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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| creator | Suresh, Shalini Paxton, Anne Pun, Bhim Kumari Gyawali, Min Raj Kshetri, Indra Dhoj Rana, Pooja Pandey Cunningham, Kenda |
| 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 |
| doi_str_mv | 10.1371/journal.pone.0221260 |
| format | Article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0221260</identifier><identifier>PMID: 31449529</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Age ; Analysis ; Biology and Life Sciences ; Child ; Child health ; Child malnutrition ; Child Nutrition Disorders - epidemiology ; Child Nutrition Disorders - physiopathology ; Child, Preschool ; Children ; Children & youth ; Cross-Sectional Studies ; Diet ; Epidemiology ; Exposure ; Female ; Food ; Food groups ; Health aspects ; Health Knowledge, Attitudes, Practice ; Hemoglobin ; Households ; Human nutrition ; Humans ; Infant ; Infant Nutritional Physiological Phenomena ; Interpersonal communication ; Intervention ; Keller, Helen, 1880-1968 ; Male ; Malnutrition ; Mass media ; Maternal & child health ; Maternal behavior ; Medicine and Health Sciences ; Mothers ; Multiculturalism & pluralism ; Nepal - epidemiology ; Nutrition ; Nutritional Status - physiology ; People and Places ; Personal communication ; Platforms ; Pregnancy ; Prevalence studies (Epidemiology) ; Public health ; Radio programs ; Regression analysis ; Regression models ; Sanitation ; Social Sciences ; Socioeconomic Factors ; Standard deviation ; Undernutrition ; Womens health ; Workers ; Young Adult</subject><ispartof>PloS one, 2019-08, Vol.14 (8), p.e0221260-e0221260</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Suresh 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>2019 Suresh et al 2019 Suresh et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-1784dec790f722eb62d3ba99eacc454f66ab4bef25bbc20baf794b0f73c99fef3</citedby><cites>FETCH-LOGICAL-c585t-1784dec790f722eb62d3ba99eacc454f66ab4bef25bbc20baf794b0f73c99fef3</cites><orcidid>0000-0002-4067-1349 ; 0000-0002-6300-3220 ; 0000-0002-0016-9215</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/PMC6709950/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709950/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31449529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suresh, Shalini</creatorcontrib><creatorcontrib>Paxton, Anne</creatorcontrib><creatorcontrib>Pun, Bhim Kumari</creatorcontrib><creatorcontrib>Gyawali, Min Raj</creatorcontrib><creatorcontrib>Kshetri, Indra Dhoj</creatorcontrib><creatorcontrib>Rana, Pooja Pandey</creatorcontrib><creatorcontrib>Cunningham, Kenda</creatorcontrib><title>Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program</title><title>PloS one</title><addtitle>PLoS One</addtitle><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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Child</subject><subject>Child health</subject><subject>Child malnutrition</subject><subject>Child Nutrition Disorders - epidemiology</subject><subject>Child Nutrition Disorders - physiopathology</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Children & youth</subject><subject>Cross-Sectional Studies</subject><subject>Diet</subject><subject>Epidemiology</subject><subject>Exposure</subject><subject>Female</subject><subject>Food</subject><subject>Food groups</subject><subject>Health aspects</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Hemoglobin</subject><subject>Households</subject><subject>Human nutrition</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant Nutritional Physiological Phenomena</subject><subject>Interpersonal communication</subject><subject>Intervention</subject><subject>Keller, Helen, 1880-1968</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Mass media</subject><subject>Maternal & child health</subject><subject>Maternal behavior</subject><subject>Medicine and Health Sciences</subject><subject>Mothers</subject><subject>Multiculturalism & pluralism</subject><subject>Nepal - epidemiology</subject><subject>Nutrition</subject><subject>Nutritional Status - physiology</subject><subject>People and Places</subject><subject>Personal communication</subject><subject>Platforms</subject><subject>Pregnancy</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Public health</subject><subject>Radio programs</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Sanitation</subject><subject>Social Sciences</subject><subject>Socioeconomic Factors</subject><subject>Standard deviation</subject><subject>Undernutrition</subject><subject>Womens health</subject><subject>Workers</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptks1u1DAUhSMEoqXwBggsISE2M_gvTswCqSoFKlViA2vLdq4zGTnxYCcjeAseGWcmraaIleP4u-f4Xp-ieEnwmrCKvN-GKQ7ar3dhgDWmlFCBHxXnRDK6EhSzxyffZ8WzlLYYl6wW4mlxxgjnsqTyvPjzCdoIgIJD8GsX0hQBjQF1wwhxD8PYhSHlnfMTDBYS6nU-yLZIDw2ym843qOlg1PE32kVtxy5DH9D1vmtmHrkYeqSR17GFVbLaA-onP3YJ7BhilhmmMXazSy4PbdT98-KJ0z7Bi2W9KH58vv5-9XV1--3LzdXl7cqWdTmuSFXzBmwlsasoBSNow4yWErS1vOROCG24AUdLYyzFRrtKcpNhZqV04NhF8fqou_MhqWWYSVFaY17Nw8nEzZFogt6qXez63KUKulOHHyG2SsfcsAdFBWPaYC4xN9zVlRaE0UbXpZGNoYZkrY-L22R6aGyebO7-gejDk6HbqDbslaiwlCXOAu8WgRh-TpBG1XfJgvd6gDAd7k0IpVzMXm_-Qf_f3UK1-VFUfuGQfe0sqi5LWWUhIatMvT2hNqD9uEnBT4dcPAT5EbQxpBTB3fdGsJrzencJNedVLXnNZa9O53JfdBdQ9herHuvM</recordid><startdate>20190826</startdate><enddate>20190826</enddate><creator>Suresh, Shalini</creator><creator>Paxton, Anne</creator><creator>Pun, Bhim Kumari</creator><creator>Gyawali, Min Raj</creator><creator>Kshetri, Indra Dhoj</creator><creator>Rana, Pooja Pandey</creator><creator>Cunningham, Kenda</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4067-1349</orcidid><orcidid>https://orcid.org/0000-0002-6300-3220</orcidid><orcidid>https://orcid.org/0000-0002-0016-9215</orcidid></search><sort><creationdate>20190826</creationdate><title>Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program</title><author>Suresh, Shalini ; Paxton, Anne ; Pun, Bhim Kumari ; Gyawali, Min Raj ; Kshetri, Indra Dhoj ; Rana, Pooja Pandey ; Cunningham, Kenda</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-1784dec790f722eb62d3ba99eacc454f66ab4bef25bbc20baf794b0f73c99fef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Analysis</topic><topic>Biology and Life Sciences</topic><topic>Child</topic><topic>Child health</topic><topic>Child malnutrition</topic><topic>Child Nutrition Disorders - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suresh, Shalini</au><au>Paxton, Anne</au><au>Pun, Bhim Kumari</au><au>Gyawali, Min Raj</au><au>Kshetri, Indra Dhoj</au><au>Rana, Pooja Pandey</au><au>Cunningham, Kenda</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-08-26</date><risdate>2019</risdate><volume>14</volume><issue>8</issue><spage>e0221260</spage><epage>e0221260</epage><pages>e0221260-e0221260</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31449529</pmid><doi>10.1371/journal.pone.0221260</doi><orcidid>https://orcid.org/0000-0002-4067-1349</orcidid><orcidid>https://orcid.org/0000-0002-6300-3220</orcidid><orcidid>https://orcid.org/0000-0002-0016-9215</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-08, Vol.14 (8), p.e0221260-e0221260 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2280474952 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adolescent Adult Age Analysis Biology and Life Sciences Child Child health Child malnutrition Child Nutrition Disorders - epidemiology Child Nutrition Disorders - physiopathology Child, Preschool Children Children & youth Cross-Sectional Studies Diet Epidemiology Exposure Female Food Food groups Health aspects Health Knowledge, Attitudes, Practice Hemoglobin Households Human nutrition Humans Infant Infant Nutritional Physiological Phenomena Interpersonal communication Intervention Keller, Helen, 1880-1968 Male Malnutrition Mass media Maternal & child health Maternal behavior Medicine and Health Sciences Mothers Multiculturalism & pluralism Nepal - epidemiology Nutrition Nutritional Status - physiology People and Places Personal communication Platforms Pregnancy Prevalence studies (Epidemiology) Public health Radio programs Regression analysis Regression models Sanitation Social Sciences Socioeconomic Factors Standard deviation Undernutrition Womens health Workers Young Adult |
| title | Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program |
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