Degree of exposure to interventions influences maternal and child dietary practices: Evidence from a large-scale multisectoral nutrition program

• Published in: PloS one 2019-08, Vol.14 (8), p.e0221260-e0221260
• Main Authors: Suresh, Shalini, Paxton, Anne, Pun, Bhim Kumari, Gyawali, Min Raj, Kshetri, Indra Dhoj, Rana, Pooja Pandey, Cunningham, Kenda
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Analysis; Biology and Life Sciences; Child; Child health; Child malnutrition; Child Nutrition Disorders - epidemiology; Child Nutrition Disorders - physiopathology; Child, Preschool; Children; Children & youth; Cross-Sectional Studies; Diet; Epidemiology; Exposure; Female; Food; Food groups; Health aspects; Health Knowledge, Attitudes, Practice; Hemoglobin; Households; Human nutrition; Humans; Infant; Infant Nutritional Physiological Phenomena; Interpersonal communication; Intervention; Keller, Helen, 1880-1968; Male; Malnutrition; Mass media; Maternal & child health; Maternal behavior; Medicine and Health Sciences; Mothers; Multiculturalism & pluralism; Nepal - epidemiology; Nutrition; Nutritional Status - physiology; People and Places; Personal communication; Platforms; Pregnancy; Prevalence studies (Epidemiology); Public health; Radio programs; Regression analysis; Regression models; Sanitation; Social Sciences; Socioeconomic Factors; Standard deviation; Undernutrition; Womens health; Workers; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221260

The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal's 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII's 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2-5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p