Effects of participatory learning and action with women’s groups, counselling through home visits and crèches on undernutrition among children under three years in eastern India: a quasi-experimental study

Autor: Megha De, Prasanta Tripathy, Hemanta Pradhan, Audrey Prost, Rajesh Sinha, Shampa Roy, Ranjan Panda, Sanjib Kumar Ghosh, Ganapathy Murugan, Jayeeta Chowdhury, Vandana Prasad, Swati Sarbani Roy, Raj Kumar Gope
Rok vydání: 2019
Předmět:
Counseling
Male
Rural Population
Non-Randomized Controlled Trials as Topic
Groups
Psychological intervention
Community
Day care
South Asia
Crèche
0302 clinical medicine
030212 general & internal medicine
Wasting
lcsh:Public aspects of medicine
House Calls
Quasi-experimental
Child
Preschool
Female
Underweight
medicine.symptom
Research Article
Adult
medicine.medical_specialty
Mothers
India
030209 endocrinology & metabolism
Child Nutrition Disorders
03 medical and health sciences
Patient Education as Topic
Child undernutrition
medicine
Humans
Women
Home visits
business.industry
Public health
Malnutrition
Community mobilisation
Public Health
Environmental and Occupational Health
Infant
lcsh:RA1-1270
Patient Acceptance of Health Care
Anthropometry
medicine.disease
Cross-Sectional Studies
Biostatistics
business
Demography
Zdroj: BMC Public Health, Vol 19, Iss 1, Pp 1-15 (2019)
BMC Public Health
ISSN: 1471-2458
Popis: Background India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women’s groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits. Methods We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation’s primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children. Results We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51–0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59–0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96–1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55–0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47–0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57–0.93). Conclusions Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches. Trial registration The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019. Electronic supplementary material The online version of this article (10.1186/s12889-019-7274-3) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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