Barriers to utilize nutrition interventions among lactating women in rural communities of Tigray, northern Ethiopia: An exploratory study

Qualitative assessment of programmatic constraints in delivery of effective interventions for improving maternal nutrition in Bangladesh

INTRODUCTION

Maternal undernutrition is highly prevalent in most of the developing countries. Prevalence of both extremes of maternal malnutrition (undernutrition and overweight/obesity) are common in those countries. For Bangladesh, the scenario is not different. The Government of Bangladesh recognises maternal nutrition as a public health priority and addresses the issue in its policies and programmes. We identified and analysed the existing maternal nutrition programmes and determined the bottlenecks in implementing the programmes in Bangladesh using qualitative approach.

METHODS

We followed a qualitative research approach and conducted 25 key informant interviews with the programme managers and policymakers, 10 in-depth interviews with the service providers and six focus group discussions with the pregnant women to identify the constraints of programme implementation. We analysed data using thematic and inductive approaches of qualitative research methods.

RESULTS

We have found that successful implementation of maternal nutrition intervention was being hampered by both the demand and supply side issues. On the demand side, major constraints were financial inability of the families to avail maternal nutrition-related services, ignorance of the family members and cultural barriers of using maternal nutrition-related services. Lack of priority and heavy workload of the service providers, lack of human resources, poor monitoring system, lack of medicine to supply and incoordination have been identified as major supply-side constraints in providing maternal nutrition-related interventions in Bangladesh.

CONCLUSION

Both supply side and demand side issues are responsible for the existing bottlenecks in implementing maternal nutrition-related programmes in Bangladesh. Findings of this study will help the policymakers to learn about the programmatic constraints regarding maternal nutrition services in Bangladesh.

Effect and Challenges of an Integrated Nutrition-Intervention Package Utilization among Pregnant Women and Lactating Mothers in Rwanda: An Exploratory Qualitative Study

Background

Malnutrition among pregnant women and lactating mothers remains an issue of public health concern in developing countries. The Gikuriro program, an integrated nutrition-specific and nutrition-sensitive intervention, was implemented in 5 districts of Rwanda for 5 y to address this problem. Postprogram quasi-experiments showed significant effect of the intervention on maternal and child undernutrition. Notwithstanding, there was a need for a qualitative study to explore the views of the beneficiaries and implementers regarding its benefits, challenges, and limitations to inform future interventions.

Objective

This study aimed to explore the effect and challenges of an integrated nutrition-intervention program among pregnant women and lactating mothers.

Methods

This was a qualitative study involving 25 community health officers and 27 nutritionists as key informants and 80 beneficiaries in 10 focus group discussions. All interviews and group discussions were audio-recorded, transcribed verbatim, translated into English, and double coded. A deductive and inductive content analysis approach was used with the help of ATLAS.ti, version 9.15.

Results

The study identified several positive effects, such as improved knowledge and skills on nutrition, a positive mindset toward a balanced diet, perceived improved nutrition, and economic independence among pregnant women and lactating mothers. However, some of the main obstacles of the integrated nutrition intervention were lack of awareness of the program, negative beliefs, poverty, lack of spousal support, and time constraints. Moreover, the study identified a main limitation: the lack of inclusiveness for all social categories.

Conclusions

This study demonstrates that integrated nutrition interventions have perceived positive effect on nutrition; however, such interventions may face some challenges and limitations. These findings suggest that, apart from contributing to the body of evidence for scale up of such interventions in resource-limited settings, economic challenges and misconceptions have to be addressed to maximize the effect of such interventions.

Assessment of nutrient adequacy and associated factors among lactating women of rural Bangladesh using observed intake: Findings from Bangladesh Integrated Household Survey 2018-2019

Lactating women of low- and middle-income countries are prone to develop deficiencies in essential nutrients due to various demographic and socioeconomic components. This study aimed to estimate the adequacy of dietary intake and the determinants of diet quality of lactating women in rural Bangladesh. One-day dietary recall (24-Hour recall) data of 973 lactating women were obtained from the Bangladesh Integrated Household Survey (BIHS) 2018-2019. Nutrient adequacy was determined using the Estimated Average Requirement (EAR) cut-point approach. The molar ratios of phytate to zinc, calcium, and iron were calculated. Mean Adequacy Ratio (MAR) was calculated to measure diet quality, and multiple linear regression analysis was performed to assess the sociodemographic determinants of MAR. While the intakes of protein and carbohydrate were equal to/above the Acceptable Macronutrient Distribution Range (AMDR) among most of the subjects, intakes of total energy and fat were below the reference intakes for 74.4% and 98.3%, respectively. Nutrient adequacy remained unmet for riboflavin, calcium, vitamin A, and folate among most (87.2%-97.6%) of the study population, and the mean (SD) MAR was 0.72 (0.12). Cereals were the major contributor of energy and B vitamins, while protein and iron mainly came from plant-based sources. The molar ratio of phytate to iron was greater than the critical limit among most respondents. Maternal Body Mass Index (BMI) (beta = 0.003, p = .014) and education level (beta = 0.017, p = .038) were associated with their diet quality. The diet of most lactating women in rural Bangladesh indicates the inadequacy of several micronutrients. This can lead to a worsening of the double burden of malnutrition in women. Lactating women should be given special consideration when designing food and nutrition programs for reproductive women in rural Bangladesh.