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Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program

The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversit...

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Autores principales: Suresh, Shalini, Paxton, Anne, Pun, Bhim Kumari, Gyawali, Min Raj, Kshetri, Indra Dhoj, Rana, Pooja Pandey, Cunningham, Kenda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709950/
https://www.ncbi.nlm.nih.gov/pubmed/31449529
http://dx.doi.org/10.1371/journal.pone.0221260
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author Suresh, Shalini
Paxton, Anne
Pun, Bhim Kumari
Gyawali, Min Raj
Kshetri, Indra Dhoj
Rana, Pooja Pandey
Cunningham, Kenda
author_facet Suresh, Shalini
Paxton, Anne
Pun, Bhim Kumari
Gyawali, Min Raj
Kshetri, Indra Dhoj
Rana, Pooja Pandey
Cunningham, Kenda
author_sort Suresh, Shalini
collection PubMed
description The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII’s 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2–5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6–24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2–5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2–5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets.
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spelling pubmed-67099502019-09-10 Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program Suresh, Shalini Paxton, Anne Pun, Bhim Kumari Gyawali, Min Raj Kshetri, Indra Dhoj Rana, Pooja Pandey Cunningham, Kenda PLoS One Research Article The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII’s 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2–5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6–24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2–5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2–5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets. Public Library of Science 2019-08-26 /pmc/articles/PMC6709950/ /pubmed/31449529 http://dx.doi.org/10.1371/journal.pone.0221260 Text en © 2019 Suresh et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Suresh, Shalini
Paxton, Anne
Pun, Bhim Kumari
Gyawali, Min Raj
Kshetri, Indra Dhoj
Rana, Pooja Pandey
Cunningham, Kenda
Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title_full Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title_fullStr Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title_full_unstemmed Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title_short Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program
title_sort degree of exposure to interventions influences maternal and child dietary practices: evidence from a large-scale multisectoral nutrition program
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709950/
https://www.ncbi.nlm.nih.gov/pubmed/31449529
http://dx.doi.org/10.1371/journal.pone.0221260
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