Maternal nutritional supplement delivery in developing countries: a scoping review

BACKGROUND: Maternal under-nutrition in low-income countries has been inextricably linked to negative child outcomes. Developing countries lack policies for monitoring and evaluating maternal nutritional programs, which has led to a gap in data collection regarding the effectiveness of prenatal supplement delivery methods. The objective of this scoping review is to examine and determine the delivery methods of maternal nutritional supplements in developing countries. METHODS: Scoping review of maternal supplement programs delivery methods in low-income countries including Bangladesh, Ethiopia, India, Kenya, and Nepal are examined. A systematic search was performed in six databases; CINAHL (Cumulative Index to Nursing & Allied Health), MEDLINE, Web of Science, PubMed, Scopus, and FSTA (Food Science and Technology Abstracts). RESULTS: A systematic search performed in six databases yielded a total of 510 un-duplicated results; (CINAHL: 42, Medline: 112, Web of Science: 77, PubMed: 46, Scopus: 179, FSTA: 38, and additional records: 16). Results after duplicates were removed (n = 308), these results were screened, and relevant studies based on the research question identified and selected (n = 12). The 12 full-text articles were assessed for eligibility and 8 of these studies were excluded for not meeting the scoping review criteria. Data was extracted and charted from the four remaining studies. The findings were collated and summarized. Three modes of delivery were identified: 1. Volunteer maternal nutrition educator delivered supplements to the pregnant woman’s home; 2. The pregnant woman received a maternal supplements from school, health/local center, or village market; and 3. The pregnant woman received a ration card for subsidized food. CONCLUSIONS: Barriers in delivering maternal supplements included lack of trained professional volunteers, limited support and guidance provided to volunteers, and a high cost of equipment, supplies, and buildings. Pregnant women in developing countries faced many obstacles in accessing maternal supplement programs including poverty, rural isolation, limited transportation, low social status, traditional, cultural, and religious practices. Strategies required to improve program delivery involved an earlier invitation to prenatal supplements, increase in partnerships, a focus on adolescent girls’ health, paid maternal leave, increase in training and incentives for volunteers, and self-help groups focused on prenatal education and counseling services.