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" Assessment of Pregnant Women’s Nutritional Status and Impact of Multi-level Interventions on Their Antenatal Care Seeking Behavior and Iron Folic Acid Adherence in Zinder, Niger "
Ouedraogo, Cesaire Tania
Hess, Sonja Y.
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Latin Dissertation
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English
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| Record Number
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1052291
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TL51408
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| Main Entry
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Ouedraogo, Cesaire Tania
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| Title & Author
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Assessment of Pregnant Women’s Nutritional Status and Impact of Multi-level Interventions on Their Antenatal Care Seeking Behavior and Iron Folic Acid Adherence in Zinder, Niger\ Ouedraogo, Cesaire TaniaHess, Sonja Y.
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| College
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University of California, Davis
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| Date
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2019
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| Degree
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Ph.D.
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2019
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| Note
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141 p.
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| Abstract
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Undernutrition among pregnant women is believed to be a serious public health concern in Niger, but there is only limited information available on women’s nutritional status and factors that influence their nutrition and the growth and development of their offspring. The present research is based on the study (also called "NiMaNu project") conducted in Zinder, a rural area in Niger from 2013 to 2015 implemented by the University of California Davis and Helen Keller International, with technical support from Nutrition International. The objectives of this study were to: 1) estimate the prevalence and the determinants of inadequate nutritional status among pregnant women; 2) describe the impact of a package of multilevel interventions on pregnant women’s nutritional status and their antenatal care (ANC)-seeking behavior; and 3) calculate the out-of-pocket costs (OPCs) and time spent by pregnant women to attend ANC, and examine how these factors were linked with ANC attendance. The study was designed as a quasi-experimental study with continuous enrollment and implementation of interventions with the aim of comparing a cohort of women at baseline to another cohort at endline. Briefly, 18 integrated health centers and 68 cluster villages surrounding these health centers were randomly selected and assigned to time of enrollment. Participants were enrolled over a period of twelve months through two community-based surveys conducted at baseline (pre-intervention) and six months later after the implementation of the program interventions (i.e., endline or post-intervention survey). The final sample size of 2313 was designed to detect a difference of 10% in prevalence of anemia among pregnant women using pre-and-post time-matched comparisons. To address objective 1 and 3, adjusted models were used to assess pre-specified associations in minimally adjusted and confounder adjusted models. To address objective 2, minimally adjusted and covariate adjusted models using generalized estimating equations were used to account for the study’s cluster randomized, time-matched, quasi-experimental design. At the time of enrollment, mean (±SD) age of pregnant women was 25.8 ± 6.4 years (n=2307) and 41.9 % and 56.2% were in second and third trimester of pregnancy, respectively. The sample-wide anemia prevalence was 79.0%. The prevalence of low gestational weight gain (GWG) was 62.9% and 27.5% according to the 2009 US Institute of Medicine guidelines (<0.35 kg/week) and <3rd centile of the multi-country INTERGROWTH-21st Project, respectively; and a quarter of pregnant women (24.9%) had low mid- upper arm circumference (MUAC< 23 cm). Determinants of GWG and MUAC included socio-economic, demographic, and biological factors, although only markers of inflammation (C-reactive protein and alpha-1-acid glycoprotein) were consistent predictors across different definitions of low GWG. The multilevel programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving iron folic acid (IFA) supplements (45.8% at baseline vs. 60.0% at endline). This was also reflected in the percentage of women who reported consuming IFA supplements as recommended (32.8% at baseline vs 46.4% at endline), but the intervention did not affect ANC attendance and pregnant women’s nutritional status as measured by GWG and MUAC. OPCs and time spent to attend ANC sessions were not a barrier to ANC attendance, but the provision of IFA supplements and insecticide-treated bednets increased ANC attendance. In conclusion, undernutrition among pregnant women is a public health concern in Zinder and its determinants diverse, although only markers of inflammation were consistent predictors of low gestational weight gain Given that undernutrition and infection in pregnancy are risk factors for adverse pregnancy outcomes, women should be motivated to attend ANC as it offers opportunities to monitor health status and provide recommended IFA supplements and other health interventions. Thus the provision of IFA supplements and mosquito bed nets may be used as motivators to improve ANC attendance. Considering the high prevalence of low GWG, low MUAC and anemia more intensive interventions, balanced energy and protein dietary supplementation and be required in the study population as recommended by WHO for undernourished populations.
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Behavioral psychology
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Economics
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Health care management
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Health sciences
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Nutrition
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Obstetrics
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Public health
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Sub Saharan Africa studies
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Womens studies
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Hess, Sonja Y.
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University of California, Davis
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