在三个中低收入国家实施孕产妇营养干预措施后，孕妇的铁和叶酸摄入不平等以及饮食多样性。
Inequality in iron and folic acid consumption and dietary diversity in pregnant women following exposure to maternal nutrition interventions in three low- and middle-income countries.
机构信息
Consultant for Alive & Thrive Initiative, FHI Solutions, FHI 360, Indore, MP, India.
Alive & Thrive Initiative, FHI 360, Washington DC, USA.
出版信息
Public Health Nutr. 2024 May 24;27(1):e149. doi: 10.1017/S1368980024001150.
OBJECTIVE
Research is available on improved coverage and practices from several large-scale maternal nutrition programmes, but not much is known on change in inequalities. This study analyses wealth and education inequality using Erreygers and Concentration indices for four indicators: adequate iron and folic acid (IFA) consumption, women's dietary diversity, and counselling on IFA and dietary diversity.
DESIGN
A pre-test-post-test, control group design.
SETTING
Maternal nutrition intervention programmes conducted in Bangladesh, Burkina Faso and Ethiopia during 2015-2022.
PARTICIPANTS
Recently delivered women (RDW) and pregnant women (PW).
RESULTS
Statistically significant reductions in education inequality were observed for adequate IFA consumption, counselling on IFA and dietary diversity in intervention areas of Bangladesh and for adequate IFA consumption in intervention areas of Burkina Faso.A significant decrease in wealth inequality was observed for adequate IFA consumption in the intervention areas of Bangladesh, whereas a significant increase was observed in the non-intervention areas for counselling on IFA in Ethiopia and for dietary diversity in Burkina Faso.
CONCLUSION
The results can be attributed to the extensive delivery system at community level in Bangladesh and being predominantly facility-based in Burkina Faso and Ethiopia. COVID-19 disruptions (in Burkina Faso and Ethiopia) and indicator choice also had a role in the results.The main takeaways for nutrition programmes are as follows: (a) assessing inequality issues through formative studies during designing, (b) monitoring inequality indicators during implementation, (c) diligently addressing inequality through targeted interventions, setting aside resources and motivating frontline workers to reduce disparities and (d) making inequality analysis a routine part of impact evaluations.
目的
已有研究探讨了多项大型孕产妇营养计划在改善覆盖范围和实践方面的情况，但对于不平等现象的变化知之甚少。本研究使用 Erreygers 和集中指数分析了四个指标的财富和教育不平等情况：适当的铁和叶酸（IFA）摄入、妇女的饮食多样性以及 IFA 和饮食多样性咨询。
设计
预测试-后测试、对照组设计。
地点
2015-2022 年在孟加拉国、布基纳法索和埃塞俄比亚开展的孕产妇营养干预计划。
参与者
最近分娩的妇女（RDW）和孕妇（PW）。
结果
在孟加拉国的干预地区，适当的 IFA 摄入、IFA 和饮食多样性咨询以及布基纳法索的干预地区适当的 IFA 摄入方面，教育不平等呈统计学显著减少；在孟加拉国的干预地区，适当的 IFA 摄入方面观察到财富不平等显著减少，而在埃塞俄比亚的非干预地区，IFA 咨询以及布基纳法索的饮食多样性方面观察到财富不平等显著增加。
结论
这些结果可归因于孟加拉国广泛的社区层面的提供系统，以及布基纳法索和埃塞俄比亚主要以机构为基础的情况。COVID-19 疫情的干扰（在布基纳法索和埃塞俄比亚）和指标选择也在结果中发挥了作用。营养计划的主要收获如下：（a）在设计阶段通过形成性研究评估不平等问题，（b）在实施过程中监测不平等指标，（c）通过有针对性的干预措施认真解决不平等问题，预留资源并激励一线工作人员减少差距，以及（d）将不平等分析作为影响评估的常规部分。
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