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A study by A&T in two districts of Uttar Pradesh in December 2017 (baseline) and 2019 (endline) showed that it was feasible to integrate maternal nutrition interventions during antenatal care (ANC). The study also highlighted a need for improving coverage of maternal nutrition, a need echoed by findings of NFHS-5 in 2020-21. Based on the key findings, Alive & Thrive collaborated with UNICEF, the National Centre of Excellence, and Advanced Research on Diets to develop a brief on the integration of maternal nutrition in community-based services.
The brief has been developed with technical inputs and support from the Ministry of Health & Family Welfare (MoHFW), Government of India, National Health Mission and the ICDS, Government of Uttar Pradesh, District and Block level Health and ICDS officials from Unnao, and Kanpur Dehat districts of Uttar Pradesh and partners including UNICEF, Nutrition International, National Center for Excellence and Advanced Research on Diets(NCEARD) at Lady Irwin College, Lady Hardinge Medical College (LHMC) and Kalawati Saran Children’s Hospital(KSCH). It is a resource for officials from blocks, districts, and state Health and ICDS in India to plan, manage and implement nutrition programs by leveraging existing community-based services in alignment with MoHFW guidelines. The brief includes protocols for integrating maternal nutrition services at facilities and ANC services provided at community or Village Health Sanitation & Nutrition Day along with other important aspects that need to be considered.
Application of the four-step Point of Care Quality Improvement (POCQI) approach using Plan–Do–Study–Act cycle for implementation of the maternal nutrition protocol during ANC led to improvements in measurement and recording of anthropometric parameters, Hb testing, blood pressure monitoring, and delivery of maternal nutrition counseling, according to this case study.
Formative research conducted in UP in 2016 found that only 9% of pregnant women in UP consume the five recommended food groups, as per global recommendations. Ganesh Shankar Vidyarthi Memorial Medical College Hospital is one of the four high case load tertiary care facilities in Kanpur, UP. It was identified that pregnant women visiting the Outpatient Department for ANC were not receiving maternal nutrition-related services, and anthropometric measurements to assess nutritional status and gestational weight gain were also not done. The department of OBGY decided to apply the four-step Point of Care Quality Improvement (POCQI) approach using Plan–Do–Study–Act cycle for implementation of the maternal nutrition protocol during ANC in April 2019 with support from A&T. By the end of 2019, the measurement and recording of anthropometric parameters increased to 84% and 74% for height and weight, respectively, from the baseline of zero. Hb testing increased from 58% to 84% and blood pressure (BP) monitoring from zero to 84%. Maternal nutrition counseling was delivered to 76% of the pregnant women visiting the OPD, which was a significant achievement for a new practice introduced into the system.