Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.

The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal's 77 districts to improve dietary div...

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Main Authors: Shalini Suresh, Anne Paxton, Bhim Kumari Pun, Min Raj Gyawali, Indra Dhoj Kshetri, Pooja Pandey Rana, Kenda Cunningham
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2019-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0221260
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spelling doaj-2633ab04904b4f87a6132da85b9db2b12021-03-03T20:32:08ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01148e022126010.1371/journal.pone.0221260Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.Shalini SureshAnne PaxtonBhim Kumari PunMin Raj GyawaliIndra Dhoj KshetriPooja Pandey RanaKenda CunninghamThe prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal's 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII's 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2-5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6-24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2-5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2-5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets.https://doi.org/10.1371/journal.pone.0221260
collection DOAJ
language English
format Article
sources DOAJ
author Shalini Suresh
Anne Paxton
Bhim Kumari Pun
Min Raj Gyawali
Indra Dhoj Kshetri
Pooja Pandey Rana
Kenda Cunningham
spellingShingle Shalini Suresh
Anne Paxton
Bhim Kumari Pun
Min Raj Gyawali
Indra Dhoj Kshetri
Pooja Pandey Rana
Kenda Cunningham
Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
PLoS ONE
author_facet Shalini Suresh
Anne Paxton
Bhim Kumari Pun
Min Raj Gyawali
Indra Dhoj Kshetri
Pooja Pandey Rana
Kenda Cunningham
author_sort Shalini Suresh
title Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
title_short Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
title_full Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
title_fullStr Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
title_full_unstemmed Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program.
title_sort degree of exposure to interventions influences maternal and child dietary practices: evidence from a large-scale multisectoral nutrition program.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2019-01-01
description The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal's 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII's 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2-5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6-24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2-5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2-5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets.
url https://doi.org/10.1371/journal.pone.0221260
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