Background
Undernutrition during pregnancy and lactation is a critical determinant of maternal, neonatal, and child health outcomes. Maternal undernutrition is associated with an increased risk of maternal mortality (Christian et al., 2008), and both maternal stunting and wasting are associated with term and preterm births of children small for gestational age (SGA) (Black et al., 2013) and low birth weight (ACC/SCN, 2001, among others). Children born SGA are more likely to become stunted children and adults, which, for women, can place them at increased risk for delivery complications, morbidity, and mortality over time (Bhutta, 2013; Mason et al., 2012). Low birth weight has been shown to cost society in increased infant mortality (Katz et al 2013), lost wages and productivity in adulthood, increased stunting and related illness, and increased rates of noncommunicable disease (NCDs) in adulthood (Alderman and Behrman, 2006).
Maternal anemia is associated with an increased risk of maternal death, and there is a strong causal link between iron deficiency anemia and both low birthweight (LBW) and perinatal mortality (Rasmussan and Stolzfus, 2003). Maternal vitamin A deficiency is associated with visual impairment among women (Black et al., 2013) as well as increased risk of infants being LBW (Tielsh et al., 2008) and infant mortality (Christian et al., 2001). Deficiencies of zinc, iodine, folate, and calcium are also implicated in adverse maternal and child health outcomes.
Improving dietary adequacy during pregnancy and lactation is critical to helping women accommodate their nutritional requirements as well as their children’s requirements during intrauterine development and while breastfeeding (Haileslassie, et al., 2013).
There is limited evidence regarding the effectiveness of protein and energy-related interventions to address maternal wasting and SGA. The strongest evidence comes from a Cochrane Review which concluded that balanced energy protein supplementation reduced the incidence of SGA by 32%. A subsequent meta-analysis found that balanced energy protein supplementation increased birth weight by 73g and reduced the risk of SGA by 34% (Bhutta et al., 2013).
Evidence supporting the benefits of maternal micronutrient supplementation and fortification is more robust. Iron folic acid supplementation during pregnancy is associated with improved mean birth weight and a 79% reduction in megaloblastic anemia (Lassi et al., 2013). Multiple micronutrient supplementation in pregnant women is associated with a 10% reduction in SGA and 11% reduction in LBW babies (Haider and Bhutta, 2012). The consumption of micronutrient and iron-rich foods can also contribute to improved maternal nutritional status. Increasing the consumption of certain plant-based foods (such as green leafy vegetables) or meat and fish can have a considerable impact on an individual’s iron status (Allen et al., 2001).
This chapter focuses on the effectiveness of Social and Behavior Change Communication (SBCC) approaches to increase the quantity and quality of women’s dietary intake during pregnancy and lactation.
Table 3.1.1: Number of studies reviewed (with number of studies reporting statistically significant results in parentheses),
by recommended practice and study design
| Reviews with meta-analysis | RCT | Longitudinal studies | Repeated crosssectional studies | Crosssectional studies | Total | |
| Increased energy and protein intake during pregnancy and lactation | 1 (1) | 0 | 1 (0) | 3 (2) | 0 | 5 (3) |
| Enhanced quality of diet during pregnancy and lactation | 1 (0) | 1 (1) | 0 | 4 (3) | 0 | 6 (4) |
| Micronutrient supplementation or fortification | 0 | 3 (2) | 0 | 3 (1) | 0 | 6 (3) |
| Increased rest and decreased work during pregnancy | 0 | 0 | 0 | 1 (0) | 1 (1) | 2 (1) |
* Note that columns do not sum to the “total” since some articles reported on multiple practices.
Search Results
Fifteen peer-reviewed studies on women’s dietary practices met the review’s inclusion criteria.5 A complete list of the studies reviewed, including a summary of the SBCC approach(es) utilized, the study design, practices measured, and levels of significance is presented in Table 3.1.4.
Ten studies reported a statistically significant change in at least one of the priority practices. Each of those articles is described in greater detail below. Studies reporting a statistically significant change in more than one of the prioritized practices and/or utilizing more than one SBCC approach are cited and discussed multiple times. Where this occurs, we have provided a detailed description of the study in the first reference, and only discuss results in subsequent references.
The findings are organized by practices targeted, SBCC approach(es) utilized, and study design. This organization enables the reader to derive an independent judgment regarding findings from each study. In addition, implementation processes followed are also discussed.
Of the 15 studies reviewed for this chapter, one was a literature review including a meta-analysis, four were randomized controlled trials (RCT), one was a longitudinal study (including a control group), eight were repeated crosssectional studies (five of which included control groups and three that did not) and was a cross-sectional study implemented only at one point in time. See Table 3.1.1.
Overview of the Evidence, by Practice
The evidence focuses on four key maternal nutrition practices: increased energy and protein intake during pregnancy, enhanced quality of diet during pregnancy and lactation, consumption of micronutrient supplements, and reduced work during pregnancy and lactation. While health status is also an important determinant of women’s nutritional status, practices associated with improved health status were not explored in this review.
Of the studies reviewed, five explored energy and protein intake among pregnant and lactating women, six assessed enhanced quality of diet among pregnant and lactating women, six reported on the intake of micronutrient supplements, and two looked at increased rest and reduced work during pregnancy. See Table 3.1.1.
Increased energy and protein intake during pregnancy and lactation
Of the five studies that discussed increased energy and protein intake, two measured the proportion of women consuming more food during pregnancy, one measured the proportion of women consuming more food during lactation, two measured caloric intake and two measured protein intake. Three of the five studies reported statistically significant results.
Literature Reviews with meta-analysis
Ota et al. (2012) conducted a meta-analysis of four RCTs looking at energy and protein intake among pregnant women. The authors included three studies in each of the analyses comparing intake among women who received nutritional advice during pregnancy and those who did not. Following a pooled analysis, the authors concluded that “advice to increase protein intake seems to be successful in achieving its goal [mean difference of +6.99 g/day], but there was no significant increase in energy intake.”
Cross-sectional studies
Garg and Kashyap (2006) conducted a repeated crosssectional study looking at mean daily energy and protein intake among pregnant women in one village in India. The nutrition education intervention included facility-based counseling, weekly home visits to pregnant women, and six group meetings for pregnant women over a period of two to four months. Following baseline data collection, the intervention was delivered to 50 pregnant women having completed 5-7 months of gestation. Another 50 women in month 8-9 of pregnancy were considered to be the control group. By the time women in the intervention group had reached 8-9 months of gestation they consumed 686 kcal more per day than those in the control group.
Guyon et al. (2009) looked at dietary intake during lactation in two highland provinces in Madagascar. The intervention included training of health workers, interpersonal communication including small and large group activities, one-to-one counseling in homes and at local health facilities, community/social mobilization events such as festivals celebrating breastfeeding and child health days, and the use of mass media to air breastfeeding promotion songs. The authors found that women in intervention communities were 12% more likely to report increased food intake during lactation than women in control communities.
Enhanced quality of diet during pregnancy and lactation
Of the six studies explored the effectiveness of SBCC interventions on the consumption of specific nutrient-rich foods, including fortified foods, during pregnancy, four reported statistically significant results.
Randomized controlled trials
Sun et al. (2007) conducted an RCT exploring the “effectiveness of social marketing (SM) on the improvement of women’s knowledge, attitudes, and behaviors” regarding consumption of iron fortified soy sauce (FeSS) in Guidzhou Province, China. The intervention included the use of mass media and “social marketing strategies using an integrated 6 Ps approach (product, price, place, promotion, policy, and partnership).” The SM strategy included physician-led counseling of patients on the benefits of consuming FeSS, as well as the distribution of FeSS samples and calendars with FeSS information at the community level. The authors reported an increase in eating and purchasing behaviors in rural and urban intervention site as well as in control sites. In rural sites there was a net increase in FeSS purchase in intervention sites of 35 percentage points compared with rural control sites. Likewise, the net increase in was 29.5 percentage points in urban intervention sites compared with urban control sites. With regard to the consumption of FeSS, the authors reported a net increase of 21.1 percentage points in rural intervention sites compared with rural control sites and a net increase of 25.6 percentage points in the proportion of urban women consuming FeSS.
Repeated cross-sectional studies
Garg and Kashyap (2006) conducted a repeated crosssectional study looking at mean daily intake of green leafy vegetables. By the time women in the intervention group had reached 8-9 months of gestation they consumed 49.3g of green leafy vegetables daily compared with only 12.9g among women in the control group.
Ndiaye et al. (2009) looked at the intake of animal products among pregnant women in rural Senegal. The study compared two intervention packages within the Micronutrient and Health Program (MICAH). Control communities received the standard MICAH intervention package which included basic nutrition education and a supply of iron supplements and other products through health centers. Intervention communities received the standard MICAH package along with a positive deviance (PD)/Hearth6 intervention, exposure to mid-sized media (such as community radio/ video, local billboards), home counseling by peers, and group education. After eight months, the percent of pregnant women consuming meat or fish increased from 49.4% to 70.7% in PD/Hearth intervention communities while it had declined from 41.5% to 32.0% in control communities.
Finally, Wang et al. (2009) conducted a study to look at “the effectiveness of social mobilization and social marketing in improving knowledge, attitudes and practices (KAP) and Fe status in an Fe-deficient population.” The intervention included a kick-off meeting with key stakeholders as well as the training of community health workers, community heads and store owners/market managers. In addition, “schoolchildren were mobilized to distribute information, education and communication (IEC) materials to the whole family after they learned the relevant knowledge through specially designed classes” and “trained volunteers were recruited to disseminate IEC materials in public areas like hospitals, culture and sports centres.” After one year, the percentage of women in the intervention area who had ever purchased FeSS increased from 8.9% to 36.6%.
Table 3.1.2: Number of studies reviewed (with number of studies reporting statistically significant results in parentheses),
by SBCC approach and study design
| SBCC approach | Reviews with meta-analysis | RCTs | Longitudinal studies | Repeated crosssectional studies | Crosssectional studies | TOTAL |
| Interpersonal Communication | 1 (1) | 4 (3) | 1 (0) | 8 (5) | 1 (1) | 15 (10) |
| One-on-One Counseling | 1 (1) | 3 (2) | 1 (0) | 6 (4) | 1 (1) | 12 (8) |
| Counseling in facilities | 0 | 1 (1) | 1 (0) | 1 (1) | 0 | 3 (2) |
| Counseling in communities | 0 | 1 (1) | 0 | 0 | 0 | 1 (1) |
| Counseling in homes (home visits) | 0 | 2 (1) | 0 | 5 (3) | 1 (1) | 8 (5) |
| Counseling in other settings | 1 (1) | 0 | 0 | 1 (1) | 0 | 2 (2) |
| Group Education | 1 (1) | 1 (1) | 1 (0) | 6 (2) | 0 | 9 (4) |
| Education in facilities | 0 | 0 | 1 (0) | 2 (1) | 0 | 3 (1) |
| Education in communities | 0 | 1 (1) | 0 | 3 (0) | 0 | 4 (1) |
| Education in other settings | 1 (1) | 0 | 0 | 1 (0) | 0 | 2 (1) |
| Support Group | 0 | 0 | 0 | 2 (1) | 0 | 2 (1) |
| Support group in facilities | 0 | 0 | 0 | 1 (0) | 0 | 1 |
| Support group in communities | 0 | 0 | 0 | 0 | 0 | 0 |
| Support group in other settings | 0 | 0 | 0 | 1 (0) | 0 | 1 |
| Media | 0 | 3 (3) | 0 | 3 (3) | 1 (1) | 7 (7) |
| Mass media | 0 | 1 (1) | 0 | 1 (1) | 0 | 2 (2) |
| Mid-sized media (community radio / video, local billboards) | 0 | 1 (1) | 0 | 1 (0) | 0 | 2 (1) |
| Small media (posters, flyers, calendars, reminder stickers) | 0 | 3 (3) | 0 | 1 (0) | 0 | 4 (3) |
| Traditional media (songs, drama) | 0 | 0 | 0 | 0 | 1 (1) | 1 (1) |
| Social media (Twitter, Facebook, etc.) | 0 | 0 | 0 | 1 (0) | 0 | 1 |
| Community/Social Mobilization | 0 | 0 | 0 | 3 (2) | 0 | 3 (2) |
| Campaign, event, special "days" | 0 | 0 | 0 | 1 (1) | 0 | 1 (1) |
| Issue groups | 0 | 0 | 0 | 2 (1) | 0 | 1 (1) |
| Other | 0 | 0 | 0 | 1 (1) | 0 | 1 (1) |
Micronutrient supplementation or fortification
Although many studies reported on micronutrient supplementation or fortification among pregnant and lactating women, just six presented results in a way that allowed for examination of the distinct effect of SBCC approaches on uptake, and all of these were associated with iron supplementation. Three of these reported statistically significant results.
Randomized controlled trials
Adhikari et al. (2009) assessed the effect of an “education program and/or pill count on the change in hemoglobin levels and the prevalence of anemia in pregnant women” among 320 pregnant women receiving prenatal care at the Tribhuvan University Teaching Hospital in Nepal. Women were randomly assigned to one of four groups (education, pill count, education with pill count, and control). By the end of the intervention, women in the education with pill count group were significantly more likely to comply with iron supplementation recommendations than women in the pill count alone group (88% and 73%, respectively).
Risonar et al. (2008) assessed a “redesigned Fe supplementation delivery system” on the island of Negros in the Southern Philippines. The project included providing iron tablets to all pregnant women in two provinces (one intervention and one control). In the intervention group, village health workers and traditional birth attendants also identified and registered pregnant women for antenatal care, and used IEC materials such as posters and flyers to promote iron supplementation. After six months, the percentage of women in the intervention group taking iron tablets had increased from 57.4% to 79.2%, an increase nearly four times greater than in the control group (OR=3.79).
Repeated cross-sectional studies
Baqui et al. (2008b) conducted a repeated cross-sectional study focused on iron folic acid (IFA) supplementation for pregnant women in two districts in India. Both intervention and control groups received counseling on preventive care, nutrition, preparedness for child birth, and health-care utilization for complications during home visits by health care providers. In intervention communities, community health workers recruited additional community volunteers (“change agents”) to further the reach of the program through additional counseling. The authors report a net increase of 14.7 percentage points in the number of women consuming ≥100 IFA tablets during pregnancy in intervention sites compared with control sites.
Increased rest and decreased work during pregnancy
Two studies reported on rest and work during pregnancy. One of those two reported statistically significant results. Omer et al. (2008) conducted a cross-sectional study focused on reducing heavy workload during pregnancy (such as lifting), attending prenatal check-ups, and feeding colostrum to newborns in the Sindh province of Pakistan. The intervention trained lady health workers (LHW) to present and discuss an embroidered cloth panel portraying key messages during routine home visits with pregnant women. Following the intervention, the authors found no difference in overall workload practices between the intervention and control groups, but did find that women in the intervention group were 50% more likely to reduce routine heavy work compared with those in the control group (OR=1.48). No baseline data were collected.
Summary of the Evidence
SBCC approaches utilized
SBCC approaches are organized SBCC activities into three primary categories or approaches: interpersonal communication, media, and community/social mobilization. These approaches and the specific activities associated with each are described in further detail in the introductory chapter.
The studies reviewed in this chapter included a broad range of approaches to promote optimal dietary intake among pregnant and lactating women. Most included more than one specific SBCC activity and many utilized more than one approach.
The review conducted by Ota et al. (2012) included several studies involving interpersonal communication (IPC) approaches – specifically individual counseling and group education for the promotion of women’s energy and protein intake.
Among the nine other studies reporting statistically significant results, all included IPC approaches, seven included some form of media, and two included community/social mobilization. One-on-one counseling (in the home) was the most commonly used IPC approach, and small media (such as posters, flyers, stickers) was the most commonly used media approach. See Table 3.1.2.
The breadth of evidence regarding the effectiveness of SBCC in changing dietary practices during pregnancy and lactation varies greatly by type approach. Table 3.1.3 provides a summary of these findings.
Interpersonal communication
There is some evidence of the effectiveness of IPC approaches in increasing protein/energy intake, enhancing the quality of diet, and increasing intake of micronutrient supplements.
The meta-analysis conducted by Ota et al. (2012) found a statistically significant increase in women’s protein intake as a result of individual counseling and group education (pooled mean difference of 6.99g per day), but no increase in energy intake.
In addition to the meta-analysis, two other studies reported significant outcomes related to the effect of IPC approaches on protein/energy consumption, four reported significant outcomes related to enhanced quality of diet, three report significant outcomes with respect to iron intake, and one reported a significant effect on workload during pregnancy.
Among these studies, two reported on the effectiveness of IPC, even after controlling for other SBCC approaches. In a repeated cross-sectional study, Baqui et al. (2008b) documented an increase from 5% to 21.3% in the percentage of women consuming <100 IFA tables as a result of an IPC intervention, while Garg and Kashyap (2006) reported an increase from 13.9g to 49.3g in the daily intake of green leafy vegetables as a result of an IPC intervention.
We found no evidence to support the effectiveness of IPC approaches on the intake of other micronutrients during pregnancy and lactation, or related to decreasing work load or increasing rest during pregnancy.
Table 3.1.3: Number of studies reviewed (with number of studies reporting statistically significant results
in parentheses), by SBCC approach, practice, and study design
| SBCC approach | Increased energy and protein intake during pregnancy and lactation | Enhanced quality of diet during pregnancy and lactation | Micronutrient supplementation or fortification | Increased rest and decreased work during pregnancy |
| Interpersonal Communication | 5, 3 reporting statistical
| 6, 4 reporting statistical
| 6, 3 reporting statistical
| 2, 1 reporting statistical
|
| Media | 1, 1 reporting statistical
| 3, 3 reporting statistical
| 2, 2 reporting statistical
| 1, 1 reporting statistical
|
| Community/ Social Mobilization | 1, 1 reporting statistical
| 1, 1 reporting statistical
| 1, none reporting statistical significance | No studies |
Media
We identified six primary research studies that reported positive outcomes associated with interventions that included media-based SBCC approaches. One study reported positive outcomes related to protein/energy consumption, three reported positive outcomes related to enhanced quality of diet, two reported positive outcomes related to iron intake, and one reported a positive effect on workload during pregnancy.
None of these media-based interventions was delivered in isolation. All included some form of IPC, one included both IPC and community/social mobilization approaches, and the independent effect of media-based approaches was not assessed. It is therefore difficult to derive conclusions regarding the independent, net effective of these mediabased approaches. We identified no evidence related to intake of micronutrients other than iron.
Community/social mobilization
We identified two primary research studies looking at the effect of community/social mobilization approaches on the uptake of optimal dietary practices during pregnancy and lactation. Both studies, however, included IPC and media approaches in addition to community/social mobilization, and the independent effect of community/social mobilization approaches on maternal dietary practices was not assessed.
Multiple SBCC approaches
We identified nine primary research studies that assessed the effectiveness of multiple SBCC approaches to improve maternal dietary practices, and seven of the nine reported statistically significant results. Guyon et al. (2009) reported a difference of 12 percentage points between intervention and control communities, while Ndiaye et al. (2009) reported a difference of 21 percentage points in the intake of animal products. Sun et al. (2007) reported a difference of 21-26 percentage points in intake of iron fortified soy sauce between intervention and control communities in rural and urban areas, and Adhikari et al. (2009) and Risonar et al. (2008), both RCTs, reported differences in micronutrient intake of 15 and 22 percentage points respectively. Finally, Omer et al. (2008) reported a positive, statistically significant effect with respect to reduction in workload during pregnancy (OR=1.48); however, no baseline data were collected, making attribution to the intervention difficult.
Just one study, Adhikari et al. (2009), compared the effect of more than one SBCC approach to a single SBCC approach. The authors found higher compliance rates with iron supplementation recommendations in an intervention that combined education with pill counting (88% compliance) compared with an intervention that included pill counting alone (73% compliance). Iron supplementation compliance was not reported for the control group.
Implementation processes followed
None of the studies reviewed in this chapter specifically assessed the effect of implementation processes (e.g. intensity and timing of communications; type and training of person communicating messages, or target audience) on the effectiveness of the SBCC approach on women’s dietary practices during pregnancy or lactation, nor did they consistently report all aspects of the implementation processes.
The intensity of communications ranged between one and four visits/sessions or weekly to monthly visits/sessions for various lengths of time. None of the studies compared the effect of timing or frequency.
In terms of target audiences, the studies reviewed primarily targeted the potential or actual breastfeeding woman. The literature review by Ota et al. (2012) conducted a metaanalysis of studies of interventions targeting the woman alone, and among nine primary research studies reporting at least one statistically significant difference, eight targeted the woman herself, three targeted direct influencers, four targeted local community actors, and two targeted actors of the enabling environment. Six targeted more than one target audience or behavioral influencer, but none compared the effect of targeting one vs. multiple audiences or of targeting different audiences.
Conclusions
The body of literature on the effectiveness of SBCC to improve women’s dietary practices during pregnancy and lactation is small, but indicates that SBCC approaches can and do succeed in improving uptake of those practices. While the literature may reflect a bias to publish positive results, it also underscores the important role of SBCC approaches to improve nutrition practices – practices which have been shown to have an impact on nutritional status of women, infants, and children.
What stands out from this review is the lack of evidence (or attention) that has been given to improving women’s dietary practices during pregnancy and lactation. The greatest gap was in evidence of effectiveness of SBCC approaches in improving rest and workload during pregnancy.
In addition, there is considerable variation in the description of SBCC interventions, interactions or combinations with other interventions, target groups, content, messages, scale and coverage, length and intensity, as well as context.
There is also variation in how nutrition practices are defined and measured. Of the five studies that discussed energy and protein intake during pregnancy and lactation, four different indicators were measured and no one indicator was measured more than twice. Of the six studies that looked at the quality of diet during pregnancy and lactation, four reported statistically significant results related to distinct indicators. Each of the three studies reporting on micronutrient supplementation or fortification measured a slightly different indicator. This underscores the importance of developing indicators related to women’s dietary practices during pregnancy and lactation that are globally recognized, accepted, and used by the research and program communities alike.
The SBCC approach most used, and the only one used without other communication interventions, was IPC. While media and community/social mobilization were used, they were always used with at least one other communication approach. Evidence suggests that using multiple SBCC approaches and channels to change behaviors is more effective than using one, but this is not tested in the literature. It is difficult and expensive to disaggregate the contribution of single channels within a multi-channel intervention, and an important question for SBCC practitioners and researchers is whether that line of research is useful.
All but one of the studies reviewed targeted the pregnant or lactating woman herself. More than half targeted other audiences or influencers as well.
The majority of the studies were implemented on a relatively small scale (e.g., in one hospital or community) and typically with between 50 and 350 people per group. The small scale of research on this topic constrains the generalizability of findings and raises important questions about the scalability and sustainability of approaches used.
Differences in local context (including social norms, culture, and environmental factors) as well as differences in the implementation and scale of implementation affect the success of interventions. This underscores the importance of proper context assessments, formative research and/or ethnographic study prior to SBCC implementation.
Because of the relatively limited body of evidence on this topic and due to the lack of standardization in the way research related to SBCC is designed and described, it is challenging to make conclusions beyond the fact that projects with SBCC result in uptake of promoted practices. While there is much to be learned from this body of literature to aid us in developing future programs, there are also many questions generated from reviewing this literature that can and hopefully will guide future evaluations and operations research. These include questions related to:
- globally recognized indicators related to women’s dietary practices during pregnancy and lactation;
- the generalizability of research in this area;
- the positive (or negative) effect of using multiple SBCC approaches compared with focusing on only one;
- the positive (or negative) effect of targeting multiple audiences or influencers of the behaviors being promoted, rather than focusing on just one target population;
- the role of context, in other words, the effect of the same SBCC intervention implemented in different contexts;
- the effectiveness of different approaches (including intensity and targeting) for different behaviors;
- the cost and cost effectiveness of various SBCC approaches (particularly as it relates to scalability); and
- the effectiveness and sustainability of these approaches when implemented at scale.
Footnotes
5 See the introductory chapter of this literature review for a full description of search procedures and inclusion/ exclusion criteria.
6 According to the CORE Group’s Resource Guide for Sustainably Rehabilitating Malnourished Children, “a Positive Deviance/Hearth Nutrition Program is a home- and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in developing countries. The program uses the “positive deviance” approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and to transfer such positive practices to others in the community with malnourished children. The “Hearth” or home is the location for the nutrition education and rehabilitation sessions.” (McNulty, 2005).
7 Comparison is intervention vs. control group, unless indicated otherwise.
8 Differences reported as not significantly different at the 0.05 level are indicated by “NS”. Differences for which statistical significance was not reported are indicated by “--“.
9 NS = not significant either according to what is reported in the original article or p<0.05.
10 P-value for difference-in-difference test adjusted for age, education, parity, religion and standard-of-living score.
11 Note that there were no significant socio-demographic differences between intervention and control communities.
References
ACC/SCN. 2001. What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions, Allen LH and Gillespie SR. ACC/ SCN: Geneva in collaboration with the Asian Development Bank, Manila.
Adhikari, Kamala, Tippawan Liabsuetrakul, and Neelam Pradhan. 2009. “Effect of Education and Pill Count on Hemoglobin Status During Prenatal Care in Nepalese Women: a Randomized Controlled Trial.” The Journal of Obstetrics and Gynaecology Research 35 (3) (June): 459–466.
Ahrari, Mahshid, Robert F Houser, Siham Yassin, Mona Mogheez, Y Hussaini, Patrick Crump, Gary L Darmstadt, David Marsh, and F James Levinson. 2006. “A Positive Deviance-based Antenatal Nutrition Project Improves Birth-weight in Upper Egypt.” Journal of Health, Population, and Nutrition 24 (4) (December): 498–507.
Akter, S.M., S.K. Roy, S.K. Thakur, M. Sultana, W. Khatun, R. Rahman, S.S. Saliheen, and N. Alam. 2012. “Effects of Third Trimester Counselling on Pregnancy Weight Gain, Birthweight, and Breastfeeding Among Urban Poor Women in Bangladesh.” Food & Nutrition Bulletin 33 (3) (September): 194–201.
Alderman, H, and JR Behrman. 2006. “Reducing the Incidence of Low Birth Weight in Low-Income Countries Has Substantial Economic Benefits.” The World Bank Research Observer 21 (1): 25–48.
Allen, Lindsay H. 2005. “Multiple Micronutrients in Pregnancy and Lactation: An Overview.” The American Journal of Clinical Nutrition 81 (5) (May): 1206S–1212S.
Baqui, Abdullahh, Emma K Williams, Amanda M Rosecrans, Praween K Agrawal, Saifuddin Ahmed, Gary L Darmstadt, Vishwajeet Kumar, Usha Kiran, Dharmendra Panwar, Ramesh C Ahuja, Vinod K Srivastava, Robert E Black, and Manthuram Santoshama. 2008. “Impact of an Integrated Nutrition and Health Programme on Neonatal Mortality in Rural Northern India.” Bulletin of the World Health Organization 86 (10) (October): 796–804.
Bhutta, Zulfiqar A, Jai K Das, Arjumand Rizvi, Michelle F Gaffey, Neff Walker, Susan Horton, Patrick Webb, Anna Lartey, and Robert E Black. 2013. “Evidence-based Interventions for Improvement of Maternal and Child Nutrition: What Can Be Done and at What Cost?” The Lancet 382 (9890) (August): 452–477.
Black, Robert E, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-income and Middle-income Countries.” The Lancet 382 (9890) (August): 427–451.
Bortolini, Gisele Ane, and Márcia Regina Vitolo. 2012. “The Impact of Systematic Dietary Counselling During the First Year of Life on Prevalence Rates of Anemia and Iron Deficiency at 12-16 Months.” Jornal de Pediatria 88 (1) (February): 33–39.
Casey, Gerard J, Damien Jolley, Tran Q Phuc, Ta T Tinh, Dang H Tho, Antonio Montresor, and Beverley-Ann Biggs. 2010. “Long-term Weekly Iron-folic Acid and De-worming Is Associated with Stabilised Haemoglobin and Increasing Iron Stores in Non-pregnant Women in Vietnam.” PloS One 5 (12): e15691.
Cochrane Database of Systematic Reviews.
De-Regil, Luz Maria, Parminder S Suchdev, Gunn E Vist, Silke Walleser, and Juan Pablo Peña-Rosas. 2011. “Home Fortification of Foods with Multiple Micronutrient Powders for Health and Nutrition in Children Under Two Years of Age.” Cochrane Database of Systematic Reviews 2011, edited by The Cochrane Collaboration and Luz Maria De-Regil. Chichester, United Kingdom: John Wiley & Sons, Ltd.
Dewey, K G, R J Cohen, K H Brown, and L L Rivera. 2001. “Effects of Exclusive Breastfeeding for Four Versus Six Months on Maternal Nutritional Status and Infant Motor Development: Results of Two Randomized Trials in Honduras.” The Journal of Nutrition 131 (2) (February): 262–267.
Garg, Aashima, and Sushma Kashyap. 2006. “Effect of Counselling on Nutritional Status During Pregnancy.” Indian Journal of Pediatrics 73 (8) (August): 687–692.
Guyon, Agnès B, Victoria J Quinn, Michael Hainsworth, Priscilla Ravonimanantsoa, Voahirana Ravelojoana, Zo Rambeloson, and Luann Martin. 2009. “Implementing an Integrated Nutrition Package at Large Scale in Madagascar: The Essential Nutrition Actions Framework.” Food and Nutrition Bulletin 30 (3) (September): 233–244.
Haider, BA, and ZA Bhutta. 2012. “Multiple-Micronutrient Supplementation for Women During Pregnancy.”
Haileslassie, Kiday, Afework Mulugeta, and Meron Girma. 2013. “Feeding Practices, Nutritional Status and Associated Factors of Lactating Women in Samre Woreda, South Eastern Zone of Tigray, Ethiopia.” Nutrition Journal 12 (1): 28
Katz, Joanne, Anne CC Lee, Naoko Kozuki, Joy E Lawn, Simon Cousens, Hannah Blencowe, Majid Ezzati, et al. 2013. “Mortality Risk in Preterm and Small-for-Gestational-Age Infants in Low-Income and Middle-Income Countries: A Pooled Country Analysis.” The Lancet 382 (9890): 417–25.
Mason, John B, Lisa S Saldanha, and Reynaldo Martorell. 2012. “The Importance of Maternal Undernutrition for Maternal, Neonatal, and Child Health Outcomes: An Editorial.” Food and Nutrition Bulletin 33 (2 Suppl) (June): S3–5.
McNulty J. and CORE Group. Positive Deviance / Hearth Essential Elements: A Resource Guide for Sustainably Rehabilitating Malnourished Children (Addendum), Washington, D.C.: CORE Group, 2005.
Ndiaye, Mamadou, Kendra Siekmans, Slim Haddad, and Olivier Receveur. 2009. “Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women.” Food and Nutrition Bulletin 30 (2) (June): 128–136.
Omer, Khalid, Sharmila Mhatre, Noor Ansari, Jorge Laucirica, and Neil Andersson. 2008. “Evidence-based Training of Frontline Health Workers for Door-to-door Health Promotion: a Pilot Randomized Controlled Cluster Trial with Lady Health Workers in Sindh Province, Pakistan.” Patient Education and Counselling 72 (2) (August): 178–185.
Ota, Erika, Ruoyan Tobe-Gai, Rintaro Mori, and Diane Farrar. Antenatal Dietary Advice and Supplementation to Increase Energy and Protein Intake. In Cochrane Database of Systematic Reviews 2012, edited by The Cochrane Collaboration and Erika Ota. Chichester, United Kingdom: John Wiley & Sons, Ltd.
Risonar, Maria Grace D, Pura Rayco-Solon, Lorena W Tengco, Jesus N Sarol, Lourdes S Paulino, and Florentino S Solon. 2008. “Effectiveness of a Redesigned Iron Supplementation Delivery System for Pregnant Women in Negros Occidental, Philippines.” Public Health Nutrition 12 (07) (August 27)
Senanayake, Hemantha M, Samanthi P Premaratne, Thilina Palihawadana, and Sumeda Wijeratne. 2010. “Simple Educational Intervention Will Improve the Efficacy of Routine Antenatal Iron Supplementation.” The Journal of Obstetrics and Gynaecology Research 36 (3) (June): 646–650.
Sun, Xinying, Yan Guo, Sisun Wang, and Jing Sun. 2007. “Social Marketing Improved the Consumption of Iron-fortified Soy Sauce Among Women in China.” Journal of Nutrition Education and Behavior 39 (6) (December): 302–310.
Wang, Bo, Siyan Zhan, Jing Sun, and Liming Lee. 2009. “Social Mobilization and Social Marketing to Promote NaFeEDTAfortified Soya Sauce in an Iron-deficient Population through a Public-private Partnership.” Public Health Nutrition 12 (10) (October): 1751–1759.