Examining coverage, content, and impact of maternal nutrition interventions: The case for quality-adjusted coverage measurement

  • Journal of Global Health, Volume 10, No. 1, Year 2020

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Study Justification:
– Reductions in neonatal mortality remain stagnant despite improved access to healthcare.
– Maternal nutrition interventions during antenatal care and postpartum period have been shown to improve neonatal outcomes.
– Adjusting coverage estimates for the quality of care provided can provide insights into health system performance and potential population health benefits.
Highlights:
– The study used household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey and direct observations of antenatal care and delivery from the 2013 Service Provision Assessment.
– Nutrition interventions were provided less frequently than sought during antenatal care.
– Quality-adjusted coverage of nutrition interventions was associated with reduced risk of low birthweight and increased likelihood of immediate breastfeeding.
– Delivering nutrition interventions consistently within the existing coverage would decrease the prevalence of low birthweight and increase the prevalence of immediate breastfeeding.
Recommendations:
– Strengthen the provision of nutrition interventions during antenatal care and post-delivery care.
– Improve the quality of existing maternal health services in Malawi.
– Increase the coverage and utilization of nutrition interventions to improve infant health outcomes.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Healthcare providers: Deliver nutrition interventions during antenatal care and post-delivery care.
– Community health workers: Educate and support pregnant women on nutrition interventions.
– Non-governmental organizations: Provide resources and support for nutrition interventions.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers and community health workers.
– Procurement of necessary equipment and supplies for nutrition interventions.
– Monitoring and evaluation of the implementation and impact of nutrition interventions.
– Public awareness campaigns and educational materials on maternal nutrition.
– Collaboration and coordination efforts between stakeholders.

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Background Reductions in neonatal mortality remain stagnant, despite gains in health care access and utilization. Nutrition interventions during antenatal care (ANC) and in the immediate postpartum period are associated with improved neonatal outcomes. Adjusting coverage estimates for the quality of care provided yields greater insight into health system performance and potential population health benefits of accessing care. In this cross-sectional study, we adjust maternity care coverage measures for quality of nutrition interventions to determine the impact on infant birth weight and breastfeeding. Methods We used household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey to assess use of maternal health services and direct observations of ANC and delivery from the 2013 Service Provision Assessment to measure nutrition interventions provided. We adjusted coverage measures combining self-reported utilization of care with the likelihood of receipt of nutrition interventions. Using adjusted log-linear regression, we estimated the associations of these nutrition quality-adjusted metrics with infant birthweight and immediate breastfeeding. Results Health facility data provided over 2500 directly observed clinical encounters and household data provided 7385 individual reports of health care utilization and outcomes. Utilization of ANC and facility-delivery was high. Women received nutrition-related interventions considerably less often than they sought care: over the course of ANC women received a median of 1.6 interventions on iron, 1 instance of nutrition counseling, and 0.06 instances of breastfeeding counseling. Nutrition quality-adjusted ANC coverage was associated with a reduced risk of low birthweight (adjusted relative risk [ARR] 0.87, 95% confidence interval (CI) = 0.79, 0.96) and increased likelihood of immediate breastfeeding (ARR = 1.04, 95% CI = 1.02, 1.07); nutrition quality-adjusted post-delivery care was also associated with greater uptake of immediate breastfeeding (ARR = 1.08, 95% CI = 1.02, 1.14). Based on these models, delivering nutrition interventions consistently within the existing level of coverage would decrease population prevalence of low birthweight from 13.7% to 10.8% and increase population prevalence of immediate breastfeeding from 75.9% to 86.0%. Conclusions Linking household survey data to health service provision assessments demonstrates that despite high utilization of maternal health services in Malawi, low provision of nutrition interventions is undermining infant health. Substantial gains in newborn health are possible in Malawi if quality of existing services is strengthened.

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The recommendation proposed in this study is to adjust coverage estimates for the quality of nutrition interventions provided during antenatal care (ANC) and the immediate postpartum period. This means combining self-reported utilization of care with the likelihood of receiving nutrition interventions to obtain a more accurate measurement of health system performance and potential population health benefits.

The study used household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey and direct observations of ANC and delivery from the 2013 Service Provision Assessment. The findings revealed that women received nutrition-related interventions considerably less often than they sought care. For example, during ANC, women received a median of 1.6 interventions on iron, 1 instance of nutrition counseling, and 0.06 instances of breastfeeding counseling.

The results showed that nutrition quality-adjusted ANC coverage was associated with a reduced risk of low birthweight and increased likelihood of immediate breastfeeding. Similarly, nutrition quality-adjusted post-delivery care was associated with greater uptake of immediate breastfeeding. The models used in the study suggest that delivering nutrition interventions consistently within the existing level of coverage would decrease the population prevalence of low birthweight and increase the population prevalence of immediate breastfeeding.

In conclusion, the recommendation is to strengthen the quality of existing services by ensuring consistent delivery of nutrition interventions during ANC and the immediate postpartum period. This can lead to substantial gains in newborn health in Malawi. The findings of this study were published in the Journal of Global Health in 2020.
AI Innovations Description
The recommendation proposed in this study is to adjust coverage estimates for the quality of nutrition interventions provided during antenatal care (ANC) and the immediate postpartum period. By combining self-reported utilization of care with the likelihood of receiving nutrition interventions, a more accurate measurement of health system performance and potential population health benefits can be obtained.

The study used household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey and direct observations of ANC and delivery from the 2013 Service Provision Assessment. The findings revealed that women received nutrition-related interventions considerably less often than they sought care. For example, women received a median of 1.6 interventions on iron, 1 instance of nutrition counseling, and 0.06 instances of breastfeeding counseling during ANC.

The results showed that nutrition quality-adjusted ANC coverage was associated with a reduced risk of low birthweight and increased likelihood of immediate breastfeeding. Similarly, nutrition quality-adjusted post-delivery care was associated with greater uptake of immediate breastfeeding. Based on the models used, delivering nutrition interventions consistently within the existing level of coverage would decrease the population prevalence of low birthweight and increase the population prevalence of immediate breastfeeding.

In conclusion, the recommendation is to strengthen the quality of existing services by ensuring consistent delivery of nutrition interventions during ANC and the immediate postpartum period. This can lead to substantial gains in newborn health in Malawi. The findings of this study were published in the Journal of Global Health in 2020.
AI Innovations Methodology
The methodology used in this study involved combining household data from the Malawi 2013-2014 Multiple Indicator Cluster Survey with direct observations of antenatal care (ANC) and delivery from the 2013 Service Provision Assessment. The researchers adjusted coverage measures by combining self-reported utilization of care with the likelihood of receiving nutrition interventions during ANC and the immediate postpartum period.

To simulate the impact of the main recommendations on improving access to maternal health, the researchers used adjusted log-linear regression models. They estimated the associations between nutrition quality-adjusted ANC coverage and post-delivery care with infant birthweight and immediate breastfeeding.

The study found that women received nutrition-related interventions considerably less often than they sought care. For example, during ANC, women received a median of 1.6 interventions on iron, 1 instance of nutrition counseling, and 0.06 instances of breastfeeding counseling. However, nutrition quality-adjusted ANC coverage was associated with a reduced risk of low birthweight and increased likelihood of immediate breastfeeding. Similarly, nutrition quality-adjusted post-delivery care was associated with greater uptake of immediate breastfeeding.

Based on the models used, delivering nutrition interventions consistently within the existing level of coverage would decrease the population prevalence of low birthweight and increase the population prevalence of immediate breastfeeding.

In conclusion, the researchers recommend strengthening the quality of existing services by ensuring consistent delivery of nutrition interventions during ANC and the immediate postpartum period. This can lead to substantial gains in newborn health in Malawi. The findings of this study were published in the Journal of Global Health in 2020.

Statistics:
Citations: 10
Authors: 5
Identifiers:
DOI: 10.7189/JOGH.10.010501
ISSN: 20472978
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Malawi
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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