The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger

Cesaire T Ouedraogo, K Ryan Wessells, Rebecca R Young, Ibrahim Foungotin Bamba, M Thierno Faye, Ndiaye Banda, Sonja Y Hess, Cesaire T Ouedraogo, K Ryan Wessells, Rebecca R Young, Ibrahim Foungotin Bamba, M Thierno Faye, Ndiaye Banda, Sonja Y Hess

Abstract

Background: Anaemia is prevalent among pregnant women in rural Niger and antenatal care (ANC) attendance is suboptimal. We designed a programmatic intervention including community-based behaviour change communication, provision of essential drugs (including iron folic acid (IFA) supplements) and quality improvement activities at selected integrated health centres (IHCs).

Objective: To assess the impact of the programmatic intervention on: (1) utilisation of ANC, (2) adherence to daily IFA supplementation and (3) prevalence of adequate gestational weight gain (GWG) and anaemia among pregnant women in Zinder, Niger.

Methods: Using a quasi-experimental study design comparing a cohort of women at baseline to another cohort of women at endline, 18 IHCs and surrounding villages were randomly assigned to time of enrolment over 1 year. A baseline survey was implemented among randomly selected pregnant women in 68 village clusters. Subsequently, the intervention was rolled out and an endline survey was implemented 6 months later in the same villages.

Results: Mean age in the baseline (n=1385) and endline (n=922) surveys was 25.8±6.4 years. The percentage of pregnant women who reported attending any number of ANC and an adequate number of ANC for their gestational age, respectively, was not significantly different between the endline and the baseline surveys. Pregnant women in the endline survey were more likely to have received IFA (60.0% vs 45.8%, OR: 2.7 (1.2, 6.1)); and the proportion of pregnant women who reportedly consumed IFA daily in the previous 7 days was significantly higher in the endline than in the baseline survey (46.4% vs 32.8%, OR: 2.8 (1.2, 6.5)). There was no impact on the prevalence of adequate GWG or anaemia.

Conclusions: The programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving and consuming IFA supplements as recommended, but did not affect ANC attendance and nutritional status.

Keywords: anaemia; maternal health; nutrition.

Conflict of interest statement

Competing interests: BN works for Nutrition International.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Timeline of the baseline and endline surveys.
Figure 2
Figure 2
Implementation of the selected components of the programmatic intervention. □ Selected component of the intervention was implemented over 6 months. ∆ Selected component of the intervention was implemented

Figure 3

Flow diagram of participants through…

Figure 3

Flow diagram of participants through the baseline and endline surveys.

Figure 3
Flow diagram of participants through the baseline and endline surveys.

Figure 4

Percentage of pregnant women who…

Figure 4

Percentage of pregnant women who reported attending antenatal care, receiving iron folic acid…

Figure 4
Percentage of pregnant women who reported attending antenatal care, receiving iron folic acid and adhering to the recommended iron folic acid supplementation in the baseline versus endline surveys.
Figure 3
Figure 3
Flow diagram of participants through the baseline and endline surveys.
Figure 4
Figure 4
Percentage of pregnant women who reported attending antenatal care, receiving iron folic acid and adhering to the recommended iron folic acid supplementation in the baseline versus endline surveys.

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