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| Name | Class |
|---|---|
| AFRICSanté | OTHER |
| FHI 360 | OTHER |
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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.
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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | A&T intervention areas: intensified maternal nutrition behavior change interventions during antenatal care delivered through government health facilities. |
|
| Control | No Intervention | Comparison areas: standard antenatal care services delivered at government health facilities. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Health Facility Level Interventions | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Dietary diversity during pregnancy | Mean number of food groups consumed by pregnant women on the day preceding the interview. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Minimum dietary diversity during pregnancy | Proportion of pregnant women who consumed 5 or more food groups on the day preceding the interview. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Consumption of iron-folic acid tablets during pregnancy | Mean number of IFA tablets consumed during last pregnancy by recently delivered women with a child 0-5.9 months of age. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Consumption of 90+ iron-folic acid tablets during pregnancy | Proportion of women who consumed 90+ IFA tablets during last pregnancy by recently delivered women with a child 0-5.9 months of age. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Measure | Description | Time Frame |
|---|---|---|
| Micronutrient, protein and energy adequacy during pregnancy | Proportion of pregnant women whose micronutrient, protein and energy intakes are equal to or above the dietary reference intake. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Early initiation of breastfeeding |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| International Food Policy Research Institute | Washington D.C. | District of Columbia | 20005 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26433230 | Background | Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta K, Purandare CN, Yajnik CS, Rushwan H, Morris JL. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: "Think Nutrition First". Int J Gynaecol Obstet. 2015 Oct;131 Suppl 4:S213-53. doi: 10.1016/S0020-7292(15)30034-5. No abstract available. | |
| 18207566 |
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In compliance with donor open access policy requirements, fully anonymized datasets will be made publicly available one year after the end of the project. Metadata and other documentation of data collection procedures (such as the codebook, data collection instruments and interviewer guides/protocols) will also be made publicly available.
Fully anonymized datasets will be made publicly available one year after the end of the project.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Oct 23, 2020 | Feb 18, 2022 |
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|
| Community Level Interventions | Behavioral |
|
|
| Health System Level Interventions | Behavioral |
|
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Proportion of children aged 0-5.9 months who were breastfed within 1 hour of birth. |
| Approximately 16 months after baseline in a cross-sectional endline survey |
| Use of ANC services during pregnancy | Total number of ANC visits and month of first ANC first during last pregnancy reported by recently delivered women with a child age 0-5.9 months. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Exposure to nutrition interventions during ANC | Proportion of recently delivered women with children 0-5.9 months of age who received nutrition interventions during their last pregnancy during ANC and in the community based on survey responses. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Women's knowledge of maternal nutrition and breastfeeding | Proportion of recently delivered women with children 0-5.9 months of age with correct knowledge of maternal nutrition and appropriate breastfeeding practices based on survey responses. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Health worker knowledge of IFA supplementation, dietary diversity, weight gain during pregnancy, and early and exclusive breastfeeding. | Proportion of Nurse-Midwives and community health workers (ASBCs) with correct knowledge of IFA supplementation, dietary diversity, weight gain during pregnancy and appropriate breastfeeding practices based on survey responses. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Availability of ANC service supports | Proportion of health facilities with ANC materials and equipment based on enumerator observation. | Approximately 16 months after baseline in a cross-sectional endline survey |
| Background |
| Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J; Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008 Jan 19;371(9608):243-60. doi: 10.1016/S0140-6736(07)61690-0. No abstract available. |
| 28079998 | Background | WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva: World Health Organization; 2016. Available from http://www.ncbi.nlm.nih.gov/books/NBK409108/ |
| Background | Partnership for Maternal, Newborn and Child Health (PMNCH). 2006. Opportunities for Africa's newborns: Practical data, policy and programmatic support for newborn care in Africa. Edited by Joy Lawn and Kate Kerber. Cape Town: PMNCH. |
| Background | United Nations Children's Fund (UNICEF). 2016. The state of the world's children 2016: A fair chance for every child. New York: UNICEF. |
| 25013954 | Background | Alkema L, New JR, Pedersen J, You D; UN Inter-agency Group for Child Mortality Estimation; Technical Advisory Group. Child mortality estimation 2013: an overview of updates in estimation methods by the United Nations Inter-agency Group for Child Mortality Estimation. PLoS One. 2014 Jul 11;9(7):e101112. doi: 10.1371/journal.pone.0101112. eCollection 2014. |
| 37336320 | Derived | Kim SS, Zagre RR, Ouedraogo CT, Sununtnasuk C, Ganaba R, Zafimanjaka MG, Tharaney M, Sanghvi T, Menon P. Intensified Nutrition Interventions in Antenatal Care Services Increased Consumption of Iron and Folic Acid Supplements and Early Breastfeeding Practices in Burkina Faso: Results of a Cluster-Randomized Program Evaluation. J Nutr. 2023 Oct;153(10):3058-3067. doi: 10.1016/j.tjnut.2023.06.016. Epub 2023 Jun 17. |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Mar 1, 2021 | Feb 18, 2022 | SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Nov 16, 2020 | Feb 18, 2022 | ICF_002.pdf |