Menu ENN Search

Impact on birth weight and child growth of women’s groups with and without transfers of food or cash during pregnancy in Nepal

View this article as a pdf

Research snapshot1

While the links between undernutrition in pregnancy and birth outcomes have long been established, understanding of the effectiveness of intervening prenatally to improve birth outcomes and subsequent child growth remains limited. This study aimed to explore potential interventions in pregnancy to improve birthweight and subsequent child growth until 16 months of age (measured by weight-for-age z-scores (WAZ)). Behaviour-change interventions were facilitated through community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers. A four-arm, non-blinded cluster randomised control trial was designed, with 25,092 pregnant women recruited for interventions between December 2013 and February 2015. The four arms consisted of: PLA alone (n=5,626, receiving nutrition and health educational sessions); PLA plus food (n= 6,884, receiving 10 kg/month of fortified wheat-soya ‘SuperCereal’ on a monthly basis); PLA plus cash (n= 7,272, receiving ≈USD7.5 per month, equivalent to the cost of 10kg of Super Cereal or two days’ wage labour); and a control arm (n=5,310, receiving government services). Women were entitled to one monthly transfer up to a maximum of seven transfers until delivery, provided they received the transfer personally and had photo ID cards. Primary outcomes were birthweight measured within 72 hours and WAZ measured at endline.

After exclusions, 10,936 women were eligible for outcome analyses. In PLA plus food/cash arms, 94% to 97% of pregnant women attended the PLA groups and received an average of four transfers. In the PLA-only cohort, 49% of pregnant women attended PLA groups. Response rate for birthweight was low (n=2,087; 22% of potential birthweights) due to conflict affecting field-team performance, but endline data was higher (n= 9,242). Compared to the control arm, mean birthweight was significantly higher in the PLA-plus-food arm by 78g (95%CI 13.9-142), but not significantly higher in PLA-only and PLA-plus-cash arms. Average WAZ measurements of children aged 0-16 months (average age nine months) sampled cross-sectionally at endpoint were not significantly different from those in the control arm. When exploring secondary outcomes, compared with control, more institutional deliveries (OR= 1.46; 95% CI 1.03, 2.06) and less colostrum discarding (OR=0.71; 95% CI 0.54, 0.93) were noted in the PLA plus-food-arm, but not in PLA-only or PLA-plus-cash arms.

This study showed that food supplementation with behaviour-change strategies during pregnancy increased birthweight (suggest cautious conclusion given low response rate on birthweight data [eds]). However, the improvements were not sustained by 16 months. This highlights the need for additional interventions for infants postpartum to improve growth outcomes.

Read more...

1 Saville NM, Shrestha BP, Style S, Harris-Fry H, Beard BJ, Sen A, et al. (2018) Impact on birth weight and child growth of Participatory Learning and Action women’s groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal. PLoS ONE 13(5): e0194064. https://doi.org/10.1371/journal.pone.0194064

More like this

FEX: Effect of supplementation during pregnancy and lactation on the nutritional status of infants in Pakistan

View this article as a pdf Research snapshot1 Despite economic and social development, malnutrition remains a major public health problem in Pakistan, especially low...

FEX: Impact of a conditional cash transfer programme on determinants of child health in Colombia

Summary of research1 Location: Colombia What we know: Conditional cash transfer (CCT) programmes have demonstrated large impacts on child education, health and nutritional...

FEX: Effect of adding RUSF to ageneral food distribution on child nutritional status and morbidity: a cluster randomised controlled trial

Summary of research1 Child during appetite test at a health facility offering treatment in Monrovia, Liberia The authors of a recent study hypothesized that including a daily...

FEX: Impact evaluation of a nutrition-sensitive social protection programme in northern Nigeria

View this article as a pdf By Caroline Antoine, Stella Esedunme, Céline Sinitzky Billard, Sabi'u Suleiman Shehu and Gladys Esther Ahuwan Caroline Antoine is a health...

FEX: Briefing on the Bihar Child Support Programme, India

By Oxford Policy Management (OPM) India Oxford Policy Management (OPM) is a development and research based consultancy company that has 30 years' experience is providing...

FEX: Diluted F100 v infant formula in treatment of severely malnourished infants < 6 months

By Caroline Wilkinson and Sheila Isanaka Caroline Wilkinson was Nutrition Advisor with Action Contre la Faim - France (ACF-F), until November 2008. She spent most of 2007 in...

FEX: The REFANI Project in Pakistan: adapting research to a multi-sectoral programme for impact measurement

By Zvia Shwirtz, Bridget Fenn, Riccardo Mioli, Ghulam Murtaza Sangrasi and Maureen Gallagher Zvia Shwirtz is currently the REFANI Communications and Research Uptake Officer,...

FEX: Cash, food or vouchers? Evidence from a randomised experiment in northern Ecuador

Summary of research1 Location: Northern Ecuador What we know: There is ongoing debate on the most effective form of food assistance: cash, food vouchers or food...

FEX: Cash-based intervention and risk of acute malnutrition among children in internally displaced persons camps in Somalia

Research snapshot1 Cash-based interventions (CBI) have been used in Somalia since 2011, a country with one of the highest prevalences of acute child malnutrition in the world....

FEX: Cash transfers and child nutrition

Summary of research1 Location: Global What we know: Cash transfer (CT) programming is an expanding form of social protection that has potential to improve child...

FEX: A cluster RCT to measure the effectiveness of cash-based interventions on nutrition status, Sindh Province, Pakistan

By Bridget Fenn View this article as a pdf Bridget Fenn is an epidemiologist with a background in nutrition. She is currently a consultant for the Emergency Nutrition Network...

en-net: Micronutrients and Low Birth Weight - India

Dear colleagues, I am a Research Analyst working with a Tufts University/USAID study, evaluating the sustainability of impacts and activities within Title II food aid and...

FEX: Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali

Summary of research1 Location: Mali What we know: Community-led total sanitation (CLTS) is being scaled up, but there is limited evidence on child health impacts. What this...

FEX: MUAC vs WHZ in predicting mortality in hospitalised children under five years of age

Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...

FEX: Chronic disease outcomes after SAM in Malawian children (ChroSAM): A cohort study

Summary of research* Location: Malawi What we know: Little is known about the long-term health effects of survivors of severe acute malnutrition (SAM), particularly risk of...

FEX: Diagnostic criteria for severe acute malnutrition among infants under six months of age

Summary of research1 Location: Kenya What we know: Diagnosis of acute malnutrition in infants under six months old (U6M) is currently based on weight-for-length z score...

FEX: A series of three related published papers share findings regarding quality of care, treatment outcomes and cost-effectiveness of uncomplicated SAM treatment delivered by community health workers (CHWs) in rural Mali.

By Eleanor Rogers, Karen Martínez, Jose Luis Alvarez Morán, Franck G. B. Alé, Pilar Charle, Saul Guerrero, Natalie Sessions and Chloe Puett Quality of...

FEX: Integrated protocol for severe and moderate acute malnutrition in Sierra Leone

Summary of research1 Location: Sierra Leone What we know: Impliementing separate protocols for MAM and SAM treatment can be administratively cumbersome in emergency...

FEX: Impact evaluation of cash, food vouchers, and food transfers among Colombian refugees and poor Ecuadorians in urban Ecuador

Summary of evaluation1 Evaluation headlines: Levels of food insecurity and associated anaemia are high amongst Columbian refugees and poor Ecuadorians in the northern...

FEX: Evaluation of an integrated health-nutrition-WASH project to reduce malnutrition prevalence in children under two in Bangladesh

By Monsurul Hoq and John Brogan Monsurul Hoq was working as a Statistician Epidemiologist during the study. He has experience in monitoring and evaluation of community-based...

Close

Reference this page

Impact on birth weight and child growth of women’s groups with and without transfers of food or cash during pregnancy in Nepal. Field Exchange 63, October 2020. p71. www.ennonline.net/fex/63/birthweightandchildgrowthimpact

(ENN_6805)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.