
 
>> Smart investment: saves young lives, promotes growth and intelligence
>> Benefits both poor and rich people
>> Can be improved rapidly and at scale

Community leaders were invited to orientations in which they watched short video films and made commitments to supporting pregnant women and their husbands.

All activities were reinforced through mass communications that emphasised key practices.

Community events engaged village elders, pregnant women and their families through videos followed by discussion, question and answer sessions, and quizzes. Street theatre teams brought essential nutrition messages to life through storytelling.

Dietary diversity, iron-folic acid and calcium supplementation, and breastfeeding practices were some of the areas they ensured through the project implementation.

Outcomes

The results show that in less than two years, nearly 130,000 pregnant women were reached through home visits by community health workers—including nearly 334,000 in-home demonstrations. About 64,000 husbands were also involved through community forums.

Dietary diversity in programme areas increased significantly, with nearly 90 percent of pregnant women consuming more than five food groups, the research found.

Both iron-folic acid (IFA) and calcium supplementation increased dramatically; IFA supplementation more than doubled, from 44.8 percent to 96.5 percent, while calcium supplementation more than tripled, from 31.5 percent to 96.3 percent.

# Why should we start feeding homemade food after six months of a child?
 
>> Develops children’s bodies and brains
>> Improves ability to fight illness and reduce infections.

Breastfeeding practices also improved significantly -- early initiation increased by about four percentage points to 57.4 percent, and exclusive breastfeeding increased by about 26 percentage points to 77.8 percent.

Other practices that improved included weight monitoring of women throughout pregnancy and overall diet quantity.

“Bangladesh is now one of the few countries in the world that has successfully scaled up breastfeeding, complementary feeding and maternal nutrition interventions,” said Karin Lapping, Global Project Director for Alive & Thrive.

“This is a tremendous accomplishment, and programs around the world will be looking to follow in Bangladesh’s footsteps.”

Director General for Health Services Prof Abul Kalam Azad hailed the model and said the government is ready to take this countrywide.

The initial programme was implemented in four districts—Kurhigram, Lalmonirhat, Mymensingh and Rangpur.

Looking ahead, Alive and Thrive said, the Bangladesh government and the partners are working to deliver the programme nationwide as part of the government’s National Nutrition Operational Plan.

“We must continue to reinforce good nutrition practices at all ages—for mothers, infants, children and adolescents—to ensure we fully end the cycle of malnutrition,” said Dr Zeba Mahmud, Country Manager, Bangladesh Alive & Thrive.

“And we must continue to develop a health work force that is prepared to deliver the counselling and support that families need to be healthy”.

However, this is not the first time Bangladesh is showing the way in nutrition practices.

From 2010 to 2014, a programme helped increase the exclusive breastfeeding rate from 43 percent to 55 percent--and it even reached 88 percent in programme-intensive areas.

The Bill and Malinda Gates Foundation, which helped the Alive and Thrive to implement the programme, had then said they would take this lesson around the world.