Improving coverage and quality of selected priority nutrition-specific interventions in the first 1000 days of life to prevent childhood undernutrition.

Abstract

This thesis explored improving the quality and coverage of selected nutrition-specific interventions during the first 1000 days of life including iron and folic acid (IFA) supplementation, anaemia assessment, weight gain monitoring and nutrition education at antenatal care (ANC), and promotion of breastfeeding and dietary diversity. The thesis employed quantitative research methods using data collected in Bangladesh from a cross-sectional health facility assessment, a population-based survey, and a community-based cluster-randomised controlled trial. The findings of the thesis have important policy and programmatic relevance for improving the quality and coverage of priority nutrition-specific interventions in LMICs. This thesis demonstrates the importance of improving health facility readiness, healthcare providers' skills for better provider-client communication, ensuring consistent guidelines, adopting useful job aids, and reforming healthcare providers' training and supportive supervision to ensure the delivery of high-quality nutrition services. Receiving a higher number of ANC visits, starting the first ANC ≤4 gestational months and receiving advice on IFA are critical to increase user adherence-adjusted coverage of antenatal IFA supplementation of consuming ≥180 IFA tablets. Starting ANC early was important to achieve the positive effect of higher ANC visits on antenatal IFA coverage. Digital job aid-supported face-to-face nutrition counselling of mothers during pregnancy and in the first six months after birth by community health workers improved coverage of nutrition counselling, reduced the provision of prelacteal feeds and increased exclusive breastfeeding. Similarly, job aid-supported complementary feeding counselling increased dietary diversity and consumption of animal protein among children aged 6-23 months. However, nutrition counselling had a limited effect on child’s dietary diversity in food-secure and severely food-insecure households.