Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi
Background: Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives: To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods: We performed a...
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Elsevier
2024-12-01
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| Series: | Current Developments in Nutrition |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475299124024405 |
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| author | Penjani Rhoda Kamudoni Lillian Kaunda Marion Tharrey Maggie Mphande Shyreen Chithambo Elaine Ferguson Zumin Shi Ibrahimu Mdala Kenneth Maleta Alister Munthali Gerd Holmboe-Ottesen Per Ole Iversen |
| author_facet | Penjani Rhoda Kamudoni Lillian Kaunda Marion Tharrey Maggie Mphande Shyreen Chithambo Elaine Ferguson Zumin Shi Ibrahimu Mdala Kenneth Maleta Alister Munthali Gerd Holmboe-Ottesen Per Ole Iversen |
| author_sort | Penjani Rhoda Kamudoni |
| collection | DOAJ |
| description | Background: Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives: To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods: We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12–18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education. Results: Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043). Conclusions: Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.This trial was registered at clinicaltrials.gov as NCT03136393. |
| format | Article |
| id | doaj-art-780ae6a6efc34c4391e71ee8a8d25299 |
| institution | OA Journals |
| issn | 2475-2991 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Developments in Nutrition |
| spelling | doaj-art-780ae6a6efc34c4391e71ee8a8d252992025-08-20T02:39:07ZengElsevierCurrent Developments in Nutrition2475-29912024-12-0181210450610.1016/j.cdnut.2024.104506Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural MalawiPenjani Rhoda Kamudoni0Lillian Kaunda1Marion Tharrey2Maggie Mphande3Shyreen Chithambo4Elaine Ferguson5Zumin Shi6Ibrahimu Mdala7Kenneth Maleta8Alister Munthali9Gerd Holmboe-Ottesen10Per Ole Iversen11Department of Community Medicine and Global Health, University of Oslo, Oslo, NorwayDepartment of Nutrition, University of Oslo, Oslo, NorwayDepartment of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg; Department of Precision Health, Luxembourg Institute of Health, Strassen, LuxembourgSchool of Nursing, Kamuzu University of Health Sciences, Lilongwe, MalawiMinistry of Health, Lilongwe, MalawiDepartment of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United KingdomDepartment of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, QatarDepartment of General Practice, General Practice Research Unit, University of Oslo, Oslo, NorwaySchool of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, MalawiCenter for Social Research, University of Malawi, Zomba, MalawiDepartment of Community Medicine and Global Health, University of Oslo, Oslo, NorwayDepartment of Nutrition, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway; Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa; Corresponding author.Background: Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives: To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods: We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12–18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education. Results: Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043). Conclusions: Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.This trial was registered at clinicaltrials.gov as NCT03136393.http://www.sciencedirect.com/science/article/pii/S2475299124024405dietary intakesinfantslow birth weightMalawimothersnutrition education counseling |
| spellingShingle | Penjani Rhoda Kamudoni Lillian Kaunda Marion Tharrey Maggie Mphande Shyreen Chithambo Elaine Ferguson Zumin Shi Ibrahimu Mdala Kenneth Maleta Alister Munthali Gerd Holmboe-Ottesen Per Ole Iversen Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi Current Developments in Nutrition dietary intakes infants low birth weight Malawi mothers nutrition education counseling |
| title | Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi |
| title_full | Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi |
| title_fullStr | Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi |
| title_full_unstemmed | Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi |
| title_short | Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi |
| title_sort | context tailored food based nutrition education and counseling for pregnant women to improve birth outcomes a cluster randomized controlled trial in rural malawi |
| topic | dietary intakes infants low birth weight Malawi mothers nutrition education counseling |
| url | http://www.sciencedirect.com/science/article/pii/S2475299124024405 |
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