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" Evaluation studies on the newly-married couples strategy of the Bangladesh Integrated Nutrition Project "
Thomas T. Schaetzel
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Latin Dissertation
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English
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| Record Number
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54462
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| Doc. No
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TL24416
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| Call number
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3451884
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| Main Entry
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Thomas T. Schaetzel
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| Title & Author
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Evaluation studies on the newly-married couples strategy of the Bangladesh Integrated Nutrition Project\ Thomas T. Schaetzel
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| College
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Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy
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| Date
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2006
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| Degree
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Ph.D.
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2006
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| Page No
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405
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| Abstract
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The maternal nutrition intervention of the Bangladesh Integrated Nutrition Project (BINP) provided, starting from the identification of pregnancy, nutrition counseling and food supplementation targeting increased food intake during pregnancy. Increased food intake was expected to improve pregnancy weight gain, which was in turn expected to increase birth weight. BINP also introduced an experimental strategy among newly-married wives (NM) that offered counseling from the time of marriage rather than from the identification of pregnancy. This NM strategy was expected to be more effective in motivating increased energy intake during pregnancy, and thus also more effective in increasing birth weight outcomes. Other goals were increased use of antenatal care, and reduced workload and increased rest during pregnancy. Because of the initiation of counseling prior to conception, behavioral change resulting from it was expected to be permanent and to eliminate the need for subsequent programmatic intervention. For this reason NM strategy services were available only for a couple's first pregnancy. Restriction of services to the first pregnancy also was expected to be an incentive for delayed first pregnancy. The effectiveness of this experimental strategy was tested by comparing the acquisition of knowledge about key project dietary recommendations and self-reported dietary behaviors in pregnancy among new wives participating in it with new wives participating in the standard BINP maternal nutrition, and with new wives receiving no project intervention. To inform future projects targeting increased pregnancy weight gain and birth weight using behavioral change and food supplementation, the factors explaining change in energy intake during pregnancy were determined using multiple regression analysis. The incentive effects of project service availability during the first pregnancy only also were assessed. After controlling for other explanatory factors, the newly married (NM) strategy was successful, in comparison with the non-intervention comparison (C) group and with the standard BINP (StdB) intervention group, in influencing pregnant women's opinions that they should eat more (OR=2.6 against C, 2.6 against StdB), and rest more (OR=1.9 against C, 2.0 against StdB), but it was unable to affect the corresponding behaviors (as self-reported). The predictors of positive change in energy intake during pregnancy were higher prepregnancy BMI, greater wife's education, greater wife's father's education, and absence of prepregnancy belief that a small baby or easy delivery is desirable. The model explained 20% of the variation in change in energy intake. Based on Kaplan-Meier and proportional hazards survival analysis, both the NM and StB intervention groups reported pregnancy earlier and had a greater relative risk of pregnancy than the non-intervention group (adjusted hazard ratios for standard BINP and experimental newly married groups 1.7 and 1.3, respectively). Intensive counseling from the time of marriage can influence opinions about nutritional behaviors in pregnancy, and behaviors concerning antenatal care and iron tablet consumption in pregnancy. Opinion alone is not sufficient to induce increased food intake and rest during pregnancy among newly married wives in Bangladesh, however. The factors associated with positive changes in energy intake during pregnancy suggest that continued improvements in duration of education, especially girls' education, in Bangladesh could have important benefits for maternal nutrition, especially if concurrent improvements in health services reduce the fear of a difficult delivery. In projects where services, especially food, are available based on pregnancy status, planners should take care during design, and monitor during implementation, to ensure that project services do not motivate participants to become pregnant.
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| Subject
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Health and environmental sciences; Bangladesh; Married couples; Pregnancy; Medicine; Nutrition; 0570:Nutrition; 0380:Medicine
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| Added Entry
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Tufts University, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy
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