2023-09-28 14:46:10 +00:00
|
|
|
abstract: 'Background To address gaps in coverage and quality of nutrition
|
|
|
|
|
|
|
|
|
|
services, Alive \& Thrive (A\&T) strengthened the delivery of maternal
|
|
|
|
|
|
|
|
|
|
nutrition interventions through government antenatal care (ANC) services
|
|
|
|
|
|
|
|
|
|
in Uttar Pradesh, India. The impact evaluation of the A\&T interventions
|
|
|
|
|
|
|
|
|
|
compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found
|
|
|
|
|
|
|
|
|
|
modest impacts on micronutrient supplementation, dietary diversity, and
|
|
|
|
|
|
|
|
|
|
weight-gain monitoring. Objectives This study examined
|
|
|
|
|
|
|
|
|
|
intervention-specific program impact pathways (PIPs) and identified
|
|
|
|
|
|
|
|
|
|
reasons for limited impacts of the A\&T maternal nutrition intervention
|
|
|
|
|
|
|
|
|
|
package. Methods We used mixed methods: frontline worker (FLW) surveys
|
|
|
|
|
|
|
|
|
|
(n = similar to 500), counseling observations (n = 407), and qualitative
|
|
|
|
|
|
|
|
|
|
in-depth interviews with FLWs, supervisors, and block-level staff (n =
|
|
|
|
|
|
|
|
|
|
59). We assessed 7 PIP domains: training and materials, knowledge,
|
|
|
|
|
|
|
|
|
|
supportive supervision, supply chains, data use, service delivery, and
|
|
|
|
|
|
|
|
|
|
counseling. Results Exposure to training improved in both I-ANC and
|
|
|
|
|
|
|
|
|
|
S-ANC areas with more job aids used in I-ANC compared with S-ANC (90\%
|
|
|
|
|
|
|
|
|
|
compared with 70\%), but gaps remained for training content and
|
|
|
|
|
|
|
|
|
|
refresher trainings. FLWs'' knowledge improvement was higher in I-ANC
|
|
|
|
|
|
|
|
|
|
than S-ANC (22-36 percentage points), but knowledge of micronutrient
|
|
|
|
|
|
|
|
|
|
supplement benefits and recommended foods was insufficient (<50\%). Most
|
|
|
|
|
|
|
|
|
|
FLWs received supervision (>90\%), but supportive supervision was
|
|
|
|
|
|
|
|
|
|
limited by staff vacancies and competing work priorities. Supplies of
|
|
|
|
|
|
|
|
|
|
iron-folic acid and calcium supplements were low in both areas (30-50\%
|
|
|
|
|
|
|
|
|
|
stock-outs). Use of monitoring data during review meetings was higher in
|
|
|
|
|
|
|
|
|
|
I-ANC than S-ANC (52\% compared with 36\%) but was constrained by time,
|
|
|
|
|
|
|
|
|
|
understanding, and data quality. Service provision improved in both
|
|
|
|
|
|
|
|
|
|
I-ANC and S-ANC areas, but counseling on supplement benefits and
|
|
|
|
|
|
|
|
|
|
weight-gain monitoring was low (30-40\%). Conclusions
|
|
|
|
|
|
|
|
|
|
Systems-strengthening efforts improved maternal nutrition interventions
|
|
|
|
|
|
|
|
|
|
in ANC, but gaps remained. Taking an intervention-specific perspective
|
|
|
|
|
|
|
|
|
|
to the PIP analysis in this package of services was critical to
|
|
|
|
|
|
|
|
|
|
understand how common and specific barriers influenced overall program
|
|
|
|
|
|
|
|
|
|
impact.'
|
|
|
|
|
affiliation: 'Nguyen, PH (Corresponding Author), Int Food Policy Res Inst IFPRI, Washington,
|
|
|
|
|
DC 20005 USA.
|
|
|
|
|
|
|
|
|
|
Kachwaha, Shivani; Phuong H Nguyen; Avula, Rasmi; Menon, Purnima, Int Food Policy
|
|
|
|
|
Res Inst IFPRI, Washington, DC 20005 USA.
|
|
|
|
|
|
|
|
|
|
Lan Mai Tran; Young, Melissa F., Emory Univ, Atlanta, GA 30322 USA.
|
|
|
|
|
|
|
|
|
|
Ghosh, Sebanti; Forissier, Thomas; Escobar-Alegria, Jessica; Sharma, Praveen Kumar,
|
|
|
|
|
FHI Solut, Washington, DC USA.
|
|
|
|
|
|
|
|
|
|
Frongillo, Edward A., Univ South Carolina, Columbia, SC 29208 USA.'
|
|
|
|
|
author: Kachwaha, Shivani and Nguyen, Phuong H and Tran, Lan Mai and Avula, Rasmi
|
|
|
|
|
and Young, Melissa F. and Ghosh, Sebanti and Forissier, Thomas and Escobar-Alegria,
|
|
|
|
|
Jessica and Sharma, Praveen Kumar and Frongillo, Edward A. and Menon, Purnima
|
|
|
|
|
author-email: p.h.nguyen@cgiar.org
|
|
|
|
|
author_list:
|
|
|
|
|
- family: Kachwaha
|
|
|
|
|
given: Shivani
|
|
|
|
|
- family: Nguyen
|
|
|
|
|
given: Phuong H
|
|
|
|
|
- family: Tran
|
|
|
|
|
given: Lan Mai
|
|
|
|
|
- family: Avula
|
|
|
|
|
given: Rasmi
|
|
|
|
|
- family: Young
|
|
|
|
|
given: Melissa F.
|
|
|
|
|
- family: Ghosh
|
|
|
|
|
given: Sebanti
|
|
|
|
|
- family: Forissier
|
|
|
|
|
given: Thomas
|
|
|
|
|
- family: Escobar-Alegria
|
|
|
|
|
given: Jessica
|
|
|
|
|
- family: Sharma
|
|
|
|
|
given: Praveen Kumar
|
|
|
|
|
- family: Frongillo
|
|
|
|
|
given: Edward A.
|
|
|
|
|
- family: Menon
|
|
|
|
|
given: Purnima
|
|
|
|
|
da: '2023-09-28'
|
|
|
|
|
doi: 10.1093/jn/nxab390
|
|
|
|
|
earlyaccessdate: JAN 2022
|
|
|
|
|
eissn: 1541-6100
|
|
|
|
|
files: []
|
|
|
|
|
issn: 0022-3166
|
|
|
|
|
journal: JOURNAL OF NUTRITION
|
|
|
|
|
keywords: 'maternal nutrition; micronutrient supplementation; diet diversity;
|
|
|
|
|
|
|
|
|
|
weight-gain monitoring; systems strengthening; service delivery;
|
|
|
|
|
|
|
|
|
|
counseling; India'
|
|
|
|
|
keywords-plus: 'MIDDLE-INCOME COUNTRIES; CHILD FEEDING PRACTICES; MIXED-METHODS
|
|
|
|
|
|
|
|
|
|
RESEARCH; UNDERNUTRITION; HEALTH; IMPLEMENTATION; PROGRAMS; ACHIEVE;
|
|
|
|
|
|
|
|
|
|
INFANT'
|
|
|
|
|
language: English
|
|
|
|
|
month: FEB 8
|
|
|
|
|
number: '2'
|
|
|
|
|
number-of-cited-references: '35'
|
|
|
|
|
orcid-numbers: 'Young, Melissa Fox/0000-0002-2768-1673
|
|
|
|
|
|
|
|
|
|
Nguyen, Phuong H/0000-0003-3418-1674'
|
|
|
|
|
pages: 612-629
|
|
|
|
|
papis_id: cfc13ccb5a6f1ed019d28520f596e0f7
|
|
|
|
|
ref: Kachwaha2022specificitymatters
|
|
|
|
|
researcherid-numbers: 'Young, Melissa Fox/AAW-2016-2021
|
|
|
|
|
|
|
|
|
|
'
|
|
|
|
|
times-cited: '4'
|
|
|
|
|
title: 'Specificity Matters: Unpacking Impact Pathways of Individual Interventions
|
|
|
|
|
within Bundled Packages Helps Interpret the Limited Impacts of a Maternal Nutrition
|
|
|
|
|
Intervention in India'
|
2023-10-01 08:15:07 +00:00
|
|
|
type: article
|
2023-09-28 14:46:10 +00:00
|
|
|
unique-id: WOS:000766302000027
|
|
|
|
|
usage-count-last-180-days: '0'
|
|
|
|
|
usage-count-since-2013: '1'
|
|
|
|
|
volume: '152'
|
|
|
|
|
web-of-science-categories: Nutrition \& Dietetics
|
|
|
|
|
year: '2022'
|
