You are here

Article Text

Article menu

Download PDFPDF

Research
The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger
  1. Cesaire T Ouedraogo1,2,
  2. K Ryan Wessells1,
  3. Rebecca R Young1,
  4. Ibrahim Foungotin Bamba2,
  5. M Thierno Faye2,
  6. Ndiaye Banda3,
  7. Sonja Y Hess1
  1. 1Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
  2. 2Helen Keller International, Niamey, Niger
  3. 3Nutrition International, Dakar, Senegal
  1. Correspondence to Dr Sonja Y Hess; syhess{at}ucdavis.edu

Abstract

Background Anaemia is prevalent among pregnant women in rural Niger and antenatal care (ANC) attendance is suboptimal. We designed a programmatic intervention including community-based behaviour change communication, provision of essential drugs (including iron folic acid (IFA) supplements) and quality improvement activities at selected integrated health centres (IHCs).

Objective To assess the impact of the programmatic intervention on: (1) utilisation of ANC, (2) adherence to daily IFA supplementation and (3) prevalence of adequate gestational weight gain (GWG) and anaemia among pregnant women in Zinder, Niger.

Methods Using a quasi-experimental study design comparing a cohort of women at baseline to another cohort of women at endline, 18 IHCs and surrounding villages were randomly assigned to time of enrolment over 1 year. A baseline survey was implemented among randomly selected pregnant women in 68 village clusters. Subsequently, the intervention was rolled out and an endline survey was implemented 6 months later in the same villages.

Results Mean age in the baseline (n=1385) and endline (n=922) surveys was 25.8±6.4 years. The percentage of pregnant women who reported attending any number of ANC and an adequate number of ANC for their gestational age, respectively, was not significantly different between the endline and the baseline surveys. Pregnant women in the endline survey were more likely to have received IFA (60.0% vs 45.8%, OR: 2.7 (1.2, 6.1)); and the proportion of pregnant women who reportedly consumed IFA daily in the previous 7 days was significantly higher in the endline than in the baseline survey (46.4% vs 32.8%, OR: 2.8 (1.2, 6.5)). There was no impact on the prevalence of adequate GWG or anaemia.

Conclusions The programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving and consuming IFA supplements as recommended, but did not affect ANC attendance and nutritional status.

  • maternal health
  • nutrition
  • anaemia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2018-001200

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Handling editor Soumitra S Bhuyan

    • Contributors The NiMaNu Project was conceived and designed by SYH, KRW and CTO. Data were analysed by CTO with the guidance from RRY and SYH. Results were interpreted by all coauthors. CTO drafted the manuscript, and SYH edited the manuscript. All authors reviewed and approved the final version of the manuscript.

    • Funding This study was funded by the Government of Canada through Global Affairs Canada and Nutrition International. Nutriset SAS provided financial support for tuition fees of CTO’s PhD dissertation.

    • Competing interests BN works for Nutrition International.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The datasets generated and analysed during the current study are available from the study principal investigator on reasonable request (syhess@ucdavis.edu).