A Feasibility Study of Integrating Maternal Nutrition Interventions Into Antenatal Care Services in Ethiopia

Summary

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 Ethiopia, A\&T integrated a package of maternal nutrition interventions into existing antenatal care (ANC) services delivered through government health facilities (counselling on diet quality during pregnancy, distribution and promotion of iron-folic acid (IFA) supplementation, weight gain monitoring, counselling on early breastfeeding practices, and systems strengthening through training and supportive supervision) and community platforms (home visits, Pregnant Women Conferences/Mother Support groups, and community gatherings). The evaluation used a two-arm cluster-randomized, non-masked trial design, consisting of two cross-sectional surveys in 2019 and 2021.

Conditions

• Maternal Dietary Diversity
• Iron-Folic Acid Supplementation
• Early Initiation of Breastfeeding

Interventions

BEHAVIORAL

Health Facility Interventions

1. Intensified counselling on dietary diversity and increased meal frequency during pregnancy. 2. Strengthened government distribution of IFA supplies with counseling about its importance, managing side effects, and reminder about subsequent supplies. 3. Weight-gain monitoring with messaging to mothers about healthy diet and adequate rest; excess weight gain as a danger sign. 4. Intensified counseling on importance, benefits, and how-tos of early initiation of breastfeeding and exclusive breastfeeding.

BEHAVIORAL

Community Interventions

1. Home visits to pregnant women by HEWs to discuss maternal nutrition (dietary diversity, adequate food intake, IFA supplementation, and weight gain), early breastfeeding practices, provide ANC and Pregnant Women Conference referrals, and engage husbands. 2. HEWs use A\&T intervention tools (e.g. posters and maternal nutrition follow-up card) at Pregnant Women Conferences/ Mother Support Groups to reinforce maternal nutrition messages, encourage ANC attendance, distribute IFA tablets, measure and track weight gain, promote early breastfeeding practices, and encourage husband participation. 3. HEWs and community volunteers (Women's Development Army (WDA), imams, etc.) deliver maternal nutrition messages and encourage ANC visits at kebele and community meetings.

BEHAVIORAL

Health System Interventions

1. Trainings on the maternal nutrition interventions for health center heads, nurse-midwives, HEWs, community volunteers (WDA, imams, etc.), woreda health officers, and other key actors. 2. Supportive supervision of maternal nutrition activities conducted by woreda nutrition officers, woreda health officers, TDA or A\&T.

Sponsors & Collaborators

• Addis Continental Institute of Public Health

  collaborator OTHER

• FHI 360

  collaborator OTHER

• International Food Policy Research Institute

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

15 Years

Max Age

49 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-10-08

Primary Completion

2021-09-04

Completion

2021-09-04

Countries

• United States

Study Locations