Extrait

Background and study aims Insufficient food intake during pregnancy is a major problem in many developing countries. Bangladesh has among the highest rates of maternal and child undernutrition globally. In the rural areas of Bangladesh, poverty is three times higher than in urban areas, women are less likely to access antenatal and postnatal services, and children suffer from higher rates of chronic malnutrition. In Bangladesh, one in five children are born with a low birth weight and one in three pregnant women are undernourished. Maternal undernutrition increases the risk of poor foetal growth. A fifth of childhood chronic malnutrition (stunting) may be caused by poor foetal growth as shown by having a low birth weight when born. For pregnant women, the World Health Organisation (WHO) recommends additional calories every day. There are many reasons why women in developing countries are not able to consume additional calories during their pregnancy. The pregnancy period presents a key phase for ensuring the survival, growth and development of the offspring. When pregnant women are undernourished, extra food during pregnancy can improve birth outcomes and has the potential to improve the nutritional status of pregnant women. The development of food based supplements using locally available and preferred foods have proved effective, but research to-date has focused on contexts that are not generalizable to that of northern Bangladesh or focused on different target groups such as children. This study aims to develop a locally produced food based supplement, assess its acceptance, and identify its effect on child growth when consumed by undernourished pregnant women. Who can participate? Undernourished pregnant women living in northern Bangladesh. What does the study involve? Using group discussions, photographs and interviews, we explored the diet of pregnant women living in northern Bangladesh. This information was used to develop a food based supplement which uses locally available and preferred foods. We asked pregnant women to participate in a small study so that we could measure the acceptance of the supplement, and modify it if required. Women consumed the locally developed supplement, and shared their experiences through the completion of a questionnaire at day 15 and day 30. The results informed the next phase of the study. The composition of the supplement was influenced by the preferences of women in the selected communities and the local availability of foods that are accessible year-round. The production of the supplement involved the establishment of a local business enterprise, building on local capacity and providing an income generation opportunity to the community. We conducted a study to see if the food based supplement had an effect on child physical growth when consumed by women that were undernourished. We screened all women in the selected villages on a monthly basis for undernutrition. Undernourished pregnant women were invited to participate in the study and written consent was obtained. In eight randomly selected intervention villages the women received the supplement until delivery of the child. We selected four control villages to ensure that they were as similar to the intervention villages as possible, and to ensure that the control villages had limited/no exposure to the intervention. All women in the selected communities (intervention and control), undernourished and nourished, also received maternal nutrition education, antenatal and postnatal care services, and iron-folic acid supplementation. The child was measured (weight, length, head circumference) at birth, 1, 3, 6 and 12 months. What are the possible benefits and risks of participating? Participation in this study may result in improved nutritional status of the participant and her child. There are no expected risks in participating. Where is the study run from? The research site is in northern Bangladesh, and coordinated by James Cook University (Australia). When is the study starting and how long is it expected to run for? From March 2012 to March 2015. Who is funding the study? World Vision (New Zealand). Who is the main contact? Ms Briony Stevens [email protected]

Critère d'inclusion

• Maternal undernutrition (defined as Middle Upper Arm Circumference <22.1)

Liens

• ictrp
• isrctn