Effect of Integrated Nutrition Intervention Package on Maternal Nutritional Status and Birth Weight in Rwanda

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 nutritionsensitive 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 primaryschool (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. Keywords Integrated Intervention Package, Low Birth Weight, Maternal Undernutrition, ‘Nutrition sensitive’, ‘Nutrition-specific’.