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Cliffer IR, Millogo O, Barry Y, Kouanda I, Compaore G, Wang D, Sie A, Fawzi W. School-based supplementation with iron-folic acid or multiple micronutrient tablets to address anemia among adolescents in Burkina Faso: a cluster-randomized trial. Am J Clin Nutr 2023; 118:977-988. [PMID: 37716443 DOI: 10.1016/j.ajcnut.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Iron-deficiency anemia is a leading cause of morbidity among adolescents (aged 10-19 y), especially in low- and middle-income settings. Few policies and programs have targeted adolescent health. OBJECTIVES This study aimed to evaluate the effectiveness of school-based supplementation with iron-folic acid (IFA) or multiple micronutrient supplements (MMSs) in addressing anemia among adolescents in Burkina Faso. METHODS In this cluster-randomized trial, 3123 secondary school students aged 10 to 18 y in Burkina Faso were either supplemented with weekly IFA, daily MMSs, or received standard nutrition education as controls. Supplementation occurred between April 2021 and April 2022 over 2 supplementation periods (10 wk, then 16 wk) separated by a gap of 20 wk without supplementation. Hemoglobin was evaluated 4 times: at baseline prior to each supplementation period and at the end of each period. Anemia was categorized by the World Health Organization hemoglobin level cutoffs as none, mild, moderate, or severe. Associations between treatment arm and anemia or continuous hemoglobin (g/dL) were assessed using multilevel mixed effects generalized linear models with schools as a random effect, controlling for baseline hemoglobin or anemia status. RESULTS Baseline anemia prevalence was similar across study arms, with 32.7% in IFA, 31.2% in MMS, and 29.5% in the control arm. Over the full study period, adolescents provided IFA had hemoglobin levels higher than those in the control arm (adjusted β: 0.32; 95% CI: 0.02, 0.62). No significant associations were observed for MMS or for anemia outcomes; however, the direction and magnitude of nonsignificant associations indicate potential protective effects of IFA and MMSs on anemia. CONCLUSIONS The results do not provide strong evidence that weekly IFA or daily MMS alone is effective, but supplementation may play a role in addressing adolescent anemia if combined with cointerventions. Additional research is required to determine the best strategy to address anemia. This trial was registered at clinicaltrials.gov as NCT04657640.
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Affiliation(s)
- Ilana R Cliffer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.
| | - Ourohiré Millogo
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso; Institut de Recherche en Sciences de la Santé (IRSS), Centre National de Recherche Scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
| | - Yllassa Barry
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso
| | | | | | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Ali Sie
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
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de Romaña DL, Mildon A, Golan J, Jefferds MED, Rogers LM, Arabi M. Review of intervention products for use in the prevention and control of anemia. Ann N Y Acad Sci 2023; 1529:42-60. [PMID: 37688369 PMCID: PMC10876383 DOI: 10.1111/nyas.15062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Anemia remains a major public health problem, especially in low- and middle-income countries. The World Health Organization recommends several interventions to prevent and manage anemia in vulnerable population groups, including young children, menstruating adolescent girls and women, and pregnant and postpartum women. Daily iron supplementation reduces the risk of anemia in infants, children, and pregnant women, and intermittent iron supplementation reduces anemia risk in menstruating girls and women. Micronutrient powders reduce the risk of anemia in children. Fortifying wheat flour with iron reduces the risk of anemia in the overall population, whereas the effect of fortifying maize flour and rice is still uncertain. Regarding non-nutrition-related interventions, malaria treatment and deworming have been reported to decrease anemia prevalence. Promising interventions to prevent anemia include vitamin A supplementation, multiple micronutrient supplementation for pregnant women, small-quantity lipid-based supplements, and fortification of salt with iodine and iron. Future research could address the efficacy and safety of different iron supplementation formulations, identify the most bioavailable form of iron for fortification, examine adherence to supplementation regimens and fortification standards, and investigate the effectiveness of integrating micronutrient, helminth, and malaria control programs.
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Affiliation(s)
| | - Alison Mildon
- Global Technical Services, Nutrition International, Ottawa, Ontario, Canada
| | - Jenna Golan
- Global Technical Services, Nutrition International, Ottawa, Ontario, Canada
| | | | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Mandana Arabi
- Global Technical Services, Nutrition International, Ottawa, Ontario, Canada
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Jaisamrarn U, Esteban-Habana MA, Padolina CS, Decena DCD, Dee MT, Damodaran P, Bhaskaran V, Garg V, Dorado E, Hu H. Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion. SAGE Open Med 2023; 11:20503121231173377. [PMID: 37223672 PMCID: PMC10201185 DOI: 10.1177/20503121231173377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.
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Affiliation(s)
- Unnop Jaisamrarn
- Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
| | | | - Christia S Padolina
- University of the East Ramon Magsaysay
Memorial Medical Center, Quezon City, Philippines
| | | | - Marlyn T Dee
- UST Faculty of Medicine and Surgery,
Manila, Philippines
| | - Premitha Damodaran
- Pantai Hospital Kuala Lumpur, Wilayah
Persekutuan Kuala Lumpur, Malaysia
| | | | - Vandana Garg
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Egbert Dorado
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Henglong Hu
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
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Thahir AIA, Nasir S, J Holmes A, Li M, Gordon A. Mothers' and Midwives' Experiences of Maternal and Child Health Services during the COVID-19 Pandemic in Banggai, Indonesia: A Qualitative Study. Int J Community Based Nurs Midwifery 2023; 11:96-109. [PMID: 37114096 PMCID: PMC10126445 DOI: 10.30476/ijcbnm.2023.97114.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 04/29/2023]
Abstract
Background Maternal and child health (MCH) services have been affected by the Coronavirus disease (COVID-19) pandemic in all countries, including Indonesia. Information regarding the impact of COVID-19 on MCH service access and provision is limited, particularly in the context of rural Indonesian communities. This study aimed to explore the experiences of Indonesian mothers and midwives from a rural regency regarding MCH services delivery during the pandemic. Methods This study was a sub-study of a pre-existing cohort study conducted in four sub-districts in Banggai, Indonesia, as the qualitative research. This study was conducted from November 2020 to April 2021, involving 21 mothers and six midwives. We selected the participants using snowball sampling. In-depth interviews were conducted in Bahasa. The study used both deductive and inductive approaches for analysis. Data analysis was performed using NVivo v.12. Results The study identified three themes and eight sub-themes from the analysis incorporating the midwives' and mothers' data. The themes included health service change, perceived barriers to service delivery, and family impact. This study highlights health service changes due to the pandemic, such as relocating the MCH services. Mothers perceived barriers to accessing health services, including distance reasons and fear of COVID-19. Only the shortages of staff affected the midwives in providing optimal services. Conclusion The pandemic triggered health service changes and caused some barriers to service delivery. This study recommends that the local government and stakeholders should pay more attention to the health service changes according to the mothers' experiences and address barriers to optimize access to MCH services during the pandemic.
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Affiliation(s)
- Andi Imam Arundhana Thahir
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Sudirman Nasir
- Department of Health Promotion, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Andrew J Holmes
- School of Life and Environmental Sciences, Faculty of Science, the University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, NSW, Australia
| | - Mu Li
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Adrienne Gordon
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- RPA Newborn Care, Sydney Local Health District, Sydney, NSW, Australia
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Gomes F, Askari S, Black RE, Christian P, Dewey KG, Mwangi MN, Rana Z, Reed S, Shankar AH, Smith ER, Tumilowicz A. Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method. Maternal & Child Nutrition 2023:e13509. [DOI: 10.1111/mcn.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences New York City New York USA
- NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal
| | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Kathryn G. Dewey
- Department of Nutrition University of California, Davis Davis California USA
| | | | - Ziaul Rana
- The New York Academy of Sciences New York City New York USA
| | - Sarah Reed
- The Bill & Melinda Gates Foundation Seattle Washington USA
| | - Anuraj H. Shankar
- Nuffield Department of Medicine University of Oxford Oxford UK
- Summit Institute for Development Mataram Indonesia
| | - Emily R. Smith
- Milken Institute School of Public Health The George Washington University Washington District of Columbia USA
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Abraham JM, Melendez-Torres GJ. A realist review of interventions targeting maternal health in low- and middle-income countries. Womens Health (Lond) 2023; 19:17455057231205687. [PMID: 37899651 PMCID: PMC10617292 DOI: 10.1177/17455057231205687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit.
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Urassa W, Pembe A, Fawzi WW. Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania. J Nutr 2022; 152:1091-1098. [PMID: 34964890 PMCID: PMC8970983 DOI: 10.1093/jn/nxab448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birth weight. However, the effect of multiple micronutrient supplements on GWG has been understudied. OBJECTIVES We examined the effect of daily supplementation of pregnant women with multivitamins on GWG in relation to the GWG recommendation by the Institute of Medicine (IOM). METHODS Pregnant women with gestational age between 12 and 27 wk were randomly assigned to receive daily multivitamins or placebo until delivery. Weight was measured at enrollment and every follow-up visit. Percentage adequacy of GWG was calculated as actual GWG divided by the recommended GWG according to the IOM recommendation. Binary outcomes included severely inadequate (<70%), inadequate (<90%), and excessive GWG (≥125%). The analysis included 7573 women with singleton pregnancies. Multiple linear regression models were used to examine the association between multivitamin supplementation and percentage adequacy of GWG, and log-binomial models were used for binary outcomes. RESULTS The mean percentage adequacy of GWG was 96.7% in the multivitamin arm and 94.4% in the placebo arm, with a mean difference of 2.3% (95% CI: 0.3%, 4.2%; P = 0.022). Compared with women in the placebo arm, those who received multivitamins had a lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.97; P = 0.008) and inadequate GWG (RR: 0.95; 95% CI: 0.91, 0.99; P = 0.018). No significant difference was found in excessive GWG. CONCLUSIONS Multivitamin supplementation increased GWG and reduced the risk of severely inadequate and inadequate GWG among pregnant women in Tanzania. Together with previously reported beneficial effects of the supplements on birth outcomes in low- and middle-income countries, our findings support scaling up the use of prenatal supplements that include multivitamins in addition to iron and folic acid.This trial was registered at clinicaltrials.gov as NCT00197548.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Millanzi WC, Osaki KM, Kibusi SM. The effect of educational intervention on shaping safe sexual behavior based on problem-based pedagogy in the field of sex education and reproductive health: clinical trial among adolescents in Tanzania. Health Psychol Behav Med 2022; 10:262-290. [PMID: 35251774 PMCID: PMC8896187 DOI: 10.1080/21642850.2022.2046474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The majority of adolescents are currently becoming sexually active before their 18th birthday having to battle with unsafe sexual behaviors, teenage pregnancies, sexually transmitted infections, and school dropouts. The study designed and tested the effect of integrated reproductive health lesson materials in a Problem-Based pedagogy (PBP) to enhance safe sexual behaviors among adolescents in Tanzania. Methods Clustered Randomized Controlled Trial was adopted among 660 adolescents in Tanzania. The study consisted of three research arms including pure PBP, Hybrid PBP, and Lecture-Based Pedagogy (LBP). Sexual-risk Behavior Beliefs and Self-esteem Scale adopted from previous studies measured adolescents' sexual behaviors. A Statistical Analysis Software (SAS) version 9.4 was used to analyze data. Descriptive analysis established adolescents' socio-demographic profiles. Generalized Estimating Equation (GEE) determined the effect of interventions on adolescents' intentions to practice safe sexual behaviors at a 95% confidence interval and a significance level of 5%. Results Adolescents' mean age was 15 ± 1.869 years. Sums of 57.5% (n = 380) were females. 39.5% of adolescents were sexually active whereas 44.8% of them initiated sexual intercourse by the age between 10 and 12 years. The end-line findings showed that 54.9% of adolescents in the LBP group demonstrated a significant intention to unsafe sexual behaviors against 26.3% and 30.9% of adolescents in the pure PBP and Hybrid PBP groups respectively. The Difference-In-Difference odds ratio for unsafe sexual behavior among adolescents in the Hybrid PBP and pure PBP was less (AOR = 0.30; p < 0.0001; 95%CI: 0.1398, 0.5559) and (AOR = 0.30, p < 0.0002; 95%CI: 0.1386, 0.5487) contrary to a control group respectively. Conclusion The integrated RH lesson materials in a PBP can change a spectrum of sexual behavior among adolescents in Tanzania. This study suggests school teachers and health workers work together to facilitate RH lessons using PBP to enhance safe sexual behaviors among adolescents for their healthy adulthood and future investment. Trial registration:Pan African Clinical Trial Registry identifier: PACTR202009656160779.
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Affiliation(s)
- Walter C Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Kalafunja M Osaki
- Department of Science Education and Curriculum Studies, St. Augustine University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Stephen M Kibusi
- Dean School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
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Akseer N, Keats EC, Thurairajah P, Cousens S, Bétran AP, Oaks BM, Osrin D, Piwoz E, Gomo E, Ahmed F, Friis H, Belizán J, Dewey K, West K, Huybregts L, Zeng L, Dibley MJ, Zagre N, Christian P, Kolsteren PW, Kaestel P, Black RE, El Arifeen S, Ashorn U, Fawzi W, Bhutta ZA. Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs. EClinicalMedicine 2022; 45:101309. [PMID: 35243274 PMCID: PMC8885463 DOI: 10.1016/j.eclinm.2022.101309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries. METHODS This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals. FINDINGS Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group. INTERPRETATION The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations. FUNDING Bill and Melinda Gates Foundation (Grant No: OP1137750).
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily Catherine Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Pravheen Thurairajah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - David Osrin
- Institute for Global Health, University College London, United Kingdom
| | - Ellen Piwoz
- The Bill and Melinda Gates Foundation, United States
| | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Lingxia Zeng
- School of Public Health, Xi'an Jiaotong University Health Science Centre, China
| | | | - Noel Zagre
- UNICEF Regional Office for West and Central Africa, Senegal
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, United States
| | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
- Corresponding author at: Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
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Leroy JL, Koch B, Roy S, Gilligan D, Ruel M. Social Assistance Programs and Birth Outcomes: A Systematic Review and Assessment of Nutrition and Health Pathways. J Nutr 2021; 151:3841-3855. [PMID: 34590144 PMCID: PMC8643580 DOI: 10.1093/jn/nxab292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 08/06/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Poor birth outcomes are an important global public health problem. Social assistance programs that provide cash or in-kind transfers, such as food or vouchers, hold potential to improve birth outcomes but the evidence on their effectiveness has not been reviewed. OBJECTIVES We systematically reviewed studies that used experimental or quasi-experimental methods to evaluate the impacts of social assistance programs on outcomes in low- and middle-income countries. METHODS The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to assess the certainty of the evidence for birth weight and neonatal mortality (most common outcomes reported). We summarized the evidence on hypothesized nutrition and health pathways of impact. RESULTS We included 6 evaluations of 4 different cash transfer programs and 1 evaluation of a community-based participatory learning and action program that provided food and cash transfers. The 4 studies that assessed birth weight impacts found significant (P < 0.05) effects ranging from 31 to 578 g. Out of 3 studies that assessed neonatal mortality impacts, 2 found significant effects ranging from 0.6 to 3.1 deaths/1000 live births. The certainty of the evidence for both outcomes was rated as very low due to several methodological limitations. In terms of potential pathways, some studies documented positive effects on maternal diet, antenatal care (ANC) utilization, and delivery in a health facility. CONCLUSIONS Better-designed evaluations are needed to strengthen the evidence base on these programs. Evaluation studies should elucidate underlying mechanisms of impact by including outcomes related to maternal diet, ANC seeking, use of skilled delivery, and women's empowerment in nutrition and health domains. Studies should also assess potential unintended negative consequences of social assistance, such as reduced birth spacing and excess pregnancy weight gain.
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Affiliation(s)
| | - Bastien Koch
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Shalini Roy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Daniel Gilligan
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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