An integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study
Undernutrition below two years of age remains a major public health problem in India. We conducted an evaluation of an integrated nutrition and health program that aimed to improve nutritional status of young children by improving breast and complementary feeding practices over that offered by the G...
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| Veröffentlicht in: | PloS one 2017-09, Vol.12 (9), p.e0185030-e0185030 |
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| creator | Singh, Veena Ahmed, Saifuddin Dreyfuss, Michele L Kiran, Usha Chaudhery, Deepika N Srivastava, Vinod K Ahuja, Ramesh C Baqui, Abdullah H Darmstadt, Gary L Santosham, Mathuram West, Jr, Keith P |
| description | Undernutrition below two years of age remains a major public health problem in India. We conducted an evaluation of an integrated nutrition and health program that aimed to improve nutritional status of young children by improving breast and complementary feeding practices over that offered by the Government of India's standard nutrition and health care program.
In Uttar Pradesh state, through multi-stage cluster random sampling, 81 villages in an intervention district and 84 villages in a comparison district were selected. A cohort of 957 third trimester pregnant women identified during house-to-house surveys was enrolled and, following childbirth, mother-child dyads were followed every three months from birth to 18 months of age. The primary outcomes were improvements in weight-for-age and length-for-age z scores, with improved breastfeeding and complementary feeding practices as intermediate outcomes.
Optimal breastfeeding practices were higher among women in intervention than comparison areas, including initiating breastfeeding within one hour of delivery (17.4% vs. 2.7%, p |
| doi_str_mv | 10.1371/journal.pone.0185030 |
| format | Article |
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In Uttar Pradesh state, through multi-stage cluster random sampling, 81 villages in an intervention district and 84 villages in a comparison district were selected. A cohort of 957 third trimester pregnant women identified during house-to-house surveys was enrolled and, following childbirth, mother-child dyads were followed every three months from birth to 18 months of age. The primary outcomes were improvements in weight-for-age and length-for-age z scores, with improved breastfeeding and complementary feeding practices as intermediate outcomes.
Optimal breastfeeding practices were higher among women in intervention than comparison areas, including initiating breastfeeding within one hour of delivery (17.4% vs. 2.7%, p<0.001), feeding colostrum (34.7% vs. 8.4%, p<0.001), avoiding pre-lacteals (19.6% vs. 2.1%, p<0.001) and exclusively breastfeeding up to 6 months (24.1% vs. 15.3%, p = 0.001). However, differences were few and mixed between study arms with respect to complementary feeding practices. The mean weight-for-age z-score was higher at 9 months (-2.1 vs. -2.4, p = 0.0026) and the prevalence of underweight status was lower at 12 months (58.5% vs. 69.3%, p = 0.047) among intervention children. The prevalence of stunting was similar between study arms at all ages. Coefficients to show the differences between the intervention and comparison districts (0.13 cm/mo) suggested significant faster linear growth among intervention district infants at earlier ages (0-5 months).
Mothers participating in the intervention district were more likely to follow optimal breast, although not complementary feeding practices. The program modestly improved linear growth in earlier age and weight gain in late infancy. Comprehensive nutrition and health interventions are complex; the implementation strategies need careful examination to improve feeding practices and thus impact growth.
The trial was registered with ClinicalTrials.gov, NCT00198835.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0185030</identifier><identifier>PMID: 28931088</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Babies ; Biology and Life Sciences ; Breast feeding ; Breast Feeding - statistics & numerical data ; Breastfeeding & lactation ; Child development ; Childbirth & labor ; Children ; Children & youth ; Colostrum ; Correlation analysis ; Design ; Families & family life ; Feeding ; Female ; Food ; Health care ; Health Promotion ; Health services ; Humans ; India ; Infant ; Infant Nutritional Physiological Phenomena ; Infants ; Intervention ; Longitudinal Studies ; Measles ; Medicine and Health Sciences ; Mothers ; National Health Programs ; Nutrition ; Nutrition education ; Nutritional Status ; People and Places ; Pneumonia ; Pregnancy ; Pregnant women ; Preschool education ; Public health ; Quasi-experimental methods ; Random sampling ; Socioeconomic Factors ; Surveys ; Undernutrition ; Underweight ; Womens health</subject><ispartof>PloS one, 2017-09, Vol.12 (9), p.e0185030-e0185030</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Singh et al 2017 Singh et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6070-6ff0b6d0f9743fdd56e4c5c7d6c543c19b705944986e4a8aab3bb45e366459e13</citedby><cites>FETCH-LOGICAL-c6070-6ff0b6d0f9743fdd56e4c5c7d6c543c19b705944986e4a8aab3bb45e366459e13</cites><orcidid>0000-0002-6296-3318</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607187/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607187/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28931088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>van Wouwe, Jacobus P.</contributor><creatorcontrib>Singh, Veena</creatorcontrib><creatorcontrib>Ahmed, Saifuddin</creatorcontrib><creatorcontrib>Dreyfuss, Michele L</creatorcontrib><creatorcontrib>Kiran, Usha</creatorcontrib><creatorcontrib>Chaudhery, Deepika N</creatorcontrib><creatorcontrib>Srivastava, Vinod K</creatorcontrib><creatorcontrib>Ahuja, Ramesh C</creatorcontrib><creatorcontrib>Baqui, Abdullah H</creatorcontrib><creatorcontrib>Darmstadt, Gary L</creatorcontrib><creatorcontrib>Santosham, Mathuram</creatorcontrib><creatorcontrib>West, Jr, Keith P</creatorcontrib><title>An integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Undernutrition below two years of age remains a major public health problem in India. We conducted an evaluation of an integrated nutrition and health program that aimed to improve nutritional status of young children by improving breast and complementary feeding practices over that offered by the Government of India's standard nutrition and health care program.
In Uttar Pradesh state, through multi-stage cluster random sampling, 81 villages in an intervention district and 84 villages in a comparison district were selected. A cohort of 957 third trimester pregnant women identified during house-to-house surveys was enrolled and, following childbirth, mother-child dyads were followed every three months from birth to 18 months of age. The primary outcomes were improvements in weight-for-age and length-for-age z scores, with improved breastfeeding and complementary feeding practices as intermediate outcomes.
Optimal breastfeeding practices were higher among women in intervention than comparison areas, including initiating breastfeeding within one hour of delivery (17.4% vs. 2.7%, p<0.001), feeding colostrum (34.7% vs. 8.4%, p<0.001), avoiding pre-lacteals (19.6% vs. 2.1%, p<0.001) and exclusively breastfeeding up to 6 months (24.1% vs. 15.3%, p = 0.001). However, differences were few and mixed between study arms with respect to complementary feeding practices. The mean weight-for-age z-score was higher at 9 months (-2.1 vs. -2.4, p = 0.0026) and the prevalence of underweight status was lower at 12 months (58.5% vs. 69.3%, p = 0.047) among intervention children. The prevalence of stunting was similar between study arms at all ages. Coefficients to show the differences between the intervention and comparison districts (0.13 cm/mo) suggested significant faster linear growth among intervention district infants at earlier ages (0-5 months).
Mothers participating in the intervention district were more likely to follow optimal breast, although not complementary feeding practices. The program modestly improved linear growth in earlier age and weight gain in late infancy. Comprehensive nutrition and health interventions are complex; the implementation strategies need careful examination to improve feeding practices and thus impact growth.
The trial was registered with ClinicalTrials.gov, NCT00198835.</description><subject>Age</subject><subject>Babies</subject><subject>Biology and Life Sciences</subject><subject>Breast feeding</subject><subject>Breast Feeding - statistics & numerical data</subject><subject>Breastfeeding & lactation</subject><subject>Child development</subject><subject>Childbirth & labor</subject><subject>Children</subject><subject>Children & youth</subject><subject>Colostrum</subject><subject>Correlation analysis</subject><subject>Design</subject><subject>Families & family life</subject><subject>Feeding</subject><subject>Female</subject><subject>Food</subject><subject>Health care</subject><subject>Health Promotion</subject><subject>Health services</subject><subject>Humans</subject><subject>India</subject><subject>Infant</subject><subject>Infant Nutritional Physiological Phenomena</subject><subject>Infants</subject><subject>Intervention</subject><subject>Longitudinal Studies</subject><subject>Measles</subject><subject>Medicine and Health Sciences</subject><subject>Mothers</subject><subject>National Health Programs</subject><subject>Nutrition</subject><subject>Nutrition education</subject><subject>Nutritional Status</subject><subject>People and Places</subject><subject>Pneumonia</subject><subject>Pregnancy</subject><subject>Pregnant women</subject><subject>Preschool education</subject><subject>Public health</subject><subject>Quasi-experimental methods</subject><subject>Random sampling</subject><subject>Socioeconomic Factors</subject><subject>Surveys</subject><subject>Undernutrition</subject><subject>Underweight</subject><subject>Womens 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integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study</title><author>Singh, Veena ; Ahmed, Saifuddin ; Dreyfuss, Michele L ; Kiran, Usha ; Chaudhery, Deepika N ; Srivastava, Vinod K ; Ahuja, Ramesh C ; Baqui, Abdullah H ; Darmstadt, Gary L ; Santosham, Mathuram ; West, Jr, Keith P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6070-6ff0b6d0f9743fdd56e4c5c7d6c543c19b705944986e4a8aab3bb45e366459e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age</topic><topic>Babies</topic><topic>Biology and Life Sciences</topic><topic>Breast feeding</topic><topic>Breast Feeding - statistics & numerical data</topic><topic>Breastfeeding & lactation</topic><topic>Child development</topic><topic>Childbirth & 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P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-09-20</date><risdate>2017</risdate><volume>12</volume><issue>9</issue><spage>e0185030</spage><epage>e0185030</epage><pages>e0185030-e0185030</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Undernutrition below two years of age remains a major public health problem in India. We conducted an evaluation of an integrated nutrition and health program that aimed to improve nutritional status of young children by improving breast and complementary feeding practices over that offered by the Government of India's standard nutrition and health care program.
In Uttar Pradesh state, through multi-stage cluster random sampling, 81 villages in an intervention district and 84 villages in a comparison district were selected. A cohort of 957 third trimester pregnant women identified during house-to-house surveys was enrolled and, following childbirth, mother-child dyads were followed every three months from birth to 18 months of age. The primary outcomes were improvements in weight-for-age and length-for-age z scores, with improved breastfeeding and complementary feeding practices as intermediate outcomes.
Optimal breastfeeding practices were higher among women in intervention than comparison areas, including initiating breastfeeding within one hour of delivery (17.4% vs. 2.7%, p<0.001), feeding colostrum (34.7% vs. 8.4%, p<0.001), avoiding pre-lacteals (19.6% vs. 2.1%, p<0.001) and exclusively breastfeeding up to 6 months (24.1% vs. 15.3%, p = 0.001). However, differences were few and mixed between study arms with respect to complementary feeding practices. The mean weight-for-age z-score was higher at 9 months (-2.1 vs. -2.4, p = 0.0026) and the prevalence of underweight status was lower at 12 months (58.5% vs. 69.3%, p = 0.047) among intervention children. The prevalence of stunting was similar between study arms at all ages. Coefficients to show the differences between the intervention and comparison districts (0.13 cm/mo) suggested significant faster linear growth among intervention district infants at earlier ages (0-5 months).
Mothers participating in the intervention district were more likely to follow optimal breast, although not complementary feeding practices. The program modestly improved linear growth in earlier age and weight gain in late infancy. Comprehensive nutrition and health interventions are complex; the implementation strategies need careful examination to improve feeding practices and thus impact growth.
The trial was registered with ClinicalTrials.gov, NCT00198835.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28931088</pmid><doi>10.1371/journal.pone.0185030</doi><tpages>e0185030</tpages><orcidid>https://orcid.org/0000-0002-6296-3318</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-09, Vol.12 (9), p.e0185030-e0185030 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1940905879 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Age Babies Biology and Life Sciences Breast feeding Breast Feeding - statistics & numerical data Breastfeeding & lactation Child development Childbirth & labor Children Children & youth Colostrum Correlation analysis Design Families & family life Feeding Female Food Health care Health Promotion Health services Humans India Infant Infant Nutritional Physiological Phenomena Infants Intervention Longitudinal Studies Measles Medicine and Health Sciences Mothers National Health Programs Nutrition Nutrition education Nutritional Status People and Places Pneumonia Pregnancy Pregnant women Preschool education Public health Quasi-experimental methods Random sampling Socioeconomic Factors Surveys Undernutrition Underweight Womens health |
| title | An integrated nutrition and health program package on IYCN improves breastfeeding but not complementary feeding and nutritional status in rural northern India: A quasi-experimental randomized longitudinal study |
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