Abstract:
In Rwanda, low birth weight (LBW), which is caused by maternal undernutrition, is a public health
concern. Five Districts have adopted the Gikuriro Program, which consists of an integrated
‘nutrition-sensitive’ and ‘nutrition-specific’ intervention. However, there is no information on the
effect of such intervention on maternal nutritional status and birth weight. Therefore, the study
had three main objectives: ‘to determine the effect of integrated nutrition-specific and nutrition sensitive intervention package on maternal undernutrition among pregnant women’; ‘to assess
the effectiveness of an integrated maternal nutrition intervention package on birth weight’; and
‘to explore the effect and challenges of an integrated nutrition intervention package utilization
among pregnant women and lactating mothers’.
A quasi-experimental design was employed for the first and second objectives. A total of 552
and 545 pregnant women for intervention and control group were recruited respectively. The
highest percentage were aged 25-29years (27.3%), married (46.1%) and attended primary
school (62.6%). More than half (56.1%) of babies were females and the average birth weight
was 3,106.84grams. When compared to the control group, maternal undernutrition was
significantly lower in the intervention group (4.7% vs 18.2%; p<0.001). After adjusting for
relevant confounders, the intervention group's risk of maternal undernutrition was 77.0% lower
[AOR = 0.23; 95%CI = 0.15 – 0.36]. For the second objective, the intervention has increased the
average birth weight by 219grams (p<0.001) and decreased LBW by 66.99% (p<0.001). The
intervention group showed a decreased risk of LBW (AOR = 0.23; 95%CI = 0.12 - 0.43). For the
third objective, qualitative research was conducted among 25 community health officers and 27
nutritionists for key informant interviews (KIIs), as well as 40 pregnant women and 40 lactating
mothers in 10 focus group discussion (FGDs). Among implementers and beneficiaries, the view
of the intervention was improved nutrition knowledge and skills, enhanced attitude toward a
balanced diet, perceived improved nutrition, and financial independence. However, some of the
main challenges identified were lack of awareness of the Gikuriro Program, undesirable attitude
towards nutrition, economic constraints, lack of husband support, and time constraints.
Thus, to establish causation and provide information for the possible national scale-up of this
intervention, more research using randomization approach is recommended. Besides, other
upcoming nutrition intervention projects should consider the challenges highlighted in this study
for optimal nutrition intervention implementation and utilization.