NCT04155437

Assessing the Feasibility of Integrating a Package of Maternal Nutrition Interventions Into Antenatal Care Services in Burkina Faso

Assessing the Feasibility of Integrating a Package of Maternal Nutrition Interventions Into Antenatal Care Services in Burkina Faso: A Cluster-Randomized Evaluation

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 8,110 (actual)
• Sponsor: International Food Policy Research Institute · Academic / Other
• Sex: Female
• Age: 15 Years – 49 Years
• Healthy volunteers: Accepted

Summary

Alive \& Thrive (A\&T) is an initiative that supports the scaling up of nutrition interventions to save lives, prevent illnesses, and contribute to healthy growth and development through improved maternal nutrition, breastfeeding and complementary feeding practices. In Burkina Faso, A\&T developed an intensive package of maternal nutrition interventions to be integrated into existing ANC services delivered through government health facilities that align with the latest global evidence. These included intensified counseling and support on dietary diversity and quality during pregnancy, iron-folic acid (IFA) supplements consumption, importance of ANC and increasing the number of visits, adequate weight-gain monitoring, and early initiation of and exclusive breastfeeding. The evaluation used a two-arm cluster-randomized, non-masked trial design, consisting of two cross-sectional surveys of pregnant and recently delivered women (i.e. with a child under 6 months of age) in 2019 and 2021.

Detailed description

Routine antenatal care (ANC) offers opportunities to receive a broad range of health promotion and prevention services including support for adequate nutritional care for pregnant women and their newborns, and any required medical treatment. In 2016, World Health Organization (WHO) updated its guidelines on ANC with a high priority placed on nutrition interventions. These guidelines also recommended increasing the number of ANC from at least four to eight contacts to improve women's positive experience of care and to reduce perinatal morbidity and mortality. Following these new recommendations, the government of Burkina Faso is working with WHO and other partners to revise the national guidelines on ANC and test elements of the essential core package of routine ANC needed by women throughout pregnancy. A\&T Burkina Faso, developed an intensive package of maternal nutrition interventions to be integrated into existing ANC services delivered through government health facilities that align with the latest global evidence. These included intensified counseling and support on dietary diversity and quality during pregnancy, iron-folic acid (IFA) supplements consumption, importance of ANC and increasing the number of visits, adequate weight-gain monitoring, and early initiation of and exclusive breastfeeding. IFPRI tested the feasibility of the behavior-change interventions and examined their impacts on pregnant women's health and nutrition practices and breastfeeding practices of recently delivered women, compared with standard antenatal care services provided in control areas. The study was designed as a two-arm cluster-randomized, non-masked trial, consisting of two cross-sectional surveys at baseline and endline. The unit of randomization was the health and social promotion center (CSPS, Centre de Santé et de Promotion Social in French) catchment area. 40 CSPS in Boucle du Mouhoun and 40 CSPS in Hauts-Bassins were randomly assigned to intervention/control. A baseline cluster/facility-level and household survey took place in November-December 2019. Soon after the completion of the baseline survey, the interventions were implemented at the CSPS and villages within the intervention areas for approximately 10 months (less than 1 year, caused by brief service interruptions in March-April 2020 due to the COVID-19 pandemic). The endline survey took place in January-March 2021. The overall study objective is to evaluate the feasibility of integrating locally relevant maternal nutrition interventions into ANC services provided by the government health system and their impact on diet quality and quantity and utilization of nutrition interventions during pregnancy. The implementation research study addresses three research questions: 1. What are the program impacts on maternal nutrition practices: (1) consumption of diversified foods and adequate intake of micronutrient, protein and energy compared to recommended intakes; (2) consumption of IFA supplements during pregnancy; and (3) early breastfeeding practices? 2. Can the coverage and utilization of key nutrition interventions (maternal nutrition counseling, weight gain monitoring, distribution of and counseling on IFA supplementation, and breastfeeding counseling) and number of ANC contacts be improved through health system strengthening and nutrition-focused social and behavior change communication (SBCC; interpersonal communication and community mobilization) approaches? 3. What factors influenced integration and strengthening of maternal nutrition interventions into the government ANC service delivery platform?

Conditions

• Maternal Dietary Diversity
• Iron-Folic Acid Supplementation
• Early Initiation of Breastfeeding

Interventions

Type	Name	Description
BEHAVIORAL	Health Facility Level Interventions	* Intensified counseling on maternal dietary diversity and quality using job aids * Counseling on purpose of IFA supplementation, managing side effects, and importance of adherence to daily consumption * Distribution/prescription of IFA tablets at each ANC visit * Use of pill card/reminders for pregnant women and their spouses * Monthly IFA tablet stock monitoring to assure sufficient supplies * Measurement of weight gain during each ANC visit and advise on healthy weight gain * Checks for functioning scales and use of monitoring sheets * Intensified counseling on early initiation of breastfeeding and exclusive breastfeeding using job aids * Reminder on importance of early ANC attendance and 4+ visits
BEHAVIORAL	Community Level Interventions	* Advocacy among community leaders (traditional and religious leaders, local associations, etc.) about ANC * Gatherings among grandmothers, husbands, and other influencers about ANC and their roles * Promotion of ANC service utilisation and the importance of early ANC visit during the first trimester. * Early identification of pregnant women * Support women's group discussions * 2-3 home visits per pregnant woman by community health workers (Agent de santé a base communautaire; ASBC) which will include counseling on diet quality, breastfeeding, importance on adherence to daily IFA consumption and side effect management, etc.
BEHAVIORAL	Health System Level Interventions	* Training on nutrition interventions during ANC for all ANC providers and community health workers * Semi-annual supervision by the Regional Health Directorate (Direction Regionale de la Santé; DRS) * Quarterly supportive supervision of health facility staff by the health district management team * Monthly supportive supervision of ASBCs * Monthly review between health facilities and ASBCs * Training and use of data registers * Training and use of mother's cards to record up to 8 ANC visits and nutrition services * Training on data utilization to improve coverage and quality

Timeline

• Start date: 2019-11-06
• Primary completion: 2021-03-05
• Completion: 2021-03-05
• First posted: 2019-11-07
• Last updated: 2022-03-10

Locations

1 site across 1 country: United States