Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: A nested cross-sectional study

Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, int...

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Bibliographic Details
Published in:PLoS medicine 2019-10, Vol.16 (10), p.e1002927-e1002927
Main Authors: Todd, Catherine S, Chowdhury, Zakaria, Mahmud, Zeba, Islam, Nazia, Shabnam, Sadia, Parvin, Musarrat, Bernholc, Alissa, Martinez, Andres, Aktar, Bachera, Afsana, Kaosar, Sanghvi, Tina
Format: Article
Language:English
Subjects:
Adult
Anemia
Bangladesh - epidemiology
Biology and Life Sciences
Bleeding
Breastfeeding & lactation
Calcium
Calcium carbonate
Catchment areas
Child health
Childrens health
Cluster Analysis
Community Health Workers
Complications
Counseling
Cross-Sectional Studies
Diet
Diet therapy
Dietary intake
Dietary Supplements
Female
Folic acid
Food
Health
Health aspects
Health Promotion - methods
Hemorrhage
Human nutrition
Humans
Hypertension
Intervention
Iron
Low income groups
Malnutrition
Maternal Mortality
Maternal Nutritional Physiological Phenomena
Medical personnel
Medicine and Health Sciences
Micronutrients - administration & dosage
Missing data
Morbidity
Mortality
Newborn infants
Nutrition
Placenta
Population
Postpartum
Postpartum fever
Postpartum Period
Preeclampsia
Pregnancy
Pregnancy complications
Pregnancy Complications - epidemiology
Public health
Rural areas
Sepsis
Supervision
Television
Undernutrition
Vitamin A
Workers
Young Adult
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Summary:Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42-60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32-0.82; p < 0.001). For sp
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1002927