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'
type: article
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'