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A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study.

ABSTRACT: Prenatal balanced protein energy supplementation consumed by undernourished women improves mid-upper arm circumference in early infancy. This study aimed to identify whether locally produced maternal food-based supplementation improved anthropometric measures at birth and early infancy.A village-matched evaluation, applying principles of a cluster randomised controlled trial, of a locally produced supplemental food to 87 undernourished pregnant women. 12 villages (intervention: n?=?8; control: n?=?4) in Pirganj sub-district, Rangpur District, northern Bangladesh. Daily supplements were provided.Anthropometric data at birth were available for 77 mother-infant dyads and longer-term infant growth data for 75 infants. Mid-upper arm circumference (MUAC) was significantly larger in infants of mothers in the intervention group compared with the control group at 6 months (p ?0·05; most likely due to small sample size). The intervention reduced the risk of wasting at 6 months by 63.38% (RRR?=?0.6338), and of low birth weight by 88·58% (RRR?=?0.8858), with NNT of 2.22 and 6.32, respectively. Only three pregnant women require this intervention in order to prevent wasting at 6 months in one child, and seven need the intervention to prevent low birth weight of one child.Locally produced food-based balanced protein energy supplementation in undernourished pregnant women in northern Bangladesh resulted in larger MUAC in infants at 6 months. Further research, with larger sample sizes, is required to confirm the role of locally produced supplementation for undernourished pregnant women on weight and linear growth in newborns and infants.This research was registered with the ISRCTN registry (ISRCTN97447076). This project had human research ethical approval from the James Cook University (Australia) Ethics committee (H4498) and the Bangladesh Medical Research Council (BMRC/NREC/2010-2013/58).

SUBMITTER: Stevens B

PROVIDER: S-EPMC6030796 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study.

Stevens Briony B Watt Kerrianne K Brimbecombe Julie J Clough Alan A Judd Jenni A JA Lindsay Daniel D

BMC pregnancy and childbirth 20180704 1

<h4>Background</h4>Prenatal balanced protein energy supplementation consumed by undernourished women improves mid-upper arm circumference in early infancy. This study aimed to identify whether locally produced maternal food-based supplementation improved anthropometric measures at birth and early infancy.<h4>Methods</h4>A village-matched evaluation, applying principles of a cluster randomised controlled trial, of a locally produced supplemental food to 87 undernourished pregnant women. 12 villag ...[more]

PMID: 29973170

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Project description:BackgroundWomen in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial.MethodsWe conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants.ResultsThe analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household.ConclusionsThis study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study.Trial registrationFAARM is registered with ClinicalTrials.gov ( NCT02505711 ).

Project description:BACKGROUND:Pesticide exposure during pregnancy is thought to adversely affect fetal growth, which in turn may impact child growth, but results have been inconsistent across studies and few have explored these effects in developing countries. OBJECTIVES:To quantify urinary concentrations of pesticide biomarkers in early pregnancy (<16?weeks' gestation), and to estimate the association of these concentrations with preterm birth, low birth weight, small for gestational age, and stunting at ~1 and 2?years of age. METHODS:Eight pesticide biomarkers were quantified in urine collected from 289 pregnant women (aged 18-40?years) participating in a birth cohort study in Bangladesh. Anthropometry measurements were conducted on the index child at birth and approximately 1 and 2?years of age. A directed acyclic graph was used to identify minimal sufficient adjustment sets. Log-binomial regression was used to estimate the relative risk (RR) with 95% confidence intervals (CI). RESULTS:3,5,6-trichloro-2-pyridinol (TCPY), a metabolite of chlorpyrifos and chlorpyrifos methyl, and 4-nitrophenol, a metabolite of parathion and methyl parathion, were detected in nearly all women with geometric mean (95% CI) values of 3.17 (2.82-3.56) and 18.66 (17.03-20.46) µg/g creatinine, respectively. 3-phenoxybenzoic acid (3-PBA), a non-specific metabolite of several pyrethroids, and 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMPY), a diazinon metabolite, were detected in 19.8% and 16.1% of women, respectively. The remaining four pesticide biomarkers were detected in <10% of women. Women in the highest quartile of 4-nitrophenol were more than 3 times more likely to deliver preterm than women in the lowest quartile: unadjusted RR (95% CI), 3.57 (1.65, 7.73). Women in the highest quartile of 4-nitrophenol were also at increased risk of having a child born small for gestational age: RR (95% CI) adjusted for household income, maternal education, and maternal total energy and meat intake, 3.81 (1.10, 13.21). Women with detectable concentrations of IMPY were at increased risk of having a child born with low birth weight compared to women with non-detectable concentrations: adjusted RR (95% CI), 2.13 (1.12, 4.08). We observed no association between any of the pesticide biomarkers and stunting at 1 or 2?years of age. DISCUSSION:Exposure to the insecticides parathion and diazinon during early pregnancy may increase the risk of adverse birth outcomes.

Project description:Consuming wild foods is part of the food ways of people in many societies, including farming populations throughout the world. Knowledge of non-domesticated food resources is part of traditional and tacit ecological knowledge, and is largely transmitted through socialization within cultural and household contexts. The context of this study, a small village in Northeast Thailand, is one where the community has experienced changes due to the migration of the parental generation, with the children being left behind in the village to be raised by their grandparents. A case study approach was used in order to gain holistic in-depth insight into children's traditional ecological knowledge as well as patterns of how children acquire their knowledge regarding wild food resources. Techniques used during field data collection are free-listing conducted with 30 village children and the use of a sub-sample of children for more in-depth research. For the sub-sample part of the study, wild food items consisted of a selection of 20 wild food species consisting of 10 species of plants and 10 species of animals. Semi-structured interviews with photo identification, informal interviews and participatory observation were utilized, and both theoretical and practical knowledge scored. The sub-sample covers eight households with boys and girls aged between 10-12 years old from both migrant families and non-migrant families. The knowledge of children was compared and the transmission process was observed. The result of our study shows that there is no observable difference among children who are being raised by grandparents and those being raised by their parents, as there are different channels of knowledge transmission to be taken into consideration, particularly grandparents and peers. The basic ability (knowledge) for naming wild food species remains among village children. However, the practical in-depth knowledge, especially about wild food plants, shows some potential eroding.

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A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study.

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A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study.

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